CBBS e-Network Forum

New Discussion: Anti-C3b/C3d testing in the evaluation of a positive DAT

Thu, 18 Apr 2013 08:01:30 -0700

A Blood Bank Specialist in Northeast Wisconsin asks if there are any institutions that have abandoned using anti-C3 reagent and C3 check cells as a cost savings measure. The test for presence of complement coating (with anti-C3b, -C3d reagent) is offered as a reference laboratory send-out test when the DAT (polyspecific reagent) is positive. Is this an acceptable practice?

Revisited Topic: Is it necessary to perform antigen screening when a patient has anti-Jsa?

Thu, 28 Mar 2013 11:20:54 -0700

A colleague from a transfusion service in the Midwest asks if it is necessary to perform antigen screening of units using either a serologic or molecular method (in addition to crossmatching) for patients with anti-Jsa.

Revisted Topic: Should we irradiate red cells transfused to patients with sickle cell anemia?

Thu, 28 Mar 2013 11:19:58 -0700

A Blood Bank Supervisor in New York reports that her transfusion service currently has a policy to irradiate blood for exchange transfusion in sickle cell patients (both adult and pediatric). The transfusion service is planning to eliminate this policy barring any compelling evidence to contraindicate such a change. Any feedback would be appreciated.

Comments Posted: Problem re-labeling a parent unit after removal of an aliquot

Thu, 14 Mar 2013 11:58:08 -0700

A blood bank technologist reports that her transfusion service is preparing to upgrade their blood bank software and has run into a problem labeling Codabar units. Her facility sometimes removes an aliquot from a unit of RBC for an infant and then uses the remainder of the unit for an adult transfusion. In the new version of the software there is no built-in way to print a label for the remaining parent Codabar unit after removal of an aliquot. They have been unable to come up with a good way to re-label the parent unit that meets regulatory requirements.

New Discussion: Should donors be screened for Wr(a)?

Sun, 03 Mar 2013 09:55:45 -0800

A European colleague in transfusion medicine notes that some blood centers in Europe have established a policy of screening blood donors for the Wr(a) antigen. Wr(a) positive donors are then deferred from donation. The rationale is that there is a remote risk that blood from these donors may cause a hemolytic reaction since anti-Wr(a) antibody is relatively frequent in transfusion recipients. The medical director asks if any U.S. centers defer Wr(a) positive donors based on this reasoning.

New Discussion: Therapeutic Phlebotomy for Testosterone Replacement? REVISITED

Tue, 26 Feb 2013 06:09:43 -0800

A query originally posted in 2011 is revisited with a review from Michael Petzar, MD, Transfusion Medicine Physician (Interim) at Puget Sound Blood Center in Seattle.

Comments Posted: How much information is really needed to issue blood from the transfusion service?

Tue, 26 Feb 2013 05:59:25 -0800

How much information is really needed to issue a blood product from the transfusion service? Can the paperwork used to issue blood in a pneumatic tube be streamlined?

New Discussion: Is RhIg prophylaxis indicated for D neg women with anti-D?

Sun, 17 Feb 2013 20:44:32 -0800

A Medical Director in the Midwest asks if anyone worries that a D negative female with anti-D may actually have an antibody against the G antigen instead. To prevent “true” anti-D sensitization, should all D negative mothers be given RhIG prophylaxis even if they have a record of an anti-D antibody on file?

New Discussion: Strategies to prevent transfusion-transmitted CMV

Wed, 06 Feb 2013 17:13:10 -0800

A Pathologist in Northern California asks two questions re-visiting issues in transfusion-transmitted CMV:
What institutions consider leukoreduced blood products “CMV-safe” and no longer issue CMV-tested seronegative products?
What is the status of nucleic acid testing for CMV in blood donations to capture donors in the window-period of CMV viremia?

New Discussion:Continuous Observation of Blood Donors

Mon, 14 Jan 2013 06:54:24 -0800

A VP of a blood donor center in California asks how other facilities handle the Title 17 California Code of Regulations (CCR) requirement that “donors shall be kept under continuous observation throughout the entire procedure of blood collection and for at least 15 minutes thereafter.” If a phlebotomist is running a two-bed whole blood donor section, how does continuous observation apply?

New Discussion: Are platelets being tranfused too rapidly?

Mon, 14 Jan 2013 06:53:35 -0800

A pathologist in the Midwest submits the following for discussion:
It has become customary to transfuse platelets over a very short time period - usually 20 minutes or even less. In the era where both TACO and bacterial contamination of platelets are being increasingly recognized it makes sense to transfuse platelets more slowly so that should a complication occur as above the medical repercussions can be limited. I would appreciate other's insights regarding the duration over which platelets are transfused.

