Cathy

We usually use TMT or ECR to change the antibody to ABR (antibody removed) and then explain in PTC what happened. We have had a few rare instances where this wouldn't work, or we could not remove the antibody completely from the history. (For example, an antibody id and an antibody from an eluate were resulted on the same accession number, or someone did a CMB in error.) There is a utility function out there, but I recommend getting direction from Cerner, called U84 you can use to change or delete an EH99.

Another vote for Helmer...

We use the last four digits of the patient's red blood bank band for the secure code when tubing blood products. When we first started tubing blood products we did not use the secure transaction feature. We had two nursing units sharing a station. Both units had called for red cells not realizing the other side had called for a different patient. Someone picked up blood intended for the other side. No harm done but a good opportunity for improvement. So the nurse calls us to request a product. She has to provide the patient name and unique bb id at that time. It takes us a couple of minutes to issue it. She removes it from the tube station, using the last four digits of what she just gave us, initials the release form, writes the time she rec'd the product and sends it back down to us. If we don't have it back within 15 minutes we need to call the nursing unit. This system has worked well for us for many years.

We have been using the Safe-T-Vue indicators for quite some time and, for the most part, are satisfied. I think one of our biggest problems is at the time of application. The instructions say when applying multiple indicators at once to first stick them to the bag, then go back and fold each one closed. I think you also have to be careful and only take out the number of indicators needed and be sure to keep them cold during the application process.

We are doing the same as Sandy L. We are using Digitrax.

When we have an inconclusive gel panel we will try tubes. I like to try a 3 cell screen with liss and another with peg. That way I can see how this antibody will react without using up too much sample. Then I have a better idea of what media to use on the panel. We have missed a couple of newly forming antibodies with gel, they came up great with liss. As long as we rule out all of the clinically significant antibodies (with gel and liss) we will transfuse crossmatch compatible, but if no additional information was gained from the liss or peg, give gel crossmatch compatible.

We do the same as Mabel. After getting too high on a survey, we reviewed the Technical Manual and changed our procedure accordingly.

Thank you Pat. Now I am wondering about product codes. I think E0339 (AS-1 added, supernatant removed) is the code I would want for our neonatal syringes. We spin the unit upside down so we can attach a syringe and removed packed red cells. My problem is E0339 does not specify leukocytes reduced, do I need a code that specifies leukoreduced? What about irradiated, I cannot find a code for AS-1, supernatant removed, leukoreduced, irradiated. Thanks.

It is still a work in progress, but here's our plan right now for autologous collections. We are ordering preprinted numbers, to include our ICCBBA assigned facility id. Prior to collection, we will use a a tie-tag on the side of the bag for the patient (donor) identification and stick one of the preprinted unit numbers on the bag. After the unit and patient types are done, we will remove the plasma and add adsol. Then we will print a full face label using digi-trax. There is a cut out for the unit number, so the unit number originally assigned does not have to be covered up. We are printing our FDA registration number on the full face label. We will not print labels for the whole blood nor the plasma which is being discarded immediately. Hope this helps, Cathy

We no longer receive non-leukoreduced unit so I didn't worry about entering those product codes. Our most common product is RBCLD. The following barcodes are included in RBCLD: AS-1, 3, and 5; and the codes for the leukopoor apheresis red cell units. So in BB3, I have the barcodes for both codabar and isbt 128. There was not enough room for all of the barcodes (on that one line in bb3) so we were able to write more directly to the table. We have LDIRR as our leukopoor red cell irradiated product. Within that product, I have the same codes listed as above, except now substituting the irradiated products, again for both codabar and isbt 128. I thought I had the FFP all set but we recently started accepting FP24 so I'll need to add those product codes. I think I have my divided products all set now. I am bringing the original product into MOD and creating the AO; then bringing in the original product into MOD again and creating the B0. The volume of the original unit is then at 0 mL, and the original product is disposed. I had been trying to perform this modification using BCB but couldn't get it to work. So the user would then use the digi-trax printer to print two new full face labels. The original product code will remain the same, the user will just have to check off that it is a divided product to print the AO, then the screen stays up so all one has to do is change the divided information and print the label for the second half, the B0. For the autologous that we collect: We are using a preprinted unit number (with our ICCBBA assigned number) to PIM in the whole blood. Then we type the unit and patient. Then we use BCB to make the autologous rbc and ffp. (We make the ffp only to FDE and discard it.) So on the quick-pick list in digitrax I have the appropriate product code to use when printing a full face label. We only use one type of bag for our autologous draws so this should be easy for the users. I hope this helps, it's still a work in progress for us. Cathy

We continue to perform antibody titers in tube. Are the scratchy reactions you refer to newly formed antibodies by any chance? We have found that the antibodies we missed in gel were newly formed and easily picked up with Liss or PEG.

We are not ready. I have also been working on divided units and aliquots. We irradiate plts and rbcs on site, those modifications seem pretty straightforward. I have identified procedures that need updating. I am working on a spreadsheet for users to to refer to when performing a modification, so when they go to print a new label on the digi-trax printer they don't have to search through the entire database, they can just type in the new product code. It's hard for me to specify how much time I have into this since I can usually only work on this as the workload permits.

