Beverly Morris

Our gel AHG crossmatch includes an IS phase. We bill both CPT codes 86920 and 86922, which is allowed. We instituted that with gel implementation in 2007. In April of 2009, following research done by the University of Michigan and in-house validation, we dropped the IS phase in gel but not tube PeG AHG crossmatching. We have reinstuted the IS phase based on the response of the CLIA inspector at the AABB meeting. Our Ortho rep sent us the following: "We are waiting on the response from our company, it is in the works. I would also like to point out that inspecting agencies do not necessarily inform us (manufacturers, transfusion facilities, etc.) ahead of time when they are planning to change how they view certain test applications by any method. Also there can be considerable variation between individual inspectors. OCD cannot 'make sure' they are all covered. Even asking the same question of the inspecting agency today may not make sure all bases are covered for the future. We are very discouraged by all of these changes as well. As soon as I get the official letter, I will make sure you have it. Thank you for your questions and I will pass this along with the other requests for such a letter." I have also asked our LIS vendor, SCC, for confirmation that the SoftBank Version 23.2 does all the system checks for ABO compability when the AHG crossmatch is requested. Currently, our version prompts that the "patient is not eligible for ELXM" when an AHG crossmatch is requested. That response is also pending. You cannot bill ELXM CPT 86923 together with 86922.

If the only way to identify the unit as retyped during computer downtime is a physically-affixed label, then you need to continue to label them. If there is a downtime workaround, this step could be omitted.

I received the attached list of ISBT codes from ICCBBA. This may help some of you. Thawed Plasma codes.doc

We use Azer Scientific 10L cube disodium phosphate buffered saline ph 7.0-7.2 with 30 day expiration after opening. It maintains the pH range during the opened dating perod. We have a very low false-positive rate, but they still occur. We just had one last week. I do not plan to change to the Immucor reagent saline.

The AABB Primer of Blood Administration published August 2008, states in Chapter 5 page 7 in the Obtaining Blood section to "wear gloves when handling blood component unit bags."

We use gentle heat elution for cord bloods to elute IgG antibody. We set our waterbath to 45 C and gently agitate a 4-5% suspension of cord blood (may take up to 15 minutes). The weak D test can the be performed and on most specimens this is successful. We also stock EGA for the stubborn ones. This may be a simple, cheap solution for smaller labs. We don't read the weak D test microscopically (follow reagent manufacturer's directions).

In a recent AABB audioconference "Advanced Transfusion Reactions," one of the physician speakers stated that a 15 mm change in diastolic or systolic pressure would be considered significant.