Barbarakym

Niser what kind of discrepancy would you test for? We use it along with A2 cells when back type doesn't match front type on a patient.

1. I have some trauma references that recommend 16 wks. But most hospitals where I am do >12. Just cuz of risk. We chose 16 wks. Previously was 20 wks since 1990s. I am sure it is just being extra cautious. 2. Re: testing women's husbands is not safe. While we would like to think women don't mess around on hubby or boyfriend and would tell the truth if needed but I can tell you from experience at more than 1 hospital where i have worked they don't all. Which is why, I am sure, a woman's medical treatment is recommended based only on her results and her babies once born, per AABB recommendations.

I should have made clear that REAL allo antibodies can and do hide out amongst this stuff which is why we go to tube and follow regular tube identification methods for any antibodies found. Like Mabel I have found allo antibodies on the tube in a distinct pattern once the gel interferences were removed. But once we go to tube screen any further antibody identification continues by tube.

How does this work? Another surface reader like the infrared? Or? Who makes or distributes it?

I have never seen a REAL mixed field reaction on gel. It is always junk. Usually a cold or rouloux. IT can also be too many plts or too much plasma protein or idiopathic junk. I would never call something mixed field without looking under a microscope on tube. At least not with technology now available to me. What we do with 'mixed field' gel reactions (top and bottom cell populations): Repeat by tube and stay with tube if workup needed. Probably 70% are colds showing at IS. Most of these do not show any specificity though Anti M will sometimes present this way.

Here in CA: CA state law follows AABB standards, whether you are AABB certified or not: As such actually now and for the past several years there are several requirements for issue of rhogam. Minimum testing is RH and ABS. IF there is an antibody you need to know it is not Anti D (not just by pattern, so must rule out) and must verify it is not allo as opposed to passive. You also need to know if you are giving enough. Which for prenatal that statement in dr request would be enough. But if patient is having a bleed as opposed for prophalatic you must also do a fetal screen of some type at some point (we chose 16 weeks.. others have 12 weeks, others have 20 weeks). So forms if done as outpatients should have some of these questions answered (Reason, weeks pregnant). IF you are doing testing and issuing rhogam. However if outside source does the testing and pharmacy dispenses I don't know the nuences of the law. A local hospital near us just needs a prescription dubmitted to pharmacy. If that passes all standards if checked, I don't know.

Exactly our process here in So Cal..... Kym

Actually our policy is to give XM compatible blood if antibody shows anywhere, even IS (cold) while showing. Colds if not showing revert to IS XM, but all other non-specific and/or clinically significant antibodies remain at AHG forever. So bottom line: Yes, AHG XM. Which means sometimes O blood instead of A.

All very good in larger labs. But smaller labs can't necessarily rotate like this. We have 1 person in BB on AM and PM, though they sometimes have to help out in main lab. There is only 1 gy person. But gy only does emergency work so GY is the one who does QC. If we run out of something and a new reagent needs to be brought in then a person on another shift must do the qc. All of this is documented in the procedure manual. PM is AM responsiblity as that is when BB is staffed the best (1 person, more or less dedicated to BB). These procedures are also in the procedure manual if someone new is there. So our 'stations' are not really rotatable in that personel are assigned by lab staffing and not just BB. And often BB is understaffed. We fit the 'tasks' where they work into the workload/staffing best. But yes, this means some people don't get a chance to do everything. Though everything is documented in procedure manual in step by step format should they find themselves having to do something out of their norm.

We do not differenciate in types of A. But we do mention if Anti A1 is present. We do the A1 lectin and A2 testing and document this, but in the results what is put in the computer is Type A, Antibody iD: Anti A1. Then of course follow our internal procedures on how to deal with that.

Are there places in the US that still able to receive plt concentrate? I have not seen a plt concentrate in years (I am in So Cal).

So true. Don't allow heterozygous except in rare situations (Anti D, for C and E, very few others). For initial identification we require 3 to rule in. and 3 to rule out as stated. But for confirmation, 1 will do. And I do like to confirm. It is how I found a patient was going regularly to another state and getting transfused when they came back and had an old antibody that was no longer showing at 3+. We called the other hospital. Got us all to the same place (she had 4 clinically significant antibodies) and talked to the patient about how important it was for her to tell any new providers about her antibody history. Kym

We send stuff like this to reference labs.