Just when I thought I knew how we were going to handle these, another thought crops up in my head. In the previous example, where we might call the first aliquot A0, the second B0, etc.... Don't we need to change the original bag? How can we put the bag away labelled 00 with these aliquots removed? My next thought is to change the original bag to A0 when removing the first aliquot, since it will no longer be an undivided unit. The first aliquot would then be Aa, the second Ab, etc.

We do immediate spin crossmatches on everyone unless there is a problem, in which case we do antiglobulin crossmatches.

We are aliquotting 1ml samples into plain plastic tubes. I am so thrilled to be seeing good, clear-cut negatives again! Our original vials are 10ml, so we are doing one set at a time and assigning a 24hr room temp expiration. We have yet to throw any away. We are using Bar-One software for labeling the aliquots. We actually use this software for many appliations throughout the lab. We are also seeing some not-so-clear-cut negatives on panel cells as well. Fortunately this week we are not pulling out the panels so much! I'm with you Mabel, if the aliquotting didn't work we were going to start diluting the 3% daily. I'm curious as to how others are storing the gel cards. Since the requirement is 2-25'C, (I think - I don't have them in front of me) are all of you storing cards at room temp or refrigerated? Incidentally, we spin all of our cards prior to use. We started this at some other time when we couldn't seem to get good negative reactions!

We currently only report the antibody and a chartable comment regarding the need to allow us extra time... If the % compatibility is low, I usually mention it over the phone to the physician or nurse. We have considered giving an antibody card to patients who have a significant antibody. We never developed a good mechanism of when to send it, how to avoid sending multiple cards to the same patient, how to provide an explanation, etc. I think it is a good idea, working out the logistics have just gotten lower on the totem pole I guess. So back to your original question, we typically only send out a letter when a pregnant woman has an antibody, clinically significant or insignificant, with an explanation. This is generated by the supervisor, the pathologist is not involved.

If we are not sure what the antibody is, we assume it may be clinically significant. We do IgG crossmatches on these patients. If the antibody screen comes up positive we repeat the panel; every three days if need be. If the patient has a history of an NSA (non-specific antibody), and the screen is now negative, we still do IgG crossmatches.

We are still using 10% glycerol. We don't see growth in it very often. We just clean the conatiner and make up new solution.

I am curious about your SOPs. Do you define what appropriate labeling is for test tubes, gel cards or other testing materials? For example, our procedures state "Add 1 drop of Anti-A to an appropriately labeled tube." We now realize that not everyone has the same idea as to what is appropriate even though it was clearly stated during training. If you define it, is it in every procedure indicated, or do you have a General or Good Technique procedure? I have the same sort of question regarding recording of results. Does your policy state something about recording results with the tubes in hand? It seemed like we just 'knew' this stuff without it having to be spelled out in a procedure. Thanks, Cathy

Same here. We have not had much luck with the prewarm gel procedure. We go back to prewarming in tubes or using REST.

We are still trying to figure out how we want to handle the recent problems (false positives) with the reformulated cells. It appears that many of you may be rotating vials in and out of the refrigerator at a predetermined number of hours. We are considering aliquotting our screening cells instead, and using a 24 hour room temp expiration. We are experimenting with volumes now to see what might be an adequate daily volume. What are your thoughts regarding QC in this instance? If we ran out mid-day and wanted to pull another set of cells that were aliquotted, do you think qc needs to be run? Or do you think that as long as we know that we are still on the same set of vials, the daily qc is adequate? How is the swapping vials in and out of the refrigerator working for those of you doing that? At how many hours are you swapping? Did you decide to qc each set? Thanks, Cathy

We have been doing open hearts for a little over four years now. We have a small refrigerator in the operating room, in the hall, in between the two cardiac rooms. There are two plastic bins in the refrigerator, to help keep them separate. The OR staff calls for blood prior to the start of the case. We send up two units via the pneumatic tube and they place them in the refrigerator. A little while before the case is done, an OR staff member comes to blood bank to sign out a cooler. The blood goes from the refrigerator into the cooler to accompany the patient to his room. The cooler used to stay at the bedside for several hours, until it was felt that the patient was stable. The trigger was supposed to be when the patient was stable enough for family to come in, the blood could be returned. That didn't work all that great. The coolers were staying up on the floor for hours. Now we have attached timers to the coolers and the nursing staff returns the blood and cooler to us after two hours. If they need any products after the two hours, we send it via the pneumatic tube. This system has been working pretty well for us.

Well I needed a good laugh today, thank you Bob. It's amazing how things can be so similiar so far away. I have just printed your analysis to share with others. If the type and screen is already done, 5-10 minutes to get blood up to the OR. If we need to do the type and screen, I tell them 40 minutes as long as the screen is negative.

We do the same.

I had a patient with a previous Kell, now non-reactive. One of the K-neg units came up 1+ incompatible in gel. So I rechecked the antigen screen, it was fine. Gel Panel A was all negative so I decided to look for some low frequency antibodies. He was also transfused 6 weeks ago so I set up a liss screen and found that the K reacted. I ran three positive K cells with the newly formulated cells in gel, only one reacted and it was very weak