CABMT

I would strongly argue as to why this is necessary when our computer system has been validated for ABO comparison regardless of whether or not the patient has an antibody. Patient with an antibody would not qualify for electronic crossmatch, but it's still subject to the ABO logic tables at the time of selection and issue. I think we should really question the wisdom of FDA in requiring this since it makes NO sense at all!!!

We do Type and Screen and inject RhIG for some offices. Others request only an antibody sceen and they give their own RhIG. I would caution you that recommendations are there be 2 blood types on file for pregnant women to assure the correct blood type, so doing a full T&S a second time is prudent.

Have you considered the presence of anti-G? We had a similar case a few months ago and we sent it to our reference lab where they confirmed anti-G which looks like CD combination. It was very interesting.

Our patients have the blood drawn and RhIG is given during the same visit. I am interested to hear other opinions about the interval length from when the T&S is done and the RhIG is given. We've generally used a 2 week time frame; if the patient requires RhIG and we've done a T&S within 2 weeks prior, we do not repeat the testing. I have not seen any standards on this subject but this scenario does happen with some frequency and it seems a waste of time and money to be repeating the testing when we know she qualifies for the injection. Other comments?? Thanks

We simply identify it as anti-D (using the abbreviated panel) and we use a different code- DRHIG vs a-D. We also name it "Anti-D, recent RhIG injection" and include the date of the last injection. There's no way to truly differentiate the 2 antibodies so we "presume" it to be RhIG related until proven otherwise.

Our BB began using Mckesson's Horizon Tissue Manager (formerly Rosebud) in March 08. We receive all tissues in BB and I would recommend that the process be limited to only a few people for consistency sake. Room temp items are stored in the OR and refrigerated and frozen items are currently stored in BB. This is a shared process between the OR and BB where we receive, then distribute, then the OR records preparation and implantation information electronically. It satisfies the JC regulations and seems to be working well so long as the OR staff remembers to do their part. As for vendors qualifications, we made a list of expectations and had them send documentation that proves their accreditations, registrations, etc.

We changed to the use of Alba reagent anti-A, anti-B, and anti-D last May but found a problem with 3 patients in the D reaction. They reacted weakly positive with Alba but were Neg with Ortho. Unfortunately, one patient was transfused with Rh pos blood and has developed anti-D. Needless to say, we quickly changed back to Ortho, despite their ridiculously high prices.

We also use a separate computer code for passive vs apparent alloimmune anti-D. For patients that return years later with a negative antibody screen (and negative prior to the RhIG injection), we remove the antibody from their history caution window, thereby allowing us to do an electronic crossmatch. We would always give Rh negative blood anyway except in a dire emergency.

We require a second type be done by a second technologist to qualify for electronic crossmatch.

We require a Typenex band for red cell products as well as plasma, but not for platelets. We do not require a current antibody screen for plasma alone.

We enter results directly into the computer. There's no need to record results twice and transcribing results from paper to electronic leaves too much opportunity for data entry error.

We began a tissue harvest program back in the early 80's so we've stored frozen bone since then in Blood Bank. We've discontinued the bone harvesting program but still maintain the storage of commercially prepared frozen bones for the OR. I've tried for a number of years to transition this process to the OR but they have been unable and unwilling to assume the program. In light of the new JACHO rules, we're revitalizing the attempt to move it to the OR since this is far bigger than just frozen bone. The surgeons use many kinds of tissue including corneas, skin, dried lyophilized specimens, alloderm, and who knows what else! Since our Blood Bank does not order the bones, there's inherent problems with knowing what's on hand, minimizing wastage due to over ordering or product expiration, log keeping, justifying disposition, etc. I'm glad to hear we are not the only ones facing the problem and would be very interested to hear what others are doing to meet JACHO guidelines.

We use 6% albumin as negative control.