PammyDQ

how about Dr. Croak?

Precisely my thoughts, Shaunna!! I "played" with the sample a bit with this in mind, but as I was off yesterday I couldn't report my findings until now. The Ortho 0.8% Surgiscreen & Resolve panels are suspended in diluent containing Trimethoprim/Sulfamethoxazole. He reacts 2-3+ with these cells. The Ortho 3% Surgiscreen is suspended in Chloramphenicol/Trimethoprim/Neomycin. I diluted this to 0.8% and tested him again, getting a negative reaction on cells 2 & 3, but on cell 1 it had a topline reaction with most cells at the bottom. I also used these cells to test by tube method, which all 3 were negative at I.S. and IgG, but at 37C he was 1+ reactive on cell 1. That was the end of my shift and I didn't go any further at this point.

Yes, I was thinking that. However, the reagent cells we use for screening/paneling in gel have a different antibiotic than the reagent cells we test out eluates with. Still might be 2 processes going on. I'm testing that theory now...

Yes Malcolm, this is the conundrum! As I did the initial workup and the next shift did the crossmatches, we repeated it right away, and there's no question, they are perfectly compatable in gel.

He's age 93, O+, current diagnosis is renal failure and anemia. None of the meds are atypical, insulin, claritin, lopressor, synthroid, tylenol, etc. The only unusual Rx is Flutamide, which I looked up to see it's for prostate Ca, however that is not listed in his dx. He took it in 2008 and again now. He has no laboratory evidence of hemolysis.

Last week I worked up an elderly man with no history of transfusions; results as follow: Via MTS gel method: 3+ reactions on the 3 cell screen and all 11 cell panel cells and patient autocontrol. Via tube method: DAT 1+ with both anti-IgG and anti-C3BC3d Gamma Elukit 2/Tube method: Eluate: 3+ reactive with 3 cell screen and with 12 panel cells. Compatability with IgG gel crossmatches with partial phenotype matched units: COMPATIBLE x 4 units! :confused: Any ideas?

LOL no, of course not. But I only have control over my actions and how I follow protocol. If the transfusionist errs by taking "shortcuts", it's their license, not mine on the line!

Our patients complete and sign a questionnaire (Blood Bank Notification Form) when they come in for PreAdmission Testing within 21 days of surgery, and that is sent to our BB with the specimen. We enter the TS on the PAT account. If they have answered "yes" to having been pregnant or transfused within the last 3 months, we will request that a new specimen without an order be collected when they come in day of surgery and we will repeat the IAT(we record that on the patient's result card (which did not "go away" when we got a BB computer module). Also if the patient had no ABO history and they are non-O, we will request an ABO confirmation specimen be drawn. We get a copy of the surgery schedule the day before and we match it up to all the PAT questionnaires to make sure everyone is covered and let pre-op know what they need to draw the next day when the patient comes in. Any Products (for crossmatches) are ordered day of surgery, which is considered "day 1" of the specimen, regardless of the date it was collected (within 21 days). Any post-op crossmatches that are ordered, we change the date/time of collection to the date/time of surgery, therefore when you print your Expired Crossmatch Report the units that aren't transfused will come up.

NEITHER! We rarely have the need with our patient population and it's too expensive to stock just incase. However we have quick access to all factors and recently needed a ton of NovoSeven. A company called BioCare, a division of Blood Systems Inc, consigns a large assortment of Factor products to RIBC, our local blood supplier. When we need factors, we just call the hospital service department who we order our blood product inventory, and they deliver what we need. BioCare bills us direct. This system worked out great. Previously we would call another hospital BBK and they'd suppy it to us, then we'd order it through our pharmacy and replace what we borrowed. Then that hospital ended up finally sending Factors to their Pharmacy, and we discovered the BioCare arrangement. http://www.biocare-us.org/vbs/home.asp

There is no volume printed on the label of the rbcs we receive. The label states "from 500ml of CP2D whole blood" or other depending on the collection type. We use our calculated volume in our LIS and write it on our retype label. Ironically, our medical director also oversees another hospital which simply weighs their units and uses the mgs to = mls without any calculation.

Food for thought: We weigh each individual unit of prbcs. Then we do a conversion to actual cell volume, which differs depending on the collection method (ie. apheresis double unit collection vs. whole blood single unit collection) due to different anticoagulant volume/types. We have done this to collect data for our medical director which may be used in the future for one of his research studies. In doing this, we get quite a range of volumes, from 135ml. to 270ml.! So some units are twice as large as others...