New Discussion: Use of Ringer's Lactate Solution with Blood in Trauma Patients

Mon, 10 Dec 2012 15:29:23 -0800

A Blood Bank Technical Specialist in the Midwest says that his hospital Emergency Department is requesting that the transfusion service consider allowing rapid co-infusion of Ringer’s lactate (RL) solution with RBC in trauma patients. Do other hospitals use RL in the Emergency Department with blood during trauma resuscitation?

New Discussion:Use of liquid plasma for resuscitation of actively bleeding trauma patients

Sat, 24 Nov 2012 10:27:20 -0800

A blood bank consultant in Texas is working with her hospital emergency medical services director to determine if plasma should be available for use on their life flight helicopters during transport of actively bleeding patients. Any comments or the rationale for carrying various plasma products on helicopter transport flights would be welcome.

New Discussion: Centrifuge Settings for Pretransfusion Specimens?

Thu, 15 Nov 2012 23:37:36 -0800

A Blood Banker from Texas asks: Is there is a standard set for the centrifuge time and speed when spinning blood bank specimens for pre-transfusion testing?

New Discussion: Transfusion of Platelets via Infusion Pump

Thu, 15 Nov 2012 23:36:18 -0800

A request is made for advice, experience, or literature associated with the administration of platelets using a free-flow method vs. infusion pump (not a fluid warmer). Is one of these infusion methods superior to the other? Are there any issues associated with platelet transfusion by pump such as platelet dysfunction?

New Discussion: Should the blood bank waste plasma left in the waterbath?

Thu, 15 Nov 2012 23:34:50 -0800

Is there is a guideline as to how long thawed FFP or CRYO can stay in the 30-37C waterbath while thawing and still be good to use. Recently a blood bank supervisor discarded 2 units of FFP that sat in the waterbath for over an hour. She cannot find anything specific in the AABB Standards that addresses this concern. Should the FFP and CRYO left in the waterbath be wasted?

Comments Added: Document Retention and Lookback

Thu, 15 Nov 2012 23:32:41 -0800

A Blood Bank physician on the East Coast notes that AABB Standards require 10-year document retention for donation history (except for permanent deferrals which are retained indefinitely) and for transfusion records to patients (final disposition of each unit). Are any facilities keeping the transfusion records longer? Two responses have been received.

New Discussion: Antibody identification after RhIG administration

Sat, 27 Oct 2012 08:30:49 -0700

A blood bank technologist from a medical center in Montana asks what policies are in place at other facilities for antibody identification in pregnant women with positive antibody screens and a known history of RhIG administration. Specifically, if the antibody screen is positive, do you perform a panel to confirm that the antibody is anti-D?

New Comments: Washing Cord Blood for ABO Typing

Sat, 27 Oct 2012 08:31:19 -0700

A colleague in Florida notes that traditionally “4 or more” washes are recommended when performing ABO typing on cord blood. Are there any specific references stating this requirement? And has the wash procedure ever been validated or is validation necessary at each facility?

New Discussion: Apheresis donors during earthquake drills

Thu, 25 Oct 2012 12:08:29 -0700

The Medical Director of a west coast blood center was asked by her blood center safety officer if there is a standard procedure for dealing with apheresis donors on machines during an earthquake drill. The donor center recently had such a drill and the question arose as to what to do about donors in the middle of apheresis procedures.

New Discussion: Transfusion Support to a Distant ER by a Level I Trauma Center

Mon, 08 Oct 2012 09:52:26 -0700

A Blood Bank Medical Director at a hospital in the Southeast with a Level I trauma center was told recently that his transfusion service will be overseeing blood products stored and transfused to patients in a freestanding ER 10 miles away from his facility.The Director wonders if other hospital transfusion services have encountered a similar situation.

New Discussion: Request for therapeutic phlebotomy for secondary hemochromatosis in alpha-thalassemia/HbH disease

Sun, 23 Sep 2012 08:39:13 -0700

The Medical Director of a Transfusion Service received a request to start a therapeutic phlebotomy regimen for a patient in the fifth decade of life with alpha-thal/HbH and hemochromatosis. Does anyone have thoughts/experience in phlebotomy to treat secondary hemochromatosis in thalassemia or other congenital hemolytic anemia?

New Discussion: Switching to a new Fetomaternal Hemorrhage Screen test

Sun, 23 Sep 2012 08:37:58 -0700

A medical technologist from the Midwest is interested in evaluating a new fetomaternal hemorrhage screening test (rosette test) that uses an IgM anti-D reagent and allows for a 5-min RT incubation. The blood banker asks if any forum members have migrated to a similar FMH screen test and could share experiences that might be useful in making this transition.

Additional Comments Posted in Discussion RE: Use of O positive RBC in Trauma

Thu, 06 Sep 2012 15:04:34 -0700

Two questions for consideration: What RBC product (O+ or O-) do you use for trauma patients before the ABO/Rh type is performed? If O+ RBCs are transfused to an O- recipient, do you consider giving RhIG prophylaxis to prevent anti-D formation? Drs. Paul Ness,Karen King and Paul Schmidt, have offered responses.

