rcurrie

If you are asking if you have to change the expiration to 24 hours once the two bags are pooled (assuming they are kept separated during storage because the single bag capacity to offgas CO2 is exceeded), the answer is yes, at least when using the bags I use to collect platelets. My manufacturer has a 400 mL limit for one bag (as well as a 2.1 million platelet count, but that's another story). Once you combine the bags, you no longer have the capability to keep the pH within range. BC

Thanks, Linda. BC

Same as Mabel- someone on the AABB site told me about it. So, I found it despite all efforts to keep me from knowing about it. ;-) BC

I would like to hear more about the controlled access refrigerator (manufacturer, etc.). I have been looking into such for my ER. We have a full-size BB refrigerator in the OR, and although the control desk does a pretty good job of tracking the units, we have some rogue doctors who grab what they want when they want. We use temperature indicators also. We have a policy that requires blood not hung in the OR to be returned to the BB. We do that for tracking purposes. The nurses like that policy because it is one less thing to be responsible for when taking the patient to the floor after surgery. BC

We draw our own donors, so it is easy for us. We simply link the donor unit to the patient in the computer. If it is an ABO-incompatible directed unit, we simply release to allogeneic inventory. We also automatically release directed units 1 week after scheduled surgery date or after 30 days for transfusion-dependent patients. The donors are told this up front. BC

We do not address this in a policy. If the doctor wants to give RHIG, then they need to order a K-B stain. I have not seen RHIG issued for spotting only. BC

There is no problem with using stickers from the units that I am aware of except for one: I had a nurse return a unit of blood. She had removed the last sticker for use on the patient's chart. I am not talking about the last sticker from the back- I am talking about the one used to label the unit. I asked her how she wanted to pay for the unit- cash or credit card, because she just bought it. BC

Insurance fraud is fairly common. We had a patient submit to the ER with a bleeding problem. The name on the insurance card had an historical A+ blood type, and the patient was O+. I told the ER doc what I suspected. He went to the patient and said that apparently the patient's blood type had changed from A+ to O+, and that was indicative of a rare form of rapidly fatal cancer that could only be cured by removing the long bones of the legs. He said he would return in a few minutes after he scheduled the emergency surgery. When he returned, the patient was gone with the wind. BC

Our policy is the same as Cliff's. This isn't something that rarely comes up- it comes up all the time, particularly when the transfusion is stopped due to a possible reaction. Nursing frequently calls us and says not to charge for the unit because only X amount was transfused. My answer: don't charge for the nursing service or the bed for the day, and I won't charge for the blood. BC

When we run out of sample for crossmatching on a patient with a currently active type and screen, we have been collecting a new sample and reconfirming the type before using it for crossmatching. First, does anyone else do this? Second, does this note preclude that practice? There is nothing wrong with what you are doing as long as you perform an antibody screen on the new sample as well. The reasoning is that an antibody that was undetectable when you tested the first sample could suddenly become detectable on a new sample. You should perform an antibody screen on any sample you use for compatibility testing to cover this possibility. That is the intent of the CAP checklist question. Can it happen? You bet! Just last month it happened to us with a patient who had an undetectable anti-Jka (transfused at another facility) that suddenly became detectable after one transfusion with antigen positive blood. Time lapse: less than 24 hours between sample one and sample two. Yes, she had a hemolytic transfusion reaction, but she survived because we tested the second sample before crossmatching another unit. That second unit most likely would have done her in. Yes, it was pure luck that we needed a second sample, but that rare coincidence is what CAP is trying to CAPture ;-) BC BC

No albumin here- pharmacy can have it. That is one headache I don't have to deal with. Interestingly enough, my bloodbank nurses use more of it than anyone else when they do albumin exchanges. We do about 1-2 a day. BC

I have a few different cGMP Powerpoint presentations I have developed. It depends on the staff- some are for my donor room staff, some for my component production staff, and some are for my transfusion services staff. Drop me an email and let me know which type of staff you have, and I will send you the appropriate presentation. BC RCURRIE@swmail.sw.org

This link may be helpful. http://bloodjournal.hematologylibrary.org/cgi/content/full/96/10/3610/F4 BC

We do about 50 TPs a month. I don't list TP on my registration either, for the same reason David stated- we don't use the blood. BC

Thanks, Gerald. We will give that a try. More reagent racks to QC! Although I think QC'ing one rack is okay legally (as long as the lots are the same), we QC each rack. BC

The computer module is just part of the education part. We also have team members do training for each unit that draws specimens. If you send me an email request to rcurrie@swmail.sw.org I will send you the Powerpoint presentation we present to the individual units. The computer module is proprietary and contains data we do not wish to be made public, so I can't send that. Reporting is through the Adverse Event Reporting system, and goes first to Risk Management. A root cause analysis is performed for each event. Results of all investigations go to the institutional QI committee. The persons involved in the events are retrained as necessary, counseled, given 3 days off for a second offense, and terminated for a third offense. BC

We dilute and repeat to verify the high counts. That's as good as it gets. The FDA is satisfied, and that would be my answer to any CAP inspector who might question our procedure. I gave myself an Attaboy on the self check. I am satisfied with our methods, and I am pretty discriminating. BC

It's been a long time since we tried this, but we were the ones that put the blood in the bag and locked it. It was already in a locked bag at issue. We had phlebotomists that collected the blood back then, but nursing collects about half our specimens now. We abandoned the system when the point was reached where the nurses cut the unit out of the locked bag over half the time. We required the bag to be returned to the blood bank after the unit was removed. The bag was either returned "cut" or we were told they forgot and discarded it, which really meant they cut the unit out. BC

There is no requirement to label a unit as ABO/Rh confirmed. You can handle that quite nicely with your computer system. Those of us who predate computers remember the little label pink you could buy and place around the pigtail, but those days are gone. We do it by physical quarantine and computer. You could actually perform the recheck at the time you do the compatibility testing, as long as your system prevents you from issuing a unit that hasn't been reconfirmed. BC

We use the Sysmex with undiluted specimens also. The Sysmex, as you say, has been shown to be linear for undiluted apheresis components. We have done well on the CAP survey for platelet apheresis counts. BC

One of the best places to start is the product insert. Many product inserts lay out the SOP for you. BC

No. I can't see their reasoning for this. Anti-A1 doesn't react with the H antigen. BC

We pretty much do the same as Mary. We are always asked to show employee training and competency files to the FDA. BC

Thanks, Linda, but this is my last post until I return in 7 days. It is a short mission, but it will be an intense week. We will work 18 hour days, and there will be no access to the Internet. I won't even know where I will be going until I get there. I will report to the National Guard armory in Weslaco, and then be deployed from there. It will definitely be extremely rural, though. I do know that. BC