csjuarez

I hope that your blood supply is better than mine! Though it's a logical move to use only type O red cells until the patient's type can be confirmed with a second specimen, I know my inventory won't support that. As far as converting back to the patient's type once the type O units have been transfused, we join the others with doing so as soon as the type is known. However, if the patient is found to be Rh negative and has received emergency issue of Rh positive blood, we will continue to give Rh positive type compatible until the patient is stablilized.

We began requiring a second specimen on patients without previous Blood Bank history in October last year. This was primarily in response to the CAP checklist question# TRM.30575. We're also trying to get an electronic identification system. If that happens the second specimen requirement will be dropped. We've made a few exceptions to the requirement for a second specimen: 1) ABORh only orders 2) ABORh orders for the purpose of supplying components (FFP, CRYO, PLTS) - we do a second type on the same specimen. 3) Labor & Delivery patients (who rarely convert the Type & Screen to a Crossmatch), but if a Crossmatch is subsequently ordered, a second specimen is required. 4) Emergency transfusions - primarily trauma patients, but may also be other situations such as OR or L&D. We do a second type on the same specimen and get a second specimen as soon as it is feasible. We do a second type on the same specimen in these cases pending receipt of the second specimen. (Remember, if you're doing electronic crossmatches there has to be 2 types done prior to crossmatching, and we do electronic crossmatches.) There has been and still is a good bit of complaining about it, but compliance is good - we insist upon it!

We use the D- "mini panel" when the D+ cells of the antibody screen are positive and we confirm that the patient has received RhIg. We do not do this "mini panel" for anti-D in other patients. Titering any antibody at the time of delivery or post-partum seems to be a colossal waste of time, energy, and resources. The point of these titers is to help determine if the antibody is currently being stimulated and may effect the baby. And I would consider a request to titer anti-D after we know RhIg has been administered as preposterous (and I believe my Medical Director would back me up 100% on that!). As someone has already said, post-partum the focus switches to the baby, and clinical decisions will be made relative to the baby's condition, not the mother's antibodies.

We routinely do ABO/Rh and DAT on cords from all type O and Rh negative mothers. If the DAT is positive, it is followed up with Hgb, Hct, and Bili on the cord blood. We do not do elutions if the DAT can be explained by ABO incompatibility between the mother and baby or a positive antibody screen on the mother's sample. We've had this protocol for many years, so I'd like to re-evaluate it in the near future.

Does the use of the Bloodloc system eliminate the need for the second nurse to verify patient/unit identity? Another question: When do you put the Bloodloc codes on the patient ID band? On admission; when the first Blood Bank sample is drawn; at some other time? What about when there is a massive transfusion such as trauma or a bad surgery case? We're looking into this system, but it initially sounds like quite a bit of extra work for all concerned. Alternately we may need to institute a second sample protocol. Ideally we would get a barcode patient armband system, but since that's a hospital project it will take longer to convince, budget, and implement.

Since RhIg is given IM, it may take several days for the titer in the patient's specimen to be detectable in antibody screens. My experience is that it would probably usually be detectable by 6 days, but it all depends on the patient's body type and how fast she absorbs the RhIg. To my knowldege it is never recommended to test for the efficacy of the RhIg adminstration by antibody screening and/or titers. Any particular reason why an antibody screen was performed at 6 days?

Hey Abadi (is that you, Abdullah?) Are you looking for an SBB program, or an opportunity to train for a few months in a reference laboratory to get a handle on some special techniques? The accredited SBB programs in the US are listed on the AABB website, so that's a good source for those programs. If you're actually interested in a shorter "observe & learn" type opportunity, let me know and I'll check with the local reference lab here and see if they'd consider doing that.

One small thing you could do -- put the adds on the right side of the page instead of on the left. I've found that often when I try to print the page, part of the post is cut off on the right. If the adds were there and the posts shifted to the left, perhaps this wouldn't happen. Thanks for a great service!

My facility has been saving the Shipping Record/Packing List for blood products received from the blood centers for years! I don't see that there is a requirement to retain these records as the products received are entered in the computer system and includes all the information on when and by whom it was received, shipped condition, visual inspection, etc. Does anyone else retain these records, and if so for how long? Thanks!

I would be interested to hear from those of you who are doing the Computer Crossmatch how you interpret AABB Std. 5.15.2.4: "A method exists to verify correct entry of data before release of blood or components." The CAP Transfusion Medicine checklist has a similarly worded item. TRM.40690: "If a serological crossmatch is not performed, is there a method to verify correct computer data entry before issuing blood or blood components, and does the computer alert the user of any discrepancies?" The commentary says, in part: "The computer system must alert the user of any discrepancies of donor unit labeling, blood group confirmatory test interpretation, and to the existence of any ABO incompatibility." I am taking this to mean that if the computer system alerts me when the ABO/Rh retype is dicrepant with the ABO/Rh of the unit as entered in the system, when the ABO/Rh result for the patient is discrepant with the historical or previous type, and when attempting to crossmatch an ABO incompatible unit, then I have met the requirements of this standard. However, the individual in this position before me seems to have thought otherwise and so advised the Medical Director that we would not be compliant doing the Computer Crossmatch and so discontinued its use (after we'd been doing it for years!). Any thoughts?

