bbbirder

If your concern is primarily cold agglutinins, I would think a saline check after washing the cells would work. Linda Frederick

I have some similar questions as Mabel. Not as complex, we transfuse PLTs to babies about once every 5 years. (Always on evenings or nights of course, when there is a big storm and the helicopters can't fly) We might need to split a Leukoreduced Apheresis (what filters do you use then and how do you dispense it?) or give out a single non-leukoreduced random concentrate PLT (we have some Pall Purecell PL filters for one PLT concentrate, but this goes into a bag and the nurses would rather have a syringe.) Are your nurses transfusing PLTs to babies using a pump of some kind? Linda Frederick

We gram stain our random PLTs (or rather Microbiology department does). Since Micro already does a survey that includes gram stain, I see no reason to get a new survey. Same would apply to your pH testing, if you already have a survey for that same method, I would not get a different one just for PLTs. As far as I know, you need PT testing for 'regulated analytes' and if you test in one survey, you don't need to get a different survey, just because your specimen is different. Linda Frederick

I would run in tube straight before I did a titer. Ususally these are very weak or not even detectable in tube. Linda Frederick

This isn't really just a BB question, but applies to the entire LAB. Also, it isn't just a CAP question (they have a standard about it), but also Joint Commission. If the wrong patient is selected at time of registration, what processes do you have in place to make sure that the results are corrected properly? Both CAP and JC have standards that require that corrections to reports are made in a way that shows there has been a correction. So... Mary Doe is admitted but put under name Mary Roe. Lab work is done. The next day someone discovers this... now we have a problem. In Meditech, Medical Records/Adm Registration have a routine they can use to switch the account from one Medical Record to another (though as I understand it, this routine will not move everything, and some things, including some BB, sometimes is blocked) (what is moved and what is blocked is a little foggy for me). This "switch" would seem to take care of getting all of the information onto the correct patient's chart, but it does not take care of the incorrect results that went out on Mary Roe and may have been viewed by a doctor remotely... may even be printed in the doctor's office. So we don't want them to move the account, because that means it has vanished from Mary Roe's record. (This is not to mention all of the other documentation that is incorrect.) Sorry to be so long winded, but this seems to be a pretty complex problem. Anyone out there have a great plan?? Linda Frederick

With 5.6.2 there is a new feature to allow multiple specimen expirations in BB. I’d like to create a rule for this (to enter on page 3 of the Customer Defined Parameters). Specifically, we have pre-op patients who we will draw up to 2 weeks prior to surgery, if they haven’t been transfused or pregnant within 3 months. They sign a form for this. I was hoping to have a ‘T-type’ test for the BB Techs to answer, “Pre-op form signed?†and based on an answer Y/N, the expiration date would change, or be limited. However, Meditech tells me this is not possible, that instead it must be an order query and the rule is invoked when the order is placed. At this point I am not comfortable placing this as a query on BBK orders (just one more query for the nursing units to deal with, also it would require the ambulatory surgery nurses making sure this form is completed correctly, and getting it to us, etc. While I am sure they can do this, I’d prefer to keep the control within the BB, though I could change my mind...) If a query or t-type test won’t be possible, instead I’d like edits to the specimen expiration date to go to the override warning, where the techs could document that the pre-op form was signed. Has anyone created a BBK Specimen Expiration rule dealing with this or similar issues that they could share? Thanks, Linda Frederick, MT(ASCP)

Our policy allows use of Group A FFP for AB or B patients in "Massive Transfusion Situations" (greater than 10 units RBCs in 2-3 hours). We are 2 hours from our blood supplier and could not keep enough inventory of AB plasma (or B infact) on hand to handle a truly massive bleed. (Plus, we'll run out of AB or B red cells pretty quickly in this situation and switch to A or O.) Luckily, we have never had to do this. Linda Frederick

We will be going LIVE with 5.6.2 next week, but we are not implementing TAR at that time (too much other stuff to do for now). Our nurses document mostly on paper, but they can alternatively record vitals in screens set up for this (this is not TAR). I don't know the details of how they set this up, I think it is very similar to other nursing documentation, and they just created interventions (?) or whatever they call it in NUR. (I can find out details if you want). Linda Frederick

