bbbirder

OMG!!!! Linda Frederick

I tell our techs (all generalists) that it is a good idea to do the antigen typing for all the Rh antigens whenever a patient has made any antibody in the Rh system (except anti-D). I believe that it is a good idea to get antigen typing before transfusion for future reference. I also personnally think that providing c-neg blood in a c-neg patient who has already made anti-E is a good idea. The problem we encounter is a computer system that doesn't allow reminder messages attached to any antibodies. It is very difficult for generalists to remember all the complexities in BB. What the reference labs do routinely, can be different from what hospital based transfusion services do routinely. Linda Frederick

I agree also the part about Malcolm's posts and sharing of procedures being very helpful. I can't help with a swollen or exploding head. The price you pay for getting praise! Linda Frederick

I know you are discussing CAP regulations, but I thought I'd toss in CLIA regs for panels (but this one doesn't cover expired): §493.1271 Standard: Immunohematology. (a) Patient testing. (a)(1) The laboratory must perform ABO grouping, D(Rho) typing, unexpected antibody detection, antibody identification, and compatibility testing by following the manufacturer’s instructions, if provided, and as applicable, 21 CFR 606.151(a) through (e). Interpretive Guidelines §493.1271(a)(1) When condition level deficiencies in Immunohematology are in any or all phases of testing, use D5026. There are no daily quality control requirements for reagent red cell panels used in antibody identification. Panel quality control is a combination of serological test results, such as: strength of reactions and patient phenotype; statistical probability, patient’s medical history; and laboratory standard of practice (i.e., how the laboratory handles compatibility testing for patients with unexpected antibodies). However, the QC requirements pertaining to new batch, lot, shipment of identification systems at §493.1256(e)(1) must be met.

We have women show up 'on the doorstep' with no prenatal care. We recently had one show up to deliver her 2nd child, no prenatal care. Her first baby had been born with a PLT count of 12,000 and was flown out. Diagnosis: Neonatal Alloimmune Thrombocytopenia. You'd think she'd be a little worried about the next one, but I guess not! Then there are snow and ice storms that ground helicopters and prohibit any ground transportation. (Like the woman visiting from out of town, sudden fetal demise, went into DIC. BIG ice storm, unable to transport... we used expired PLTs that night... with pathologist permission, of course.)

I found this comment on the CBBC web forum and added it to another thread here, but I haven't had any comments. Any thoughts on the idea of using AS red cells just as they are? "A colleague from Spain reports that in his opinion, he agrees that the best place to prepare the component is the blood bank laboratory, and that one should take into account the following (his opinion paraphrased is shown below): The desired hematocrit is a critical issue, since the neonate hematocrit is physiologically higher that the adult. If you use an adult hematocrit (about 35-40%) for a baby with 55%, you can cause hemodilution. In the actual clinical case, the neonate could have low or high hematocrits, and the reconstituted blood should help the baby reach a desired level. If you want to minimize donor exposure, maybe it is not necessary to use whole blood. The hematocrit of red blood cells in additive solution (i.e. Adsol, SAG-mannitol) is usually within the clinically desired range. In this way, you should only use plasma if the baby shows additional coagulopathy (this is standard practice in the British Health Service). The case for washing red cells could arise from mannitol-containing solutions if the baby is not stable. Sometimes the pediatrician feels safer without manitol."

Do you have a way to audit the bedside ID to know that the wristband was being scanned? Is it impossible to scan anything except the wristband? What are the downtime plans? What is done in the Emergency Department? While I agree that bedside scanning is great, there are plenty of creative staff out there to find a way to work around this. You need to be comfortable with the new system. Linda Frederick

I agree, but I also don't think manufacturers have studied anything but the count recovered coming out the pump. I wonder if any have actually looked at if the platelets have been activated or not and how the patient will respond. Linda Frederick

For our pre-op patients we take a photo ID and they sign a form attesting to no transfusions within 3 months. The band, photo ID and a copy of the form go to our OR and the nurse puts the band on the day of surgery. We have done this for many years. We also use a similar system for our Heme/Onc patients who get drawn one day and come in the next for transfusion. Most of these don't object to wearing the band (they aren't going anywhere), but if they don't want to, we will do the photo ID and the outpatient transfusion nurse puts the band on. Linda Frederick

Yes, Mabel is right that the FDA regs now allow testing up to 72 hours. Also, we used to separate our specimens, but storage racks were getting to crowded, and we now have an Echo. We don't separate and have no problems. Linda Frederick

Our Blood Center has not included a collection date on the final label in years. We don't see it on Codabar or ISBT labels. (I really don't miss it. The only time might be selecting a 'fresh' unit for transfusion to a neonate, but going to the 'back of the shelf' will be the freshest we have.) Linda Frederick

Contact your label manufacturer to see what they say. If they are OK to apply to the unit, they should be able to provide you with documentation. The adhesive on the label must meet FDA requirements. Linda Frederick

I agree with David that an assigment rule should work. We have Meditech Magic and we have a rule that covers this. Linda Frederick

