rravkin@aol.com

JUST CURIOUS; AFTER READING THESE POSTS, EXPERIENCING AND KNOWING THE IMPORTANCE OF PATIENT TRANSFUSION, AND ANTIBODY HISTORY; ARE WE ANY CLOSER TO SOME UNIVERSAL SYSTEM WHERE SUCH HISTORY WOULD BE READILY AVAILABLE TO THE MEDICAL COMMUNITY? WE HAVE ISBT AND NOW AN SDS (UNIVERSAL CHEMICAL ID SYSTEM REPLACING THE MSDS) SO IS IT POSSIBLE THAT A UNIVERSAL TRANSFUSION AND AB HISTORY IS IN THE MAKING?

KEITH, WHEN TRANSFUSING RBC'S TO A NEONATE OUR PRACTICE IS TO TEST FOR HGBS PER STANDARD PROTOCOL, AS WELL AS IRRADIATED, CMV TESTED NEGATIVE, AND LESS THAN 7 DAYS SINCE DONATION. AND READING OVER THE POLICY THAT YOU PRESENT; IT SEEMS INCONSISTANT, WHY WOULD INTERUTERINE TRANSFUSION BE DIFFERENT THAN THE NEONATAL TRANSFUSION, AT LEAST WITH RESPECT TO HGBS TESTING OF THE DONOR UNIT?

What do you do about an unresponsive patient brought to the ED by Emergency Responder with no ID and accompanied by no one and requiring blood products?

We require a Request for Blood Products document which provides two unique patient identifiers, a date and time of the order and issue, a doctor's or RN's signature and the printed name of the transporter. Upon issue we place a sticker on this document that provides the patient info and the unit number, expiration, and volume of product. This document is required for OR as well as floor issue of products.

Tkakin, we have an Exsanguination protocol for massive bleeding, and now I know why, because our massive protocol is the same as yours. Our exsanguination protocol calls for the ordering of a test, Xsang, which provides fields for filing date/ time and doctor who calls and ends the exsanguination event, along with Type and Screen testing, if able, and emergency release of products.

Goodchild, it has been my experience that although Gel testing of Cord DAT, manually or automated, is very work-flow friendly it is not more sensitive than the microscope which can readily be used to confirm negative or positive DAT's. I know that I may have just said a bad word, microscope, and I empathize, but it is still more sensitive than Gel and equally as user friendly, but not so work-flow friendly; and the only way to get to it is to use the tube method. So if you are having problems with gel, tube is the best way to go, at least for the Cord DAT.

Sandy, how, and with what frequency do you test these SDP aliquots for bacterial contamination??

Brenda, since these problems are sporadic have you checked your Gel Card Centrifuge. At maximum speed the cards are suppose to orient to a horizontal position; this ensues even migration of the cells through the gel of each column in the card. If these cards do not orient horizontally then the cells do not migrate evenly and can give the appearance of reactivity. This can happen in any of the gel card seats on the wheel lending to the sporadic nature of the problem you are experiencing. Just a suggestion and let us know what you find if and when you can.

Hi Brenda, it has been a while since we have heard from you. Were you able to resolve this problem? If so, how? Thank you in advance.

Sandy, I have practiced reserving a unit of packed cells for exclusive use by one neonatal patient once that unit is deemed compatible and an aliquot is taken. This practice ensures limited exposure for this neonatal patient and others. Do you do the same with the single donor platelet?

I agree with Dave. You are augmenting a received product from your supplier and there needs to be a new product code, expiration, and ultimately a complete explanation of what this new product is and it's intended use, as well as some documentation of the rest of the medical staff having been made aware of this new product.

Hey Dr. P I saw this at work as well n it is f....'n Awesome!!

Hi Malcolm, it's good to have you back. I sent you an email prior to reading this so there may be some redundancy.

Just goes to show what we have experienced where rbc's transfused into an opened circulation does not give the immune system an opportunity to become sensitized.

Brenda, also are gel reactions occurring primarily at the top of the column or are they dispersed throughout the gel? One other item; have you considered trying a reagent grade water to make your 10% Wash solution? I am not sure that it would make any difference but it's something else to try.

Hi Malcolm, can you give detail of your testing method; or is it the same as described here??

Wrong question

John, thank you for your post and your wisdom. It is their shout for their need of blood that I have experienced myself, and was certainly trying to address in my post. I think that DogLover, for which I am one as well, and David Saikin probably have the better ideas here. If I could speak further about the logic; here, as I stated, the logic would be that the OBG docs would have some assurance that blood products would be available when needed despite their operation being located in a different building. This assurance would come in a written policy, a procedure, and practice that would directly address their needs and concerns.

John, I deffinitely agree as far as inventory management is concerned. However, we have OBG clinic opperating in a separate building from the BB and the OBG docs, I would think, want some assurance that when they need PC's emergently, they will get them. These docs, as you know, can be very anxious when the BB is in the same building; imagine how anxious they are in a separate building, and all understandably so.

You might consider keeping O Neg Emergency Issue RBC's ( 2 to 4 or other; your choice) that are pretagged for Emergency Patient (in your case, would cover ER trauma, if needed, and/ or L&D, or separate emergency issue units available for each); segments prepulled and labled with unit# lable for crossmatch after issue; and cooler/ ice and/or other means of tranport predetermined.

Has anyone given any consideration to the storage conditions of the eluate kit and how that may play a role in your findings?

Might consider steric hinderence with respect to the reaction of patient plasma with the donor AB cells as the molecular structure of this antigen would differ from that of the patient who appears to be A-subB. Have you tried any other enhancements of this reaction?

Because we do not know the potential use in the future of any information we generate and because there would be know additional specimens collected, and because the specimen we do have is perishable I would lean towards completion of any testing to the extent of the blood bank performing the testing.

What is the patient's history and/ or diagnosis?