Principle: | Specimen: | Materials: | Reagents: | Standardization: | Processes: | Blood Supplier: | References:
Blood Bank General Processes explains the various processes necessary to ensure that the United Clinical Laboratories (UCL) Blood Bank departments function in an efficient and standardized manner.
1. Only Blood Bank procedures with special specimen requirements will have specimens listed in the individual procedures.
2. A fresh blood sample collected in EDTA is the specimen of choice for most Blood Banking procedures. Citrate, Heparin, ACD and clot tube specimens are also acceptable. PST/SST tubes are never acceptable. Hemolyzed or lipemic specimens may cause some difficulty in test evaluation. If test results are questionable, a new specimen may need to be collected. Serum samples containing fibrin strands may cause a “halo effect” in Gel testing, causing difficulty in interpretation.
3. All specimens obtained for compatibility testing require extra identification steps in addition to the “Patient Identification” policy:
A. The phlebotomist must transcribe the patient identification number from the patient’s armband onto the requisition. The name and ID number must be matched on the tube, the armband and the requisition.
B. The technologist performing the testing on the patient sample must confirm that all identifying information on the request form agrees with the information on the specimen tube label before using the specimen for blood grouping, typing or compatibility testing. Record action by placing a checkmark by the “Specimen Integrity” field on the requisition.
C. Reject any specimen not meeting all the patient/specimen identification criteria and document this in the Blood Bank Incidence Log.
4. Blood Bank specimens are routinely tested within 3 days of collection. Older specimens may be used for problem solving or transfusion reaction work-ups. The specimens may be held at room temperature for up to 24 hours. After testing is complete, all specimens are stored at 2-8°C for 10 days.
5. Specimens used for crossmatching must be tested within 3 days of collection.
6. In cases where multiple UCL Accession numbers are assigned to a patient’s specimen, the number assigned to one of the Blood Bank tests is the identification number for that specimen. Do not obstruct this original number in any way. (No subsequent numbers may be placed on this tube.) This number will be the identification number of the specimen for the entire life of the specimen.
The Materials List contains all materials used in the Blood Bank department along with the current vendors and product numbers. It will be updated as the materials are changed in the individual procedures.
All materials are stored at Room Temperature unless otherwise noted.
2. 12 x 75 mm Test Tubes (CardinalHealth #SP1290-3)
3. Graduated Transfer pipettes (CardinalHealth #P5214-12)
4. Glass Blood Bank pipettes (CardinalHealth #P5201-3)
5. Red rubber bulb (CardinalHealth #P5215)
6. MTS Incubator or 37ºC Waterbath or 37ºC Heat Block
Any 37ºC air incubator may also be used as a backup.
7. MTS Centrifuge
Any UCL site can provide backup service. Cards must be transported upright and must be sealed (scotch taped). Cards will be returned to the sending site for reading and completion of work.
A backup MTS pipettor is stored at MMC-DBQ; a 25 µl and 50 µl Rainin pipettor may also be used.
9. MTS Pipette tips (Ortho #MTS9633)
10. MTS diluent dispenser (Ortho #MTS9610)
A backup MTS diluent dispenser is stored at MMC-DBQ; a 500 µl Rainin pipettor may also be used.
11. SafeTrace Tx Software for recording Blood Bank testing and results.
12. Blood Bank Worksheets; for backup use when SafeTrace Tx is not operational (Copy Works #BB-001)
13 Blank Product ID Tags; for backup use when SafeTrace Tx is not operational
14. Blank Product ID Labels; for backup use when SafeTrace Tx is not operational. (Shamrock Scientific #Therm-2611R-DO)
15. Blood Bank Reagent Quality Control Log; for backup use when SafeTrace Tx is not operational
16. Panel Antigrams
17. Marking Pen (water resistant)
18. Cell washer
Note: Our defacto standard for microscope field # is based on a field size defined by a fixed ocular diaphragm of 18 mm diameter. In order to obviate the need for scope-specific procedures, the scopes with large field of view have been corrected to the standard by means of a custom reticle that has been installed in the right-side oculars. The reticle superimposes a thin circle over the visible field. When counting formed elements, count only those target elements, which fall within the circle.
