vilma_mt

I can't see why you can't apply 'electronic crossmatch' rules.....2 blood types on record. It's a waste of reagent to perform typing for every add-ons. Performing IS xm do not catch mistypes....if a patient was mistyped as "O" you will not catch the error on IS xm no harm done (for red cell transfusion) but still an error.

BloodBank armbands have been a 'pain'. Nurses/Docs cut them off....they become unreadable at times. I have worked at big hospital where BB armbands were not used, it's a hospital policy for patient to always wear hospital armbands and no blood draws or any procedure done on patients without one and encourages employees to report....they don't mess around with patient identification and they let everybody know they mean it! Blood Bank's special requirement was for every new specimen 'attestation statement' is submitted with the phlebotomist's FULL SIGNATURE'. It's surprising how people are very careful in what they do whenever they have to sign something. Unfortunately I haven't had any luck with the new places I've worked in to implement this kind of policy....everybody is uncomfortable drawing and transfusing patients without BB armband

It's 6 hours (single donor or pre-pooled prior to freezing)....4 hours after pooling. (Circular of Information for the Use of Human Blood and Blood Components) When using the word 'storage', pertaining to any blood product, temperature needs to be monitored/recorded every 4 hours.

I doubt that anyone in blood bank allows thawed/pooled cryo to sit for more than 1 hour. They're easy to thaw and pool. The product is thawed and pooled for immediate tranfusion only. Do not use the word 'storage' while it's waiting to be picked up.This is not the same as platelet....Blood Bank stores Platelet and waits for physician's order Besides, it expires within 4 hours same amount of time given for any product released for transfusion.

I don't think Lab has the ability to screen each and every patient. It is a hospital policy. I suggest find this policy and make a copy for Blood Bank for Blood Bankers to refer to during inspection.

I don't think your system would allow you to proceed to electronic crossmatch due to the positive antibody screen.Even if lab knows patient received Rhogam, In routine setting you would still proceed performing antibody panel and IgG crossmatch. Besides, how can you tell it's due to Rhogam and that patient has not been sensitized and already produced anti-D? I thought the difference between the two is presence/titer when patient's blood is tested few weeks after last Rhogam administration. Rhogam will not be detected after few weeks of last dose. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm073253.htm#ELEMENTSOFACOMPUTERCROSSMATCHSYSTEM

The products chosen for 'exhange transfusion' should be based on your: 'crossmatching and tranfusion protocols' (neonatal or adult), criteria for CMV neg or leukoreduced productrs, criteria for Irrad. products, Hgb S etc.....Exchange transfusion is just a treatment for several conditions.....patient's blood removed and replaced. The information blood bank need are 'desired hematocrit' and 'total volume'.

correction: Weak Ds and partial Ds although can be considered not a candidate for Rhogam can produce Anti-D and therefore need Rh neg blood or RhIg.

Performing weak D testing on pre-natal patient is unnecessary. Weak D testing on baby's blood to determine if mom is a candidate for Rhogam is necessary. You may want to look into 'what if your D testing reaction is <2+', specially if you are using a monoclonal blend Anti-D. Weak Ds and partial Ds although can be considered not a candidate for Rhogam can still ellicit an immune response and therefore need Rh neg blood or RhIg. When in doubt it is far safer to give Rhogam than deal with the complications of not giving it. However, when performing an FetalBleed Screen with Anti-D reagent you may want to perform weak D testing as a control. Rh Pos maternal blood would give a 'false positive' result.

Check this book...you may want to purchase, it is a good addition to your hospital or blood bank library http://books.google.com/books?id=PpKHZDjvBlcC&pg=PA327&lpg=PA327&dq=Techniques+for+Warming+Red+Blood+Cells+Packaged+in+Different+Containers+for+Neonatal.Transfusion&source=bl&ots=GGjsrJ6S1J&sig=ZbyXFGW6EjAJVeg3VKRzzyjjI_Y&hl=en&ei=xnWtS7aDJoOoswOYysTzCw&sa=X&oi=book_result&ct=result&resnum=5&ved=0CCUQ6AEwBA#v=onepage&q=Techniques%20for%20Warming%20Red%20Blood%20Cells%20Packaged%20in%20Different%20Containers%20for%20Neonatal.Transfusion&f=false