We use 1 Homozgyous to rule out. No heterozgous rule outs except by supervisor approval. Of course most antibodies have more than this. Multiple antibodies is where we use only 1 most of all. With that said, we rule in with 3 examples, hetero or homoz. And yes you have to use your brain, look at what is in front of you. I have called an antibody where 1 homozygous was there to rule out but only explanation was that antibody.

After this thread I am changing my procedure, no more returns on routine issues. Issuing with a Sav T Vue would suffice, however we return so rarely it is not worth the extra work and cost. For units issued to surgery or massive or emergency transfusion, these units are already issued in a validated COOLER, good for 8 hours and all are issued with Sav T Vues. I validated both RBC and FFP. FFP turns red sooner... but the policy states anything returned after 8 hours or with a red sav t vue (unacceptable temp) these units will be discarded. Plts and Cryo issued in this situation are issued with a paper form which insists on storage temp of acceptable range must be documented for approval for return. Surgery takes their room temperatures with calibrated thermometers every day. However since we instituted this we have had no returns. They are just not asking for them unless they plan to infuse. So much the better. Kym

Same here.

It took me awhile to go through this great debate. I will say I agree and disagree. How is that for being consistent? I believe in ONEG for Trauma until you get a blood type. Which should be a priority as most of these traumas are not going to be ONEG and then you don't have a problem. What does a blood type take 10 min post draw? Usual order I have seen is 6 untis.. You should have 6 units set aside for this in most blood banks.... we have minimum inventory of 12. Give 6 in a cooler and if it is going past 6 units that is the time to evaluate. Usually you have an hour.. sometimes not. Blood type..... most will be different blood type and you can safely switch to that blood type if only 6 units were given. Usually we get 3-4 of these units back once we send up type specific, XM (30 min if no antibody). Save the dicy stuff for those that truly need it. Hemmoraging... will we have transfused multiple bad antibodies (duffy/kidd/kell) in emergency to having nothing more than a positive coombs on eval. maybe shorter life. But nothing more on any hemmorage case. Trick is (as someone mentioned) to stay on top and give the 'bad blood' first while its all ending up on the floor. I even had a doctor ask me in a bad antibody hemmorage... " OK this is the bad blood right"? And I said yes... he transfused. He called back "OK slowing down.. We started with blood neg for bad antigens first, as they were closing we gave the 'really good compatible stuff'. She had positive DAT, No real drop of HGB and no hemolysis. Takes a team. Sometimes BB is the forgotten member of that team. Biggest problem to proper management in a bb transfusion crises. IMO.

I have a question for you? Why do you care? We gave up weak D (exception listed below) a long time ago. You can not tell the difference between mosaic (can and will sometimes make anti-D as we found out) and weak D at the bench level.... SO we only do IS. If machines (gel or?) are used anything less than 2+ (validaded this) is done on tube and if tube is neg at IS we call them NEGATIVE. Period. NOW EXCEPTION: AABB standards require that RH NEG babies of RH NEG moms need to have a weak D done to tell if mom needs rhogam. They ALSO say there must be a method in place to tell the difference between what looks like a Wk D from a fetal maternal bleed which makes them look like they are Positive..... THUS what we do is IF the baby is RH neg of RH NEG mom, we test the baby for weak D. IF the baby is weak D positive we give the mom rhogam. BUT we call the baby RH Inconclusive (so as not to give them a positive interpretation if they come back later). We give RH inconclusive also when DAT is positive and you can't do the weak D.. so we have mechanism in place and no one questioned it. We would rather call someone Neg than positive and have them develop antibody. Which in our large facility we had happen 5 or 6 times in a 2 year period. Weak D testing not required except in above exception. But that exception is to be sure mom gets rhogam.

