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- Yesterday
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Hello MelC, Welcome to PathLabTalk. Please feel free to browse around and get to know the others. If you have any questions please don't hesitate to ask. MelC joined on the 10/17/2018. View Member
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Is there still a good serological centrifuge out there?
Mabel Adams posted a topic in Transfusion Services
We have been trying to buy a new serological centrifuge but the Clay Adams is backordered for months. All of the vendors keep suggesting others that they think will work. We have already tried a Hettich EBA21 and just can't get it to work as well as the old Clay Adams. We get different results on titers using the 2 different centrifuges. Cell suspensions that are washed in it end up mixed once the braking stops. If we set the brake lower, it takes too long to stop. Is there a good serofuge for sale in the US anymore? I miss the Immufuges of 1985. -
MelC joined the community
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Love the idea of setting a timer - it is so easy to get distracted and miss the finish of a STAT specimen. The ECHO does not have a loud (obnoxious) alarm when finished and many of our techs are out in the Main Lab anyway when the instrument is running (perpetual staff shortages).
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We use the CDC guidelines for the pathologist to interpret the reaction workup, not for nurses to determine whether it is a suspected reaction needing workup--not that they shouldn't have such information available. We also quote the JC standard in our procedures that says the workup should be performed if it meets our criteria "regardless of whether the physician deems it necessary".
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We have had the Hettich EBA 21 centrifuges for years - have never had any problems with them. Speed 3000 rpm, ramp up 9, ramp down 5, for all times (20, 45 and 60 secs). We wash our titers in the Helmer Ultra CW, but spin them in 1 of 2 Hettich EBA 21s. Within reason (and training), we do OK with titers (Cap proficiency is midrange on the bell-curve.)
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Darkening of panel cells-possible contamination?
cswickard replied to KBBB's topic in Immunohematology Reference Laboratories
While it shouldn't be affecting your in-house panel, watch for shipping damage (out of temp) also on the commercial panels. Might cause the damage. We just had one CAP survey for automated Blood Bank that we had to replace 1 out of 6 tubes that was dark (and hemolysed?). Rest were ok. -
Once the interfering drug is gone, we would treat them like a usual patient with a negative antibody screen. One caveat is that our BBIS won't allow an EXM for any patient who has ever had a positive antibody screen reported. If we ever reported the initial screen as positive instead of the DTT-treated screen (negative, I hope) we would have to do future XMs by IS rather than EXM. If we knew the patient would go back on it, I suppose we might give K negative units but most that I have seen go off of it didn't go back on and, frankly, most expired within a few months. This experience is mostly from the early days when it was only approved as a last resort therapy so now less refractory patients are taking the drug and may have different outcomes.
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1. How many beds in your facility? About 450 with additional offsite NICUs, level 1 pediatric trauma center 2. What is your TAT? We only monitor T&S from the Emergency dept- 45 minutes or less (goal is 95% resulted within 45 min. We are usually 97-99% and perform around 120-150 samples from ED per month) 3. Is the TAT calculated from order to result or receipt to result? From receipt to result only 4. Who collects your specimens? RNs, phlebotomists, others? RNs or IV team 5. Do you have any automation in your Blood Bank? Yes- one Vision; it has not impacted our TAT for these ED samples. We set a timer when a STAT is placed on the Vision so that it can be resulted as soon as results are available.
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sub-optimal staining of blood and marrow smears
kimannez replied to mminhas44's topic in General Information
We experienced the same thing with our bone marrow smears, then we realized that it was because the marrow smears were being sent in the same container as the biopsies--xylene fumes fix blood smears, but cause them to resist staining. This may not be your issue, but who knows? Also, age and storage of the smears may influence staining: we found that if smears were fixed they stained better if they were then stored in the dark after fixing. -
Darkening of panel cells-possible contamination?
KBBB posted a topic in Immunohematology Reference Laboratories
We use multiple suppliers of panel cells as well as make an in-house panel from frozen donor cells. Over the last year we have noticed several vials in multiple lots of commercial panel cells from one supplier going dark (contaminated?) as well as our in-house panel cells that are suspended in commercial red cell storage solution. Has anyone else noticed this type of problem with any of your commercial panels? Have you ever had the problem and figured out what was causing it? We have considered fungus or bacteria getting into the vials, but can't really explain what is going on with the two different issues. We are looking at another brand of modified Alsever's solution to try for our in-house panel but that doesn't solve the commercial panel mystery. Any thoughts? -
Unlike the Provue, newer gel analyzers can allow partial panels to be run.