Such a simple solution...this is what we tell them in that situation...just write in the missing letters and you're good to go! (patient wristbands are complete)

Through The Warren Alpert Medical School of Brown University, my medical director is sponsoring NEW FRONTIERS in TRANSFUSION MEDICINE in Providence, RI on April 24, 2010. The cost, including parking, breakfast and lunch, is a mere $20 for 5 hours AMA PRA category 1 credits (techs will be eligible for CEUs). Special rate for Hilton accomodations are only $99. Here is the link to the brochure: http://bms.brown.edu/cme/brouchure/TransfusionMed.pdf

Gosh Lindsey, good question. I am not a supervisor so all I can say is that was the policy/procedure in place when I came here 8 years ago. That was the policy where I also worked in another state for 12 years. That was the policy at 3 other institutions where I also worked briefly. It never occurred to me to question it as it is routine practice in my experience. I presume some sort of validation was done ages ago. All the instutions are AABB certified and my current facility received 100% in our last 2 inspections! We'll see if that holds up as our next AABB inspection will be tomorrow or Friday!! Note: If there's a increase in reaction strength on the screen, or if a unit that SHOULD be AHG compatible (ie negative for the antigen to the known antibody) reacts as incompatible, then we would proceed with a full antibody identification workup.

That's basically what we do, however we use 14 days not 8.

Speaking of "cruel"...As a young college student I was supplementing my income as a phlebotomist, my first laboratory job. Obviously it was policy to wake a patient before drawing their blood. One day I went into a patient's room (a regular room, not in ICU, that was right next to the nursing station) and he was apparently sleeping. "Mr. W...I'm here from the lab, time to get your blood drawn" I exclaimed a few times, raising my voice a bit louder each time "Wake up Mr.W", with no effect. (I know what you're thinking, and no, he wasn't expired). So I go out to the nursing station to let them know I couldn't arouse him...and chuckling, the nurses informed me...Mr.W was in fact, in a coma. Gee thanks a lot for allowing me to entertain you during my busy morning run!

Infecting your politicians would help your country? A Fawkes supporter are you?

We once worked up a trauma patient, 25yo female MVA. We sent 4 units of uncrossmatched O Negative red cells to the trauma room. While the antibody screen was incubating, a chemistry tech came to us with a specimen that was drawn after our TS specimen, they had just spun it and the serum was so black you couldn't see where the serum and cells met. The screen came out with a 3+ on one cell, and we tried notifying the ER that she was possibly having a hemolytic reaction(they were unimpressed). She unfortunately had a head trauma whose treatment of restricting fluids was opposite that of pushing fluids to treat the hemolytic reaction. She did not survive. The antibody was Kell....she received only 1 of the 4 units we had issued...the only one that was Kell+...

We reject grossly hemolyzed specimens. That was unavoidable when I used to work at a hospital with a Burn Center because certain types of burns (eg. gasoline) would cause the patient to hemolyze IN VIVO! Once (in my 23 year career) I saw a hemolytic anti-LeA in an immediate spin tube crossmatch. A cell button should be smaller than expected if there is hemolysis as a true reaction.

We use the "once per admission" guideline for all plasma products, however our "regular" HemOnc & Transplant patients are exempt. They are usually typed multiple times due to frequent RBC transfusions as well. Brenda, when we have a new patient and they're requesting FFP etc, we only require an ABORh to be done, but since they're receiving these products because they MIGHT bleed, we usually suggest a TS to be ordered just incase. As long as the MD orders it, I don't see how it can actually be questioned. We can release the product prior to the completion of the screen though.

WOW. I work in a hospital where we do many major mismatched BMTs and HSCTs ald also cord transplants, and NEVER have I heard of doing that! And the transplants "take" despite that...I'm going to inquire about it...interesting.

SAME WITH US...we have 3 bins for 3 months. When the new month comes up, we dump the oldest bin.

Addendum: remember...I'm talking about MTS GEL methods...the manufacturer has acknowledged problems with E detection in the past.

This is only really a problem when anti-D is present. We DO r/o C with 3 heterozygous. But having had a large number of patients with anti-E showing dosage, our medical director decided we shouldn't rule out E with heterozygous cells. It's not a big deal to give E-negative units to patients with Anti-D, as most Rh negative units are also E-neg. It's just a minor inconvenience to have to phenotype the unit for E.

Note: Due to the issues with Anti-E strength using Ortho MTS Gel technology, we only r/o E with homozygous ONLY...which means in the presence of Anti-D we rarely have a cell available that can r/o E.