20. Illuminated optical aid
21. Hematype Segment Device (Baxter-Fenwall #4R5126)
22. Polystyrene 12 x 75 mm test tubes with caps (CardinalHealth #T1340-2)
23. 10 µl Rainin pipettor
24. Red Typenex Band (Baxter-Fenwal #4R4608)
25. Hand Sealer (Baxter-Fenwal #BS-4)
26. Hand Sealer Clips (Baxter-Fenwal #4R4418)
27. Transfer Packs (Baxter-Fenwal #4R2014)
28. Plasma Transfer Sets (Baxter-Fenwal #4C2243)
29. O-ring Collector Kit (Cell Washer) (Kendro Lab #12850)
30. Sorvall Replacement Tubing Kit (Cell Washer) (Fisher #NC9220033)
31. Sorvall T6000 B Brush Kit (Cell Washer) (Kendro Lab #12994)
32. Platelet Cabinet Recorder Charts (Helmer Labs, Inc. #220273)
33. Room Temp Recorder Charts (Dickson #C314)
34. Refrigerator Recorder Charts (Jewett #RDR019) MMC-DBQ
35. Refrigerator Recorder Charts (Jewett #RDR020) Finley (refrigerator), MMC-DV (refrigerator & freezer)
36. Freezer Recorder Chart (Kendall Lab #6282-240) Finley
37. Freezer Recorder Chart (Dickson #C818) MMC
38. Temperature Recording Log/Blood Bank (IS 233)
39. Temperature Recording Log/Refrigerator/Freezer (IS 232)
40. Room Temperature Recording Log (IS 430)
41. Sorvall CWII Cell Washer (IS 420)
42. Centrifuge MFv Log (IS GCENT 0198)
43. ID Micro Typing System Log (IS MTS0208)
44. Serofuge MFv Log (IS 236 12/08)
45. Microscope MFv Log (IS MS0501)
46. Waterbath MFv Log (IS 306)
47. CytoTherm D-4; M/FV Log (IS CTD40109)
48. Markamatick II Ink System (Jewett # RDR024)
49. Red pen (recording chart red pen) for room temp recorder, DV only (Dickson #P222)
50. Tachometer Marking Tape & Disk Set (CardinalHealth #C3305-11)
51. Bulb 25W120V Agglutination Lamp (CardinalHealth #B0281-001)
52. Bulb 6V2.75Amp A/O Scope (Miller Electric #ATR 1460)
53. Duracell Battery - Min/Max Thermometer (Miller Electric #EVE357BP)
54. 200 µl Rainin pipettor
55. Rainin pipette tips (Rainin #RC-250)
56. 1 ml pipette
57. Graduated Cylinder
59. Clean dropper bottles
60. 5 or 10 ml pipette
61. Wash Bottle (CardinalHealth #B7510-4)
62. Rubber bands (Corporate Express #ALL37646)
63 Bladder for CytoTherm D-4 (CytoThem #CD4-BL)
64. Air Filter for CytoTherm D-4 (CytoTherm #C4-FILT)
65. “Y” Accelerator for CytoTherm D-4 (CytoTherm #C4-FILT)
The Reagent List contains all reagents used in the Blood Bank department along with the current vendors and product numbers. This list will be updated as the reagents are changed in the individual procedures.
1. Gel Cards
A. Store Gel Cards upright at room temperature.
B. Visually inspect the Gel Cards before use. Each microtube should have a clear liquid layer on top of the opaque Gel.
C. DO NOT USE A GEL CARD IF:
a. The Gel matrix is absent or the liquid level in the microtube is at or below the top of the Gel matrix.
b. The Gel Card shows signs of drying, discoloration, bubbles, crystals or other artifacts.
c. The foil seals appear damaged or are opened.
