Dan87

Just curious: Other than common sense, is there a regulation that says coolers or blood boxes/transports need to be cleaned?
Obviously, if there is some overt issue, they should be cleaned, but in practical terms, the OUTSIDE of blood bags do not claim to be clean/sterile. I can't imagine that the coolers themselves are taken into "clean" areas like ORs, but if they are, that's a different story - they should be clean INSIDE and OUT. While the Blood Bank is probably cleaner than the "smoking" shack, I'm sure it's not claimed to be clean in the clinical sense.
As a parallel.....how often are blood storage refrigerators and freezers cleaned? Certainly not every time they are used.
Perhaps more focus should be on coolers returned with noticeable blood contamination: where did it come from?, was the blood inside compromised?, did a unit of blood with a hole in it get transfused? Of course, that still implies an inspection process, but doesn't necessarily mandate cleaning.
Just a few brain drippings, no soap box or intent to offend.

We have a log book that we use to keep track of coolers. We indicate what cooler went where, when so we know when they are approaching 4hr being out of the department and if they go missing we have a way to track it down. When the cooler is returned it is cleaned and that is documented on the form also.
COOLER LOG.doc

Quick wipe down after every use (Cavi wipes) if not bloody. Disinfect thoroughly quarterly or if bloody. 
OR are meant to return coolers clean i.e. No blood but does occur. 

We use Safe-T-Vue 10 in our blood products: RBCs and thawed Plasma (obviously plasma should be cold enough to attach Saf-T-Vue). Beside, visual inspection of products; we depend upon Safe-T-Vue coloration for our products return.
For platelets, we return the products upon visual inspection and room temperature return.

I only know of one lab that still does AHG crossmatches on every patient.  Waste of time and resources.  The resistance to change is always scary to me, after all, we're scientists.

While I have personally identified antibodies like Kpa, Jsa, V, Cw; our facility have identified antibodies like anti-scianna, anti-Wr(a), anti-henshaw, anti-Do(a), VS.
Scianna antibodies, Wr(a) and henshaw are the antibodies I have never heard before.

.....among few, one of the reason cited by our BB leadership for not switching into IS or electronic XM was our patient population. Most of our patient are Sickle cell patients who get chronically transfused and leadership are right to some extent as we have been able to detect rare/weird antibodies during our full XM.

I absolutely agree with you, R1R1. The value IS / EXM bring to blood bank work flow out weighs doing AHG XM on every single patient; but it would be a herculean task to change the conception of our leaderships.

Congratulations on finding that little lot - very impressive!
The Scianna Blood Group System is the 13th in the ISBT numerical system.  When I started out in this game, there were only three antigens in the System (Bua, Sm and Sc3), but things have changed!  Sm, a high prevalence antigen, has been renamed Sc1.  Bua, a low prevalence antithetical antigen to Sc1, has been renamed Sc2.  Sc3 was expressed on all red cells apart from those of the very rare null phenotype.  In addition, Rd, STAR, SCER and SCAN have been added to the System (Rd being low prevalence, and the three others high incidence).
Wra was originally called the Wright antigen, and is a low prevalence antigen antithetical to the high prevalence antigen Wrb.  These two antigens have now joined the Diego Blood Group System as Di3 and Di4 respectively.Wr(a+) red cells are very rare, but anti-Wra, which seems to be made with no apparent red cell stimulus (what used to be called "naturally occurring) is actually quite common.
He is antithetical to the 'N' antigen (NOTE - not the N antigen) within the MNS Blood Group System - N is expressed on glycophorin A, whereas 'N' is expressed on glycophorin B.  Sadly, it is not as simple as that.  About 23% of S-s- red cells are He+, but the He antigen is not a "single entity", but a "collection of antigens" that come about as a result of different variant glycophorins.
I hope that helps a bit, rather than "muddying the waters" further.

Before switching to immediate spin crossmatch from AHG crossmatch on everyone, we would find many of those antibodies, that you mentioned, Dan87.  We did not blink when we switched to immediate spin (and then electronic (sorry Malcolm) crossmatch).   We are a large urban hospital system with many sicklers.   We knew that we would miss the occasional low freq ab that could not be detected on the screening cells.  (One note, many of our sicklers require full AHG crossmatch due to history of clinically significant antibody, but they would get IS XM if they qualified)   I have not seen one incident of a HTR due to the antibodies you mentioned.   I am sure that they occur, but rarely, and not a reason to stick with AHG XM for all, IMO.     One document that I love to review is the FDA report on fatalities due to transfusion.   It is always a good read.   https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/

While I have personally identified antibodies like Kpa, Jsa, V, Cw; our facility have identified antibodies like anti-scianna, anti-Wr(a), anti-henshaw, anti-Do(a), VS.
Scianna antibodies, Wr(a) and henshaw are the antibodies I have never heard before.

