Annadele

We require platelets to be on the rotator for 15 minutes after bringing them into inventory before we issue them but I'm not sure where that requirement originated from.

Do many of your laboratories also require a confirmed ABORh type on a current encounter before administering FFP (or even PPH)? I've been wondering about this because especially with the cost of healthcare in the US, it isn't outside of the realm of possibility for a patient to present him or herself as someone else that had been seen previously at our hospital and then receive incompatible plasma. Annadele

Our practice with a positive screen and negative panel is to perform a screen by tube in PEG. If it is negative, then the patient is cleared to receive electronically crossmatched units on that T&S. Annadele

My interpretation of the CAP requirement is that two ABORh types must be performed in order to issue an electronically crossmatched unit but those don't necessary need to be performed on two separately drawn samples. The laboratory I work in does not require an additional sample in order to issue electronically crossmatched units. A second ABORh type is performed using the same sample used for the initial ABORh type by a second tech by tube or by a second tech on another automated instrument. They also do not require a confirmatory ABORh type on a sample from a current encounter before issuing components to a patient who has been seen previously in our hospital. They are issued based on historical type. Annadele

Thank you so much for your input and help! Annadele

Hello All: What quality control measures are employed in your laboratory, if any, to ensure that "miscellaneous" supplies are received from suppliers in working condition before they are put into use? By miscellaneous, I mean supplies that are not necessarily considered as "critical" as reagents, blood products, or equipment are. We've recently had a couple of incidents in our laboratory that have inspired us to investigate the possibility of performing formal quality control on some of the supplies that we receive in the lab. One was that a supplier shipped some ringers lactate in a box that was supposed to be entirely 0.9% NaCl bags for our cell washer. (As the bags look identical, this went unnoticed until a tech attempted to use one of the ringer's lactate bags to deglyc a frozen unit - luckily it was outed as an incorrect bag before washing began.) Another is that we received a box of the sticky labels that we use to identify a unit as intended for a specific patient that turned out to not be adequately "sticky" and received several calls from nurses that the labels ripped right off of the units quite easily. I'd love to hear what some other labs out there are doing!

Both of our groups are done on the same sample but by different techs and/or automated instrument and include forward and reverse (though no reverse is necessary if it's an infant). I work in the US. I'm really curious about all of these discrepancies in policy for Transfusion between developed countries. As a newbie, it's hard to tell how many of these policies are based on preventative theories and how many are based on practice (like changes in policy in response to SHOT findings, etc.) or research findings. It's interesting that it seems like the tendancy to be more conservative is on the side of the countries that have a centralized health system - you'd think that if anything, there would be motivation to be more conservative in the US where in theory a hospital could charge a patient more for extra testing, etc. and therefore would want to adopt more conservative policies. The hole in this of course is that medicare reimbursements haven't increased much for laboratory work in the past decade so there's pressure to keep costs low. If anyone comes across a source about this, I'd really love to see it.

Hi again All! I have a couple of polls for the group related to electronic crossmatching and to the ABORh recheck. 1. According to the AABB Technical Manual, the electronic crossmatch is permissible if, among other things, "A method exists to verify correct entry of data before the release of blood or components." How does everyone interpret this in their laboratory? In ours, if the LIS is down, manual entry of ABORh type and/or recheck performed on an automated instrument is permissible and electronic crossmatch can still be used. This seems reasonable because presumably even if there were an error during result entry, requiring an ABORh recheck prevents an error from resulting in the issue of ABO incompatible products. I read however a SHOT report in which a patient was issued an ABO incompatible unit of RBCs because of incorrect manual result entry. (It's attached and the incident is described on page 56.) I'm not sure if the laboratory involved in that incident required rechecks or not. Are there labs out there that require a completely automated T&S process including crossover of result entry in order to use an electronic rather than IS crossmatch? 2. Do some labs require a current ABORh type (in nonemergent situations) on a sample drawn on a current encounter in order to issue components? I'm thinking here of a situation in which a patient is impersonating someone else for insurance purposes or in a case of misidentification at intake. My guess is that this isn't required because a transfusion reaction associated with the issue of ABO incompatible components is less severe than with red cells but I'm curious if other hospitals take a more conservative approach here. [ATTACH]586[/ATTACH]

Hi All, I apologize if someone has already listed these in another thread, but does anyone have a list of references for the studies (or better, a pdf) conducted by the Univ of Michigan, etc. about the frequency of antibody identification? I tried to search for the article cited earlier in this thread on Medline, DynaMed, and PubMed to no avail. I'd love to learn more about what those researching this has found! Annadele

Thanks All! What I'm really wondering is what it is about passive antibodies that makes them clinically innocuous. Is it that the dose is so small that any rbc removal is inconsequential? Do they vary structurally in some way - perhaps so that they coat fetal rbcs in the mother's circulation without actually prompting their removal?

Out of curiosity: What exactly does "passive" mean in the case of Rhogam? I know that RhIg is made from human plasma containing anti-D (so I'm assuming that it's the very same IgG1 that when naturally produced can cross the placenta and cause HDN) but is it manipulated in some way to prevent it from crossing over the placenta and causing significant hemorrhage or is any resulting hemolysis from crossing over just insignificant because of the small dose issued? I had read somewhere that occasionally it can even cause a positive DAT in the neonate (without other evidence of hemolysis) so I'd lean toward the latter but I saw a reference to a study elsewhere online that suggested that Rhogam avoids causing hemolysis even when given in high doses (I'm not sure if those high doses were warranted due to large fetal-maternal hemorrhage or not).

Duke University Hospital (924 acute care beds) uses both 24-hour and 5-day plasma products.

Disclaimer: I'm new to BBing as well. I discovered recently that antigen typing can also be helpful even if the patient has been transfused in the past 90 days. A couple of weeks ago I ag typed a patient for three antigens as a routine part of identifying new antibodies in our laboratory. (I can't recall which but I think that one was anti-c.) I was having trouble obtaining probability for two of the suspected antibodies and wasn't aware until after I performed the typing that the patient had received a transfusion about two months prior. The ag typing was clearly negative for one ag and mixed field (with a small positive population) for the other two. I was able to not only feel confident that the patient was probably negative for those antigens, but also able to presume that the transfusions they'd receive were positive for those antigens - bolstering the possibility that they were now forming those antibodies. The sample was later also sent for a bioarray to get a complete antigen type by molecular methods and I left the results open until they'd been reviewed by a specialist. I probably wouldn't have ag-typed had I known about the transfusion but now I think that those results were helpful at that moment in trying to decide if that patient needed to receive units that were negative for those antigens.

The large hospital I work for (900+ beds) houses coagulation factors with pharmacy and RhIg is distributed through Transfusion.

Does anybody know of a reference for how long Rhogam can be at room temperature and retain its effectiveness? Do any blood banks out there have policies for how long caretakers can take to issue it once it's been released?