Lcsmrz

If there is no storage of products at RT, we define our ambient temp from the requiremetns of the equipment. I think our range is 70+20 F at 50+20% humidity. Our HVAC system keeps us in that range.

We also do it weekly. If you every had Pseudomonas growing in the line of a cell washer, you'd never miss the system flush -- it takes months to clean out all the nooks and crannies!! Items like this are best addressed with a risk management approach: the risk of not doing it, compared to the benefits of doing it. I almost always accept a written decision to go against a manufacturer's recommendation, as long as the sole reason isn't cost.

These are the situations that get dumped on the pathologist, who has to talk to the clinician, weigh the risks of each available option, and deliver a response. Sometimes it's a time-sensitive issue, rather than a component-of-choice one. I don't always agree with what they tell me to do, but I don't have their medical background or the clinical information. And I can sleep at night, knowing I didn't make the decision ...

The Medical Director can delegate this responsibility to someone qualified -- an SBB sure sounds OK to me! -- but should delegate this responsibility in writing, such as in meeting minutes or Job Description. I also like to submit a report to him/her, stating it was completed and what exactly was done for the annual review. Gives 'em a chance to ask questions ...

Alot depends on your comfort level and your patient population. A small rural site with one in-date panel will have a different set of rules than an AABB reference lab with three or four panels available, plus a frozen stock of rare cells and a rack full of antisera. Clinical significance also plays a role in the small facility. In a patient with a well-defined Anti-E and no incompatible gel crossmatches with E-neg RBCs, I'm not going to spend alot of time and reagents trying to find an Anti-M reacting below room temp with only homozygous cells. I'm usually happy ruling-out with one homozygous or two heterozygous cells in gel -- apologies to Dr Judd for the use of common terminology. The problem is dealing with reactions with no apparent specificity or with a patient with mutiple allo's. How far do you go before you write it off depends on being able to sleep at night ...

We do not require a separate consent form for derivitives. Except for RhIg, pharmacy handles all of it for us (yeah !!)

"Less than 38 C" implies that the temp could be 37.99999 C, but probably means that the decimal point on the digital thermometer is immaterial -- and it probably is! We set our waterbath at 36.0 C to make sure the digital display doesn't exceed 37.0 C. I had the pleasure of speaking to a Metrologist years ago, who all but laughed at my assertion that the thermometers I was using were accurate because they were NBS-certified or -calibrated. I wish I still had the article he gave to me that delved heavily into the uncertainty of measurements.

There is no daily check on our blood warmers of which I am aware.

Stds says your crossmatching should be AHG, unless the Ab Screen is negative, and there is no prior history of an antibody. Then, a test for ABO incompatibility (IS XM) can be used. My thinking is that a patient who formed one antibody is certainly capable of forming another, and I want to find it before a transfusion reaction workup does. Your SOP can differentiate between clinically-significant and -insignificant antibodies. A patient with an Anti-Lea reactive at IS but not at AHG may be best crossmatched at IS, if you don't type units for Lea. We gel crossmatch any patient with an antibody.

We run diluent against screen cells to show that the bottle is not contaminated with something that would cause false positives. The same wells show that the gel is not causing false positives with the screen cells. In tube testing, we run C3-coated check cells after performing a DAT with Anti-C3, but only on days that we perform testing with Anti-C3 reagent. We don't have poly-AHG any more.

Your blood supplier may have a procedure or a recommendation in place that you can plagerize. I equate those SOPs as the "mafufacturer's recommendation."

In addition to our regs, the Biomedical community has their own set of standards that they apply to all electrical devices under their oversight. I give our standards to them and leave them do their thing, sending me a summary of their work for the few blood warmers we have. They are much better at defending their work than I am, and can usually provide the assessor with documentation that they are following all applicable regulations and recommendations.

I would feel most safe by all donor staff being required to open-carry a weapon in a thigh holster and have an SOP for its use; adding a military theme and camo uniforms would be a plus. The drive coordinator could have an M-4 or a tactical shotgun. Donors intimidated by the sight of such a well-armed group may fill the bag faster with their increased B/P, leading to shorter draw times, and would leave quicker without eating alot of cookies -- however, the vets may stick around to talk and eat more cookies. And we could use the short-draw bags as targets after the drive home. (At least you'd collect alot of units that way at an NRA or GOA convention ...) Serioiusly, most companies have requested your presence and work hard to make the drive a success. They typically have their own security arrangements, and there's always "911" if all else fails. I like the Drive Coordinator system for immediate de-escalation of minor situations, and having an action plan for non-medical emergencies would be a good idea. Back when I coordinated mobiles, I have them an info packet that included fire alarms and exits, emergency numbers, where the bathrooms are located, and the like.