Gel is more sensitive than tube. I agree with the above assessment (below 2+ will be negative on tube). What company makes your screening cells? Ortho had a problem 2 or 3 years ago when they went to gel (0.8%) cells where they were missing weak Anti-E. The cells also can degrade if left out more than 1 shift at a time without going back in the refrigerator, though I have had that be mixed contamination or slightly lysed cells and not necessarily missed antibody. Still be sure your 0.8% cells are stored properly (validated for no more than 8 hours at RT in Ortho studies), that you have lots which have been fixed for the weak Anti E problem (write Ortho)... how they had us solve that was to incubate the cards 40 minutes instead of 15 until they figured it out. It sound like to me that she had a weak E that was not showing even on gel and the first unit spiked her. Still not strong enough to show on gel when you gave the next unit and she had a reaction but it looked ok. Now you are getting junk (as well as the E). The junk CAN be from patient issues (protein high, plts high, colds (did you do IS with your tube method), rouloux, junky plasma (some drugs do this, some disease states do this). Good luck, but it sounds like you did all the right stuff. Why is she still getting blood? Usually moms have problem during delivery but afterwords clear up. Maybe something else going on? Kym

I just re-wrote a policy. This policy covers John Does/ Disaster ID (Different in our hospital/ AND those pesky admitting errors, and VIP hidden id's. Where name is incorrect and/or double MR # assigned. Basically what it says is that Original Admitting information must remain visable on the chart, dummy name, medical record, etc. That BOTH new info and old info will be required on pick up slip (what they bring down to id patient), That THEN we ASSIGN AN AKA on PT BB record for that 3 day period. Either name/mr can be used as long as it is matched up. If any of this fails (old id is removed for example). Pt must be redraw and reworked. At the end of the regular expiration date for the specime it must also be redone to only the correct information. We get quite a few of these and so far the policy appears to be working.

Forgot to add. Patient records and crossmatched units. MUST have a plan for this. You do not want crossmatched units at one location and patient at another. Also if records are not on computer (ours was not---Cards), they need to be where the blood and patient is. We arranged to move patients via dept. We had a list and when nursing supervisor said ICU patients were leaving now... all blood and records from that dept was sent to new hospital. ETC. There was one snafuu.. but patient was stable and able to wait.. otherwise we would have done Emergency release.. cause starting over would have been more time than waiting for delivery. THIS part is very important and plan may be looked at by inspector also.

We moved Dec, 2010. Do not forget that you should re-validate all equipment. TJC did come out and look at that documentation about 8 months later and we passed without complaint. I re-did all the centrifuges, cell washer, thawers as well as the refrigerator/freezer/plt incubator. I am sure your plans are already in place for building, but if building is not already closed in you should look at electric and computer access as people stated. We had plenty planned and then due to project overruns alot of IS budget was cut and we lost 1/2 of everything. It hurts and we have to use power strips.... not good but all we have. It costs 3X more to add these lines once walls are complete. When you set up your benches... do so with 5S standards. All your supplies for what you need right at hand. I was lucky to learn about this at place I worked before and set up my dept this way. Spagetti diagrams are good for this. All thawing stuff in one place. All stuff needed for issue in one place. Reference books where they will be looked at. Supplies stored at point of use. All this makes for a comfortable work place. Everyone touched on product first. We did not have 2 freezers. We arranged empty freezer boxes from ARC (our provider) with dry ice to move stuff after we opened at new place. We had new stuff delivered to new place but kept in the box. They are good and validated from ARC for 24 hours (I believe if memory serves, but I did get this in writing)... UNTIL you open the box. We put thermometer inside and each time it had to be opened, we took temp (made a form) every 4 hours like any storage compartment. While we validated our freezer 24 hours post move before moving stock. If you have a freezer at old place and new place (as well as refrigerators) this can be avoided. We had double refrigerator. Freezer was our problem. Our solution was accectped in TJC inspection.

Yes, the infrared takes the outer surface of the bag and not the core blood. To do a proper validation one should validate per saf t vue validation with a calibrated temp probe going into a bag(s) to see how long the center takes to come to 10 degrees. my next thought is just discard. In my hospital they can't even get to the floors and back in 10 minutes.

However strange ortho writes their instructions. It is ok and their own instrument finds the empty wells. So the answer is yes. The storage temp is RT, so they don't want them stored for several months at 37, they just let you incubate them X 6 at 37 (which would be 90 minutes for 6 single times. Though generally they are used faster than this. ABS is usually 3 cells.... Then there is daily QC. And select cells are varying. SO rarely would you safe a card for just 1 xm at a time. If ever.

I work in Ca, and this is our policy as well. ONEG unless our supply is depleted below our minimum safety, need pathologist approval and doctors need to sign saying patient condition demands blood, (emergency release with this as one of the criteria). Kym