Bill

We do same as David--works with rapid infusers.

Like AMcCord, we only do autocontrol with Antibody ID, only do DAT with positive autocontrol. We are small hospital with 165 beds.

Transfers from our facility are usually a 2 hour ride and the transporting company paramedics(or RN) have been inserviced to complete the transfusion record; the original is put on ambulance medical record (presumably onto new inpatient record) and the second copy returned to our blood bank when ambulance gets back into town.

Cliff, I know this may be a little late but I just have to ask: with all the new tabs (and hopefully new members) will there be enough bandwidth on the site to handle the increased traffic without slowing down to a crawl?

It would be nice to here from some of our military laboratorians who have served in Iraq and/or Afghanistan. It is my understanding that they use walking donors more often than not AND yet are able to maintain the quality of AABB & FDA requirements. Let's hear from some of those HEROES (from both sides of the pond).

We will begin TS by verbal order but do not thaw FFP or issue any product on verbal order. In fact had an MD come to blood bank for unit of blood and would not give it until he wrote and signed order on sheet of paper which was put on chart.

When the blood is moved from the testing/storage area to the crossmatch/issue area, is there a transfer paper sent with the unit? If so, that is the same as a blood center sending (transfer) blood several miles. Also, are all areas under one CLIA certificate?

Since your system will not let crossmatch without retype, are there retype results entered in the computer? If so, your'e OK, otherwise that aspect should also be reported--in my humble opinion, if you cannot prove that it was retyped, report that aspect as well. The last thing you want is for an inspector come in and find that without you having reported it first.

The fact that unit 2 was not retyped in your lab is also reportable IF your policy does not state that split units only need to be typed once.

Two of three hospitals that I have worked at toss the unit (with tag) after transfusion is completed. We do have to remind nursing to keep the bag with attached filter and any other solutions when they report a suspected reaction.

What records do you need to keep for "infinity?"

It has been awhile since I used Meditech, but you should be able to write a rule attached to crossmatch that would add Ag typing if there is an antibody present. This could be on all AHG crossmatches that it would look for antigen. IS crossmatches would not be appropriate for antigen typing for patients with antibodies.

Only with ABIDs. We do neither autocontrol or DAT w/ antibody screening tests.

How high is the temp spike and for how long? In almost 40yrs of laboratory/blood bank experience I have seen more than once where fooling the patient has prevented fever and/or rash. The way we have done it is to use a leukoreduction filter (even though the blood is leukoreduced) and tell the patient that it is a very special filter that works better than the regular filter. This has worked more than it hasn't. Never underestimate the power of the mind.

At two of three institutions where I was on Transfusion Committee, we wrote the procedure to state "any lookback notice from our supplier" would be handled the same way. The Blood Bank Director just changed the letter that accompanied the form to include the disease or condition of the donor to be appropriate for the situation. According to the procedure, the Director also had authority to NOT to send letter if it is not mandated by regulation (as the Director sees fit) but all notices from supplier were reported to committee for review.

Nicely done--THANKS!

Dawn--Can you post it here as an attachment, please?

I don't like to disagree with my learned members, but the dextrose is probably in Y-tubing mixing with the blood prior to entering the patient. This, to me, comes under the realm of manufacturing and since the dextrose will hemolyze the blood (making it useless), it does affect purity etc which makes it reportable. My understanding is that the FDA wants actions reported that make the product unhealthy --this action makes the blood unhealthy

What is the purpose of labelling & banding the patient and tube? To ensure that the two match! Once the computer was changed, the phlebotomist could go to patient with new band and match old band with new band which ensures that tube and patient match--without having to perform an invasive procedure on the patient. What is the difference if she does it before leaving the room or a little later considering all items match. Also, as all know, a patient with an ectopic pregnancy can bleed out VERY quickly.

Very well stated John!

The three hospitals were I worked, transfusion committee met quarterly. Discussed same items as adiescast plus performed peer review of transfusions that did not meet screen criteria. This info was given to medical staff QA and MD credentially committees. At one hospital, the committee was also instrumental in changing blood supply vendors to one that charged 54% less.

melvolny, you state "but then it seems these should be part of the patient's history in the blood bank." Why? I can think of no good reason to keep all the nursing documentation in the blood bank. In my opinion, nursing documentation belongs on the chart.

I think you are correct--the antibody response is quite dramatic which probably IS causing the back type problems. Is the patient's hemoglobin dropping; is this a delayed hemolytic transfusion reaction? This is classic presentation for one.

We require physician signature for emergency release. All transfusions of any component is documented on the transfusion record in addition to any other part of chart required by nursing, anethesia, dialysis, etc. Our place LOVES duplication!!

Donna-- Your welcome Bill