Sandy Jo

As for my own views I too find it ridiculous that you can ship blood for 24 hours (or more)across the country at 1-10C but I can't keep it in our surgery for a couple of hours at the same temp range. I have not yet "officially" changed my temp range on my procedure but am contemplating it. I validate the two igloo coolers (rarely used) every 6 months and did come up with a configeration that seemed to work at 1-6C. I use frozen gel coolants with a plastic barrier between the blood and the ice packs. I think regular ice above and below would work better, but it would have to be obtained from the hospital cafeteria and would not be as convenient. I imagine I will change my procedure this year to comply...

For Ann Viernes: I would love to have more info about the cooler set-up you use. Would you be willing to share the PowerPoint as well? What a great idea for staff training. Has it been a successful tool for training purposes? For the moderators...Perhaps a new forum area with Powerpoint presentations that people would be willing to share would be a great idea for this forum... Ann, here is my fax (813) 634-0127 and email sandra.rothenberger@hcahealthcare.com

I am Transfusion Service Supervisor in a fairly small hospital and only stock 20 units of cryo. Use it only once or twice a year. We generally stock what our supplier gives us (type O). This also allows us to pool the product together as they are all usually O's. For the number of times we actually use the product, I don't see a point in requesting a specific type as most of the time it just sits in storage until we swap it out with 2-3 months left on it.

I am planning to validate selected antigen typing using gel methodology. If you would be willing to share your validation and/or procedures I would greatly appreciate having them as a resource during my validation. Any tips or info greatly appreciated! Thanks for the input... fax: (813) 634-0127 email: sandra.rothenberger@hcahealthcare.com

Would anyone be willing to share their Gel Antigen typing validation and/or procedure? I am planning to validate gel antigen typing and I would like to read over some helpful resources before starting the project. Thanks so much for your assistance... fax (813)634-0127 email sandra.rothenberger@hcahealthcare.com

I came from a facility that utilized direct computer entry when the LIS was implemented. I am now supervisor at a facility that has both manual cards and computer entry. I require direct entry at time of reading to either the card or the computer. But I do see instances where the "other" is sometimes left incomplete. My plan is to get rid of the manual entry cards and keep a card file with patient demographics and problems only, not the actual results. I feel it is much better to have only one DIRECT entry method, less errors. Sandy R.

We do not perform a full AHG crossmatch based on a positive DAT. If prior or current clinically significant antibody detected, or unidentified antibody, that would warrant an AHG crossmatch. If DAT was run (based on positive autocontrol or on physician order) and was positive, an elution may be performed, depending on whether the patient has been transfused recently (up to 6 months). If an elution was done and a clinically significant antibody was identified, than we would perform an AHG crossmatch. Sandy R.

The responsible physician's signature is not required before the transfusion, and the AABB TM recommends it is obtained "only after the emergency is over, typically within 24 hours." We include this in our SOP's. See current AABB TM, pages 510-511. We have a form on which all the Emergency Issued products are listed for an event and the physician needs to only sign that one form, as opposed to each of the cards attached to the units. The form includes a statement to the effect that the clinical situation required release of the product prior to completion of compatibility testing, to comply with Standard 5.18.4. Sandy R. South Bay Hospital Sun City Center, FL

I have changed our acceptable criteria to within 2 degrees celsius for different thermometers for both refrigerators and freezers as described under QC of Equipment (Thermometers) in chapter 8 (p. 198) of current AABB TM. "A 2 C variation between calibrated thermometers allows for the variation that may occur between thermometers calibrated against the NIST thermometers." Sandy R. South Bay Hospital Sun City Center, FL

Our facility has a 24 hour expiration date for thawed FFP at present. I am considering changing it to either 3 or 5 days for thawed plasma for selected usage. Also, we currently pool thawed FFP into 1L bags for our TPE's with a 24 hour outdate (open system). If we extend the outdate on the thawed plasma I may reconsider pooling the product for TPE's, or pool immediately before issue to ensure optimum shelf life of the product. If we decide not to pool we may be able to send the thawed plasma back to our supplier for credit if another local facility may be able to use the product. We are a fairly small hospital, approx 110 beds. Wondering about others that have extended the dating on thawed plasma as far as what selected usage do you cite in SOP and how do you monitor that it is used appropriately? Also do you pool the thawed plasma for TPE's or not? Thanks, Sandy Rothenberger Transfusion Service Supervisor SouthBayHospital Sun City Center, FL

