KarenJ

We are a smaller community hospital and do not have dedicated blood bank staff. Generalists rotate through the blood bank. We are giving blood natched for Rh, K, S/s, Fya/Fyb, and Jka/Jkb. We were thinking more aling the lines of treating it like a warm. So far we have had less than 10% of our Dara patients multiply transfused with no known problems to date.

We are getting full genotype on our dara patients before they start on the drug. Currently we have one patient that requires transfusion and are giving matched blood. Our question is how often should we send a sample to our reference lab for testing? There doesn't seem to be a whole lot of agreement on what to do. Every 72 hours is unrealistic. Any guidance would be appreciated. Thanks, Karen

We were wanting to do something besides add it in ourselves, then comment that its a genotype. The BAD file can be a bit difficult to read when there are multiple antigens/antibodies. We are checking with Sunquest. Thanks Karen

Has anyone come up with a way to get genotype into Sunquest? We have just started getting them on our Weak D ob patients and now with the multiple myeloma patients. We want to get the info in the computer but the antigen/antibody display is difficult to read at best. I suppose we could do a problem or comment but would like to have its own entry. Thanks Karen

We do quite a few outpatient transfusions and many times the hemoglobins are performed elsewhere. We would like to have some way to document the hemoglobin in our system before giving blood. We have Sunquest and it shows the most recent H&H on file. This has caused some confusion as it isn't always the most recent available. we don't want to imply that we don't trust results from outside---. Does anyone have a policy that would cover this? I had though about building a separate test that would not be reported or charged but that doesn't seem like a great idea. Of course we wouldn't charge the patient for it either way. Thanks in advance for any help you can offer, Karen

If we have a mother who types weak pos we send a sample out for molecular testing. Just had our first one under the new policy and she is not a candidate for Rhig.

It is cell 9.

Just started using lot VRA226. Anybody else seeing some unexpected reactions? Thanks Karen

We built a nonbilled test BTRC blood type recheck. If the patient is preop we send a form over to surgery informing then that this patient has no history and requires a second specimen. For any other patient it is the responsibility of the blood banker to be sure we have a second type on file before any blood is issued. There is a prompt in Sunquest for previous history which should cue the blood banker to order the retype. We will accept a sample from a previous draw if availalble/

Thanks to all for the help. I did check the maintenance in BMA and think I have it working correctly now. I put a lengthy comment in the patients file also. Karen

We had a crossmatch ordered on a new patient today and when I checked our blood center antibody registry I discovered that she had an anti V detected about 6 months ago at another facility. Of course my screen was negative, I had pulled 2 panel cells to see if the V was still reactive and coombs crossmatched my units. I had consulted the IRL and they said as long as the V can be demonstrated the crossmatch is valid. So far so good, now for the problem. Our LIS is Sunquest and I could not override the antigen/antibody failure. Is it acceptable to call the units V negative based on the non reaction with the patients plasma? With some sort of disclaimer of course. Any help or advice will be greatle appreciated. Thanks, Karen

We use tube for IS crossmatch. Lawrence Memorial Hospital Lawrence Ks

Our supplier has been sending male plasma for several years now. We haven't noticed any supply issues.

We use Sunquest, so no rule, we have to go in and manually change it to the date we want.

We are considering not allowing any returns. It happens so infrequently that it wouldn't be a huge issue.

When it happened to us we gave it 24 hrs of continous monitoring also.

We go with what the current type is and note in history that they had a BMT. We also had a patient that relapsed, but her type did not revert back to her original ABO.

We require a 2nd specimen prior to transfusion or surgery if we have no history. For patients that have preadmission testing we send a hot pink form to OR notifying them that we will need a 2nd specimen. The nurses draw it when they start the IV. Karen Lawrence Memorial Hospital, Lawrence Kansas

I am wondering how to handle orders for delayed transfusion reactions. We don't get very many, and our current practice is for the physician to order a direct and indirect coombs. With CPOE up and running, I am trying to decide between the individual tests, or a battery that would include those plus maybe appearance and an interpretaion. Any suggestions??? Thanks, Karen

We do the same as Mary and Brenda.

We do---and we have an extra step built in. We have a test called CBH, cord blood hold. It must be resulted with Mom's name and Rh type. Helps us make sure the nursery orders the cord ABO/Rh. Sometimes they forget.

We looked at our patient population and history of positives and decided the odds of a low incidence antibody are too slim to justify doing complete work ups on all cord bloods. The nursery has transdermal bilirubin monitors and if the baby's bili goes up or there are signs of problems they will order a workup on the cord. We keep all our samples for 2 weeks and have had less than 2% come back with jaundice and orders for the workup. It seems to work pretty well for us and the physicians are happy with it.

We do them on Rh negative Moms only. Occasionally a doctor will order one that isn't Rh neg, and we do it, although we may grumble a bit.

We have a couple of canned comments we use when the D is 2+ or less, to the effect that the patient may be a D variant and could benefit from RhoGam, and also to transfuse Rh negative. At least the doctor is aware of the problem, assuming they read the report.

When we get a weak D reaction in gel, we use a comment "possible D variant transfuse Rh negative" We actually had one the other day that was 2+ in gel, and negative in the tube, when we did the Du it was positive.