bbbirder

We use the typenex system and handle a name change by doing a band change. We remove the old band (with name "Trauma Green") and replace it with a new one with patient's real name. Hopefuly, we will still have 2 patient identifiers that match (the typenex number and the account number or medical record number.) If there was a change in addition to name change (e.g., now a number did not match) we'd get a new specimen. We have asked that our registration staff not do any name changes, etc. until the dust has settled (we have told them to wait at least one hour.) They don't always wait but, fortunately, most of the time that patient is not using blood. Linda Frederick

This has been an interesting investigation and well, this is what I found when searching on the web about it: References from Anathesiologists in Belgium: "The marrow cavity is in continuity with venous circulation and can therefore be used to infuse fluids and drugs, and to take blood samples for crossmatch, for example." And Austria, an article on "Intraosseous blood gases during hypothermia..." (...blood gas values obtained from bone marrow aspirates may be helpful to adjust ventilation and optimize fluid and drug therapy...") And similar references from Germay and UK From WebMD (Dept of Pediatrics, UMass) "Of note, the levels of chemistries, drugs, and hemoglobin; the blood typing; and the acid base status obtained from the blood in the marrow aspirates...have been found to be reliable predictors of serum levels..." And some research studies in piglets from the Pediatric Dept at the University of Florida. So, it sounds like it can be done, but it would be nice to know how it works in practice. I don't think this will ever really happen at our hospital. Linda Frederick

You covered that pretty well, Bob. I'm sure we aren't as busy as you over all, but we only have one tech in BB (night shift it is 1/3 of a tech since only 2 techs cover our entire lab, so they are running ABGs, CBCs, you name it.) It doesn't really take us one hour, but that is what we publish. It takes 10 minutes to spin the specimen. 1 minute or so to dispense plasma (we use manual gel testing for Ab Screen) 15 minute incubation 10 minute spin (by the time it brakes it is 11 minutes.) Then result in computer (and get units labeled) total time 10+1+15+11+1 = 38 minutes. But, that is when everything goes perfect and is without interruptions at the critical times going to the next step. So when we beat 1 hour, they think we are great! Linda Frederick

From the time we first get a specimen, 1 hour (to complete type & screen). If T&S already done, 5-10 minutes for 2 units. Linda Frederick

Ditto on what Bob said. Linda Frederick

Yikes! Bob, you are absolutely right. No more 6 hours... down to 4 hours! Thanks, LF

I am trying to find out if anyone uses a 'cutoff' for their Galileo (or Echo) analyzer when testing Rh? I read on the AABB forum that JJudd recommends a cutoff of <3+ for anti-D when using gel for D typing (because some of these can be partial Ds), but I can't find if anyone has studied this with the Galileo or Echo. I know that on the Echo, Immucor says you need to use Immucor Series 4 & Series 5 anti-D reagents. From what I have read and from an Echo Beta test site customer I spoke with, the Capture system is very sensitive. Unlike donor centers, I want to be able to call D-Variants Rh negative. We current get a few Rh typing discrepancies each year from OB patients who have prenatal work done by a different lab using gel (they have no cutoff for anti-D reaction) vs our manual tube method. Thanks, Linda Frederick

I think part of the problem with RhIG injections relate to some ACOG recommendations. The January, 2007 issue of AABB news had a Q&A page about some of this. ACOG recommends if there is an event withing 3 weeks of injection that 'if an indirect antiglobulin test result is positive for anti-D, not additional RhIG is necessary.' But, as the Q&A says there is no data to support this recommendation. Do the fetal screen or fetal cell stain initially, then you should know if you have given an adequate dose. We have also had OBs question a negative antibody screen after an injection. Who knows? Maybe it was just doing it's job. Maybe the woman is really a D-variant and absorbed it herself? (We no longer do weak D testing routinely.) We detect what is probably passive anti-D for 5 months or so, when using gel. Mabel, about fetal bleed volumes... there is a post on the CBBS web page about 'chronic FMH'... amazing how much blood can be lost over time. I am rambling on... Linda Frederick

I don't know why we are so lucky, but our cooler validation routinely shows they maintain 0-6C for 24 hours. (2 units plus equal volume of ice. We put absorbant 'paper' material on bottom, top, and between ice & blood.) Of course the validation is in our lab, and we don't open the coolers. We don't allow OR to keep them that long, and require new ice after 6 hours. (Fortunately, we don't have surgery cases that last that long.) We have both Igloo and Coleman coolers. Linda Frederick

I also tried MERS-TM (a couple of years ago) and got no reply. My guess is that it is no more. Too bad, because it seems like a good idea and a way to share benchmarks. Linda Frederick

A question has come up at my hospital about intraosseous blood collection. I am not familiar with this, but apparently intraosseous access is used (commonly?) for infusions in emergency settings when peripheral or central venous access is impossible, especially in children. So, can blood collected from the bone be used for crossmatching? what about anything else? It has been many years since I assisted with bone marrow collections and it seems to me that even though we might be able to get a blood type, there would not be much plasma to be used for the antibody screen, etc. Would a potassium or any other tests be accurate? Thanks, Linda Frederick

