Bet'naSBB

OK - maybe TMI and totally not what you're looking for....but, i've attached our spreadsheet to show how we do it here for our blood bank. i've added VERY BRIEF explanations. i'd be happy to give more info if your'e interested! we send out a memo to staff at the beginning of the year outlining what they must complete by......usually 11/30 of that year. included in the memo is a simplified checklist for staff to keep up with their progress. i just sent an email to staff (1/2 way point) stating if they wanted to update/check their sheet - to let me know. some did - some didn't - but that's up to them! at the end of the year they must have all of their requirements finished. we check them. the tech and mgmt sign it and it gets filed in their file. competency_example .xlsx

we use a calibrated stopwatch

I've been Blood Banking for 35 years......... (albeit in the same hospital) but I've never heard of that - nor do I know of any AABB or CAP regs that would imply that...... (and we've just been inspected by both!)

I just answered this question. My Score FAIL  

Does it specifically call for DI water? We've had one for YEARS and always use tap water and their clean bath. We empty, clean and refill ours once a week.

Our PEG and LISS testing are built the same - with 3 charges - one per phase of testing. We do observe for hemolysis with PEG testing after 37 incubation (do not spin) - so, no hemolysis is resulted in our LIS as negative.

Sorry - no reference to share - but, for the most part, we only "report" cold autos if the DAT is pos with anti-C3D and they interfere with IS testing(XM or Reverse)......OR if the patient has evidence of hemolysis. That being said - once reported, we repeat the a full DAT profile (gel for Poly/IgG; tube for complement) at each visit. Once the DAT's are negative and there's no evidence of cold remaining in the IS testing on TWO successive visits, our techs can remove the "Cold". We then replace it with a comment stating "Pervious Warm/Cold" antibody. (So, that being said, we treat Warm's the same way) We also do Thermal Amplitude testing when we have C3D pos DAT and pos reactions @ IS. Our Medical Director considers "colds" reactive at 28-30C clinically significant.

Would you consider a remote refrigerator in your ED? you can get small ones and then they could access it at any time IN the ED? Might be a big expense upfront - but, in the long run it would be much easier!

We are getting ready for it. Our surgeons want it in place of ?sp? Riostap?? . We don't use very much cryo for traumas. It's super expensive. We will be getting it from Cerus until it's available elsewhere. There is an ISBT code for it. Our "plan" is to have one unit thawed at all times. We currently get pooled cryo from our supplier and we use about 1 unit per week with a max of 4 days between uses. So - hope to have one thawed, use it and if they need more - use regular pooled cryo. Then thaw to replace the IFC. Remains to be seen if our plan actually works.

We do! Feel free to message me and I'll see what I can share!

Well - just to follow up - we approached our Laboratory Compliance team to see what they knew and their response was. "we don't remember, but it was a "BIG DEAL". We then discussed with the Pathology Medical Director (he was the director when this happened) and he had some insight and suggested contacting the hospital's CLIA person (who was the same person who mad this "decision") Our Path. Med. Dir. emailed them and - lo and behold - they were perfectly fine with it....... Needless to say, that email has been sent to compliance and is now added as an attachment in our QP manual so no one can dispute what we all think is correct! Thanks for letting us know that we weren't crazy in our thought process!

We are a large blood bank in an academic medical center. Our blood bank does just about everything in the lines of testing with exception of testing related to donors (we don't collect donors). That being said - we get quite a few CAP proficiency testing surveys. YEARS ago (>10) the individual samples in the PT Kits would get divided up amongst the staff where each "sample" was tested by a different tech. In comes CLIA for an inspection of the entire Clin. Path department and they say that ONE individual must perform ALL the testing associated with the kit. Meaning if the kit comes with 5 samples, one tech must complete ALL the testing on ALL 5 samples. We are now under new management and are curious if other Blood Banks have experienced the same thing? Our AABB inspector told us we were asking for trouble, and also eluded to the fact that we could get cited by CAP for doing it the way CLIA says we have to...... We have yet to find another lab that follows these CLIA "rules". Just searching for a little "clarification"

@Malcolm Needs......YAY! it always makes me feel a little "smarter" when my thoughts are consistent with your answers!!! PCH was my first thought!

