labguru

We do this to cover all of the bases in the event of a transfusion reaction. We keep an unopened segment and the segment that was used in the crossmatch. We keep everything related to the crossmatch for a period of ten days.

We do this to cover all of the bases in the event of a transfusion reaction. We keep an unopened segment and the segment that was used in the crossmatch. We keep everything related to the crossmatch for a period of ten days.

We do not do the testing in tube to confirm. We will send the sample to American Red Cross for Genotyping for RHD variants if the reaction is 1-2+. The majority come back as weak D type 1 and are not considered to be at risk for production of allo-anti-D. It is generally accepted that females of child-bearing potential with weak D type 1 can be considered D positive for transfusion and are not candidates for Rh immune globulin. Their type will be updated with that comment. If the patient comes back as one of the other weak D types and there is a chance for production of the allo-anti-D, we will leave it as Rh negative and put the comment that testing was done in the patient history.

We do not do the testing in tube to confirm. We will send the sample to American Red Cross for Genotyping for RHD variants if the reaction is 1-2+. The majority come back as weak D type 1 and are not considered to be at risk for production of allo-anti-D. It is generally accepted that females of child-bearing potential with weak D type 1 can be considered D positive for transfusion and are not candidates for Rh immune globulin. Their type will be updated with that comment. If the patient comes back as one of the other weak D types and there is a chance for production of the allo-anti-D, we will leave it as Rh negative and put the comment that testing was done in the patient history.

We do not do the testing in tube to confirm. We will send the sample to American Red Cross for Genotyping for RHD variants if the reaction is 1-2+. The majority come back as weak D type 1 and are not considered to be at risk for production of allo-anti-D. It is generally accepted that females of child-bearing potential with weak D type 1 can be considered D positive for transfusion and are not candidates for Rh immune globulin. Their type will be updated with that comment. If the patient comes back as one of the other weak D types and there is a chance for production of the allo-anti-D, we will leave it as Rh negative and put the comment that testing was done in the patient history.

Without a doubt I would send it for KB, because the operative word in the limitations is "may" - they are not always destroyed.  In addition, even if the delivery was an uncomplicated PV, that does not rule out that there may have been a major, but silent FMH that requires a larger dose of anti-D immunoglobulin than your standard dose.

So tube is your back up method?

A lot of folks like to run 20 of everything.  There is no regulatory requirement on the number of samples you need to use.  Whatever you feel is necessary to make you feel comfortable.  Personally, I would validate the temperature in each of the card slots (you'll need a small thermocouple, this was not well thought out by Ortho)  and then verify the centrifuge rpms.  The timer is digital so it needs no validation.  I don't see that you need to run patient specimens, it is not reagent, it is equipment.  Would you run specimens to verify a heat block?

We run the current positive and negative controls (before they expire) with the new lot of Indicator cells and D reagent. We are not comparing results, we are just making sure our new reagents are giving us a positive and negative result. This was under direction from a call to CAP. I guess it could depend on who you talk to there as to what answer you get though.

Just wanted to comment that starting 6/27/2016 I will become the interim Blood Bank Manager for the Cottage Hospital system in Santa Barbara, California.  Looking forward to the challenges and opportunities this will bring my way.

If your computer is validated to detect ABO incompatibiliity you do not need to perform an IS XM.  Our procedure says that only if the LIS is down that we need to perform an IS XM for antibody patients.

pbaker-Do you weak D type your babies?  We do if the mother is D-, but even if the baby is weak D+, we would report it as D- since we don't want a blood type discrepancy in the future.  On weak D+ babies with D- mom, we report that a fetal hemoglobin F should be ordered to confirm a bleed and that the mom is still a candidate for Rhogam.

We enter the units we are testing in the computer and we can enter our results. QC for antigen typing is maintained on a paper log so other techs can see that controls have been done for the day on a particular type and lot number of antisera. We don't want to waste those precious drops by having to repeat it. I keep those logs for at least a full 10 years.
On that log I have a column to indicate that the antisera was visually acceptable on the day of use and a column to write the panel lot # used for Ag controls and if the panel cells were visually acceptable. The column for panel lot # was my way of documenting that the panel performs as expected with the antisera used. This shows the panel is QC'd multiple times over the life of panel. (TRM.31234) Probably overkill but I have something documented if they ask if I QC my panel. If something didn't work right, I would hear about it!
 

