Liz

oups oups and oups, it is obvious that I am not on the ground. Ok, I asked the supervisor what we do and indeed if we know that the patient is coming in for plasma we only do the ABO Rh. Apparently it is in the SOP that I signed...:surrender:disbelief where is that blushing face?? ok this will have to do: (for past performance).....

I know that theoretically you are right, Dave. However, practically I would screen. Do you screen, Dave?

Eoin, thank you that is interesting, interesting , intertesting. I am going to write to the Hospital director and insist. He made me a remark once that I must have ownership of the blood units, ok so he will have to execute this plan. Thank you.

If by ASC you mean antibody screen on the recipient, then yes it is necessary. Beacuse there may be a minimal number of non visible rbcs AND because anyhow you routinely perform the antibody screen on recipients as they may need RBCs. Don't break the cycle, don't ask busy technologists to stop and anlayse and waste their time. Better be safe than sorry. And with automation it's great. Keep the work streamlined. You, yourself, said there is very little risk, you did not say "no" risk.

Welcome Iris!!!

In addition to gel IS or the gel major crossmatch it is routine for us to repeat the forward blood group on the already confirmed types of the donor and the patient. We do not charge for that. I sleep well.

Thanks Dr. Pepper, are your antbody screening cells 3% ?

We can partly use the in-house made software and then the actual returned tags will be checked by hand. Thank you for the tips. Liz

Norbert, How often do you count the forms that return and compare them to what was issued? Thanks Liz

Thanks Norbert.

A donor forward types as A but does not have Anti-B. Do you discard?

They should arrive together. But then again, there are centers who recieve the request on the computer. I look forward to replies.

Thank you Cliff!! Great job!!!

Hello Norbert, Can you tell me when the Blood Bank part is sent back, is it immediately at the end of transfusion? Thank you very much. Yes it is in German and I am able to decipher it. This has given me a good idea for improvement. We have this information on a tag, an additional 4A form similar to yours will be better for tracking. Thanks Liz

O cells are fine for transfusion especially if you remove as much plasma as you can and add ADSOL. Yes one can encounter Anti-A1 in an A1 patient, it may also be non specific or specific to an antigen not mentioned on the antigram ..it is weakly reacting with the B cells. So, it may be another auto that is present on the A1 reagent cells. I would give 0 RBCs. Your patient has an autoimmune disorder, possibly Guillame Barre', and these auto-immune disorders are associated with auto abs to the RBCS. Once treatment is started, IVIG -/+ Plasma pheresis, +/- Rituximab, +/- Steroids, you will see a great improvement and your tests will be straightforward. Nice case. Keep us informed.

Norbert, these are excellent results, you do have ownership of the blood. Can I see a form please, and does it have duplicates? Thank you

Hello Eoin, Can you elaborate of that: full blood tracking system Eg: if a unit is spiked and for some reason not used and and in the rare case disposed of at the OR and the Blood Bank is not informed, how would you trace that? thank you

Thank you Colleen for the help.

Absolutely Alan !!!!! Well said! I fully agree. "We work so hard to ensure that the services we offer are of the highest quality, and that the blood products we process and issue are "safe, pure, and efficacious." Thus we would want our clinical partners at the bedside to be just as dutiful in their processes. "

Thank you, which filters do you use? What do you mean "good for 5 days" after collection? and do you have references? This is good info. Thank you

I want to go to 100% prestorage filtration. The thing is we are a hospital based Blood Bank with the donor room and the rest. Moreover, I have nearly 100% one-time donors. That means that we will be discarding ~ 10% of the units because we perform the infectious screening after we collect. That will be a huge financial loss. Am I justified financially? No. This is of course for patient-care but I cannot justify it if it’s a financial loss. The reason I am (and the Blood Utilization Committee is) thinking of this is because of the 0.7 % reported NHTRs and the fact that we presently filter ~ 50% upon request (but not prestorage). Option 2: If I go for filtering AFTER I perform the infectious screening and use the sterile connecting device to connect the filter, the inconvenience is that the units may sit for more that 8 hours. What is the policy on the 24 hour FFP? And, what happens once the units are put in the cold quarantine storage, should I then filter in the cold? I would be happy to have some thoughts on this and on others’ practices. Thank you!

OMG, we had an MD who sent in her mom's blood for a work-up under her own name and insurance! When she was called to be informed that she had cancer, she said "oh, thats ok, I know that’s my mom's blood!" What!! ??!! The MD was terminated [her contract was terminated ) ] the same day for illegal use of her insurance policy! She did not get the chance to make a phone call.

Since your Administration is concerned, you must speak to them. As AMcCord and others have stated, make friends. I cannot believe that non-compliance has been tolerated. See if the Administration can lure Nursing into Magnet Recognition! See who can commend and counsel, and the Nurse Managers should be empowered to train and document the training, then there are audits and re-training, its a Nursing process, all you have to do is to get them started. Documentation is important because if not available it can lead the hosptal to medico-legal problems. I dont know what more to say, but go to the top to get it done, change the CNO I am surprised really really surprised, and I applaud you for taking this matter into your hands.

thank you Brenda!!

Here the Nursing Department is one of the best, that was not true before. Now, they are really into training, and competency. Then they fill out a lot of paperwork, because if they do not document it, it means they did not do it. Most importantly they are accountable and take ownership of the blood unit once it leaves the dear ol' Blood Bank. There is an incredible organization scheme with preceptors, Nurse Managers, educators etc.... Ask for it, you should get it. As Dave said, once you are CAP cited and it is their fault then they have no choice. But more importantly you do not want a sentinel event, patient safety comes first.