I did not think it was practical to use blood warmer due the small amount of blood involved and slow rate of infusion. Check this site and scroll to page 320 http://books.google.com/books?id=PpKHZDjvBlcC&pg=PA327&lpg=PA327&dq=Techniques+for+Warming+Red+Blood+Cells+Packaged+in+Different+Containers+for+Neonatal.Transfusion&source=bl&ots=GGjsrJ6S1J&sig=ZbyXFGW6EjAJVeg3VKRzzyjjI_Y&hl=en&ei=xnWtS7aDJoOoswOYysTzCw&sa=X&oi=book_result&ct=result&resnum=5&ved=0CCUQ6AEwBA#v=onepage&q=Techniques%20for%20Warming%20Red%20Blood%20Cells%20Packaged%20in%20Different%20Containers%20for%20Neonatal.Transfusion&f=false

i was curious about the coding of this product sooo I went searching. Codes I've seen all refer to frozen plasma, pooled or solvent-detergent treated anything but LP. What I've noticed which would be of interest to you is...there are a lot of Blood Centers who have posted the billing codes or have provided the information to their clients. Since your vendor want to sell this product to you, I think they can also provide the coding so you can get reimbursed. Either nobody has seen your post or nobody else uses this product. Goodluck!

I don't have an answer to your billing question....but I'm a little baffled. Why use this product? Why would you prefer this over FFP or FP. If it is for coagulation protein this certainly is not the product of choice neither as a volume expander. Is it to save thawing time? There are a lot of plasma thawers i.e. microwave (FDA approved only and not kitchen microwave) and waterbath that thaws plasma <10 mins. I used to work in a Trauma center and we did not have this in our inventory. I would really like to know the appropriate use of this product.

check out AABB's website: STATEMENT OF THE AMERICAN ASSOCIATION OF BLOOD BANKS BEFORE THE BLOOD PRODUCTS ADVISORY COMMITTEE ON THE EFFECT OF LEUKOREDUCTION ON CMV TRANSMISSION THROUGH BLOOD TRANSFUSION SEPTEMBER 19, 1997 Presented by Roger Y. Dodd, PhD Mid-Atlantic District Representative to the AABB Board of Directors The AABB is the professional society for almost 8,500 individuals involved in blood banking and transfusion medicine. It also represents more than 2,200 institutional members including community and Red Cross blood collection centers, hospital based blood banks, and transfusion services as they collect, process, distribute, and transfuse blood and blood components. Our members are responsible for virtually all of the blood collected and more than 80 percent of the blood transfused in this country. Throughout its 50-year history, the AABB’s highest priority has been to maintain and enhance the safety of the nation’s blood supply. The AABB appreciates the opportunity to comment on the effect of leukoreduction on CMV transmission through blood transfusion. Over the past year, an ad hoc committee of the Association has reviewed the issue in detail and has reported that both retrospective and prospective data support the conclusion that the leukocyte reductionlevel currently accepted for the reduction of alloimunization to HLA molecules (that is, to fewer than 5 X 106 per transfused component) reduces transfusion-transmitted CMV to a level at least equivalent to that observed with the use of CMV-seronegative components. The data supporting this conclusion reflected a number of different studies, encompassing a variety of technical approaches to leukocyte reduction. These studies are reviewed in some detail in AABB’s Association Bulletin #97-2, dated April 23, 1997, and entitled “Leukocyte Reduction for the Prevention of Transfusion-Transmitted Cytomegalovirus (TT-CMV).” A copy of the Association bulletin has been provided to committee members. The AABB therefore endorses the use of leukoreduced components as a measure to reduce the risk of transmission of CMV to susceptible patients. The Association encourages the use of procedures which can be performed in a fashion which assures that current Standards for leukoreduction are consistently achieved. Last modified on 2/1/2010 2:44:01 PM

http://www.thepathologycenter.org/Education.asp http://www.asm.org/division/c/index.htm http://www.microbeworld.org/ Goodluck!!!

I had a case quite awhile back.....Patient was typed Rh Pos was transfused and few days later developed Anti-D. Upon retesting and reading the tube immediate spin, patient was Rh Neg. Tube was incubated at room temp = 'pos' ; at 37C = 'pos'. DAT was negative. Was there previous transfusion? if yes I would re-test Rh type if specimen is still available. Extended incubation at room temp can detect weak D.

