Trek Tech

We had a repeat patient this week. We have transfused him about 4 times over the past year. He has always had a negative antibody screen. He is A Pos (A1). This week my tech gets him, everything looks good; ab screen neg. She pulls two A Pos off the shelf and does an IS xm. One of the units is 4+ incompatible. She repeated it with another segment. Same results. I retyped the unit and the patient and they are both A1 Pos. I did a DAT on the unit and it was negative. I crossmatched the unit with another A patient and it was compatible. I look in the Technical Manual and it says that most antibodies to low frequency antigens are clinically insignificant. I called my reference lab and they said just use a different unit (Duh!). I do a gel xm with unit and it is 4+ incompatible. (How could this be clinically insignificant?) I am concerned that this patient will go to the local hospitals which all use electronic crossmatching. We are small and have a low volume so I would never consider doing e-xm. He would be a candidate with his negative antibody screen. Should I give him a card with "Antibody to low frequency antigen"? Malcolm! I need your expert opinion...I bow to your wisdom!!!!

The fresh bottles are fine. I did email them saying that I was concerned about the "purity and potency" (a statement directly from CGMP) of their product and that got their attention. They assure me they are working on the problem. They thought it was my storage. I sent them 6 months of my chart recorders from my Helmer fridges (which were perfect). Unless they come up with something soon I will have to switch back to Ortho. Sometimes you get what you pay for when you go for lower cost. Thank you for validating my concerns.

We use Biotest's A1 and B cells for reverse grouping in tube. For the past 6 months our cells "go bad" after 3 weeks. The negative control turns 1+ in either one, the other or both bottles. When you look at a drop microscopically there are needle like crystals in the bottles. Biotest has been great about overnighting a new set but this is getting very old. They tell us that there is only one other account with this problem but I have to believe that it happens more frequently. Most people do not run a "negative" control with their reverse cells. (I have even tried using an AB plasma as a negative). We are very small and don't get both an A or B everyday. We might see an AB once a week. I believe this should be reported to FDA as a purity and potency problem. Anybody have any ideas?

I wouldn't want to be the "rare mom" who did make Anti-D and had problems with subsequent pregnancies.....life is too precious.

Ok, I'll bite....what is a spotty herbert?

We tried pulling of at time of issue but we had too many people forget to pull them at time of issue (especially in stressful situations or off shifts). We currently pull them when the units come in and stick a unit number on each one. We put them in a zip lock bag. The bag is then labeled with the date the unit was received and is dated for discard in 42 days (longest possible out date of units).

Years ago I was working 2nd shift at a hospital. I received a bloody spinal fluid from the ER. An internist had tapped a patient of his. The tubes were very bloody but not clotted. The policy was to do a differential but to report "unable to perform count due to traumatic tap". The physician called and asked me to "correct it for the WBC's and RBC's by using the patient's CBC results". I immediately laughed thinking he was joking. When I realized he was serious I told him that if he could tell me the exact volume of blood in the spinal fluid I might be able to work it out (not!).

It is easier to keep a c= patient from making anti-c than it is to do rule outs when a patient has anti-c and anti-E. Look at a panel of cells and I think you would agree. Most of the hospitals in my area (as well as our reference lab) have a policy to give c neg units if the patient has Anti-E and is c neg.

It happens with saline and it happens with an A1 patient. When you look at the cells under the scope there are actual crystals in the bottle of reverse cells.

We routinely test our reverse cells daily for positive and negative reactivity. We use anti-D for our negative control with the reverse cell as they are Rh negative. This is the second month in a row that we have found reactivity with our A1 cells and anti-D. The negative control comes off very rough and when observed microscopically needle-like crystals are seen. Biotest tells me that there is only one other account besides us reporting this. I don’t know if others routinely perform a negative control with these cells. Perhaps you should consider doing so.

Modern Day Vamp is correct! Helmer is the best there is. No volume adjustments from the new box of saline to the end of the box! I have never had to adjust the volume in the year I have had it. The cell button is absolutely dry. This is the cell washer we have all wanted but never thought they could make!

