rcurrie

We extend our samples for 14 days for surgeries. We don't freeze, but we do antibody screening on day one, and on the day of the surgery make the patient sign a waiver stating they have not been transfused within the last 3 months (or been pregnant if a female). If the patient has an antibody, we require a fresh specimen within 72 hours of the surgery. If the patient has no antibody or a history of an antibody, we do electronic crossmatches. Since we do electronic crossmatches, the specimen itself is not used past day 1.
BC

We extend our samples for 14 days for surgeries. We don't freeze, but we do antibody screening on day one, and on the day of the surgery make the patient sign a waiver stating they have not been transfused within the last 3 months (or been pregnant if a female). If the patient has an antibody, we require a fresh specimen within 72 hours of the surgery. If the patient has no antibody or a history of an antibody, we do electronic crossmatches. Since we do electronic crossmatches, the specimen itself is not used past day 1.
BC

In my previous employment in a level 1 trauma center, we switched blood types ASAP in adults with no ill consequences ever noted. As Abdulhameed noted, there is so little plasma in our packed cells these days that whatever anti-A,B is there is just insignificant, regardless of the number of units given to an adult. We transfused about 20 pedi units a day in our neonatal and pediatric ICUs, and we always used O cells with no ill consequences. However, within the last year or so, a less-experienced tech swapped to type-specific in a patient with HDFN, without crossmatching to AHG, and the maternal anti-A,B was still high, with disasterous consequences. The baby lived, but it was touch and go for many days.
On a side note, I have joined Ex-Bloodbankers Anonymous. It has been 136 days since my last crossmatch . . . .
BC
Workin' on the railroad

That's nothing, Karen: My OR has a monitored refrigerator for platelets!
BC

I have been waiting for the other shoe to drop for years, just like Mabel. I suspect that a lot of research $$$ will now be redirected toward NO research. I always try to help physicians who request more info, but those who demand "this and that" research results are simply told that I am offering my product for their use as is, and it is up to them to decide how and when to use it. In other words, do your own research. That may sound cold, but the colder reality is that when a patient dies and blood transfusion is implicated, the physician will try to pass the buck by pointing to the blood bank. I have seen this happen, and been on the receiving end. It won't happen again. I don't refute any research. When one of our cardiovascular surgeons showed us some research that said that redo CABG patients needing transfusion were less likely to survive unless given fresh blood <7 days old, I didn't say "rubbish." I said that we can support one patient a week with a requirement to provide blood <7 days old. With that limitation, suddenly it wasn't the issue it was before. I have had physicians demand products we don't offer. My answer is we have what we have- this is our menu. Our blood cooks follow recipes from which they cannot deviate. Dallas is 150 miles up the road. I can certainly recommend a good blood restaurant up there if you absolutely have to have such-and-such. (The proper wine to serve with blood is a nice Merlot.)
I can see one direction this may go. In the future, we may issue a nitric acid popper with each unit of blood. "Okay, Mr. Jones, I am starting the transfusion now. If you feel any tightness in your chest, pop this ampule, wait 2 seconds, then inhale the white smoke deeply twice and hit your call button."
BC

900 AM- Receive specimen
901 AM- Receive phone call from OR asking if blood set up on Room 3- spend 3 minutes on hold while OR finds out name of patient in Room 3, 1 minute looking up patient in computer and answering "No, no specimen was submitted for testing," 1 minute explaining why it will take 40 minutes to an hour to perform a stat workup ("it's STAT! Don't you understand!?"), 1 minute to explain that emergency release blood is always available, 1 minute on hold because the surgeon wants to chew someone out, 1 minute to explain to surgeon "no specimen- no compatibility testing, no mind readers on duty in the blood bank"
909 AM- Accession specimen into computer and place in centrifuge
910 AM- Take specimen to testing rack and begin pipetting
911 AM- Release 2 emergency release units for patient in OR 3 to angry anesthesiologist (2 minute rant), explain that testing requires a specimen (1 minute)
915 AM- Back to bench- pipet screen cells and plasma into gel card and begin 15-minute incubation
917- Phone call from Day Surgery saying that a specimen was drawn for compatibility testing on patient in OR 3 only five days earlier; spend 3 minutes explaining that specimen is good for 3 days unless waiver is signed, and no waiver (not transfused, not pregnant) on file, and no date of surgery on request, and no mind readers on duty in blood bank when request for T&C received; 1 minute giving Day Surgery phone number of medical director so they can report us for not having mind readers on duty, 1 minute kicking side of file cabinet to keep from going down to Day Surgery and throttling the Day Surgery nurse, who has an associate degree and knows all there is to know about blood.
923 AM- Issue 2 units of RBC to ICU, 1 unit to PACU, two platelet units to Hem/Onc (can someone give me a hand at the issue window?), and 15 FFP for exchange transfusion.
940 AM- Do ABO/Rh and place gel screen in gel card centrifuge (5 minutes)
945 AM- Field call from Medical Director, who has spent 10 minutes on phone with surgeon of patient in OR 3 (5 minutes saying who said what and when)
950 AM- pull gel card from centrifuge to read, then answer the phone call from 5 South wanting to know if we have a current specimen on Room 517 Bed A, explain that we have some metal shavings from the left leg of the bed, but that they were rusty and we needed a new specimen, and if she needed any blood on the patient in Bed A, then we would need a blood specimen from the patient as well, and be sure to find out what that patient's name is.
955 AM- read gel card, enter results into computer
1000 AM- Confirm results in computer for Type and screen
Any questions?
BC

I gave my first surprise CAP inspection last week. It was a small lab. I did Lab General and Blood Bank (naturally). It was a very, very thorough inspection, and they did quite well. There was no one in the lab under 50. Not that the kids can't keep up with us old folks, but, you certainly aren't going to pass us up ;-)
BC

As far as the background colors of a field, you set that by going to Format then Conditional Formating. I make two columns- one is the date of the last review. The column next to it is the due date for the next review, which is a formula such as =B12+365 where B12 is the field with the date of the last review. I then go to Conditional Formating and select the condition "Less than" and put "=TODAY()", then format the background to be pink if the statement is true (in other words, the review date has passed); I add another condition "Greater than" and "=TODAY()" and format the background to be green if the statement is true (in other words, you still haven't passed the review date yet).
I have attached an Excel sheet with an example of the formatting (click on New Sheet attachment).
I hope this helps.
BC
New Sheet.xls