Barbarakym

How do we follow up on a patient who came onto the ER requiring uncrossmatched emergency? Antibody screen turned out positive. ID was Anti Jka. 1 of the 2 units given before ID was Jka positive.

Where I have worked in the past we used Safe T Vue's on any unit being dispensed to Surgery (for their refrigerator). We followed up on any blood not returned to the blood bank by end of day. If some blood came back after that day of surgery there were incident forms filed. However we could tell by the Safe T Vue if the blood was safe for re-issue. They turn red and do not revert to former temperature. Where I am located now, they want coolers (presently have nothing). I have validated the coolers but was worried about this very issue and thus we are combing the cooler (with log tag to take temps) with safe t vues which must be acceptable for re-issue. Coolers can only be out of the BB for a specific period of time (now 4 hours, we may increase it to 6). Kym

This happens to this day in many urban areas with large amounts of un-insured people. They just don't understand the importance of a medical record history. RE: Other possible reasons mentioned. Faulty admitting (to a wrong file) does happen. Not infrequently I am afraid. I think safest bet is to always think identity first. Redraw and confirm and question the patient. Kym

I am getting tripped up in AABB terminology. AABB Suggests Function tests for centrifuge be done every year. Tube fill be be day of use Saline fill volume be weekly. At this moment we do Method 8.5 : (Calibrating a serologic centrifuge) 1 X year and after repairs or when we get one new. Can I assume this is a function test? At this moment we do a variation of Method 8.6: (Testing Automatic Cell Washer) at the same interval. Is this also a function test? Though this tests how the tubes fill. Surely this involved procedure (as in the methods) is not expected to be done every day of use? I would think this is also a function test, but if so what are they saying needs to be done daily? Weekly we have been doing the Volumn Dispense of the Cell Washer (50-55 CC). Is this what AABB considers Saline Fill Volume? I started here last year and have now gotten around to these procedures to reveiw and re-write. Any input would be greatly appreciated as to what meets AABB standards in this area. Thank you, Kym

I would like to NOT put patient identifiction on the unit (UNXM, Type O) if at all possible. As this is what is slowing everyone down. Our labels require writing, sticker from floor does not work. Of course I can make a label JUST for this purpose, but in some cases, doctors want the blood waiting for an ambulance (no id, no MR number yet) to roll in. Right now I am leaning on lables which have a place for pt sticker. But could this be optional. IE : No pt information, just UNCROSSMATCHED? We do (to be revised based on info from this thread) have a form where we can list unit numbers where pt ID will go and DR signature. Thanks, everyone. Kym

So there are no written standards for HOW to make sure which patient got the units? I have been reading the AABB standards and I do not see where any abreviated labeling is endorsed for emergency. Standards 5.18.5 say: 5.18.5.3 Container or Tie Tag shall say in conspicous fashion that testing is not completed at time of issue. Is a UNCROSSMATCHED sticker enough? 5.18.8.5 Records shall contain a signed staement from requesting physician saying clinical situation was urgent...... Is this where you write (to track) the unit numbers you are releasing? What patient identifiers must be on this physician statement? So my basic question is how much info is required to meet 5.18.8.3? Name or identifier of patient? Or just that it is uncrossmatched? If name is not required how do we know this specific patient received this specific unit? And regarding other paperwork how much info is required to meet 5.18.8.5? I know what has been done here since before my time here is way to cumbersome. I want to streamline it but also want to meet standards. Thanks again, Kym

I need to re-write the Emergency release (uncrossmatched) procedure in my blood bank. What are minimum requirements for issuing Emergency Release? Especially as regards to labeling and paperwork. The system set in place many years ago is very cumbersome (I don't see any difference in amount of paperwork-we are not on computer- than for a regular crossmatch). Which is why I don't see people following the procedure and if they try the dr yells at them for being too slow. Label on unit (required?): now currently requires the same as for a xm unit except a different box is set up. Paperwork for unit (goes with unit, hand written): Same as for crossmatched unit... Just says uncrossmatched. VERY time consuming to write all this stuff. No computer in site for now. Would appreciate information and advice. Kym