Comments Submitted: Donors presenting to donate blood in order to decrease hematocrit

Sat, 21 Jul 2012 08:07:59 -0700

The medical director of a blood center reports that donors occasionally say that their physicians have recommended that they donate blood. The most common reason is increasing hematocrit in men on testosterone therapy. In the opinion of the director, these donors should be treated as therapeutic phlebotomy patients rather than volunteer allogeneic blood donors.

New Discussion: Difference in upper vs. lower shelf temperatures in a blood product storage refrigerator

Fri, 22 Jun 2012 11:08:00 -0700

A blood bank manager in Northern California states that her blood bank has a newer double-door refrigerator with temperature probes placed to monitor both upper and lower shelf temperatures. Is there any standard stating that the upper and lower temperatures of a blood product storage refrigerator must match within 1° C?

New Discussion: How to validate an infrared thermometer

Mon, 11 Jun 2012 10:09:44 -0700

A Senior Medical Technologist in the Midwest recently purchased a traceable infrared thermometer for the Blood Bank. The technologist found some literature on validating the thermometer such as proper liquids/containers to use. Can anyone provide additional feedback on how to properly validate the infrared thermometer?

Revisted Issue: Crossmatching both parts of a double RBC collection by apheresis

Mon, 11 Jun 2012 10:08:31 -0700

A blood banker at a donor center in the Midwest asks if the issue of whether it is necessary to crossmatch both parts of a double red cell (automated RBC by apheresis) collection been addressed by AABB? What is the current standard of practice?

New Discussion: Significance of a positive DAT in teen blood donors

Mon, 11 Jun 2012 10:07:47 -0700

The Medical Director of a blood donor center in the West notes that in the last year, the Director’s facility reference laboratory has seen an increased number of young donors (less than 19 years of age) with positive direct antiglobulin tests. Does anyone have any ideas or theories as to why a young, apparently healthy person would have a positive DAT?

Responses Received on Informed Consent Discussion

Fri, 01 Jun 2012 16:27:40 -0700

An RN from a medical center in Southern California asks how long before a transfusion is given can the patient's consent be obtained? Since elective surgeries are sometimes scheduled 30-60 days in advance, would getting the blood consent signed at this time be valid?

Revisited Topic: Is it possible to bill for the second independent ABO/Rh test?

Sat, 26 May 2012 10:33:35 -0700

A blood banker asks if it is possible to bill for the second independent ABO/Rh test required in the April 2011 FDA Guidance document “Computer Crossmatch”?

New Discussion: Can an outside laboratory ABO/Rh type be used as an historical type?

Sat, 26 May 2012 10:32:40 -0700

Can an outside laboratory ABO/Rh type be used as an historical type for the purposes of electronic crossmatch? This issue stems from the fact that the lab work for some patients must be performed at an outside reference laboratory based on the patient's insurance provider.

Comments Received: Is it necessary to place ABO/Rh confirmation labels on units?

Fri, 07 Sep 2012 13:35:59 -0700

A blood bank colleague from the Southeast asks if it is necessary for a transfusion service to place ABO/Rh confirmation labels on red blood cell units received from a blood supplier after ABO/Rh confirmation testing. A Transfusion Service Supervisor at a regional medical center in the South describes her facility's system.

New Discussion: Blood bank test orders as “add-ons”

Fri, 04 May 2012 07:41:29 -0700

A Blood Bank System Supervisor with extensive experience recently began managing a transfusion service that routinely allows providers to “add-on” blood bank testing to an existing sample drawn for CBC testing. She asks, are there any ideas as to how to persuade other managers and the laboratory director to discontinue this practice?

New Discussion: Ethics of end of life transfusion

Fri, 04 May 2012 07:39:44 -0700

A transfusion medicine physician in Los Angeles just read the article entitled "How do I allocate blood products at the end of life? An ethical analysis with suggested guidelines" and wonders how others approach this situation in their own institutions.

Issuing blood prior to birth

Fri, 20 Apr 2012 05:18:22 -0700

A blood bank colleague asks how other transfusion services handle issuing blood to a newborn during a “crash” delivery when complications for the baby are anticipated. The baby is not yet born and there is no infant sample available for testing.

New Comments posted in question RE: donor deferral for travel to Cancun

Fri, 20 Apr 2012 05:19:00 -0700

Blood Donor Malaria Deferral for Travel to Cancun: A question regarding a possible future FDA guidance document regarding designation of malaria endemic areas

New Discussion: Does reconstituting whole blood for neonatal exchange transfusion require FDA registration?

