kirkaw

ChrisH, I am re-validating our Cell-Safe coolers. According to one of my predecessors, coolers only needed to be validated when put into use. I've learned recently that they needed to validated 2x/year. Since I have worked at my current facility (8 years), we have used Igloo and Coleman frozen packs in our coolers for the OR. We use 3 packs surrounding a 'basket' that holds 2-4 units of red cells. The 1st 2 coolers I've tested have yielded temps close to Zero for the 1st 2 hours. Then the temp stabilizes at 3-4 degrees. It seems to really matter if the units are in an upright position in the basket or if they are lying down. I am interested to hear from others, what cold medium you use in your coolers, wet ice or ice packs and how much, i.e. 8 lbs of ice or 2 or 3 ice packs. Also, do you require that units be stored upright in the coolers - especially those that are deemed 'temporary storage' as opposed to transport.

I found a reference in a shared procedure that says that in the 'Ask the FDA' session at the 2005 AABB meeting in Seattle, the FDA representatives clarified storage vs. transport temperatures for blood products in coolers. The approved temperature range for transport is 1-10C, while the FDA clarified that blood stored in a cooler for use in the OR, etc, is indeed temporary storage and therefore must be maintained at 1-6C.

We too, require 2 patient identifiers. If the patient has not been positively ID'ed, the following is done: 'If the identity of the patient is not know and there is no patient information, the patient will be entered as First name military alphabet (Alpha - Zulu) and the last name Doe. The middle initial will be M or F for male or female. The date of birth on all unknown patients is to be 1/1/1899.' Once the patient is identified, the 'Doe' record is merged with the correct patient by the Medical Records department.

I cannot find annual calibration records for our calibrated thermometers. My boss says they are to be sent off for calibration. To whom do I send them?? The one calibration record I could find was from 2004 and I can't find that company anymore.

Looking closer, the article is 'Reversal of drug-induced anticoagulation: old solutions and new problems' in an issue supplement, Volume 52, S1, pages 45S-55S, May 2012. Thank you pstruik for you input. I found that PCC's have 2 formulations, 3 factor and 4 factor. It seems that, while more effective, the 4 factor is not available in the US. This may explain why so few people know about it's use. I'm still pursuing this issue.

Greetings, I read an article in the Nov/Dec. issue of AABB News about transfusion issues with older people. One of the things it highlighted was the risk of TACO with plasma transfusion for warfarin reversal. It suggested the use of Prothrombin complex concentrates (PCC's) for this purpose. I started looking into this and found a not-so-favorable article on the use of PCC's in a May 2012 article in Transfusion. Is anyone using PCC's at their hospital? If so, what are the guidelines? Thanks, Amelia

Joanne, what LIS and HIS do you have at your facility? what order entry system? Thanks, Amelia

Joanne, I like your initial response and agree with what you said. Unfortunately, we, in the blood bank don't see orders to transfuse. We only see crossmatch orders. It would be too time consuming for us to call on all crossmatch orders to see if there is also an order to transfuse. It would be nice if we could see the transfusion orders, as we too, use immediate spin and electronic crossmatch. Although I understand that C/T ratio may not mean today, what it did years ago, but I feel like in my situation, the high ratio is indicative of antiquated ordering practices by providers. Maybe one day we will have a transfusion committee where meaningful dialogue can take place to ensure best practice and proper resource allocation.

Thanks for the input. We do not have a transfustion committee (I know, GASP!) and our cardiothoracic surgeons are averaging a C/T ratio of 3.3! I have been watching this for 4 months now and before I call attention to it, I wondered if anyone else let's this slide. I know 20+ years ago, when I started in blood banking, we set up 8 units of blood for every open heart surgery, but now it's only 2 and most of those come back. Also, I believe or protocol heart surgeries was implemented in 1995 and it might be time to revisit.

Hi, does anyone give any particular service lines or physician groups a 'pass' on achieving an appropriate crossmatch/transfusion ratio? For example, cardiothoracic surgeons? Thanks, Amelia

I am glad to find this thread. I have a patient who was determined to have WAIHA in 2009. We did not see the patient again until June of this year, when it was determined that the patient had likely developed allo-antibodies to little c and big E. At that point we phenotyped the patient and decided to give phenotypically matched red cells. On the current admission, phenotypically matched red cells are still slightly incompatible. Without doing an adsorption, we transfused 2 units (phenotypically matched) and the patient seems to be tolerating them well with appropriate increase in hemoglobin. The question is, should adsorptions have been done this time before transfusion? We do not have the resources to do them and and have to send the specimen to a reference lab, who typically turns the work around in 24 to 48 hours. Although this patient was hemodynamically stable at the time of the crossmatch request, I felt that the cost of the delay was too great since we were giving phenotypically matched red cells.