I recommend you reading the AABB guidelines pamphlet on Prenatal and Pregnancy and neonate testing, I am sorry I am at home and don't have the booklet here.This was as a 2005 publication. According to that booklet, the ONLY patients required for testing are neonates born to Rh Negative mothers and THEN for the exclusive purpose of being able to give the mom's Rhogam should the baby type as Du positive (as weak D is still D from the perspective of donating cells to an Rh negative person- in blood donation and in protecting the mom with rhogam). This testing is done to protect the MOTHER. In this same booklet talking about MOTHERS....The AABB says CLEARLY that you must have a policy for not calling a mom Rh positive who might actually be Rh negative. You must have a policy which protects against accidently calling an Rh neg mom Rh pos due to a fetal maternal hemmorage, which can present as Du positive. In another section it states that Du positive mothers are candidates for Rhogam because it is not easily determined if they are weak D or mosaic. And being Rh negative, Du positive is not a reason to withhold rhogam. The booklaet is pretty cheap on AABB website and it also gives lots of information on titers and antibodies which affect the pregnancy and HDFN testing recommendations, etc. So I read and re-read this book while making my policy this year and the above is what we determined they were requiring and recommending which is why the policy is written the way it was. The ONLY tricky thing for us was....if you don't normally do DU testing but you do on a neonate HOW do you handle that baby's records so as not to be confusing later when the baby came back as a patient? As a patient the neonate would be called Rh negative.....thus we decided to NOT report the baby's incubated typing, but rather to treat this baby as an unknown Rh as that is how we treat babies with positive coombs and the mother is required to get the rhogam. Other places might handle this differntly. Still I am very comfortable with our decision as for protecting the mom with rhogam the action is the same and that is why we did the Du in the first place. Again, I recommend you get that AABB pamplet and make your own determination.

So you are saying you want to find weak D patients? Why? Do you call then Positive and treat them as Positive?

I have worked in a hospital that dropped the Du test 2 years ago. Where I am now supervisor I am also doing this. The AABB guidelines even recommend rhogam for Du positive women due to mosaic. Only requirement is Du on neonate who types NEG by IS (immediate spin or direct method) who is from a mom who is Rh Neg (for rhogam puproses). Rather than confuse everyone what was done at my previous hospital: We do IS only. If Rh negative everyone is called Rh Negative without doing a Du test. Exception is neonate of Rh negative Mom who also types Rh Neg. We do Du. If baby then proves to be Du Negative baby is called Negative, of course. IF baby types Du Positive, the baby is called Du Inconclusive. Which is a term we called those babies who were Du tested with a positive DAT which interfered with the result. This way while they are in-patients they are handled as if they are D typing unknowns (IE: Mom gets rhogam)...but when they come back at an older age they get the IS only treatment and are typed and archeived as the negative Rh our policy states they are. We have a canned comment for those folks that were originally called Rh Positive....stating that we have updated our reporting methods and these people will from now on be designated Rh neg or positive by direct test method. Due to increased sensitivity over the last decade or two of reagents, many previously Du positive people now type as positive by direct tests. We use this same comment for these people. There is still an issue however, Provue (and maybe other machines) are very sensitve to Rh D and call people positive who are not so by IS. Our policy says that any Rh of 2+ or less on the machine needs to have a IS done. And final determination is by IS. Most of our doctors offices use the direct method and thus these results more often complement them and confuse them less. Kym

I called Ortho, the supplier for our antibody panels. We are a small lab and have 1 gel panel and 1 tube panel IN DATE. Ortho replied to my question of if their panels were validated past expiration date (also says that in their pkg insert), why did they say QC was needed periodically and what that meant. Their answer was that there was no way of knowing what happened to the reagent from when it left their place to when it arrived at our place and periodically did NOT mean day of use OR every day....but at any period you wanted to define. Since their worry was shipping, we have made it our policy to QC before it is put in use (which would be soon after arrival). On our expired panels we DO run the same QC on the day of use. This is written in our procedure. Rule outs are meant to confirm what we think we know and are never the SOLE basis of making decisions. Our IN-DATE panel is our main tool. QC we run....again per ORTHO, is a WEAK antibody (as they specify) they recommended FYa. We run a panel ( FYa+ FYb+) cell with a dilute (1:20) anti- fya prepared from our in date Anti-Fya anti-sera. We do this on arrival and on any expired panel we use for select cells of any type. The reasoning is this cell will be most likely to degrade first on that particular panel. We run only this reagent. Other cells we are rulling out we may not have anti-sera to (we have limited anti-sera, the most common C.S ones). Other reagent integrity inspection is required...IE: not hemolyzed.

I really like Blood Bank Talk and do not like the other two at all. So if those are the only 2...so my vote is to stay with what works if possible. It is easy to remember. Which the others will not be for me. So hopefully I will be able to find this forum when I put in blood bank talk into google which is how I usually come to this site. bkd

In your process, do you have rechecks by a second tech to verify type? I have not seen an error in typing that went past the recheck in several years. Even those found at retype are only 1-2 a year for a hospital transfusing 500 units a month. I feel the best process is one that allows that we are human and catches any mistakes before they leave the blood bank. Any mistake that makes it past the Blood Bank is disceplinary, as it should not happen at all (0 Tolerance). If the same tech was making the mistakes,that is a tech problem. If there are multiple techs involved, I would think process is involved. I would look at WHAT ELSE they have to do. In some hospitals the Blood Bank tech is ALSO expected to work other departments at the same time, example Hematology and Coag and meet those ER TATs as the same time as doing Type and Cross in blood bank. While doing wet work in Blood Bank they should not be expected to be dividing their attentions and this is a process problem, encouraged by management. Priorities start at the top. BKD