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  2. If documentation of proper blood handling for transfusion is not appropriate, I am pretty sure that the inspectors will not care whether it's happening in the Blood Bank in the Lab or in OR. This is healthcare, after all, and this is my hospital. I do think it is worthwhile to try to correct deficiencies. It make seem like a sisyphean task at times, but one cannot just give up on this stuff just because we "are at the mercy of human beings". (We should all be used to that by now!) I do think that efforts should be concentrated on making things as simple as possible, not only for ourselves, but for those other humans in all the other departments that we work with everyday. I do think its worth the effort. Scott
  3. This is not a popular concept but at some point we have to accept there are things we can not control. Once the blood leaves the blood bank we are at the mercy of other humans and as long as the human factor is involved there will be human error be it unintentional or intentional. Attempting to complicate a process will only provide inventive humans the opportunity of coming up with creative work arounds to circumvent your best of intentions. At some point you just have to step back, do your job and hope for the best. I had a corporate transfusion QA director who could not accept that human error could not be completely eliminated with out eliminating human involvement in the process. Her directives became horribly complex solutions with multiple, redundant checks and balances only resulting in increasing problems. Bottom line, pick your battles and fight those you have a reasonable chance of winning. Make suggestions, offer insight, provide training opportunities but at the end of the day realize that you have to accept some things are simply beyond your control and even your influence. On that happy note I'll step off my soap box and stop my philosophical ramblings.
  4. Generally during the same patient stay. Scott
  5. Exactly Scott, we have many patients who are "snowbirds", spending the warmer months here in New England, the head down south for the winter. We have no idea of their transfusion history away from here, and often are not very reliable upon questioning as to where / when they were transfused. Other local patients seem to like trying out different hospitals (we have about 5 within 30 minutes of each other). We sometimes call them "shoppers".
  6. We do not have units in a fridge in OR (or anywhere else for that matter besides the BB). Our BB is just down the hall from OR, so our OR units are kept in the BB until needed for a specific patient Then they are issued in a cooler. Presumably the correct ID and read-back is done in the OR for each unit. Scott
  7. I have read several threads, some maybe 10 years ago regarding this matter but I didn't see anyone really addressing the following. My question is does anyone work at a hospital where anesthesia scans in the blood unit prior to transfusion?? According to AABB 5.28.4 "The transfusionist and one other individual (or an electronic identification system) shall, in the presence of the recipient, positively identify the recipient and match the blood component to the recipient through the use of 2 independent identifiers". There is also a similar statement from CAP TRM.41300. We had a near miss several years ago, same situation, different place. One refrigerator being shared in the OR, 2 big cases going on, you get the scenario. To me, it doesn't matter how great the cooler, refrigerator, blood tracking .... there is no fool proof system but can we get close to one? one of the threads addressed the Joint Commissions Sentinel Event Alert regarding blood for multiple OR patients in the same refrigerator among other things (1999). This was 20 years ago!!!! Have we not improved this in 20 years???? Is it that hard to scan in a blood unit? Does it not take more than 5 seconds to do this??? The people making these computer decisions at our facility just can't see how important this is. Geez and in this day and age of computers all I get is "Our computer system cannot currently check this and that and blah blah blah is all I hear. Calgon take me away! Sorry for the rant but I needed to get that off my chest.
  8. I totally agree with David. I would say most of our Anti-M's react only with the cells that have the homozygous expression and not with the heterozygous expression. I would say you have to call it an Anti-M especially if Gel is your primary method of testing with tube as your backup. I don't think you can call it negative just because the tube has no reactivity. We sometimes (very rarely) would have a Warm autoantibody that showed pan-agglutination in Gel but was negative with tube method at one hour incubation, no enhancement excluding the auto control which is usually still reactive. We would just add a comment about the negative results in tube method just for proper documentation but still result as a Warm autoantibody.
  9. Last week
  10. By definition, reagent reverse grouping A1 and B cells are used to detect anti-A and anti-B antibody in patient plasma. Accordingly A1 cells should react with anti-A but not with anti-B, and B cells should react with anti-B but react with anti-A. Therefore, A1 cells should not be agglutinated by anti-B. No agglutination is a negative test result, i.e., a negative control test. Likewise, B cells should not be agglutinated by anti-A. No agglutination is a negative test result, i.e. a negative control test. Testing A1and B cells with AB plasma, Diluent, Albumin or saline may demonstrate that the test cells are not spontaneously agglutinating in their presence which serves as a negative control for those reagents, but does not serve as a negative control test for A1 cells or B cells.
