Sandy L

Oops, sorry about that Auntie-D. That was 1998! Dyslexia strikes.

Another reason for the slow adoption of automation in the U.S. has to do with the slow process for FDA approval of automated instruments. Alas, when Auntie D had her 3 instruments in 1989 there were really no approved instruments in the U.S suitable for Transfusion Services, just a few "Mega" sized instruments for batch typing mass quantities of samples in a donor center. We purchased ProVues soon after they were 1st licensed, maybe around 2004, and at that time I believe perhaps the only other instrument was the ABS 1000. Fortunately since then quite a few good instruments have been licensed in the U.S so things are looking up!

We would do an extended Gel XM as long as the current screen is positive. It's required by the LIS. The computer system disqualifies them for electronic XM in this instance. If the screen becomes negative in the future, they would qualify for electronic XM as the antibody is classified as not clinically significant

We have two and really like them. Our sister hospitals have them too.

We use Hettich EBA20S to spin samples... plastic tubes only. It has a max RPM of 8000. (Note the digital display says 80 x 100). We purchased it from Helmer. It does a dandy job of spinning samples for testing. We use a 2 minute spin and get platelet poor plasma. Great for samples to be tested in gel.

Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required. All of these responses display in the patient's Medical Record. For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing. Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

Same as Dr. Pepper, we have an order for Transfusion Reaction Investigation that has fields to result the unit DIN and product component type, clerical check, visual hemolysis, DAT, ABO/Rh. We result those and there is also a pathologist's interpretation. We also have a worksheet that we retain internal to the blood bank that has details like signs and symptoms of reaction, when and who notified us, etc.

And from west of the pond, I would assume that the theater or theatre is the operating room/surgery? It's so interesting to see the different names we all have for the same thing/

Optical aid can be defined as an agglutination viewer with a magnifying mirror. It does not necessarily mean a micoscope is required.

Only if prepared in a closed system. Some apheresis FFP are in an open system so 24 hours if thawed. You would need to verify with the collecting facility.

Same as Terri. As part of antigen/antibody checking, each antibody is classified in our LIS system as Clinically Significant or Not Clinically Significant. We would never be able to Electronic XM/Electronic Issue to a patient who has a Clinically Significant in History even if the current antibody screen is neg. If the antibody is classified as "Not Clinically Significant" and the current antibody screen is neg the patien qualifies for Electronic XM/Electronic Issue.

We do the same.

Ditto

As you look throught the ICCBBA product database, you can find for every Red Cell product another E code with the same description, i.e. same anticoagulent, same collection method, same attributes as your origianl product but also includes "Open". It is rather tedious to do the search but you should be able to find the same product "Open" for each original product.

This is so strange. Ortho is continuing to service our 2 ProVues and the field serveice rep was here 7 days ago for the PM on one of ours. That being said we ARE looking forward to the Vision as a replacement>

We have seen this phenomenon also, usually with early anti-E that is still IgM. We have seen several OB patients with 4+gel anti-E that, in tube testing, may be picked up at 37C reading and may be negative or at best wealy positive at the antiglobulin phase. These usually seem to progress to IgG as the pregnacy progresses.

OK, we are all dying to here what this is all about!!

Similar to Liz and Scott. We recommend RhIg if the patient is female less than 50, We have seen several cases of anti-D developed following Rh Pos apheresis platelets where the platelets are the only immunizing source about which we know.

I agree with the other posters. Our manual tube and Gel QC is once per day, usually early on the a.m. shift. We can't be expected to drop everything in the middle of a massive transfusion protocol or other urgent situation just to run QC at a specified time. Our automated QC (ProVue) is run on the night shift, usually around 4 a.m. We have the instrument set to require QC after 28 hours to give us some leeway if it is crazy at the usual QC time.

We use clear plastic bags. Since the unit has a tie tag with compatibilty label and also an 8 1/2" by 11" transfusion record with same info (both containing patient information), we fold the transfusion record inside out and stick the unit inside the folded paper. That way no patient information can be seen while the unit is walked through the halls. The added benefit is that the unit is not really visible to visitors.

We have a Transfusion History card with 2 questions that they must answer, "Have you been transfused in the past three months? and "Have you been pregnant in the past three months?" It also has a statement that "I understand that removal of the Blood Bank arm band will result in having to have my blood redrawn". They answer the questions and sign the card at time of specimen collection and the card accompanies specimen to the blood bank. We also verify transfuion history in our BB LIS. We will extend the sample up to 10 days. We have an orderable test "Transfusion History" that we use to document that the patient qualifies and has signed the Transfusion History card. The test Transfusion History has an alpha response result that equates to no preganacies/transfusions in the preceeding 3 months.

If the warm autoantibody is historical only and not detected on the current sample (current negative antibody screen, Gel method), we would revert to Computer Electronic Crossmatch/Electronic Issue.

We also would do the same.

In my 39+ years (I think David has me by 1 year), I have seen one instance of ABO HDN severe enough to require exchange transfusion with a non-O mom. It was a group A mom and a group B infant and it was at least 30 years ago.

Terri, I really like your "Side Effects and Hazards" document. Adding the sections on reported Fatalities might give a physician pause to consider if the transfusion is really needed.