We do up to 30 (33 actually) days. If sample collected 1/21/23 and surgery is 2/21/23 - we set exp of sample to 2/21/23. On DOS if all documentation is rec'd from OR - then extend 3 more days.

this is what's in our freezing "solution" - but we freeze them in liquid nitrogen (they look like "Dip-n-Dots" ice cream Dissolve 15.4 g sucrose, 5.4g dextrose (D-glucose) and 0.29g of sodium chloride in 100ml of distilled water. Mix well in a 250 ml flask.

Our Blood Bank performs A1 lectin testing of the potential A donor. If they are positive, they are eliminated as a donor. as for the recipient - all B patients (potential mis-match recipients) are titered against an A subgroup cell (A2 reagent red cells here) to determine their antibody reactivity. The clinicians have an established threshold for a suitable titer (which I do not know) Potential B recipients who have an Anti-A titer with A subgroup cells below the established threshold could potentially receive an A subgroup kidney. As for O recipients - we make our own 0.01MDTT treat their plasma to determine IgG vs IgM antibody reactivity titers.

We do...... Here's our "process". First - our panels are frozen @-20(ish) for a minimum of 12 hours. After they have been frozen, but before use, we "condition" them at RT. Basically that means we let them sit at RT for about 15min. after that, we check the temperatures of all panels. If between 2-5C, they are placed in the refrigerator where they can be stored for up to 72 hours before we have to re-freeze and repeat the process. When it comes time to validate - we take the refrigerated panels, place them in the cooler. Then we place 8-12 units of refrigerated red cells and/or plasma (expired) into the cooler. The probe of a "Global Sensor" is placed between 2 units. (the digital display of the Global is left outside the cooler - attached by a sensor wire). Cooler is left for, at minimum the time frame you want your coolers to be "good" for (ours are 10 hours) We usually let ours sit for 12-15 hours minimum - after which the temp. data from the Global is downloaded and printed. If all the temps are within acceptable range for the desired time - it has passed QC/validation. We also do this with any "new"/replacement panels or inserts. It seems convoluted, but, we do ALL our coolers like this and we have at least 5 different kinds of coolers (with a total over 200 inserts/panels that have to be QC'd validated) We divide and conquer. We divide the insert inventory in half and QC them every other year and all staff members are required to complete a minimum of 4 cooler validations per year. (we have about 28 staff members that this applies to)

we see it quite a bit. we usually take it to the bench and wash a suspension and re-run it the "old fashioned way" in tube.......if still MF then we do not report unless they get us a heel stick for repeat testing bc it could mean maternal contamination.....if no MF - then report the manual testing.

I can just speak to how we do things....... When patient has NO previous hx, a second sample for ABO confirmation is required. (samples collected via in house phleb with rover (electronic scanning) do not need a verifier documented on requisition. any collection outside of in house phlebotomy/rover must have second verifier at collection. - we still use paper....and probably always will) ABO/Rh must have been performed within the last 12 months to be valid for component orders. Previous hx of ABO/Rh results / interpretation in BB LIS do not require second sample for TSX. is that what you were asking?????

my hospital security will not let me access the survey.....

This morning we tested with DTT treated screening cells - reactivity was still there. If it had been an Lw - it should have been negative.....

We have an Rh neg patient who has received 4 units of Rh neg RBC's and has made what looks to be a perfect anti-D. We do not have a pre-transfusion sample - so the C typing is mixed field (in gel- not strong......more negative cells at the bottom of the column compared to positive cells at the top - like you might imagine in a patient who is C neg and received 1 unit of C pos blood......) leaving us to wonder if they're C pos or C neg..... We typed the 4 units they received and one is C pos. We "want" to say this is an anti-G - but, there's absolutely NO anti-C reactivity. Not even with enzymes. DAT is negative. We've also scoured the few lit. resources we have and none of them address that an anti-G could / would do this..... We even repeated the weak D's on the units...........all tested weak D neg. Any insight?? Side note: We've checked about IVIG, other drugs - nothing. They did get 2 units of A pos FP24 - but that, IMHO - shouldn't have caused any of this. @Malcolm Needs??

expired red cell or plasma units

@jshepherdYES! Totally agree! We actually had staff meetings yesterday to catch almost all staff and this was one main topic of discussion! Our manager explained it very well (I'm the Asst. manager) and the hope is that they - especially one of them - will get the message!

?? Maybe mom has an antibody to a low incidence antigen that could not be detected with routine testing ?? That would be my first thought, at least.