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We can't get our Hettich EBA 21 to do a good job of spinning tubes. We find we get different answers from titers run using it. The cells get mixed up in a manual wash. The vendor suggested we change settings so the braking is less but then it takes forever to stop. My staff wants to get rid of them but there isn't much out there to buy these days. Does anyone have a good answer?
- Last week
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I did not calculate blood bank TATs from order to completion. I started the clock when the sample arrived in the blood bank. I had no control over what happened between order and sample arrival. For the rest of your quest for info, I have been out of the loop too long to provide any current info. I'm looking forward to hearing what others have to say. Oh, my reference for my limited response was a 350 bed, level II trauma center.
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Scott
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Would some of you please share your TAT's for STAT T&S or T&S with 2 unit XM? We are looking to revise our standard. To compare, the following information would be helpful: 1. How many beds in your facility? 2. What is your TAT? 3. Is the TAT calculated from order to result or receipt to result? 4. Who collects your specimens? RNs, phlebotomists, others? 5. Do you have any automation in your Blood Bank? My facility: 350 beds. 60 minutes from order to result. BB Techs and BB certified phlebotomists collect specimens. Not automated. Previous supervisors threw out most of the outliers so that the goal of 90% within 60 minutes was met. I exclude very few data points, thus our TAT hovers just under 55%. I want to establish a reasonable, meaningful standard. Thanks in advance!
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Welcome RANDELL DE JESUS.
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Hello RANDELL DE JESUS, Welcome to PathLabTalk. Please feel free to browse around and get to know the others. If you have any questions please don't hesitate to ask. RANDELL DE JESUS joined on the 10/15/2018. View Member
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Rhogam/rhophylac must be under pharmacy control
seraph44 replied to BUGGIE's topic in Transfusion Services
We will be moving our RhIG to the pharmacy within six months. I find a bit confusing because of how I've handled RhIG in the past. This is what JC currently says: QSA.05.13.01 1 The laboratory’s written policies and procedures for the administration of Rh immune globulin address: - Criteria to identify patients eligible for prophylaxis - Procedure to determine dose of RhIG required - Optimal timing of administration following exposure QSA.05.13.01 2 The laboratory follows its policies and procedures for RhIG administration. Once RhIG is moved out of the Laboratory, do we still monitor if the patients received RhIG appropriately? The part of "Criteria to identify patients eligible for prophylaxis" has me wondering. We will have doctors order a "Trauma KB" and a "Post Partum KB". This is easy to keep track off, but how do you keep track of a typical pregnant female with vaginal bleed and they order and an order for an ABO/Rh through the E.D.? Do the folks who no longer dispense RhIG have to pull any reports to and go through the trouble of making sure that all eligible patients received their RhIG? or is this something that pharmacy has to do? Would you all agree that the criteria to identify patients for prophylaxis should not be applicable to the blood bank since we no longer dispense? I would assume our only responsibility should be to perform the testing and for the pharmacy to now have a checklist to determine eligibility. Thanks, -
What is your policy for transfusion after the treatment is completed and the antibody screen is negative, again. Sorry the treatment is Daratumumab.
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transfusion
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RANDELL DE JESUS joined the community
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Hi Malcolm, I think there is an earlier article as well, but this is a good one. Thanks. And ...regarding your reply to Cliff about giving RhIg...you said to give the lady with Partial D or weak D (other than type 1, 2, or 3) a double dose of anti-D. That's new to me. Can you provide me with a reference for that? I want to discuss that idea with my medical director.
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sub-optimal staining of blood and marrow smears
Amy Sweeney replied to mminhas44's topic in General Information
Hi What stainer do you use? What slides are being used? We have fought with this also. It could be a number of things.... -
Welcome Dr Mohamed Farouk.
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Hi, We often receive unstained peripheral blood and marrow smears from other cities in the country. These smears do not stain optimally at our facility, even after manipulating stain timings. Therefore reporting these is problematic. We suspect that folks out there fix the unstained slides in alcohol before sending them to us. Is there any solution for improving the staining??
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Welcome