If you modifiy a label, you need to have a process to ensure accuracy [check AABB standards 5.1.6.3.1 #5) and #6)] "5) If a component is modified and new labels are applied, the labeling process shall include a method to ensure the accuracy of all labels includging the donation identification number, ABO/Rh, expiration date (as appropriate), and component labels. 6) The labeling process shall include a second check to ensure the accuracy of affixed label(s) including hte correct donation identification number, ABO/Rh, and expiration date (as appropriate)." We do a second check of thawed (expiration date), pooled (everything), and split/aliquoted products. If labeled wrong and you issue it, reportable to the FDA. Some computer systems have a good way to check this using the computer, ours does not, so we do a manual check. Linda Frederick

Our pneumatic tube system cannot be used to send 'high-protein' medications per the manufacturer and our pharmacy dept. (Apparently the high air-pressure slamming can denature the protein.) You may want to verify this with mfg of tube system for what you have.

Why would you defer someone who has been treated for Ehrlichia and is now healthy? I live in an Ehrlichia endemic area (the Ozarks). My guess if all those with treated Ehrlichia were deferred, in a few years we'd see a significant decline in donors. I personnally had Ehrlichia a year ago, and was treated (successfully as far as I know), do you think I have a chronic disease? I have donated blood 4 times since this. Humm....?? Linda Frederick

Ok, I figured it out: Fetal hemolytic anemia and intrauterine death caused by anti-M immunization Transfusion Volume 47, Issue 5, Date: May 2007, Pages: 911-917 Agneta Wikman, Ann Edner, Gunilla Gryfelt, Baldvin Jonsson, Jan-Inge Henter STUDY DESIGN AND METHODS:This study reports on three pregnancies in one family that all resulted in severe fetal anemia. The first fetus died in utero with hydrops fetalis during the 20th gestational week and the second child was delivered after 28 weeks of gestation with hydrops fetalis and a hemoglobin level of 16 g per L whereas the third affected child was treated with intrauterine red cell (RBC) transfusions before delivery at 28 weeks of gestation. RESULTS:The direct antiglobulin test was negative but anti-M in a low titer was detected through the three pregnancies, and its clinical relevance, which initially was uncertain, was confirmed by pronounced in vivo hemolysis in maternal blood of chromate (51Cr)-labeled M+ RBCs and normal survival of 51Cr labeled M– RBCs. CONCLUSION:It is concluded that anti-M immunization in a few cases may cause severe fetal hemolytic anemia and intrauterine death. It remains to be elucidated why a normally clinically insignificant antibody is this aggressive in a small proportion of cases. Because the condition is treatable, anti-M must be considered as a possible cause of fetal anemia and intrauterine death.

There was an article in Transfusion in the last year or two about this. As I recall it involved a fetal death and IgM anti-M. I cannot find it right now. (This is the first time I have tried searching since Transfusion migrated from Blackwell to Wiley Scientific, and I don't think I know what I am doing.) Linda Frederick

I can send you my form also, Send me your fax #. Linda Frederick

Sandra, I would not be so quick to assume that this is a problem with the test kit, or that it will carry over to patient testing. We have had problems over the years with CAP immunology, chemistry, coagulation, and other surveys, often due to 'matrix' effects or other things that CAP can't explain. As a result, we have switched many of our surveys to API. Linda Frederick

Yanxia, I think the most important thing is your finding: that she has no allo-antibodies. If you did absorptions for this workup, you could use your absorbed plasma for the crossmatches. Sometimes, you will be giving blood that is 'incompatible'. With AIHA, the patient is destroying her own cells. She will probably destroy the transfused cells the same as her own. I don't know if there is much value to give washed cells. Some people think you need to get rid of complement from the transfused units, so you don't make the destruction worse. Others don't think washing is important or will make any difference. To transfuse or not to transfuse? This depends on the patient, age, other conditions, how rapidly they are hemolyzing. We once had a young man with a HGB of 2-3 g/dl and WAIHA. This had been a slow process for him. He did just fine without transfusions until IVIG and/or steroids helped. But someone else may need to get blood. Linda Frederick