D. Gel Cards List:
a. A/B/D Monoclonal and Reverse Grouping Card (Ortho #MTS080515)
b. A/B/D Monoclonal Grouping Card (Ortho #MTS0801115)
c. A/B Monoclonal Grouping Card (Ortho #MTS080017)
d. Monoclonal Control Card (Ortho #MTS081001)
e. MTS Anti-IgG Gel Card (Ortho #MTS084024)
f. MTS Anti-IgG, -C3d Gel Card (Ortho #MTS084014)
2. A1 and B Reagent Red Blood Cells (Ortho Affirmagen #719210) Store between 2 - 8°C
3. Reagent Antibody Screening Cells (Ortho Selectogens #719610) Store between 2 - 8°C
4. Anti IgG (Ortho #716760) Store between 2 - 8°C
5. Coombs Control Cells (Ortho #719810), (Quotient #Z441U) Store between 2 - 8°C
6 MTS DILUENT 2 (Ortho #MTS9230) Store between 2 - 8°C
Discarded when evidence of bacterial growth is present.
7. Blood Bank Buffered Saline (Cardinal Health #B3158-6) Store at room temperature. Expires one month after opening.
8. 0.8% Resolve Panel A (Ortho #6902317) Store between 2 - 8°C
9. Resolve Panel B (Ortho #719520) Store between 2 - 8°C
10. Fetal Cell Screen (Immucor #780540) Store between 2 - 8°C
11. Anti-A (Ortho #3901934), (Quotient #Z001U) Store between 2 - 8°C
12. Anti-B (Ortho #6901935), (Quotient #Z015U) Store between 2 - 8°C
13. Anti-D (Ortho #6901939) Store between 2 - 8°C
14. PeG solution (Immucor 705010), (Quotient #7312U) Store between 2 - 8°C
15. Rare Antisera. Store between 2 - 8°C.
A. Anti-C (Ortho #713080)
B. Anti-E (Ortho #713180), (Quotient #Z073U)
C. Anti-c (Ortho #714080), (Quotient #Z083U)
D. Anti-e (Ortho #714180), (Immucor #7-241)
E. Anti-K (Ortho #715150)
F. Anti-k (Cellano) (Ortho #721030), (Quotient #Z137U)
G. Anti-Fya (Ortho #715130)
H. Anti-Fyb (Ortho #725230)
I. Anti-Jka (Ortho #721380), (Immucor #4142)
J. Anti Jkb (Ortho #721480), (Immucor #4143)
K. Anti A1 Lectin (Ortho #711830), (Quotient #Z241U
L. Anti-Lea (Ortho #715280), (Quotient #Z171U)
M. Anti-Leb (Ortho #715380), (Quotient #Z176U)
N. Anti-M (Ortho #715850)
O. Anti-N (Ortho #715950)
P. Anti-P1 (Ortho #715530)
Q. Anti-Cw (Ortho #721130)
R. Anti-s (Ortho #721830)
S. Anti-S (Ortho #723030)
T. Anti-I (Immucor #7-465)
U. Anti-Kpa (Immucor #7-540)
V. Anti-Kpb (Immucor #7-550)
W. Anti-Lub (Quotient #Z223U)
16. RESt; (Rabbit Erythrocyte Stroma kit for Cold Agglutinin Adsorption) (Immucor #57316) Store between 2 - 8°C
17. WARM (Adsorption kit for Warm Auto Agglutinin) (Immucor #57319) Store between 2 - 8°C
18. HPC (Adsorption kit for Bg Antibody) (Immucor #57320) Store between 2 - 8°C
19. Bovine Albumin (Ortho #718280), (Quotient #Z305U) Store between 2 - 8°C
20. Rapid Acid Elution Elu-II (Immucor #7-861) Store at room temperature
21. RhoGam 25 Doses (Ortho #780525) Store between 2 - 8°C
22. MicRhoGam 5 Doses (Ortho #780605) Store between 2 - 8°C
23. Thymol Crystals (Sigma #T0501) Store at room temperature in a desiccator.
24. LISS (Quotient #Z333U)
Yearly checks of centrifuges and thermometers comprise the standardizations in the Blood Bank department.
1. All Thermometers must be verified against an NBS certified thermometer upon installation and yearly thereafter. (Refer to the “Thermometer Verification” procedure.)
2. All Blood Bank Serologic centrifuges must be calibrated upon installation, yearly and whenever a significant repair or adjustment to the instrument occurs. It is also important to calibrate whenever a change in technique has occurred. (Refer to the “Centrifuge Calibration, Serologic” procedure.)