We order an AGID on the unit which allows us to document the results of the unit and controls, as well as the lot number and expiration date of antisera used.  There isn't a place to document the actual control used but you could enter that in comments.  We chose to also maintain a paper log for that information, mainly so that it is easy for other shifts to see if QC has been done for that antisera for that date.  I keep that for way more than 10 years, due mainly to procrastination and lack of time/motivation to clean out our storeroom.

It's testing to get a compatible unit for transfusion to a patient, so I would say that at the very least you would have to have a record of QC and the various lot numbers. 
As for the unit testing, it seems like you would have to keep a record of test results some sort as long as you would for any patient-related testing.  In the US that's 10 years.   Even if the data is transcribed to your computer system, the written record is primary, so you would have to save that anyway.  That's what we do here.
Scott

John is right on, as usual.

I am fairly certain there is no requirement for a backup method. On the other hand, most blood bankers I know suffer from a level of paranoia that requires they have at least one back up method if not two or three.  I think determining the need for a back up method would balance on the size of your facility and how much of an impact your only method being down would have and how long being down would likely be.  My guess is that instead of an entirely different method you would be better served by have backup for any critical equipment like the centrifuge required for the gel technology.  
The other aspect of a back up method is it's use in working out problem patients.  Again, if you have a reference facility within a reasonable turn around time then you would probably be better served by utilizing their expertise instead of attempting to maintaining competency in multiple methods within your staff.  
Just my 2 cents worth.  
 

Our protocol says that males under 18 and females under 50 will receive Rh neg blood whenever possible. If we were running out of Rh negative blood, I sure that we would consider switching the young males to Rh pos to save the Rh neg for the younger female patients. We discussed 55 vs 50 for females but the board certified trauma physician who is head of our emergency services department said that age 50 was what was recommended in trauma related literature. When and if age 55 predominates in the literature, I'm sure that he would reconsider. (Lab had been using < 19 years for males and 55 or < years for females.)

^ what he said.
We see a lot of high risk cases, we increased our age from 50 to 55.

You have it exactly correct as far as "child-bearing potential" is concerned labguru.  It used to be that it was written as a "female of child-bearing age", but there were occasions when D Positive blood was given to a D Negative female child, because they were not of child-bearing age, with the result that they were sensitised to the D antigen, causing all sorts of problems when they did become pregnant (the crass idiots that transfused this blood gave the "excuse" that the female child was not of "child-bearing age").  As a result, the phrase was changed to "child-bearing potential" to include all females from 0 to 50 years of age (at least, it is 50 years of age in the UK, and this upper age limit is evidence-based, although, of course, you will always get the exceptions).  50 may not be the age at which all females have reached the menopause, but UK statistics show that the likelihood of a D Negative female without anti-D, is given D Positive blood, and then makes anti-D, and then goes on to become pregnant with a D Positive foetus is disappearingly small.

Our helicopter stocks 2 O negs.  They sometimes transfer a patient from a distant hospital that is not in our system to a bigger hospital that is also not in our system.  We have a contract with the helicopter company to sell them blood and they infuse it and document it according to their protocols.  They give us paperwork whenever they give it. Usually we have the patient to be able to assign all of the documentation to the patient.  When we don't get the patient, we get patient and unit information from them and are able to put the patient into the BB computer so we can track final disposition of the units. If they don't hang the blood en route the receiving hospital won't accept it.
 
If your computer doesn't allow entering patients like this, then be sure to assign final distribution as being issued/shipped/transferred to the helicopter team.  If there is a recall they should at least be able to look up all the patients that they transported that day to identify the recipient.  I am sure that they can't look things up by unit number in their system unless it has a Google-like search function so the correct date would be important.
 
As for not getting a specimen, you would use the same policies that you use if a patient dies after receiving uncrossmatched blood and you never got a sample, I'd say.

This has happened here once as well.  I believe we used our BB system to "ship" the units to the final destination hospital.  Making them responsible for all of the transfusion records.
 
Scott

this happens to us rarely on an ambulance transport from far Northern NH to the tertiary care facility south of us. Hasn't happened in quite a while - I'd bill the ambulance company and let them pass the charges along. You should contact them afterwards to find out if the blood was infused and get the pt info for records at least. Sometimes you have to eat the charges.
Interesting topic.

I DON'T THINK ORTHO GAVE ALL THE DETAILS.  THIS IS WHAT THE CFR STATES:
 
 
§ 606.151 Compatibility testing.
Standard operating procedures for
compatibility testing shall include the
following:
(a) A method of collecting and identifying
the blood samples of recipients to
ensure positive identification.
( The use of fresh recipient serum
samples less than 3-days old for all
pretransfusion testing if the recipient
has been pregnant or transfused within
the previous 3 months.