CMCDCHI

We also use "too weak to titer"

I followed Sandy Jo's lead and asked tech support at ThermoFisher about how to disinfect. I was going to attach the document they sent me that says 70% alcohol is OK, but I can't figure out how. Help?!

Auntie-D, I certainly didn't set out to insult anyone. I was simply commenting from my experiences and those I have heard from others. The tone of your response was certainly accusatory. One of the things I appreciate most about this site is the openess of the members and I hope it stays that way to encourage conversation. Confirmation bias does not mean that someone was intentionally careless, it is often subconsious. There is also plenty of use for 2nd checks (we use several), but it should not always be the answer without an investigation of the process. Unnecessary checks can bog down a process, add cost and time, and sometimes not even add to the safety/accuracy of the process.

Adding additional tech checks isn't always the answer. There is a lot of confirmation bias in performing 2nd checks.

In a past job, we eliminated all bleach from the blood bank. In my current job, bleach is EVERYWHERE! We use bleach wipes to clean the counters, and the cell washers and saline bottles are disinfected with bleach weekly. I know there is evidence that it can denature the S antigen, but how serious of a threat is this? Do I need to put a stop to the bleach? My guts says yes. If you don't bleach how do you clean/disinfect the cell washers and saline bottles? At my past job, I don't think we EVER cleaned the saline bottles, we just kept refilling them and never had any issue with contamination. I don't see any requirement in the equipment manual to bleach the cellwashers either. I'm sure I'll get a lot of push-back if I say we don't need to do any decontamination. thanks!

Help me out- what is HT neg?

We had another suspected amniotic fluid embolism hours after I posted that article. Amazingly, mom is doing well and is being moved out of the ICU today.

Thanks for your input. We do "Everything else" as JPCroke said. The investigation of TRALI and/or TACO is largely clinical but we will certainly get our pathologists involved to help the clinicians if needed and they sign off on all suspected reactions. I almost just called your directly, DPruden . I can sleep better now knowing that we are doing the right amount of work.

How much work do you perform for transfusion reactions called on non-RBC products? My interpretation is that ALL transfusion reactions should get a post-transfusion blood type and DAT. The tribal knowledge in my lab says that non-RBC reactions do not need to have a post-transfusion sample collected. They will send the product for a gram stain/culture if there is a temperature increase or a BP drop, but otherwise, not much is completed. Thanks!

The first story in this article was at our facility. Needless to say, I don't think we will be cutting back on our OB T&S anytime soon. This one is too fresh (though it was before my time here). http://www.5280.com/magazine/2013/08/hero-work?page=full

Do you have a big L&D service? We do a T&S on all L&D admissions. This saves us time (and anxiety) when it comes to a delivery going bad. It also makes our RhIg evaluations faster. I'm all for eliminating unnecessary work, but I can't imagine not doing a T&S on our OB patients.

Here is a link to the AABB session. It was in the SmartBrief. http://static.coreapps.net/aabbam14/dailies/03db66b5ffa421bb850a31cf39e86419.pdf

Thank you for all of the input. The patient was transferred to hospice care today. I will keep all of your answers in mind for when this comes up again (since I'm sure it will). I was in the reference lab for 10 years (do all you can to get an answer), so I'm still adjusting to the hospital setting (do what is necessary to get safe blood, cost-effectively).

I have a patient with a positive DAT (IgG). She has not had any recent transfusions. Her antibody ID shows a clear cut anti-E and anti-S. Is there any compelling reason to do an elution? I used to work in a reference lab and all positive DATs would have elutions performed, but now that I'm in the hospital and it would be a send-out test for us, I'm questioning the value. There is a good chance this patient will also move to hospice care soon.

If your screen is negative (and there is no history of antibodies), you could do an immediate spin only crossmatch. That would save quite a bit of time. See AABB standard 5.16.1.1: "If no clinically significant antibodies were detected in tests performed in Standard 5.14.3 and there is no record of previous detection of such antibodies, at a minimum, detection of ABO incompatibility shall be performed."

Another option is to occasionally run a PRA (platelet antibody screen) and AVOID the antigens that are causing problems rather than trying to have a perfect match. When I worked at the blood center, we did a mixture of HLA matching, antibody avoidance, and crossmatching.

We do the same as tbostock as well. We do not always get 100% compliance though, mainly on the "How often do you need to monitor your patient" question. There is a perception that once an hour is OK though our policy says every 30 minutes.

I do allow a line to drop repeating information as long as it was written on the first and last lines. At my last job, we could not use arrows, just a line- I'm sure that part is just semantics. The techs are using arrows when only 2 lines of data are being recorded. This is still incomplete to me. Lines or arrows can still only be used for dates, initials, etc. NOT for reactions or interpretations.

Ha! I wish I could say I am that clever and I wrote it on purpose. I'm glad that there is agreement, even if no one can come up with a standard. I'm fairly new in my position and I think I still have a few people testing to see if I really stand behind what I am asking them to do (aka testing my boundaries!). Thanks for the input.

I recently asked my techs not to use arrows for repeating information on forms. Most have complied, but I was challenged by one tech. I'm having trouble finding a specific resource that says not to use arrows. Can anyone point me in the right direction?

The 3 and 3 rule is fairly common- you need 3 antigen negative cells that do not react (usually you have many more to rule out all of the other antibodies) and 3 antigen positive cells to rule in. If you are calling multiple antibodies, you need 3 that are positive for EACH antigen but negative for all the others. In your example, if you were to ID both anti-Fya and anti-C, you would need 3 Fy(a-), C- that were negative 3 Fy(a+), C- that were positive 3 Fy(a-), C+ that were positive Some labs only require 2 positive cells, but the 3 and 3 rule gives you 95% confidence in the ID. I think ruling out on a single "homozygous" cell is OK, but I know there is a lot of debate around that.

When I worked in a reference lab, we would inform the hospital that the blood was incompatible, then it was up to the hospital to follow their procedures for transfusion. We did not ask for physician acknowledgement directly.

we use the ECHO for T&S and use gel for everything rlse- including ID for positive screens on the ECHO. I would not have set it up that way, but it predates me. We will probably move to more ECHO, less gel over time for a number of reasons, but we have so many other changes coming up (including a move to a new hospital!!) that we don't want to add anything else right now.

Malcolm, I believe there is a section header in Issitt & Anstee's book that says "There is no anti-Kell." The first time I saw that (before I read the paragraph below), I almost fell off my chair. Issitt could not write a text book without putting those little things in there either!

We allow the retesting on the same specimen, but as SMILLER said, we have a robust armband requirement. It seems that there is a large blood management push in the industry right now. For those of you that transfuse group O until you get that 2nd specimen, how many group O do you think go to non-O individuals because of this rule? We try to keep very tight control on who gets group O RBCs.