Cathy

I'd say that you have to consider the capabilities of your staff. I do ask my techs to use the microscope for DATs. They are all generalists and their time in blood bank is limited. Some of them shake too hard, in spite of my best efforts to fix that problem. They use a mirror, but some don't use a mirror well. So, in order to not miss weak positive reactions they use the scope with a tube roller. We also have a definition for microscopic agglutination (right out of the Technical Manual) that says it is a clump of 4-5 cells (though I do tell them that they should be cautious with this - if tests look suspicious, check them out, don't blindly ignore what you see). When I train, I stress the difference between a clump of cells that are friendly/kissing and a clump of cells that 'love each other' (agglutination). They do very well - false positives are rare. I don't see a lot of unnecessary work being done.
 
 

We're a pretty big place.  We have an active labor unit, 50 or so ORs, level 1 trauma center, and support a huge cancer clinic.

We are similar to Brenda, O pos for the men and women over 55.  I think any O neg inventory can be quickly depleted.  Having an OB hemorrhage case can easily go through 100 units.  Those women will get switched to pos pretty fast.  Our O neg inventory is about 150 units and that can still be a worry.  Yes, 1 patient will get switched before they deplete us, but what about 2?  3?  When it rains, it pours.

We give O POS to males and women over 55 yrs old.  We give O NEG to women <  55.  That being said, if we have an ID before taking a cooler to ED and the patient is historically Rh NEG, we would start out with 4 O NEG and determine switching depending on gender, age and usage.
Brenda Hutson

I avoid giving O Pos to male trauma patients because if we give them an anti-D and they manage to show up as a trauma patient in the future, they are at grave risk of a serious reaction.  I would note though that since I am in a pediatric institution, this is more likely to occur than in a general hospital.
 
Thankfully, we have never been faced with having to use O pos for a female patient.  There is usually not much delay in getting a sample;  we generally go to type specific pretty quickly.

I would rather deal with the unlikely event that my male trauma patient develops anti-D, then presents again as a trauma, than deal with having to give a young Rh negative woman Rh positive blood because I ran out of Rh negative units transfusing an adult male or a 50+ year old female. My stock of O neg red cells is 8 with full stock and my blood supplier is 150 miles away. A trauma situation could very quickly deplete that supply.

We issue O Positive for uncrossmatched male and female >50 right off the bat. 

If I am not mistaken, for a massive transfusion, a D neg patient who receives D pos blood is unlikely to develop an anti-D, (but I appreciate the concern!).  In any case, each facility has to decide how it will reserve O neg units for those trauma  patients that must have them.
Scott

I avoid giving O Pos to male trauma patients because if we give them an anti-D and they manage to show up as a trauma patient in the future, they are at grave risk of a serious reaction.  I would note though that since I am in a pediatric institution, this is more likely to occur than in a general hospital.

Kelly, as a male myself, please could I ask what is the problem if you give a male anti-D?

We used to start with O pos for males over the age of 18 and women past child bearing age, but we don't do that anymore. We have actually given quite a few patients (ironically the majority of them being male!) an anti-D. We went back to giving O neg to all trauma patients. If the patient gets to the point where they take up to 5 or 6 units, we then convert them to Rh positive, with pathologist consent (unless we have a type by that time, and then we give type specific).

We start with O neg (2u - no more than 4u) and hope we have a specimen before the 2u are in.  We then switch to type specific and hope it is not O neg.  We are under pressure to switch to O pos by one of the ER docs - may have to go that way in the next year or so as they gear up here to be a Level 4 trauma unit.  So far, most of the emergency releases stop transfusing with 2 units.

We are Level 1 Trauma Center with approximately 15 Massive Transfusion activations per month.  We keep 6 O POS and 6 O NEG in our ER refrigerator with 4 Group A Liquid Plasma.
We started stocking O POS units last summer when our blood supplier was struggling to keep up with our O NEG need.  The majority of our traumas are male and about 80% Rh positive.  It has made a tremendous impact on our O NEG usage.  The biggest concern was the possibility of a mistake and grabbing O POS for female patient but (knock on wood) that has not happened yet.  We have segregated the units by placing O POS in a Blue plastic bin and O NEG in a Pink plastic bin - and on a separate shelf.  O POS units are wrapped in a paper stating "FOR MALES ONLY". 

We have used their C3 coated cells for quite a while with no problems at all. 
 

We also use O Pos for males and females over 50.  We use O Negs for all children up to about 20.

We start with O Pos for males and females 50+.
 

Thank you Cliff.  The blood bank staff will be responsible for storage.  We already store and issue frozen bone.  Don't get me started
Thanks,
Cathy

Nope, never did any QC on panels.  Could not see the sense in it.  How could you possibly test for all the antigens!!  As Malcolm says above, "You have to stop somewhere!"  I chose not to start. 

Heard from the FDA.  Variance is no longer required.  This is an unlicensed product and may not be shipped across state lines.
 

I asked this question at a Cleveland ARC seminar. It was explained to me by Dr Gerold Holtche who at the time was with CAP that the fetal stain is considered a special stain and did not fall under the BB QC guidelines but under Histology standards.  The QC slide that had both adult and fetal cells was sufficient to show the stain worked.  This was several years ago so you might want to check directly with CAP. 

We purchase commercially available Fetal Stain controls by Sure-Tech.  It works well for us.

I’m getting hung up on this item in regard to our KB qc:
 
TRM.40130 Alterative Control Procedures                                                                           Phase II

If the laboratory performs test procedures for which control materials are not commercially available, there are written procedures for an alternative mechanism to detect immediate errors and monitor test system performance over time.  The performance of alternative control procedures must be recorded. 

Note: “Performance” includes elements of accuracy, precision, and clinical discriminating power.  Examples of alternative procedures may include split sample testing with another method or with another laboratory, the testing of previously tested patient specimens in duplicate, testing of patient specimens in duplicate, or other defined processes approved by the laboratory director. 

Evidence of Compliance:

Written procedures for alternative quality control AND

Records of alternative control procedures

------------------------------------------------------------------------------------------------
Are most of you buying qc for Kleihauers?  We are still making our own positives by diluting a normal adult CBC tube with cord cells (high and low positive controls) and of course using the normal adult as the negative control. We count patients in duplicate and the two counts must be within 10% of each other.   Are we in compliance?  Control materials are commercially available, we jut don't use them (yet anyway!).  One other question, we have always said the number of fetal cells in the high positive control should be roughly twice the number in the low positive.  If still making your own controls, do you all define 'roughly'?
Thanks so much in advance!
Cathy
 
 
 
 
 
 
 

We are still having problems.  We are on our 4th lot of gel cards and screening cells.  These faint, weak positives are happening with panel cells as well as BioRad 3% cells diluted to 0.8%. What are you all doing?  I don't want to revert back to tube but when we've tried every lot we have here - then what?
I can't even get through to technical service this morning

We started sending the floors Tan top EDTA tubes that only the blood bank stocks (so we know it is a second draw and not just a tube of blood the RN had in her pocket) along with a label that needs to be applied at bed side.
5.16.2.2 is the standard that includes the statement about the 2nd current sample

I contacted CAP today and they stated that the lot to lot comparison does not apply to any transfusion service related reagents including kits.  I specifically asked about the Fetal Screen Kit and they said it is not required.
I may change our procedure to only the kits and not any of the other reagents just to be on the safe side.
 
thanks!!