As they say in Minnesota, Ooof-Dah... This does sound like "An opportunity for improvement". The Lab/BB should do a better job of documenting and communicating both within the department and to nursing (is that not a JCAHO patient safety requirement?). If you don't have a communication log, you need one. If you have one, do people use it? Does writing up the nurse (unless she was rude/ profane) help the situation the next time? Or improve the relationship between nursing/lab? Maybe your department needs a policy that says, "A reference tech will not be called in without Medical Director approval"? Polices can never cover every situation and good techs will deal with things as best they can. The minute you write a policy to cover one situation, another pops up. Good luck. Linda Frederick

Shily, AABB standards say a new specimen (and new antibody screen) is needed every three days. I don't have the references, but I am sure there were studies supporting this time for the detection of newly formed antibody. Some anemnistic responses can be faster than 3 days. For initial antibody formation after exposure, I think it can vary with the antigen/antibody, some are days and some are weeks.

I will never need anything like this where I work now but, try this site instead: http://www.neoterictech.com/BloodTrackHemosafe.html

It sounds like your scanners are working, if you can scan the units (such as for crossmatching?) after you enter them. Is it just the unit entry that is not working? All fields or just some fields? Are you Magic or C/S? One thing we had trouble with: if using batch entry you must scan in the source, otherwise the unit number will not scan correctly. We also had to create new Bar code fields and Bar Code Terms in the BBK dictionary for expiration and blood type, the standard content did not work for us. Linda Frederick

We don't have any written policy about what to do if we find a unit with a positive DAT. Normally we would not find these when doing immediate spin XMs (or if we ever get out of the dark ages and start doing electronic XM). But what if we find one? Lately we have had bunches of patients with antibodies, so more AHG XMs. After a unit was incompatible with a couple of patients, we got suspicious, and sure enough it had a positive DAT. Should we just use it for somebody else, who only needs IS XM? In this case, our supplier said send it back. We returned it, but since it was an O neg, I was sad to see it go. Linda Frederick

I got this from the AABB Web page, Member Area, FAQ about the Bar Code Rule (responses from the FDA): Q: In a pooled unit of Cryoprecipitate or Plasma, do all the blood types included in the pool have to be listed on the label? If so, must they all be machine-readable? A. Yes. 21 CFR 606.121©(12) requires the donor’s ABO/Rh to be on the label of products intended for transfusion. The Rh may be omitted on Cryoprecipitate. 21 CFR 606.121©(13)(iii)(D) requires the ABO/Rh to be in a machine-readable format. LF

Even if you give it one type in your computer, I believe the FDA requires all blood types in the pool to be displayed on the bag, unless you are labeling with ISBT format. I don't have the reference right in front of me... I'll try to locate it. Linda Frederick

Bob, I hope you will have internet access where you are going south of the border, I'd hate to be without your posts! Linda Frederick

We notified our physicians of the change, and told them any request for FFP would be filled with FFP or FP24. (We don't have any patients in the 'must have FFP' group.) Also, we have taken to calling the new product "SFP" (Stale Frozen Plasma)... though you could substitute some other antonym of Fresh as you like. Linda Frederick

We have transfused an infant with PLTs once in 15 years, so our situation is a little different than most of the posts. Since we don't keep many PLTs on hand and we are 2 hours from our supplier and we'd be doing this in an emergency, volume reduction isn't a viable option for us. I got information from posts on the AABB forum and one suggestion was to determine the titer of anti-A and/or anti-B in Group O PLTs if you had to use them. If the titer is less than 1:50, group O Platelets could be considered safe to use in a non-O baby. (Add a drop of platelet product to 50 drops of saline and use that dilution to test for agglutination IS macroscopically using reverse A and/or B cells.) Since reported cases of hemolysis due to ABO-incompatible platelets have all been due to group O platelets, you could use Group A or Group B (if you had them) if AB wasn't available to minimize the risk of hemolysis. Linda Frederick

We have all Jewett currently and I'd like to replace them all. I'd love to find a -40C freezer made by someone other than Jewett. Any suggestions?

I would like to reopen this thread to see if anyone else has validated gel recently. I would like to use gel for antigen typing, units especially. Has anyone been using gel for antigen typing and encountered problems? Thanks, Linda Frederick

We still do KB's. (I'd love to send them out, but turn-around-time is an issue.) We require a 2nd tech to review all of them. While doing a quick review they are to estimate the count, if they disaggree with the originally reported count, they will do a 2nd count. Because of staffing issues, the first tech's results are reported out before the review some of the time. Since 90+% of the patients are negative, this is usually a very fast review. We implemented this after we missed a CAP survey and have not had any problems with CAP since. Linda Frederick

At the request of one of the OB docs and the approval of the OB/GYN committee, we recently switched to Rhophylac; cost was nearly the same as our old product. The only 'problem' we have encountered is that they normally pull the IV within 1-2 hours after delivery and we usually don't have the testing (cord blood, fetal bleed screen on mom, etc.) completed that fast, so the patient ends up getting it IM anyway. We are trying to work with OB/NSY staff to try to speed the entire process up, so a those that have IVs can get it IV. We haven't used it for ITP. Linda Frederick