It was the early '90s when I first went to immediate spin crossmatches.  In '96 I went to a new facility and my first order of business there was to move them to immediate spin crossmatches. I met with a fair amount of resistance initially but supplied the supporting documentation to the transfusion Medical Director.  We were the first in that state wide corporation to do so.  Much to every one else's surprise our patients did not start dying right and left from transfusion reactions.  The one thing I did do to make the transfusion service medical director more comfortable was to switch from a 2 cell antibody screen to a 3 cell screen.  There is a great deal of documentation supporting both the IS crossmatch and the electronic/computer crossmatch (sorry Malcolm).  I know John Judd and his group at the University of Michigan were among the first and you should be able to find their papers in issues of Transfusion from the '80s if you are interested.  

I have this issue also. The guide doesn't give a weak reaction as a result. I always go by if it's a pellet with a few "specks" it's negative....why search for zebras.

Similar practice here.  There are thinbgs that can cause gel interference that look like they may be junk, including a dried speck of 0.8% cells that hangs above and otherwise negative bunch of cells at the bottom of the tube.  
However, if it is an artifact, somehow it must be proven to be only that.  If it is due to the gel, then we do a tube screen to see if we can get a clean negative.  Likewise, for really weak gel screening reactions (Ortho says to report as 1+), we may do a panel to make sure there is no pattern that would match an emerging alloantibody (a young zebra--but still important!).
Scott

less than 7 days old and they are not irradiated. 

Here is a good AABB presentation from 2014 on competency.  Hope it helps.
AABB_2014_Competency_Assessment_a_toolbox.pdf

We stopped using ABO Rh confirmation label; with LIS in hand and shelving unconfirmed and confirmed RBCs in different refrigerator, we found confirmation label was redundant. Confirmation label rather adds unnecessary costs and labor; however, the inception of this process was uphill task. 

We are not AABB accredited; we are inspected by CAP, but the concept is the same. Like Cliff, it took a few years, but I went through all my SOP's and all the regulations. I did it in several steps.

I read through every SOP and used the "footnote" tool in MS Word. [insert-->Reference-->Footnote] to tag each statement (or heading, or title) in an SOP that was directly related to a specific regulation with the reference number of the regulation. For example: "The sample must be labeled at minumum with the name, medical record number, date and time of collection, and the collector's employee ID1". Once you add the footnote in Word, it adds the little number and it takes you to the end of the document, or the bottom of the page, where I typed the specific reference "AABB SBBTS 5.11.2, CAP TRM.40230".
I put all of my Word Document SOP's in the same folder. Then, I went through the regulations one at a time and I used the "find" feature in windows (like how you search for a file) to search for each regulation number. If I found it, I marked it off. If I didn't find it, then I knew that this regulation had not been specifically addressed.
For all the ones that had not been specifically addressed, I had to create policy or modify existing policy to make sure each had been fully addressed. (This took a LONG time.)
Now, when the new edition comes out, I use the crosswalk of changes and the "find" feature to quickly find the location of that particular regulation in my SOP's so that I can make adjustments as necessary - or update the reference numbers.

This has worked wonderfully for me! It is also excellent at inspection time when you get nervous and can't think - just use the find feature and your own policies will tell you (and the inpsector) how you meet that standard and where to look for documentation. It's also a great help to your staff if an inspector should come when you are out of town. They don't have to know every little thing - they can just look it up if they don't know.
Good luck!

Here's mine too - if it will help anyone.  Very difficult to get everyone through and despite telling them it is THEIR responsibility - you wind up doing the lion's share of it in order to get it done.
Blood Bank Competency 2014.xls
Blood Bank Skills 2014.xls

SDP are suspended on 100-500 ml plasma and additive solutions. Giving 4 SDP can cause volume overload. Pediatric medical center with centrifuge should be able to provide you with volume reduced platelets.