A. All patient Blood Bank test records and transfusion histories.
B. All reagent quality control records.
C. Complete records of all components delivered to a UCL Transfusion Service site.
A. The “Blood Bank Worksheet (Computer Downtime)” will be used to record all Blood Bank testing activity. This will be a temporary testing record and the results will be entered into SafeTrace Tx® when it is operational.
B. A blank Product ID Tag and Product ID Label will be utilized.
C. The hard-copy Blood Bank QC form will be used to keep track of QC results if necessary. (This is the permanent record.)
D. The patient history will be automatically updated daily onto the local hard drives. When the network or server is non-operational, the patient history will be accessed from the desktop of the PC using the “DOWNTIME” icon.
E. Refer to the “SafeTrace Downtime” procedure for more information.
A. Negative Antibody Screen:
When the antibody screen is negative and the patient’s previous history is negative, the routine crossmatch method is an Immediate-Spin (IS) crossmatch (Refer to the “Crossmatch, Immediate-Spin” procedure.)
B. Positive Antibody Screen:
In all cases in which the antibody screen or the patient history is positive, an Indirect Antiglobulin Test (IAT) crossmatch (uses anti-human globulin reagent after 37°C incubation) will be performed. The MTS Gel crossmatch will be used most often, but in some cases it may be necessary to utilize another method. The crossmatch tests, which incorporate the IAT method are:
b. MTS; Prewarmed
4. Temperature Recording:
Each day the temperatures of the storage units for blood components must be recorded. (Refer to the “Temperature Monitoring” procedure.)
A. Blood Storage Refrigerators:
Record the temperature of the chart recorder at the present time. Record both the top shelf and the bottom shelf temperatures. Blood storage refrigerators must be between 1 - 6°C.
The top shelf temperature is the default temperature, which is displayed on the front of the unit. The lower temperature is viewed by pushing the button labeled “Bottom” for a few seconds. The temperature will change to the temperature of the lower-shelf probe. There also is a chart recorder, which must be viewed to verify that the chart agrees with the upper LCD display. Record all temperatures on the appropriate posted log. Mark on the log that the alarm light is OK.
1. Jewett Double wide; see Finley procedure above.
2. Jewett Round; read the digital display for the top shelf and the mercury thermometer on the lower shelf. There is also a chart recorder, which must be viewed to verify that the chart agrees with the digital display. Record all temperatures on the appropriate posted log. Mark on the log that the alarm light is OK.
The mercury thermometer on the top shelf is read. The bottom shelf temperature is displayed on the alarm box. The chart recorder temperature is read and all three temperatures are recorded on the posted log. Mark on the log that the alarm light is OK.
B. Blood Component Storage Freezers:
Record the temperature shown on the chart recorder as well as the temperature inside of the freezer. Component freezers must be no warmer than -18°C.
The temperature of the freezer is displayed on the front of the unit on an LCD readout and on a chart recorder. Record both temperatures on the appropriate posted log.
The temperature of the freezer is displayed on an eye-readable °F/°C dial on the front of the unit and on a chart recorder. Record both temperatures on the appropriate posted log.
The temperature is displayed on the alarm box and observed on the chart recorder. Record both temperatures on the appropriate posted log. Mark on the log that the alarm light is OK.
C. Platelet Storage Temperatures:
Record the Chart recording temperature and the actual temperature of the environment where platelets are stored. The storage temperature for platelets is 22 - 24°C.
a. Finley and MMC-DBQ:
The temperature of the inside of the platelet storage cabinet is displayed on the front of the unit in a LCD display. There also is a chart recorder, which must be viewed to verify that the chart agrees with the LCD display. Record the temperatures of both on the appropriate posted log.
b. MMC-DV: N.A.
D. Test incubator:
The temperature of the incubator used for 37°C incubation is checked and recorded with antibody screens and antibody identifications. The temperature range for incubation is 35-39°C.
5. Instrument Maintenance/FV:
Refer to the individual Maintenance and Function Verification procedures for the instruments used in Blood Bank. The Daily Function Verification must be checked prior to any patient testing for the day.
A. The routine reagent quality control must be done daily prior to any patient testing. Refer to the “Blood Bank Reagent; Quality Control” procedures.
B. All quality control results must be reviewed each day.
A. When receiving a delivery of reagents from a supplier, take careful note of the appearance of the reagents. There should be no turbidity, hemolysis or questionable coloration of any reagents received from the supplier.
