Jane

I agree with the other posters. We do not routinely perform DATs on donor units either. I can also speak from the experience of being a new supervisor (3 1/2 years now). You will probably discover a lot of things that need changing and the best way is to do exactly what you're doing. Just slowly make changes and chip away at all the old ways until you have them up to date. Good luck!

Ok- here is yet another question about validation. Mine is a little different. We are planning to switch from the BD pink top tube (plastic K2 edta) to the Greiner Bio-One pink top (also plastic but K3 edta) due to significant price differences. I am planning to do a small parallel study as the new tube has FDA approval for the testing we will be performing. My question is what tests should I do for the validation- we use this tube for most everything in the blood bank- ABO/Rh, DAT, Antibody screen and ID, crossmatches, etc. Will just doing tests with similar methadology be adequate- antibody screens and ABO/Rh on all the samples? Opinions please!

Yes- If you have the book from Ortho titled, "Interpretation Guide" it has pictures of samples with rouleaux listed under that and under haze. If we have a patient with rouleaux (verified by hematology or by us looking under the microscope) we do the tube antibody screen. After washing and adding AHG, rouleaux shouldn't be a problem anymore. Hope this helps!

How do you communicate information to the next shift(s)? We currently use a communication log that everyone is to write down info to pass along and everyone is supposed to read and sign when they take over the department. This does not seem to be working that well lately. I was wondering if anyone else has any ideas??

Does anyone do more than send a letter to physicians reminding them to report any suspected cases? Right now, I get a report from our computer system of all HIVs/Hepatitis tests and results and go through to see which patients received blood, when they were first positive, etc. This is a very time consuming process and I would very much like to change it.

I wouldn't mind doing away with our BB armband (Typhenex) if it meant going to one of the systems you mentioned. I feel like it gives us another layer of security right now because we require nursing to bring us the armband number when they sign out a unit and they have no where to get the number except the patient's arm. If we didn't have the armband we wouldn't have to worry about the scenario any longer where the patient or nursing has removed the BB armband and we have to start everything all over again. That would certainly be nice!

David, I was wondering how you track your armband error rates- do you just record any errors that you see in blood bank or do you go on the floors and audit to make sure the right band is on the right patient, etc.? We use typhenex and hardly ever see any problems since our phlebotomists draw these.

We have had several of these patients in the recent past and we also do not perform absorptions. Our reference lab (ARC) recommended that the full workup be repeated every 2 weeks (with the thinking that they wouldn't respond with a new allo antibody sooner than this) unless their DAT changed in strength. We still did redid our stuff every 3 days (antibody screen, DAT, etc.) It did take us longer than 3 days to get blood the first time one of these patients was worked up because she did have several underlying antibodies so on that one our pathologist decided to extend the XM expiration.

We also require that all suspected reactions be called to both the physician and blood bank. We have mandatory transfusion reaction criteria- if these are met then a workup is done whether or not the patient's physician feels it is a reaction.

It seems like I read that 2% is a reasonable amount of reactions to expect. Unfortunately, I can't remember the reference. Any more and there could be a problem, and any more and they may not be reporting them correctly. I don't have a good reference for TRALI, maybe you could copy info from the technical manual.

Here is the information I found by searching on the web: J2790 Rho(D), injection, immune globulin, human, Per 300mcg J2792 Rho(D), injection, immune globulin, human, intravenous, Per 100 IUs So, J2792, would be the code used for WinRho or a similar product and J2790 used for the 300mcg dose of Rhogam. We don't give WinRho here so we only use J2790.

It is very rare for us (even though we threaten it occasionally). We are a medium sized hospital and transfuse about 300 RBC units a month. Sometimes if we threaten to give RH positive blood the doctor will want to hold off on transfusion until we can get Rh negative from ARC.

We require a hematocrit within the past 7 days. If the patient has not had one done then we do one. Our doctors usually specify orders like for example, "draw if hct >32."

We are frequently asked about units of Rh negative blood that we are ordering from ARC. Sometimes they only ask if the blood is for a specific patient or for "stock." Other times the questions are more pointed such as- what is wrong with the patient, what is their Hgb, is the patient male or female, and the age of the patient. The responses then go before their medical director who decides when there is a severe shortage.

We just use saline for the Rh control

We only QC these each day of use. Of course for us most of the time we would only use them once each day.

Thanks so much to all of you for your answers- anybody else have any experience in this area??

We do the mini panel using Ortho gel that is usually 3-5 cells on the Resolve panel A. This rules out everything but anti-D

Thanks for your help Cliff!!

Our hospital administration has come to me wanting to transfuse outpatients at a facility the hospital owns across town (about 20min away). These would be patients that are only coming in to receive blood. Have any of you had experience with this that you could share?? I don't want to do it but if I am forced to, I want to make sure to minimize the pain.

Hi Cliff, I am having a problem viewing the new website at work. They use something called websense that screens out a lot of websites. It will not let me view this new one (could view the old one) because it says it is "uncategorized" Is there anyway you can fix this?? Thanks!

We use our reagents to QC other reagents. For example- to QC the anti-A we use the A cells and the B cells. This has worked well for us for years and keeps us from needing to buy any QC kits. To QC our screening cells (in gel) we use expired antisera- usually duffy or kidd. We dilute with albumin to the 1-3+ required by CAP and freeze aliquots. These will stay reactive for a long time and again help us keep costs down.

Would anyone be willing to post their procedure for SDPs for infant use? We do not have sterile docking so would that mean a 4 hour expiration for the platelets? Thanks again to everyone for their help!

Would anyone like to share how they are handling the fetalscreen recall? We are going to send out Kleihauer-Betkes on any we have now but what to do about the patients that have been done on those other kits?

Cliff, Do you have any formula to determine what amount from the pheresis to give to the infant?