  11. We are also Epic/SoftBank, SB since 2009, Epic new last year. Would love to hear more!
  12. Hmmm. Here in Michigan, we are indeed doing negative controls for reverse cells (we just use albumin). We are FDA and JCAHO inspected. Scott
  13. Hi Maryann, The point is that the terms homozygous, heterozygous and hemizygous can only refer to genes, but, of course, red cells do not have a nucleus (it has been extruded during the maturation process), but, in any case, the terms should not be used for antigens. In this case the closest to being correct is that M+N- red cells have "homozygous expression" and M+N+ red cells have "heterozygous expression". However, particularly in the case of the MNS Blood Group System, this terminology is not completely correct. There are many low prevalence antigens associated with both the glycophorin A and the glycophorin B molecules, and the many hybrids therein, that a red cell that groups as M+N- may not be as a result of MM homozygosity at a genetic level, but may have heterozygous expression, because there is one "M" antigen (for want of a better way of putting it), and one low prevalence antigen expressed on glycophorin A (or a hybrid), so that, in terms of expression, the M antigen has the strength of an M+N+ red cell, rather than an M+N- red cell. I hope that helps. Malcolm
  14. My understanding is: If you are irradiating then Yes. It is a new product. there are also licensing requirements that may be relevant.
  15. Thank you Malcom and David, In doing some digging I did find another thread about Anti-M a few years ago that both of you gave input on, and it was a similar situation but perhaps more tube testing rather than gel. Sorry about calling cells homozygous, Malcolm - what is the correct name for an M+, N- cell and an M+, N+ cell? Just MM and MN - no homos or heteros? Maryann
  16. I am revisiting this question. Does Irradiating a product be considered preparing?
  17. If I am qcing gel - I use the diluent as a neg control. If I am qcing tube reagents, I only test a pos and neg w anti-D, otherwise, only positive qc. (personally, I think that tubes should be qc'd pos and neg but it is not required in the US (FDA).
  18. I love this card. Had the opportunity to try it (thanks Malcolm). Too bad it's not available in the USA. I do not usually run a control with my IgG cards. When I test w anti-C3b,-C3d I use my A2 cell as a negative control/C3 sensitized cells as positive.
  19. I find a considerable number of anti-M's using gel. The majority only react w MM cells. Gel is known to enhance anti-M activity (at least Ortho's). When I find any anti-M I set up prewarmed testing to see if it is clinically significant. Usually these types are not.
  20. I certainly wouldn't use your nomenclature (only genes can be homozygous, heterozygous or hemizygous), but I know what you mean. I would most certainly say that the patient's plasma contains an anti-M, but, despite the fact that many cases of "cold reacting" anti-M are IgG, if the anti-M does not react at strictly 37oC, it is not clinically significant.
  21. I keep a notebook with calibration certificates in it. I also have a reminder on my on line calendar that comes up about 4 weeks before the calibration on that item expires. When I see the reminder(s), I order new thermometers. Ditto for the stop watch. Those things are not big budget items. Once they come, new thermometers go into service, old ones are removed and discarded, new certificate goes in notebook, old certificate goes into archive file. I decided a couple of years ago that I am too hard pressed for time to check calibrations on things like thermometers. Biomed has put my scale (for the Echo) and the tachometer on the list of things that their outside contractor checks yearly. My pipettes get sent out for calibration check - one of our evening techs is responsible for that, so all I have to do is check the certificate and file it in my notebook. When the inspector wants to see that stuff, it's all in one place. Prior to this, I had a simple spreadsheet with all of the thermometers on it, listed by serial number. Each year I used a fresh copy of it. Part of the thermometer ID was where it was at. If it got moved, I changed that info on the spreadsheet, so at least I could find them. If they failed the annual check, I would note that and indicate that they were removed from service on that document. Once removed from service, that one was removed from the spreadsheet and the replacement was added. Those went into my notebook. I make a note at the top of each item's calibration certificate the date it is placed into service and the date it is removed from service. I don't have a huge number of these types of things, so it works for me. If I had more, I think I'd add a 'permanent' spreadsheet for tracking everything that documented in service date, removal from service date, and anything else that seemed important - just adding new lines for new stuff to the bottom of the ever growing list. I'm trying to put as much of those kinds of documents as I can into MediaLab to make review/approval documentation easier.
  22. Hi Blood Bankers, Question - if you find a patient who is demonstrating an Anti-M in the MM cells only, the MN cells are negative when testing in Gel, in otherwords the Anti-M is only showing up in homozygous M cells in Gel, and in tube testing with LISS, all cells both homozygous and heterozygous for M are completely negative in all phases, would you go ahead and call the patient Positive for Anti-M antibody? I have always called these patients as having Anti-M even if it is showing with homozygous cells only but other people are telling me that they can rule out of 3 negative heterozygous cells. Thank you.
  23. We use a screening cell for the neg control and Ortho Coombs Control (made to 0.8%) as the pos control for both poly and IgG Gel cards. We only perform IgG and Poly DAT's.
  24. Smiller - When you say you have done a "recent" pos DAT workup, how do you define recent? What time frame?
  25. I have a somewhat related question and would love your (and anyone else's) input. Do you have a good system for documenting annual thermometer calibration? We have a lot of thermometers and, over the year, some get moved or broken, so I am trying to find a good way to keep track of where they are and which are due and document their calibration.
  26. Thanks for the heads up. Now if only we could get someone to tell us or tell the patient to tell us that they are on these drugs. If you have any "pull" with someone in Seattle, feel free to pass along the request.
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