Liz0316

We do issue Factors from the BB, but since they are not considered blood products, we do not require a transfuion consent.

We get a surgery schedule for the next day about 1 pm each day. The schedule is checked by the techs to be sure the PAT specimens are in the rack, and within the 21 day window. It also allows us to check for surgeries that we believe may take units (we do a lot of orthopedic and long back surgeries). While this may seem like enabling the surgeons, we are nearly 2 hours from our supplier and like to be prepared. We discard the OR schedules about once a month, this way we can look back and see if there is a PAT sample on hand when the inevidable call comes in the morning (without looking in the computer). Liz

I agree with David and Malcolm, that all antibodies have a specificty, we just don't always know what it is. I use the phrase "all common clinically significant antibodies ruled out." And of course if the antibody screen is positive, regardless of the cause, an AHG XM is used. Liz

thanks everyone!

I believe the date of collection is day "0." But, better double check with someone who works in a blood center.

I'm interested in just how everyone is accepting specimens from neonates (i.e. NICU) specimens for type and cross. Are you requiring hand written on the specimen? Do you accept bullets with a label (any style), do you require any thing under the affixed label? Historically we require the patient specimen to be hand written on the tube (or bullet). However it is easier for the nurses in NICU to affix a computer generated label (not necessarily an electronic bar-coded scanner label) and the handwritten infomation does "rub off" as proven today. Unfortunately, mother's blood was not available, so T&S and DAT needed to be done on the child. How are other transfusion services handling this scenario? thanks so much, Liz

yes, I do have a procedure that may work for you; based on the premise that an adsol unit is approximately 50 - 55% HCT. I had to come up with a procedure that generalist could do on the night shift. Normally a unit for exchange trx in a neonate is requested at 50% Hct. So we spin the unit down (hard spin) and remove the plasma, measuring how many mls we are removing (by extracting with a 60 cc syringe), then replace the plasma with AB thawed FFP (the same amount we removed). Considering you will never remove all the original plasma, the final product comes out to be approx 50%. We label the product with additional information regarding the unit # and blood type & volume of the "overlay" of FFP. Our original RBC must be an adsol unit, O neg, CMV neg, irrad, and Hgb S neg. If you don't have a refrigerated centrifuge, I think keeping the intended RBC inverted will work as well. When we get our neonate units in from our supplier we store them upside down. When we started this procedure we tested the units Hct and each time the Hct was approx 50%. I believe, as long as the FDA reg # from the supplier is obscured, or replaced with your own # you should be ok. We release the unit as a full unit, allowing NICU to transfuse as they wish, but we will not aliquot into syringes for them. We issue both products in LIS with a comment regarding the overlay with unit # ........ Liz

At our hospital, as long as the patient is a PAT candidate (no preg/trx in 3mo) the specimen can be collected 21 days prior to surgery.

If an antibody such as anti K is dosing and not reacting on heterozygous cells, what is the difference if you run 2,3 or 10. It's not reacting on heterozygous cells. We allow rule outs for anti K on a single cell, because K does not normally dose. Now if you need to run selected cells, you will more than likely run another K+ cell, whether it be heter or homozygous, so you'll feel better, but truthfully, that's all it does.

Your DAT can be negative if all the coated cells are sequestered and destroyed. An eluate will concentrate and may shed some light on the issue.

If your computer system cannot give you a new barcoded unit number when you "make" a new product, you can buy pre-printed labels. Be sure to keep a log. Also, remember, unless you are AABB, it does not have to be ISBT - just barcode readable for the FDA. And, you don't have to be able to use (computer read) the bar-coded number for the FDA either; it just has to be "bar-code readable.

no, it's not a requirement to retest antigen testing done by the supplier. Just be sure to leave the tag, describing the testing on the unit.

We do not repeat the antigen screening from the reference lab either. Keep in mind you must do an AHG XM on anyone with a clinically significant antibody. An old trick is to save your rare expired antisera, in the freezer. When you need to screen, screen with the expired antisera first, then take the negative units only and screen with indated antisera. Then do the full XM.

Right - no problem with ABO/Rh incompatibility

There won't be an ABO problem, but that doesn't rule out any atypical antibodies the mother may have due to previous pregancy or transfusion.

We use a code that translates to "weak anti D due to residual RhIg" There are 2 "tricks" you can use to determine if the anti D is due to RhIg or if you are seeing an active, immune D. First - RhIg is IgG anti D. Therefore if you run a panel at all phases, the RhIg will only be demonstrable at the AHG phase. A developing or immune anti D will (or should) be demonstrable at 37, if not IS. Second - passive anti D will not titer as high as an immune response. A low titer is indicative of a passively acquired antibody, a higher titer is most likely an immune response. Now, I realize these are crude methods, but this info, along with patient history should solve your dilemma.

most reference lab's final word is PEG. Do a PEG A/S, panel if it makes you more comfortable and full PEG XM.

It all depends on the amount of Rh Positive cells the receipient was exposed to. One dose should cover 30 ml or whole blood or 15 mls of packed RBC. Is it practical to give a women 15 shots of RhIg or give Winrho IV?

the concern is that the patient goes home and comes back. Hopefully it's the same patient!

We use a form that we developed. It's purpose is more of a "self audit" for the physician as they are completing the form. The physcian justifys the transfusion right on the form. Including H&H - consider: blood loss, anemia due to cardiac symptoms, intraop blood loss, drop in BP. For platelets consider not only count, but coagulopathy, invasive procedure, etc. The forms are then reviewed by me at the end of the month and any questionable transfusion get a chart review by the medical director. Good luck.

I would say no to firing. This is a system error. The system needs elements and steps to follow (checks and balances) prior to the issue of the unit. The second tech's errors were probably more severe than the first. Why wasn't the IS XM done? Is it behavioral issue? I'm suprised the FDA hasn't appeared. You should report it. If ever you needed a justification for a computer system, you have it. Have you considered documenting the retypes on a separate sheet of paper or log sheet? That way the line above would be no influence to the person doing the retype.

Theoretically, as long as your patient has not been transfused or pregnant in the last 3 months, their immune status won't change. Once you have done your type and screen, within the time frame of manufacturer's instructions your specimen is good for however long you need it. Though, keep in mind it won't last for too many weeks! At our hospital we keep the specs for 1 month, although we tell the pre-admission office we keep them for 3 weeks - just in case there is a schedule change. It is really a matter of space.

I would have to suggest not accepting any ABO from another institution as your second or previous type. I is not a prudent practice

We do an antibody screen on the first unit, and of course the required ABO/Rh on all donated units. The crossmatch (for the auto units) is immediate spin regardless of antibody screening status. Of course any additional units would require regular requirements.

I agree, the most likely explaination is an error in either collection or testing. Do, keep in mind, the error might have been on the first typing, so the new one could be correct. How long ago was the first type done? Monoclonal ABO reagents are much better (and more specific) than the older polyclonal. If you have the time, you could try a different manufacturer - could be a different clone; although there are only a couple of clones out there. Good luck.