A new Orthoped at our hospital wants his patient to have 'shed blood' collections after knee surgery. I know this is commonly done, I just have never been involved with it before. I am trying to assist nursing to come up with policies and procedures that will meet AABB Standards. According to the AABB 2nd Edition of Standards for Perioperative Autologous Blood Collection and Administration, 5.1.7A Collection Type:"Shed blood under postoperative ..." Expiration is "6 hours from start of collection". When do you start the clock? When the drain is inserted in surgery? Does this mean the product must be infused by the end of the 6 hour time? The company sales rep claims that, because this is a closed system, it can be used for multiple 4 hour collections. And that some hospitals use it for up to 24 hours. I'd appreciate any insight anyone can give me. Linda Frederick

I am curious if there is any sort of 'industry standard' for the number of cryo's to pool when "pre-pooling". Is each blood center free to do what it wants? Do all pre-pooled cryos get the same ISBT number (E3587), regardless of the number in the pool? It seems this could get confusing if one center pools 5 and another pools 6 and another decides to pool 10... etc. I assume there are no CMS HCPC codes for 'pre-pooled' cryo, so these then need to be billed per each unit in the pool. Is that correct? Linda Frederick

If I was better at rules I could probably help you. You should be able to write an Assignment rule that includes an error message based on the patients age. 'if patient age less than 4 months and unit ABO blood type not group O then give a message'. If tech overrides message, send it to override warning report. Then attach this assignment rule to your RBCs. Some Meditech guru could probably figure it out... Linda Frederick

A big problem is that HCPC codes don't match FDA product codes. There might be a HCPC code for 'CMV negative PLTs' , etc. but this is not an FDA recognized product code. The ideal way to bill this is to have your computer system delete the 'basic' product charge (the scannable product code) and bill the CMV negative product charge (HCPC code) if the unit and patient both have CMV negative markers. A little too complex for me. At our hosptial, we transfuse very few CMV negative units, so we can manually adjust billing for those few patients. (Often there is not an exact match in HCPC code anyway, if Irradiated, leukoreduced, CMV neg. In that case you have to bill some of the fees separately anyway.) The question of charging for CMV testing, "only if you do the testing", doesn't seem valid. If you are paying for someone else to do this testing, you should be able to charge for it. (When you send specimens to a reference lab and they bill you for it, do you let the patient have the test for free? No... you charge the patient for it.) Don't you charge for irradiation, even if you don't irradiate the product?

This was set up a very long time ago. At one time, I may have understood it... not sure I do any more. "?" is for a pattern match and I think it allows all of the fields (Year, Month, Day) to be evaluated. As I recall writing it this way allows the order to be blocked (rather than allowing a message that can be bypassed with an override). Sorry I can't help more. Meditech logic is not very logical to me. Linda Frederick

We looked at both the Provue and Echo, and I think the Echo wins hands down (at least for our lab and the way we do things.) We'll be purchasing one in the future. I also have a concern with the interfacing since we use Meditech. Linda Frederick

Here is our rule to prevent ordering a Cord Blood workup if the baby is more than 14 days old. With some minor changes (reverse the greater than/less than signs, use the age in months instead of days) you should be able to get it to work. (This needs to be built in the MIS dictionary and attached to the test in OE.) IF{Z?0N [f ord err msg](X);on patient older than 14 days."^X, IF{L(Z,"Y")^J<L(Z) Z$J^Y:0S+0^Y,Z%J^Z},Y>0 [f ord err msg](X); IF{L(Z,"M")^J<L(Z) Z$J^M:0S+0^M,Z%J^Z},M>0 [f ord err msg](X); IF{L(Z,"D")^J<L(Z) Z$J^D:0S+0^D},D>14 [f ord err msg](X); [f ord ok]}; Linda Frederick

I agree with the need to do the Fetal Cell Stain on Mom if baby is a weak-D. The problem we encounter is making sure this gets communicated the way it should...so the tech testing the Mom's blood knows this. Do you require the techs to review the cord blood results every time they do a RhoGam workup? Does anyone have a cute computer fix for this sort of thing? Linda Frederick

My understanding is that they don't routinely inspect transfusion services anymore, but they can come if/whenever they feel like it. Since we stopped collecting Autologous units, and moved our registration to inactive, we have not been inspected. We are not a large hospital, but some of the even smaller hospitals in the area may go several years without a visit. While I don't expect them to come too often, my motto... be prepared!