I ran the validation protocol provided by Immucor and have been running the new FMH kit in tandem with the old fetal bleed screening kit. I agree with rmblack's comment about the new kit being somewhat weaker but technically correlated with the previous kit. I have seen on other forums, that several (but not a majority) people are having similar experiences.

Hi All, Can you tell me why a provider would order a KB stain on an RH positive mom? Thanks!

Thanks David. Your process sounds similar to mine. I actually keep a pretty large inventory of O+ and A+. 50-60 of the former and 35-40 of the latter. (I think we could stand to keep a lower minimum inventory, but my coworkers and boss disagree). I like the idea of using a patient sample to screen, especially for expensive antisera. We usually get full 7 ml tubes so typically have plenty of plasma. I don't know if my coworkers' reticence to screen is because they don't feel like they have the time or they feel that the antisera is too expensive to 'waste' on screening lots of units.

Greetings! We are a medium sized community hospital but get quite a few patients with antibodies. We keep all the usual anitsera, except for anti-Lea , anti-Leb and anti-s. We try to find anitgen negative units for patients with antibodies when reasonable. Do other medium to small hospitals have a 'cut-off' for screening either in volume or percentages. In other words, if you have a patient with anti-e and anti-C, would you screen for that or automatically order antigen negative units from your blood supplier. How about for anti-S, anti-E and anti-K? I was wondering if you have a standard that when you have screened 'X' number of units, do you then order? If so, what does 'X' equal? Or do you say that if % compatible is less than 'X', you order units? Again, what would 'X' equal? Thanks, Amelia

Thanks for the input everyone. All valid points. -Amelia

Hi All, We had a situation yesterday where we could not locate a specimen when the OR called wanting 2 more units of red cells for a heart surgery in progress. We had 2 independent determinations of the patient's blood group and type on the current specimen and our computer system has the logic to alert the user of discrepancies between donor and recipient ABO/Rh.. The question is, could I have issued those 2 units with only the computer crossmatch? Thanks, Amelia PS. We found the specimen in a rack from a different date, but I was wondering if I would have been in violation of standards if I had not been able to put my hands on that specimen.

Hi, I have 2 unrelated questions regarding AABB requirements. 1) Regarding standard 6.1.4 annual policy/procedure review. Does there need to be a sign-off page for each procedure or just in the front of the manual. This would be for review only. Procedure revision would be handled with a different signoff sheet. 2) Regarding standard 2.1.3, competency testing. If you utilize CAP surveys but everyone has not pariticipated in one by year's end, do you manufacture your own specimens to demonstrate competence? Thanks! Amelia

I will be there and would love to meet you guys. This is my first AABB conference in about 18 years! Once the destination/date and time are decided, please post. Thanks -Amelia

I agree with both of the previous posters. We only do types and screens on our automation and therefore, we only do those tests on the automation for the CAP survey. I get the comprehensive surveys from CAP for all manual testing.

Thanks for the replies. Our approach has been much like that described by Barbarakym. This past weekend we did have to switch 3 patients to O pos and *so far* no deleterious effects. All still have negative antibody screens. We are trying to convince doctors of Rh negative patients to transfuse 1 unit and reassess rather than automatically ordering 2. So far, so good. Good luck to all those like us, who are feeling the crunch of a summer blood shortage!

Greetings, We are experiencing shortages of group O red cells. Our blood supplier is currently only releasing group O units for specific patient needs. Currently, we are at minimum levels for group O's. For a 275 bed hospital, what would you consider as minimum levels for O pos and O neg inventory? How much O neg should be retained only for emergencies? At what point would you switch O neg patients to O pos? Do you ever temporarily change your transfusion guidelines during a blood shortage? Thanks! Amelia

I'd say find another job.

We transport blood via pneumatic tube system for emergencies only. We have a procedure for doing so and it includes a form that must be sent with the unit, completed by the receiving staff and sent back to the blood bank. I cannot find where any validation was done. However, a case study was done by the pneumatic tube manufacturer (not sure if this can be considered validation since it was not done in our facility). In a previous blood bank where I worked, we tubed blood to the OR routinely without incidence.

We are in the process of dropping the IS crossmatch when doing gel crossmatches. But we validated the procedure first. We tested A, B, AB and O plasma in Gel with A, B, AB and O cells to demonstrate that the gel technique will detect ABO incompatibilites.