Here is the original article. We use this procedure and we also use the CAP ABT survey. Uniform Procedure.pdf

Actually, I do talk to all the new patients. Our setting is small and we pride ourselves on exceptional patient care and personalized service. I have called New York, California, Wyoming and other places to get a history. Having seen a fatality from a delayed transfusion reaction (Jka) makes one very cautious (18 years ago). If I can take 2 minutes to ask the patient if they have been transfused before and if so when and where and possibly save a life I will do it every time. I have that luxury here. It may or may not interest you to know that I am a BSMT first and an RN second (went to nursing school because I wanted a challenge; it wasn't but I learned patient care). Also, Malcolm...our fax is secure and the other facility also has a secure fax.

When we opened our Transfusion Service last year (8-2008) we ran into a similar difficulty. Most of our patients had been transfused at the hospital across the street from us. I started by looking at the list of transfusions our nurses had done here and gathering patient names. I emailed a request for records for this group of patients and was told I couldn't have them. What I ended up doing was making a Request for Records that we fax to the hospital blood bank everytime we get a patient. I had to make it specific though or we would get just a blood type and nothing else.(see attached) We also put the time and date of the request because they get busy and we are not a priority for them. We then enter the results of this history in our computer system under comments. What I find interesting is that they seldom ask us for histories when the patient is admitted there. I do make it a practice to fax new antibodies or special needs on patients that I know they have a history on. Record Request.doc

Our supplier recently sent us a platelet pheresis with the product code (codabar) 12711. The count on the bag is 2.8 x 10 (11th power) platelets. this code was not in our computer system and I had to investigate it. According to the Technical Manual a standard pheresis platelet should have 3.0 platelets and must be labeled with the count if it is under 3.0. A local hospital chain refuses these as a suboptimal dose. I was wondering if other facilities have a policy on this.

Is anyone using Biotest's ABO+Rh Seraclone Control with all of their typings? Their insert states "A negative control should be performed on samples tesitng positive with Anti-A, Anti-B and Anti-D." The thought of going back to having to run a control with every typing...units and patients makes me crazy!

Have a great day and don't forget to put your toys away!

We only gave 1 pheresis at a time and it had to be transfused right away. We found that the average temp in the OR is 62 degrees F. Even if issued in a cooler the anesthesiologists had a habit of taking them out of the cooler as a reminder to hang them (or that he had them). We received platelets back at 18 degrees C and they were discarded. Expensive lesson. They still throw fits that they can't store them in the OR (I hear).

What about individual stickers for each unit that is crossmatched? Or perhaps you are relying on the number to print on the crossmatch ticket to be compared to the armband? Also, they appear to be all letters and numbers. Do they print as barcodes?

We purchased a double door i series fridge, a single door fridge, plasma thaw system, platelet incubator, agitator, and cell washer when we opened. Helmer is the best for these products hands down. After 24 years in the business I can say that the customer service we have received is the best. I would buy all of these products again without reservation.

This is how we address the issue as well. If the patient has an armband on with a unique number and that number is on the unit as well as the tube this problem would probably not have happened. I know many people hate the second armband idea but I have seen (in the past 23 years) at least 3 incidents prevented by the second armband. Two were nursing related and one was lab related.

The only time the tubes were wet on the outside was when one of my techs put the top inside collar in upside down! You might tell them to check it out!

This absolutely leaves a dry cell button. If the button is not dry enough you can adjust the spin time for decant and make it so! This is the only cell washer I have worked with that doesn't need the volume adjusted with every new cube of saline. I have NEVER had to adjust the volume in the 12 months we have used it! I would (and have) recommend this product with no reservations.

You might want to adjust the temp to 37.0 (for shutoff). Anything over 37.0 is out of compliance for FFP. See Technical Manual 15th edition page 191, 16th edition page 292. I know of someone who was sited for having alarm set over 37.0.

I am a SafeTrace user. Your question should be posed to the following user group: SafeTrace Tx User Group (txug@www.wyndgate.com) Someone in your facility should be a member of it. I am sure you can set a higher level of alert. It would be in one of the tables which are able to be customized to your specifications. I will look into the tables and see what I can find.