I have also tried to research this...nothing, no hard fast rules. CAP if I remember came up with something but has since been abandoned, I believe they calculate the # of minutes it takes to perform a tes ie. takes <30minutes for ab panel. This works for Heme or Chem but not Blood Bank. I wish it's as easy as Nursing's. If your blood bank is grossly understaffed, your case maybe be heard if you press on safety, reduction of error and turn around time. There is always strength in numbers, ask to be heard as a group. Goodluck!

thanks tricore...i don't think I could have explained it any better. Unfortunately, this is an on-going discussion, to register or not register. And every so often somebody would clarify this registration issue. When it comes to pooling (please correct me if I am wrong), you still end up with the same product......platelet or cryo. I don't know if requirements have changed, I have not done both for years because of readily available plateletpheresis and pre-pooled cryo.

I think most places would wait 1 hour. But if you must, it is acceptable to draw blood from the opposite arm, if that's not possible then draw blood below IV line (follow your protocol regarding drawing blood below IV line) and document that specimen was drawn during transfusion.

Besides the hassle of re-labeling, aren't you required to register with the FDA? I remember working at a place where we gave requested amount of red cells and plasma adding some volume for the lines and released both units.

What does your package insert require. You must adhere first to manufacturer's insert. I believe Ortho requires QC upon receipt. If you deviate from CGMP i.e. using expired panel cells there should be a policy in place and quality control performed to assure reactivity etc.... Call your manufacturer, they should know the regulations more than anybody. here's part of.... Guidance for Industry: Biological Product Deviation Reporting for Licensed Manufacturers of Biological Products Other than Blood and Blood Components TESTING: Testing events include those that occur during testing, which you did not discover until after you distributed the product. This includes testing that was not performed or was performed incorrectly. It includes situations where there is no record of testing and the safety, purity, or potency of the product may be affected. This also includes testing performed using incorrect or inappropriate (e.g., expired) samples, reagents, or media. Under 21 CFR 600.14(, you must submit a report when there is an event (a deviation or unexpected or unforeseeable event) during testing that may affect the safety, purity, or potency of a licensed product you distributed. Examples of reportable events during testing may include: Safety, purity, potency, sterility, identity, or stability testing was Not performed or not performed at required interval; or Performed incorrectly. [*]There was no documentation of testing performed.

Good for her for paying attention to her blood type. I guess I would play the rare type and the recipient/donor scenario. You can test her blood to make sure she's truly a weak D first and rule out any previous typing error. She's smart enough to pay attention to her own blood type she would surely understand that in a hospital setting it would be safer to type her as Rh neg and receive Rh neg blood.

I have done this "exercise" for Proficiency/Competency testing....Techs would visually judge spun Ortho gel card, tubes have varying amounts of plasma and cells. They were asked to recognize which tube has plasma, <0.8% or >0.8% suspension of cells. And yes with this exercise one can tell if the right amounts of plasma and cells were added.

@bbnewbie....i think with your BS Biology and Lab experience ASCP will allow you to take the MT test. There is no doubt there are a lot of MLTs who are qualified/knowldgeable specially those who have good experience. Unfortunately, workplaces and accreditation agencies would not know that until they see you 'work in the bench'. Since you have chosen that route to work in the lab...you pretty much have to 'prove yourself' compared to us who went to the program and pass the test.

http://www.cap.org/apps/docs/laboratory_accreditation/forms/personnel_requirements_by_testing_complexity.pdf http://wwwn.cdc.gov/clia/regs/subpart_m.aspx#493.1449 Sec. 493.1449 Standard; Technical supervisor qualifications. The laboratory must employ one or more individuals who are qualified by education and either training or experience to provide technical supervision for each of the specialties and subspecialties of service in which the laboratory performs high complexity tests or procedures. The director of a laboratory performing high complexity testing may function as the technical supervisor provided he or she meets the qualifications specified in this section. (a) The technical supervisor must possess a current license issued by the State in which the laboratory is located, if such licensing is required; and ( The laboratory may perform anatomic and clinical laboratory procedures and tests in all specialties and subspecialties of services except histocompatibility and clinical cytogenetics services provided the individual functioning as the technical supervisor-- (1) Is a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy in the State in which the laboratory is located; and (2) Is certified in both anatomic and clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology or Possesses qualifications that are equivalent to those required for such certification. © If the requirements of paragraph ( of this section are not met and the laboratory performs tests in the subspecialty of bacteriology, the individual functioning as the technical supervisor must-- (1)(i) Be a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy in the State in which the laboratory is located; and (ii) Be certified in clinical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology or possess qualifications that are equivalent to those required for such certification; or (2)(i) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine,