mollyredone

If the subsequent antibody screen is positive and matches the previous screen in reactivity and strength(and I know screening cell reactions can change position), we do not do another workup within 30 days. As John said, if that antibody was ruled in accurately and previous antigen negative units were compatible, an AHG crossmatch should catch any new antibody. If we get incompatible crossmatches, we would perform a panel.

I think significant antigens are usually represented on the screening cells, although not all homozygously. If the screen is negative, we don't go any further. Just give antigen negative AHG XM'd units for the "biggie" antigens (Kidd, Duffy, Rh,S, Kell and a few more I'm sure I'm forgetting) and AHG XM compatible units for Lua, Lea, Kpa, M,N and the like. Other hospitals may have different policies, but this is ours.

"You also run the risk of TOCO due to the volumes needed, and also delay due to the time taken to transfuse the units safely. PCC is a small volume and dose is adjusted based on INR and weight - for an INR of >8 you are talking of 4+ units of FFP and still running the risk of incomplete reversal - Vitamin K would have worked quicker..." Auntie-D: Is TOCO another name for TACO that we use in the US?

So do you think that you have to prove through daily QC that it detects weak reactions when you have a patient that reacts weakly to show that it does? I didn't see anything in the package insert that mentioned gel, just tube testing, and we get a 2+ with tubes, which we only do if we have to do a tube screen. Our primary method is gel. Now I even wonder if this QC kit is appropriate for manual gel, since their methodology says tubes, or for automation, follow manufacturer's instructions.

Well, I would have to say that there is a lot we could learn from this incident. The first thing I did when it was announced was to pull two segments to label from all the ON and OP PRBCs that we had. We had 12 ON and 40 OP on hand. Then we thawed out 4 AB FFP, and started the second batch when they were done. With the segments we could crossmatch after the units went out and specimens came in. Unfortunately, our trauma ID system fell way short. Plus the ED did not specify “I need 2 ON, 2 FFP for this patient, 2 ON for this patient, etc.” We started out more orderly and then they came up and took our last 4 ON and 4 OP in a box, no names, and as they headed out, I shouted, “Give the OP to the guys!” We had 3 patients transferred, and a lot of units, including most of the FFP, returned to the lab. Now we are trying to backtrack and see if we can figure out who got what. The ER documentation is abysmal. One doc even noted that a patient received 1 FFP and 1 PPH. We didn’t give out any PPH. I had just been to a seminar where a hospital recounted the high school shooting in Marysville, Washington and the fact that they had a blood banker in the ED to keep track of where their trauma packs went. I definitely think that we will implement that if we have another incident. I feel that the ER took that box of 8 PRBCs and handed them out like Halloween candy. Our blood supplier called within 30 minutes to see what we needed and brought down more ON and PPH. We do have a call back system, so I had three others in blood bank to help when normally it is just me. I just reread the whole disaster thread and saw that others have had similar problems with trauma IDs and ED just wanting blood. That’s why I think having a tech in ED would go a long way to keeping track of units. I also brought up the idea of a lab internal disaster with our medical director and she thinks we ought to start making a plan for that.

Lbiggs, Where are you located? I'm in Oregon and we use Bloodworks. We are just waiting for the MTP protocol to be revised to state that we will use liquid plasma and then we will keep 4 units on the shelf. They will also be A, as there is a lot of data out there regarding using A plasma without incident. Mari

Thanks everyone! We have had an incredible outpouring of support. They are calling one of the injured victims a hero for rushing the gunman and saving people-he was shot 5 times! After the first three shots, he fell and told the gunman it was his son's birthday and was shot 2 more times. Roseburg is also the home of one of the Americans who stopped the terrorist on the train in France. He works at Costco here. People are amazing!

Well, today was a hard day at work. I was working in blood bank when we had a shooting at a community college where at least 13 people were killed and 20 injured. We are a level 3 trauma center, but fortunately had a good supply of blood and FFP and were able to weather the storm. Lots of paperwork to finish up, but I'm thankful everyone kept their cool and we had pretty smooth incident. Mari

Mayo clinic air flights have been issuing prethawed A plasma in the field since 2008. We plan to stock 4 A liquid plasma for our Massive Transfusion Protocols and emergency release. Our docs are fine with it.

I validate the four coolers that are used by our outpatient transfusion clinic to make sure there are no cracks, lid issues, etc. that might affect their usage. We just use Igloo coolers with two frozen icepacks and a basket between for the units. Our blood supplier validates the boxes they send products in, which we use for ED, OR, etc, since we would never get the coolers back if we gave them out!

I got my QC plan from someone on the forum. Each morning I run the MTS diluent with A2 cells for my negative and IgG check cells for my positive. This tests the MTS buffer as well as IgG for gel DATs.

We routinely issue two units for outpatient transfusion in the hospital. They have Safe-T-Vue devices (irreversible color change) on the units and I validate the coolers annually. They document on the form or in the computer that the unit is acceptable before transfusing, indicating that the Safe-T-Vue device is still white. The only other time we issue more than one is to ER for emergency release, massive transfusion or FFP. These are issued in a box with ice that has been validated by our blood supplier.

Malcolm, We just send out the specimen and the reference lab titrates the necessary antibodies. They don't titer anti-N or anti-Leb, and the anti-U is too weak to titer right now. But how unlucky is this patient!?!

We do our screens and identification in gel. Would it be a good idea to perform them in tube before reporting out an anti-M on a prenatal patient. We sent out a titer once a month on a pregnant woman-the titer was always too low to quantify. I don't want to miss anything, but I hate to think of the expense as well. We are now sending out a specimen to anti-U, anti-N and anti-Leb titer. Thanks, Mari

We send PRBC, FFP, and PPH through the tube. We send it by "secure send" which means the tube system alarms and will not drop the tube out until the security code is entered. We also call the floor if we don't get the tube back in a timely manner. Maintenance can track any tube in the system and we have never lost a unit yet! (Knock on wood)

I discovered that the checklist items, such as consent signed are not required to start a unit. Since we are still building it, I hope we can make it required. Do you do the monthly audits? We are doing them. The vitals pass into the lab module, but I don't think the checklist does, or any overrides when scanning the patient band and unit. As I said we don't have hospital bands available at our outlying draw sites, and ER is not going with it either.

David, you are right. I was looking at an older checklist. That seems strange that they took that out. And I don't do a low alarm on FFP freezer either.

Why can't it be in the real Portland...on the west coast! Just kidding! Wish I could!

We have quite a dilemma with giving up BB bands. Our outlying collection areas don't have the ability to use hospital bands, plus our ED is NOT going with TAR. They are so ridiculous! So outpatients will still be BB banded, as will ED patients. When the patients are drawn at our cancer care facility, which is our most frequent transfusing area, they will be BB banded, and when they are transfused they will get a hospital band and the nurses will use TAR there. So if a patient needs to be transfused in the ED, they will BB banded and the transfusion will start and finish on paper. If they are admitted and need further products, they will be transfused in TAR. ARGGGH! Suggestions if anyone has the same mixed bag like that.

David, When I read TRM.42750, it states "Is there an audible alarm for each component storage unit, is it continuously monitored 24 hours per day (in laboratory or remote) and has the response system to an alarm been validated?" So, according to this, Yes, I would cite, unless there is a remote system in place, like Isensix, that has a responder to its audible alarm. Limper55 states that they rely on security to call them, so there must be a remote system in place.

Since it is on the computer, you can see the last date it was modified. Granted, it could be changed anytime during the month before it's over, but after that a later modified date would show up. What's to keep people from redoing "indelible" QC sheets if they discover two months later the wrong lot was used?

We do have a shared drive for that. We do still print it out, but I may look into just reviewing it on the computer. We do a worksheet for each week, and then put them all together in a monthly file, with a tab for each week. We also check the reagent lot, and then copy and paste for the next row, highlighting short dated reagents in yellow for awareness.

I'll have to look into that, since that is an issue with some techs remembering to order XM GEL and cancelling XM IS for antibody patients.

We document our QC on an Excel spreadsheet. It's in the computer, but I also print it out weekly or monthly, etc. I was trying to attach the file to this reply, but couldn't figure it out, so I uploaded it to the library under forms, daily QC template. Let me know if it works. I also do my equipment log that way, temp, gel centrifuge speed, etc.