I am glad to see that I am not the only one struggling with this. I am currently updating aliquoting (for RBC and PLT) procedures as well as exchange procedures. We have a greater distance both to our supplier and to the children's hospitals that will get the transfer. We would only exchange in a dire emergency (once in 20 years? maybe), but we need to be prepared. I found the quote below on the CBBS web. Any thoughts? Especially on the idea that giving AS RBCs as they are would work? What about this in AS-3, vs AS-1, vs, AS-5? At our facility we don't have the ability to pack RBCs to express excess plasma or remove the additive solutions. Adding back FFP would result in an lower than ideal HCT. Our supplier never checks for high titer anti-A,B on any product. Again, think about this in a dire emergency only (helicopters grounded or delayed, etc.). Baby will get to a children's hospital eventually. Linda Frederick "A colleague from Spain reports that in his opinion, he agrees that the best place to prepare the component is the blood bank laboratory, and that one should take into account the following (his opinion paraphrased is shown below): The desired hematocrit is a critical issue, since the neonate hematocrit is physiologically higher that the adult. If you use an adult hematocrit (about 35-40%) for a baby with 55%, you can cause hemodilution. In the actual clinical case, the neonate could have low or high hematocrits, and the reconstituted blood should help the baby reach a desired level. If you want to minimize donor exposure, maybe it is not necessary to use whole blood. The hematocrit of red blood cells in additive solution (i.e. Adsol, SAG-mannitol) is usually within the clinically desired range. In this way, you should only use plasma if the baby shows additional coagulopathy (this is standard practice in the British Health Service). The case for washing red cells could arise from mannitol-containing solutions if the baby is not stable. Sometimes the pediatrician feels safer without manitol."

Our CT ratio is 1.3-1.4 (same for past 5 years or so.) Wastage is 1% (That is cost of wasted product vs total cost of products) (that has also been the same for 5 years M/L) For reactions, are you looking for a % of total products given? or something else? Linda Frederick

We provide Typenex bands and collection tubes (and a copy of our procedure and personalized instructions) to our Oncologist's offices so they can collect specimens for future transfusion in our Outpatient Chemo room. We in BB had them using the name and SSN. Our outpatient chemo/transfusion nurse requested that they add the DOB to this, so they did. We get good cooperation from them (sometimes better than our own staff!) Linda Frederick

Ditto what others said about the reformulated cells. Before we switched to the Echo, we were using manual gel testing and getting so much junk that we started diluting cells up each day. End of junk. We still use manual gel as our backup method for antibody screens, but we love our Echo. Linda Frederick

We also do a visual review on all of our screens and panels on the Echo. We sometimes see things that are positive (weakly, usually heterozygous cells) on visual inspection of the image but the analyzer called negative. While this is not ideal, we like the analyzer very well otherwised. When the techs were originally trained on the Echo, they felt that this was no big deal, since they had been using manual methods and grading everything by hand. Linda Frederick

Thanks, Pat! Linda Frederick

We have been live with our ECHO for several months now and we really like it. We converted from tube Blood types and manual gel testing (Antibody screens). Even the die-hards like it. As others have said, it especially speeds up antibody panels. I am looking forward to the antigen typing tests. Still working on a fully functional interface (Blood types go across but not antibody screens yet... Thanks to Meditech!). Linda Frederick

Always be aware of preganancies involving egg donors. We had an R1R1 woman make anti-c with her first viable pregnancy from an egg donor. Infant was rr. Fortunately, the titer wasn't very high and the infant didn't require exchange transfusion. This antibody was a surprise. I am not sure if OB docs consider doing a 2nd antibody screen (as they do on Rh negative females) on pregancies from donor eggs, but it seems like a good idea. Linda Frederick

So my supplier sends me E4693 (Apheresis FFP|ACD-A/XX/<=-18C|2nd container) and E4697 (Apheresis FFP|ACD-A/XX/<=-18C|3rd container) and both units have the same DIN. I want to make both of these into a 5-day product, Thawed Apheresis Plasma/ACD-A... but there is only one product code for this E2121, so I need to figure out a way to assign the correct division code to them to allow my computer system to have unique numbers/products? or request new codes? It looks like there are individual product codes for the various containers if you are calling it Thawed Apheresis FFP (I assume these have 24 hour outdate) (E4693 --> E4717 and E4697 --> E4721), but not for a 5 day product. And it looks to me if I make E2555 (PLASMA|CPD/XX/<=-18C|Frozen <=24h) or E7071 (FRESH FROZEN PLASMA|CPD/XX/<=-18C) into Thawed Plasma (5-day) that they both have the same product code (E2684, Thawed PLASMA|CPD/XX/refg)... but then there is E2701 (Thawed PLASMA|CPD/XX/refg|Frozen <=24h). What is the difference? Thanks for any help, Linda Frederick

Before we got our Echo, we used manual gel and we were chasing weak reactions that never showed up or matched any thing in gel or tube peg panels. We got better luck with making up our own fresh diluted cells, so stopped using Ortho's cells completely. Manual gel is still our back-up. Linda Frederick

We also use "3 days", not 72 hours.

We don't have a NICU, but I would not be comfortable giving anything to those little ones. Linda Frederick