B. Record that the order was complete on the packing slip and give the packing slip to the person in charge of entering supplies into the computer. (Refer to the “Delivery, Receiving; Inventory Module: SafeTrace®” procedure.)
C. The entry of the reagents into the computer requires a “Y” or “N” for reagent appearance.
Note: If the appearance is not acceptable, notify a Supervisor or the Materials Management Supervisor. Quarantine the suspect reagents and document in the Blood Bank Incidence Log.
D. Keep newly received reagents segregated in the refrigerator until the computer recording is complete.
A. Release to Available all units that have been set for more than 3 calendar days. (Refer to the “Reserve, Disassociate, Release or Crossover Components; Inventory Module: SafeTrace” procedure:)
B. Refer to the “Inventory Management, Blood and Blood Components” policy to ascertain the appropriate ordering needs for the day.
C. All stored units must be inspected for normal color and appearance prior to issue/transfer or shipment (and daily at MMC-DV). Contamination should be suspected if:
a. The red cell mass looks purple.
b. A zone of hemolysis is observed just above the cell mass.
c. Clots are visible.
d. Plasma or supernatant is murky.
e. Plasma has a purple, brown, or red color.
f. The blood in the segments appears to be a different color than the blood in the bag.
D. Quarantine any unit of blood suspected of contamination, until evaluation of the unit is completed. Notify a Supervisor or Pathologist. Record all documentation, including resolution, in the Blood Bank Incidence Log.
9. Illuminated Optical Aid:
An illuminated optical aid is used in reading tube testing. It can also be utilized for reading the reactions in the Gel Cards. The device is designed to magnify the image of the test medium for better visualization of the reactions. Adjust the light at an angle that does not obstruct the view in the mirror, yet illuminates the area. Adjust the mirror so that the image may be easily seen without straining eyes or neck to view the object. The object is held over the mirror and observed in the mirror.
A. Set a labeled test tube in a rack and place a Hematype Segment Device on top of the tube.
B. Cover one end of the segment with a gloved hand, insert the other end of the segment into the Hematype Segment Device.
C. Push down on the segment to puncture the plastic and squeeze to obtain the sample.
D. Hold the Hematype Segment Device with segment in place and discard together into an approved biohazard medical waste container.
A. 3 % suspension of packed red blood cells:
a. Label a 12 x 75 mm test tube with appropriate identification.
b. Transfer a few drops of packed red blood cells to the labeled tube.
c. Prepare a 3 - 5% suspension of the red blood cells with buffered saline as the diluent. Use the A1 or B reagent red cell vials as a guide in the preparation of the 3 - 5% suspension.
B. 0.8% dilution of packed red blood cells:
a. Label a 12 x 75 mm test tube with the appropriate identification.
b. Dispense 1.0 ml of MTS Diluent 2™ into the labeled tube by using the 0.5 ml MTS Diluent dispenser and slowly dispensing 2 premeasured aliquots.
c. Take the centrifuged patient sample and using the 10µl pipette, insert the tip through the plasma, into the packed cells. Using the forward rinse technique, aspirate 10 µl of packed cells into the tip and deliver the 10 µl of the cells into the labeled 1.0 ml diluent tube.
d. Mix by gentle agitation.
C. 0.8% dilution of a 3% suspension of red blood cells:
a. METHOD 1 (makes 30 tests):
1. Label two polystyrene 12 x 75 mm test tubes with caps: I and II.
2. Add 0.5 ml of the well-mixed corresponding 3% screening cells to each tube using a graduated transfer pipette.
3. Centrifuge the tubes for 60 seconds.
4. Quickly pour off the supernatant with a flick of the wrist.
5. Dispense 1.5 ml of MTS Diluent 2™ into the packed RBCs by using the 0.5 ml MTS diluent dispenser and slowly dispensing 3 premeasured aliquots.