You have to define your own acceptance criteria for each critical material/supplies, then compare each lot or shipment against these before use. If you say you will parallel test, then you should and document accordingly. We don't parallel test anything, espcially since the usual daily QC doesn't do alot for me as it is.

Is there a possibility that the follow-up sample was not drawn from the correct patient, or the shot was given to the wrong person, or the shot was charted as given, but really not? If the lady was very large, the RhIg may have been given IF, rather than IM, which would also hinder the absorbtion rate.

Retention of expired panels is endemic in blood banks. At one time, I noticed that donors started recycling after about 5 panels, so keeping more than the last 4 is probably not worthwhile, unless you use them for students. I look for an SOP for using expired reagents and check that they're conspiculously-marked and segregated from the in-date reagents. In the SOP, I expect to see the conditions that an expired panels may be used and any QC that must be performed. I think expired cells should not be used as the sole test for the presence of an antibody. Securing additional rule-outs in the presence of a higher freq antibody or of multiple antibodies are the most likely use.

If the reference lab tags the Bpos units compatible, I would give them. If not, your SOP reigns. Our reference lab calls them "screened compatible," but does not tag them as compatible, leaving the decision and the liability to us. We sign them out on the clinician's signature, so he verifies the addition risk.

We don't even perform a Pre-DAT, if the post-DAT is negative. How much you do with a positive DAT depends on the comfort level of the pathologist and the patient population you have. AABB is an outstanding organization -- one that deserves support and membership! No one has done more over the years for the blood banking community (from donor to recipient to Techologists to technology) than they have, and other agencies look to them for guidance in the Transfusion Medicine arena, including the FDA. Many times, though, it short-sightedly comes down to dollars in the budget ... One other thing to remember about the AABB is their 20+ year focus on systems, something that other agencies have only recently (and begrudgingly) adopted. They are a progressive voice in the very conservative lab field, and way ahead of everyone else in their view of quality -- indeed, others are following their lead and playing catch-up! Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ) Indianapolis, IN AABB Assessor

The SG of packed cells is about 1.013, if my memory serves me correctly. You can easily make a conversion table for total bag weight vs approx volume. We weight our incoming RBCs and record that weight as an approx volume for the nurses.

I've always liked the Lui eluate for ABO HDN, since everyone already has a freezer and it's a simple method that even a weekend/midnight shifter could do. We only do them on request. If the baby is ABO-incompatible with an Group O mom, we assume that we'll find something, but it doesn't always correlate well with the baby's clinical condition.

I've used them more for billing reconciliation and for troubleshooting inventory discrepancies. I can't think of any mandated retention requirements, other than your own SOP.

We were beginning a project of cross-calibrating the probe connected to the digital readouts on our storage devices, the ones on the central monitoring system for alarms, and our usual NIST Liquid-In-Glass thermometer. The outside guy started discussing the many problems measuring the cabinet air temperature between adjacent devices -- the science was well over my head -- and basically talked us out of the entire project due to cost! He did say at one point in the discussion that his probe and probably the one in the refrigerator we stood next to was accurate to half the display (0.05 C) and to keep my NIST thermometer out of the project completely as comparing apples and watermelons. The refrigerator manual does not specify the accuracy of the digital display. An email to the refrigerator manufacturer went unanswered, so I could not confirm or deny his statement, but a web search indicated that probes and controllers consistent with his statement were available. I found very little information in the online engineering literature comparing temp measuring devices, except that they are hard to compare. However, I did notice that the FDA food inspectors use non-contact infrared thermometers in their inspections, rather than thermistors, so it appears that the subject of accuracy in blood banks may not be as important as I think!

I think there is a general discouragement of OR refrigerators, but if properly controlled, I can't think of any regulation or standard preventing them. Coolers have their own set of problems, too.

I have to ask the question -- what does your SOP say ???

While we prefer a second tech & second sample, neither is always available, esp on the midnight shift and on weekends. When unavoidable, we require everything but the sample be discarded and a completely new setup for retyping, with reID of everything. A vast majority of requests has a second tech perform the retypes, but on the same sample. And we are a 100% nurse-draw facility. It seems hard enough to get one properly-labeled tube from them! Interestingly, we require a heelstick to confirm the blood type of our NICU babies, yet always give Onegs. We're not being very consistent, but this is the way our "downtown" flagship facility works ... we're required to follow along.