We require a HGB value be done in-house. It has been approved by MEC and added to the lab's list of reflex testing. If the HGB is >/= 9.0 the pathologist reviews the request and may consult with the ordering physician about the transfusion. Sandy Rothenberger

I brought up the question of retention of Antibody Panel sheets (after the patient has expired) to AABB. The response was that there is no requirement to keep the panel sheets indefinetely, just the record of the antibody. As far as the panel sheets, the response was to define in your facility as appropriate to your record retention policies. At our facility, we are still going to keep the antibody panel sheets, but review annually with a Social Security Death Index Search for patients that have expired, and retain in a separate file for five years after death. Sandy (South Bay Hospital, Sun City Center, Florida)

Today we had another Anti-E that was nearly missed with the Ortho Gel Methodology. There have been several in the last 3 years at this facility, although I really don't recall any in the previous 6 or 7 years using gel at another facility. This particular patient was transfused 7 days ago and had developed the Anti-E as a result of that transfusion. The tech performing a negative patient control with a (that) prior day's specimen detected the weak reactivity in one screening cell and then used PEG methodology to confirm the presence of a weak anti-E presenting more strongly with homozygous cells. I am a strong believer that no one method detects ALL of the antibodies ALL of the time. I AM concerned about why one tech detected it and the other did not in a testing method that is considered to be more standardized such as Gel. I DO feel it is important to remind techs that increased workloads and pressures can breed familiarity and this shouldn't take the place of taking the time to read the Gel cards carefully and thoroughly, against a white background while observing both the front and the back of the Gelcard. I do not want to routinely increase the incubation time with Gel as the turn-around-time (in batch testing) with this methodology is one of the important positive aspects of the procedure. What I am going to do is discontinue use of the prediluted 0.8% screening cells and dilute our own from 3-4% screening cells that we stock. I will continue to stock the prediluted 0.8% Ortho panel, but will instruct techs to consider increased incubation time when using that panel or to consider diluting a 3-4% antibody panel to use with gel testing. I hope this issue is resolved as soon as possible as I do like the gel methodology in general.

I saw the same FAQ and am concerned about it because it states "If a patient's history is known and they definetely have not been transfused or pregnant in the preceding six months, protocols can be established for frozen retention of the patient's serum for a longer period." It bothers me because: a) It does not state anything about needing to freeze the specimen to use it >3 days later in the JCAHO standards (AABB wants you to comply with reagent manufacturer requirements). AND Could not find anything about negative transfusion/pregnancy history for six months in JCAHO standards. They state that SOP's should be consistent with AABB standards and AABB standards use three months for the negative history. Has anyone addressed these issues with JCAHO or an inspector?

We had an instance in which we pooled the two bags together just prior to issue, then nursing brought the product back because the patient had spiked a temp and the doc decided not to transfuse. We could not return the product back to our supplier for credit because it had been pooled into one bag. We now have a strict policy of NEVER pooling the double bagged products together. We tell nursing they can do it at the time of transfusion.

I was wondering if other facilities have any success with billing/reimbursement of rare donor fees. This is especially costly when a contracted supplier has to obtain blood from another blood center and repeats the antigen typing, then passes on to the Transfusion Service the higher cost of the actual product and the rare donor fees, as well as antigen typing fees from both facilities. How much of this are other transfusion services passing on to the patient and what specific cpt codes are you using? Thanks for your response!

We had an inspector recently inquire about our process of reviewing returned crossmatch cards for completeness. Along with two signatures for transfusionist/identifier, we have start date/time, end date/time, volume given, adverse reaction? (Y or N) and "Pre," 15 Min" and "Post" documentation of Temperature, Pulse, B/P and Respirations. The inspector was recommending a procedure which would include how we would identify a change in the vital signs if it was not noticed by nursing and was not marked as an adverse reaction. Our blood administration procedure states a rise in temperature of 2F (1C) and/or a temperature greater than 101.0 F as indicating a possible adverse reaction, but we have nothing that specifies what would constitute a difference in the other vital signs. I think it may be very difficult for the transfusion service to define what to consider as a "significant change" and feel that should be a review (if necessary) by nursing personnel. Has this been addressed by anyone else with any helpful recommendations? Also, does anyone have any spreadsheets or programs set up to address tracking reviews of returned crossmatch cards that they would be willing to share? Thanks for your help! Sandy sandra.rothenberger@hcahealthcare.com fax: 813-634-0127 (Attn: Transfusion Service)