Byfaith

I'm not sure how a serologic crossmatch will help? We do require a serologic crossmatch if we have given more than 4 type O rbcs to a non-O patient before switching back to their type.

I doubt our computer could do this either (Cerner). I am puzzled by the requirement even when the discrepancy is resolved - it would seem to me it no longer "exists" once a valid typing is performed, or it is confirmed that an Rh Pos patient got Rh Neg blood. Any other thoughts on this?

1. We perform an elution on patients transfused within the last month, who develop a positive IgG DAT or have an IgG DAT which has increased in strength. 2. Gamma Elu-kit 3. Gel 4. Last wash gets a screen, Eluate gets a panel That said, have any of you Elu-Kit/Gel users had issues with broad reactivity, usually fairly crappy looking reactions? We have had a few later proven to be false positives when sent to our reference lab for followup. Any suggestions? Should we drop the wash with the Wash Solution? Drop back to tube testing?

We do exactly the same with no problems to date. We also will issue Type specific plasma without the 2nd draw "Re-type" required for RBCs. The issue of the wrong patient being registered is a bit disturbing though!

We do the same as Banker Girl - Electronic XM if current screen is negative; IS if current screen is positive due to passive Anti-D (not clinically significant in our system)

There is a good video on YouTube done by Hugh Laurie - "The Strange Case of Penny Allison". It humorously present a host of potential transfusion/labeling errors. Maybe humor is not what you want, but it does get the point across!

We have been using them as an alternate supplier for a couple of years now. We transfuse about 300-400 units a month and outdate <5 per month. The way we use them is with a small weekly standing order -14units; 6 O Pos, 5 A Pos, 1 B Pos, 1 O Neg and 1 A Neg. This comes automatically by Fed Ex on a day that the Red Cross (our main supplier) does not normally deliver. This has worked very well for us, no addtional phone calls or planning needed - and has saved a ton of $$ over the long run!

We were cited for this very thing at our recent CAP inspection - ie not being able to prove that the units stayed in the cooler. While we would argue that the OR also has specific procedures to follow and are professionals, we are now going to try the new irreversable indicators marketed by Digitrax. They look pretty simple to use - will be trying them out soon.

I'm curious about the customized course you made on the CAP website - can you elaborate? Thanks!

We have an orderable test called "Antibody History" that places the results in the patient record, but it is clear that the antibody was identified elsewhere.

Overall we are very happy with Cerner millenium in our Blood Bank - in fact, some techs here also work elsewhere with Meditech and much prefer Cerner. I was not involved in the build of our system, but as Lead tech and bench tech I am familiar with much of it. The spreadsheet layout of Results entry can seem awkward, but it also has alot of flexibility. One workaround is to make several worksheet Tabs in Blood Bank Results entry - say one for Type and Screens, one for Crossmatches, one for Antibody IDS, and one for "everything else". That way you are not stretching the results screen off the page most of the time, and can easily switch back and forth between tabs. In practice, when you are entering results as you observe them, it flows pretty naturally as long as the worksheets keep things in order of how they are normally performed. I'd be happy to try answering any other questions as you progress!

I seem to recall seeing a kit made by Hemobioscience at a recent meeting - claimed to be validated for use in Gel. We have yet to try it but may in the near future.

Has anyone else noticed this? We purchased new MTS workstations and find that the new centrifuge drawers are very stiff in comparison to the ones we currently have in use - harder to pull open, drawer won't stay open to load cards, harder to latch and start. In fact, we find we need to slam the drawers shut and now notice evidence of apparent splashing out of the MTS cards. Maybe they just need "breaking in", or is there an adjustment, or are we doing something wrong? Thanks for any suggestions!