Fri, 30 Mar 2012 05:58:46 -0700

Can a transfusion service suspend red blood cells in ABO compatible plasma to reach a desired hematocrit for neonatal exchange transfusions? Does this process require special licensing from the FDA or registration of the facility that prepares the modified product?

New Discussion: Is it always necessary to provide Rh(D) negative platelets to a patient with anti-D?

Mon, 26 Mar 2012 03:31:55 -0700

A Medical Director of a transfusion service asks if it is always necessary to provide Rh(D) negative platelets to patients who have made anti-D.

Comments Posted: How closely should the actual transfusion volume match physician's order?

Mon, 26 Mar 2012 03:31:12 -0700

How closely should the actual transfusion volume match physician's order in pediatric patients? What is an acceptable range of tolerance? What degree of shortfall should trigger a call to the provider to make a decision about whether to make up the deficit with another transfusion?

Revisited Topic: Which solutions other than isotonic saline are approved for addition to blood and components?

Wed, 14 Mar 2012 12:43:52 -0700

It has been 2007 since the last addenda to the 2000 CBBS discussion. What is the current practice in the transfusion medicine community? What are current opinions on this topic?

Query RE: Reducing Product Wastage

Wed, 14 Mar 2012 12:44:24 -0700

Reducing Platelet Wastage in OR: A colleague asks several questions regarding handling platelets that are issued to OR and then not transfused.

New Discussion in Blood Component Preparation

Sat, 03 Mar 2012 09:41:46 -0800

A CLS in the blood bank at a pediatric hospital in the Southeast asks how long it should take the transfusion service to prepare reconstituted whole blood for a neonatal double volume exchange transfusion (DVET).

Revistied Topic: Pathologist review of antibody panels

Tue, 21 Feb 2012 11:03:45 -0800

A new inquiry was submitted as an addendum to the 2009 e-Network Forum discussion, "Blood Bank Director review and sign-off for antibody investigation, including antibody panels"

New Question regarding policy on transfusion of ABO incompatible platelets

Tue, 21 Feb 2012 11:01:07 -0800

During a recent inspection, a lab administrative director in Northern California was questioned about his transfusion service policy regarding transfusion of products containing ABO incompatible plasm.

New Discussion in Blood Component Emergency Issue

Tue, 21 Feb 2012 11:02:23 -0800

A blood bank supervisor in California asks about emergency issue of uncrossmatched blood to a patient with history of a clinically significant antibody.

New Query regarding pre-transfusion samples

Sat, 21 Jan 2012 08:46:52 -0800

Issues in storage of pre-transfusion samples

New Discussion in Donor Collection Issues

Sat, 21 Jan 2012 08:44:19 -0800

Venous thrombus formation after blood donation, a very rare occurrence?

New Discussion in Component Selection Issues

Thu, 12 Jan 2012 09:06:31 -0800

Use of liquid plasma for resuscitation of actively bleeding trauma patients

New Discussion in Therapeutic Apheresis Topics

Thu, 12 Jan 2012 09:05:45 -0800

Fibrinogen levels and therapeutic plasma exchange

Comments Posted in Discussion RE: Records Retention

Thu, 12 Jan 2012 09:04:42 -0800

Long term storage of paperwork generated by antibody identification workups

New Query in Utilization Monitoring

Fri, 06 Jan 2012 08:11:38 -0800

Can a blood utilization/transfusion committee meet via email only?

New Query in Blood Product Issue

Fri, 30 Dec 2011 05:50:10 -0800

Handling returned units to blood bank

New Discussion in Pre-transfusion testing

Fri, 23 Dec 2011 12:09:26 -0800

Why is an AHG (serologic) crossmatch required when the antibody screen is positive?

Additional Comments Posted in Discussion in Blood Consents

Wed, 14 Dec 2011 09:08:46 -0800

Blood Consents: what are facilities currently doing regarding obtaining consent for transfusion?

Comments Posted to Product Storage Query

Wed, 14 Dec 2011 09:08:27 -0800

Does agitation affect thawed cryoprecipitate?

New Discussion in Donor Suitability Issues

Wed, 14 Dec 2011 09:06:59 -0800

Handling an HBsAg Positive, NAT negative Donor

New Query in Equipment & Supply Issues

Wed, 14 Dec 2011 09:07:40 -0800

Performing QC on disposable thermometers used to check donors

New Query in Equipment & Supply Issues

Fri, 09 Dec 2011 13:23:18 -0800

Are there any new methods for calibrating serofuges?

New Discussion in Regulatory & Quality Management

Sun, 04 Dec 2011 14:31:43 -0800

How can a blood donor center ensure compliance with changes or new state and federal regulations?

New Discussion in Therapeutic Apheresis Issues

Sun, 04 Dec 2011 14:29:40 -0800

Pre-procedure physical exams in therapeutic apheresis patients