6. Mix by gentle agitation for an approximate 0.8% suspension.
b. METHOD 2 (makes 15 tests):
1. Label two Polystyrene 12 x 75 mm test tubes with caps: I and II.
2. Add 0.25 ml of the well-mixed corresponding 3% screening cells to each tube using a graduated transfer pipette.
3. Centrifuge the tubes for 60 seconds.
4. Quickly pour off the supernatant with a flick of the wrist.
5. Dispense 0.75 ml of MTS Diluent 2™ using a graduated transfer pipette.
6. Mix by gentle agitation for an approximate 0.8% suspension.
c. METHOD 3 (makes 2 tests):
1. Label as many test tubes as needed for the testing to be performed (i.e. Panel Cell numbers, Patient’s Auto Control or Antibody Screening Cells if not tested with this technique previously).
2. Mix the cells to be tested by gentle agitation.
3. Add 2 drops of the well-mixed corresponding 3% Reagent Panel, or patient’s red blood cells to the appropriately labeled tube.
4. Dispense 0.5 ml of MTS Diluent 2™ into the test tube by using the 0.5 ml MTS diluent dispenser and slowly dispensing 1 premeasured aliquot.
5. Centrifuge for 60 seconds.
6. Remove the supernatant:
Quickly pour off the supernatant with a flick of the wrist.
Clay Adams Serofuge:
Place a rubber band around the centrifuged tubes in the Serofuge head. Quickly pour off the supernatant into the waste container and tap the Serofuge head with the banded tubes on the lid of the waste container. Remove the tubes.
Ensure all tube holders are intact. Quickly pour off the supernatant into the waste container and tap the Serofuge head with the held tubes into the waste container. Remove the tubes.
7. Set the ID-TipMaster to deliver 50 µl.
8. Add 150 µl of MTS Diluent 2™ to the packed RBCs using the ID-TipMaster and slowly dispensing 3 premeasured aliquots of 50 µl each to each tube
9. Mix by gentle agitation for an approximate 0.8% cell suspension.
12. Positive Antibody Screen:
The routine response to a positive antibody screen is to identify the atypical antibody. (Refer to the “Antibody Detection & Identification; MTS Gel Card” procedure.) An Auto control is run with the initial panel to determine whether an autoantibody may be interfering.
A. If the Auto control is positive the most important information to discover is the patient’s transfusion and /or pregnancy history. If the patient has received red blood cell containing components within the past three months, or if the patient has been pregnant, it is possible that the patient may be experiencing a transfusion reaction.
a. Run a Direct Antiglobulin Test (DAT) on the patient’s blood. (Refer to the “Direct Antiglobulin Test; MTS Gel Card” procedure.)
b. If the DAT is positive, do an elution on the sample. Identify the antibody(ies) eluted from the cells. (Refer to the “Elution, Acid; Elu Kit II” procedure.)
c. Search the records to identify when/if the transfusion occurred at this facility.
d. Retrieve (if possible) all samples from segments saved from the transfusions and any blood samples from the patient.
e. Antigen type (if possible) the segment samples for the antibody(ies) found on the cells.
B. If the patient has neither received blood in the past 3 months nor been pregnant, then the offending autoantibody is probably insignificant. A drug history may be helpful.
C. With the transfusion history information in hand, it may be helpful to determine the testing methods used for hard to identify (weak) antibodies.
a. If the transfusion history is positive, it would be best to try to use enhancement procedures to identify the antibody.
1. The incubation time may be extended to try to enhance antibody uptake. The Gel test can be incubated for up to 30 minutes.
2. The PeG procedure uses Poly Ethylene Glycol to remove water molecules in the test system, which allows the antibody and antigens to come closer together. (Refer to the “Antibody Detection, Identification and Crossmatch; PeG Technique” procedure.)
b. If the transfusion history is negative, it may be best to try to minimize nuisance reactions. Some test methods to minimize insignificant reactions include:
1. Prewarmed; to get rid of cold antibodies. (Refer to the “Antibody Detection, Crossmatch and Identification, Prewarm; MTS Gel Card” procedure.)
2. RESt can be used to remove stronger cold antibodies. Its use is indicated if the pre-warmed procedure reduces the reactions, but does not eliminate the cold activity. (Refer to the “Antibody Adsorbtion (Cold); RESt” procedure.)
3. HPC is used to remove Bg antibodies. (Refer to the “Antibody Adsorption for Bg Antibody” procedure.)
4. Saline Tube Technique is used to reduce autoantibody interference. (Refer to the “Antibody Detection, ID and Crossmatch; Saline Tube Technique” procedure.)