Some of our more memorable events were contests similar to those CM2 mentions, particularly to make a "Designer Lab coat" from the disposable coats we use. Also, we had a "Pea in a cup" game -basically a grid of small plastic containers into which you got to toss 3 dried peas. If you got a pea in a certain container you won a prize - everyone got to play once. Perhaps my favorite was the year we put a huge paper Lab Timeline the entire length of a hallway. The comittee started with some basic lab facts and events, pictures if there were any available - things like the dates certain analyzers were retired, people hired and retired, major lab moves or remodels etc. We have a staff that has been here "forever" so we went back about 30-40 years. Throughout the week people were free to add on any of their favorite memories in whatever part of the timeline they occured. It was really cool by the end of the week!

ElinF - Thanks for your reply! We already do the darker storage by keeping them in the box, and open a new set at least once a week. Room temp storage is more of a problem as they are in pretty much continuous use on 2 out of 3 shifts. I like your solution for a reagent holder - do you know where you got it?

Donor # in question is 309452 - we have 0.8% Surgiscreen for Gel testing.

We have recently worked up 3 different patients with 1+ to 3+ reactions in Surgiscreen 2 (lotVSS437) who have a negative ortho Panel A. Anyone else?

We have been able to utilize the Cerner Millenium blood bank system to track tissues. The ordering is done by a designated nurse in OR - we take NO responsibility for that part. We receive, store and track products. A daily list of all tissue products on hand is automatically printed in Blood Bank and OR, which includes various sizes and descriptions. When needed, OR personel pick the product off the list and send a runner with a request for that specific tissue. This has worked quite well for us Just wanted to add that our one glitch is those suprise "New products" that the surgeons simply have to have the next day and never let the Blood Bank know about. Probably no good answer to that!

Just curious about the Anti-Wra remark. We have a patient whom our reference lab identified an Anti-Wra (among other things - sample was sent for Allo-absorption ; Warm Auto and Anti-E present). Currently we have one panel cell that is Wra+ and can show the antibody to be demonstrable in room temp. phase, so fairly comfortable to issue E Neg units compatible by Liss-AHG and RT crossmatches. The Anti-Wra is only about 1-2+ in RT phase, so wondering where we will stand if A. titer decreases or even more likely B. we don't have a Wra pos panel cell to determine if currently reactive. We probably would have remained blissfully ignorant had our reference lab not worked this sample up for other issues! Sounds like it can be clinically significant??

We also do NOT repeat testing when additional units are ordered. Our computer has built in safeguards, but we have also found it helpful to store samples with a completed T/S in one box (ready to set up more units), and all other samples in a seperate box with Red Tape over the caps. Samples with antibodies also get blue tape over the cap so techs are immediately alerted to perform gel xm, antigen typings etc.

Exactly what we do here. As for labeling issues mentioned in another post, nursing labels the samples with pre-printed labels with Moms info, handwriting "Baby of" and/or "Cord Blood" on these labels. Seems to work well for us.

Just an FYI, we started using the tracking system a couple of years ago and love it! Wish we had done it sooner. I was not involved in setting it up so I have no special insight for you - but stick with it, it is worth it!

We have had the 2nd draw policy for about a year and a half - a few things that have helped are; A previously drawn CBC can be utilized for the re-type. Hematology stores samples for a few days, using a computer storage system that makes it easy to locate them. We verify that the sample is drawn at a different time, by a different phlebotomist (ALL samples are logged in with phlebotomist ID - in theory anyway). This saves many re-sticks. In an emergency or surgical case, if there is any resistance or an obvious urgent need our policy is to use Type O until a 2nd draw can be obtained. We will give O POS if first type is Rh POS, O NEG if first type is Rh NEG - the goal being to prevent transfusion of ABO incompatible blood. Our computer generates a seperate order for the retype based on the BB tech answering a question "Retype Needed?" at the time the original TXS order is resulted. Hope this helps!

Regarding RESt, I would be interested in some hospitals experience with it - - worth having or not? How about the cost and shelf life? We used it here many years ago, when we still did tube testing but abandoned it at some point. We now use Gel routinely. Thanks!