We perform an electronic crossmatch. Of course, during downtime we do an immediate spin crossmatch. We haven't considered buffered gel, but since it would take longer to do, I don't think it would really be an attractive alternative.

I do Computer Crossmatch!

AABB Standards (24th ed) 8.2 says "Transfusin facilities shall have a peer-review program that monitors and addresses transfusion practices for all categories of blood and components." This is followed by a list of activities to be monitored. Peer review means the hospital's physicians must be involved. My experience is that it is very difficult to get the physicians involved and committed to attending the meetings. The time frame is not specified, but I feel quarterly is the minimum number of annual meetings - with fewer than that nothing is really ever going to be accomplished.

We discard the plasma products (FFP/Plts/Cryo), but use the Red Cells. The cells are labelled as ABSC Pos with the antibody ID, but since there is only a relatively small amount of plasma in a Red Cell product the only restriction is that it cannot be used for neonates.

Here (in Saudi Arabia) we are required to report confirmed positive tests for HIV and HTLV on our donors.

Is there a Cerner rep in this forum? I wonder, though I think I know the answer, if it is going to be necessary to completely rebuild all the blood products with the new names and ISBT codes?

We keep our expired panels for an average of 2 months - in a separate drawer of the reagent refrigerator. If an expired cell is used for rule out and anti-sera is available, the cell must be typed for the antigen being ruled out to ascertain that antigen's expression has not deteriorated.

Does anyone have procedures or flowcharts you are willing to share pertaining to handling of donors who test positive on the screening tests? What confirmatory testing are you using? When do you allow donors to be retested and/or re-entered in the donor pool? How are you using the NAT testing in your algorithms? Any input is appreciated!

We try as much as possible to give ABO compatible platelets, but this is often not possible since our demand far exceeds our supply (and we have to collect all that we transfuse!). For neonates, ABO compatible is required -- if it's not available we give volume reduced. If an apheresis unit is known to be high-titer, we label it to be used only for group O patients, but don't have a policy or practice of doing titers routinely.1

I see absolutely no value in doing titrations of Anti-D when the patient is known to have received Rh immune globulin (RhoGam). What is the purpose for doing such titrations? The AABB Technical Manual indicates that circulating RhIg rarely reaches a titer above 4. And, as you know, the amount of antibody present is constantly declining since it is not being produced by the patient. So, very low titers would be expected. As an aside, the Technical Manual also indicates that doing titers on gel is not recommended because of a lack of data showing correlation between gel and standard tube methods.

Our donor center will be acquiring new software in the next few months and with its implementation will also implement ISBT 128 labelling. As we're preparing for this, we have some questions: 1) What are other donor centers doing to differentiate the various collection sites that were formerly designated by various 1 or 2 alpha characters? Will you use separate FINs, special numeric designations in the unit number flag field, designating certain sequences of numbers to the various sites, or something else/nothing. 2) Do you order commercially printed Donation ID labels, print them in advance on site, or print them on demand? 3) Do you get your collection bags pre-labelled or do all the labelling yourself? I'm currently working in Saudi Arabia, but will be home (Atlanta, GA) for a short while in early June. I'd love to visit a donor center which has implemented ISBT 128 labelling. If your center has and you'd be willing to let me visit, please email me!

We are working toward increasing our number of repeat donors, and therefore decreasing the percentage of first-time donors. Since first-time donors have a higher rate of positive tests, the goal is not only to increase total donations, but to decrease wastage through discards of units positive in the screening tests. Does anyone have any statistical data regarding the number of first-time donors and/or positive test rates in their centers they'd be willing to share?

I believe that there are many pros (prevent WBC alloimmunization, prevent many febrile reactions from WBC alloimmunization and presence of cytokins, prevent transmission of CMV, reduce immunomodulation effect) and no cons for the use of 100% leukoreduction. The real issue that prevents this is MONEY! Even though all patients don't "require" leukoreduced RBCs, it is not detrimental to any and their use can prevent some future problems. If I needed a transfusion, I would WANT to have leukoreduced products!

In my former position we used Cerner classic and did electronic crossmatches, so it is possible. They were doing them a year or two before I went there (in '96) and are still using the system. The system will not make all the checks for duplicate ABO/Rh types, positive antibody screen, etc., but it is not a requirement that the system make these checks. It does prohibit the crossmatch of ABO incompatible units which is the requirement for the system; and, of course, the information is there for the technologist to determine that the patient is eligible for the electronic XM.

We require a second sample, drawn by a different phlebotomist, and where possible performed by a different tech! Though that may seem to be overkill, it definitely provides a good measure of safety. Even though it is a hassle, I think that it is a good policy to do the second type on a different sample since most errors in typing a patient would stem from misidentification of the patient or sample rather than the actual testing.1