D. When all testing is completed for the antibody identification, the pathologist will sign the results and write their interpretation of the identification. There will be times when their guidance will be required during the testing phase. There is a Pathologist on call at all times. The call schedule is posted in the laboratories.
E. Some cases require sending the specimens to a reference lab for identification. This is only done through the request of the Pathologist.
13. Obstetric Patients:
Atypical Antibody discovery:
If an atypical antibody is discovered in an obstetric patient proceed as follows to ensure that the clinician receives the necessary information to appropriately treat the patient and fetus:
A. Order an Antibody Identification, and then identify and report the antibody(ies) present. (Refer to the appropriate Antibody Identification procedure).
B. Save the original plasma specimen in the freezer. Label the tube with the patient’s name, ID number, date of collection and antibody.
C. Record that there is a frozen specimen saved (date) for further testing in the “Comments” section of the SafeTrace Tx® patient profile. (Refer to the “Patient Demographics and Orders (Electronic and Manual Entry); SafeTrace Tx®” procedure.)
D. Subsequent order for an Antibody Titer:
(Refer to the “Antibody Titration; MTS Gel Card” procedure for testing.)
a. Review the comments section of the patient profile in SafeTrace to see if a specimen was frozen and saved.
b. Retrieve the frozen specimen and proceed with the testing in conjunction with the new specimen. (Refer to the “Antibody Titer; SafeTrace Tx®” procedure for results entry.)
c. Once the testing is reported, it is acceptable to discard the older specimen.
14. Washing Cell Suspensions:
Tube method cell suspensions used for antibody screening or identification must be washed at least three times with saline, decanting after the last wash, before the Antiglobulin reagent is added.
A. An automatic cellwasher may be used, if available.
B. A manual method of washing the cell suspensions can also be used.
a. Fill each tube ¾ full with Blood Bank Buffered Saline.
b. Centrifuge the tubes in the Serofuge on high speed (see time requirements for centrifugation on each instrument).
c. Decant the saline letting the last drop of saline flow back into the tube. Resuspend the cells.
d. Repeat steps A - C at least two more times, decanting thoroughly after the last wash and shaking the tubes once to remove most of the saline.
Patients are required to have a physician’s order for autologous or directed donation. Once the physician’s order is received the patient should contact Mississippi Valley Regional Blood Center donation site to make arrangements: 563-585-2144.
B. Hospital Blood Bank:
The blood supplier notifies the designated hospital Blood Bank that unit(s) for a patient will be arriving for surgery. This information is entered into SafeTrace (refer to the “Autologous and Directed Units” procedure). When the unit(s) arrives it is linked to the patient during the receipt of delivery (refer to the “Delivery, Receiving; Inventory Module: SafeTrace” procedure).
16. Proficiency Survey:
API and CAP proficiency surveys are utilized in Blood Bank. Follow all survey directions and refer to the “Proficiency Survey, Blood Bank” procedure. Proficiency results are recorded on downtime documents.
Mississippi Valley Regional Blood Center (MVRBC) is the blood supplier for the Dubuque/Dyersville hospitals. MVRBC takes an active role in maintaining adequate RBC and Platelet inventories at each site as well as exchanging older units to avoid outdating.
Refer to the “Inventory Management, Blood and Blood Components for Minimum Inventories” and the “On-Line Ordering System, MVRBC” procedures for product ordering.
1. AABB Technical Manual. Latest version.
2. AABB Standards for Blood Banks and Transfusion Services. Latest version.
3. Package inserts for all reagents listed; latest versions.
4. Package inserts for materials as needed; latest versions.
5. ID-Micro Typing System Interpretation Guide; Ortho-Clinical Diagnostics; latest version.
i. September 2002 M. Burger, S. Rodriguez, S. Hosch
ii. June 2007 M. Burger, S. Hosch, S. Rodriguez (Revised: II.5-6.; VI.4.,13.,16.; VII.)
iii. December 2008 N. Combs (Revised: III.15. added)
iv. May 2009 M. Burger (Revised: IV. Monoclonal Grouping Cards added)
September 2009 S. Hosch (Revised: VI.4.D.)