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  3. A quick disadvantage is the need to ABO match, so just from an inventory standpoint, you're going to have to manage the fine balance in stock without wasting products by the end of the expiration date. How long do you keep the WB before storage and preservation becomes more difficult? Towards the end, would you end up separating it into components? Would you just be ordering low titer group Os? Advantage that I've read is that the platelets contained in WB are kind of a "bonus" product compared to just issuing 1:1. Furthermore, one WB containing 3 different types of products essentially reduces donor exposure because the WB is only from one source. Whether that can therefore reduce immunological responses and antibody formation is another question. There was a review published in December of 2018 that outlines some of your bullet points: Massive transfusion of low-titer cold-stored O-positive whole blood in a civilian trauma setting. Transfusion, Epub Dec 27, 2018.
  4. I've seen have aliquoted units on hand ready to go that are replenished when needed/expiration. Firstly, there's an emergency release prep bag with a pre-filled out emergency issue slip with irradiated units that just need a pt identifier slapped on it before send out. Secondly, there's also other aliquots that can be irradiated and issued per need.
  5. Yesterday
  6. Yeah, we're kind of the same. In terms of standard T/S testing and the cutoff for acceptability, we just throw it on our IH and if it doesn't like the sample it's just done manually. Usually the contrast distinction chromatically is the problem that triggers a rejection/difficulty in testing via machine. Only when there's hemolysis in a post-transfusion rxn specimen is another redraw requested...
  7. Yes there is a Guidance from the FDA regarding bacteria testing of platelets that has been a Guidance for awhile. One of the methods to be compliant in this is to use pathogen reduced platelets, or perform bacteria testing on platelets on day 4 and 5 prior to issue. I was told that the FDA is being told that they need to finalize this Guidance this year around October, I believe.
  8. We very rarely transfuse neonates (like 3 times in the last 4 years). Because of the rarity, we no longer stock a quad unit. We have gotten approval to give the baby the freshest O= on the shelf until the quad unit can get here from the blood center. Here is my question for others like us. When you get an emergency request for blood for a neonate, do you take the time to aliquot for the nursery or do you issue the entire unit and let the nursery physicians aliquot what they need?
  9. At the beginning of the testing process, ProVue warns the user with a disclaimer displayed onscreen that hemolysis, icterus and turbidity (wbcs, lipemia) may interfere with reading of a sample. ProVue takes an image of the gel well and does a gray-scale analysis. The presence of turbidity, hemolysis and icterus would darken the image and prevent analysis due to lack of contrast. Byfaith was asking if her current criteria is too restrictive and for options for sample rejection criteria when using automated gel testing. My suggestion was to let the machine determine sample acceptability. Using a visual color chart comparision process that was probably developed for manual tube testing ignores the machine's capability to do sample rejection that is more consistent and appropriate for the machine.
  10. Transfusion reaction workup is a whole 'nother animal. If I get a post-transfusion specimen that is hemolyzed, the first thing I do is ask the phleb if the draw was difficult. If it was, I send up someone else to obtain a new specimen. If we can't get a clean specimen, then that information is part of the documentation and taken into consideration with the interpretation of results.
  11. Oh, I agree Malcolm. And we do accept slightly or even moderately hemolyzed samples in our lab, depending on the test. My point was, in the case of a possible transfusion reaction, when one has to document pre- and post- appearance of the plasma, it is completely pointless if the pre- specimen is hemolyzed to begin with. Anyway, this thread seems to be more concerned with automated ananlyzer requirements regarding hemolysis. I have found a few papers online, but it seems like they are only verifying that analyzers only begin have problems with at least moderate amounts of hemolysis. Not being experienced at all with what Byfaith is working with, I would guess that if the manufacturer doesn't have a problem with lesser hemolysis, they may be nothing to worry about. Scott
  12. We use Alba-Q-Chek. Packages are stored upright. On the day we open a new set (set expires 7 days after opening), we mix vial 4 thoroughly by inversion and then add 40uL of Ortho Anti-D BioClone, thoroughly mix by inversion again and centrifuge. This gives us a positive DAT control (reacts 1+ - 2+ consistently for 7 days) to run on ProVue. Any of the other 3 vials can be used as a negative DAT control.
  13. You could dilute your IgG sensitized cells to 0.8%. I'd make certain they don't react in the buffered gel card.
  14. The last guidance I could find was from 2018 and was only discussing ways for 5d plts to be extended for 7 days. This was going to the BPAC for their input. In 2016 their was a guidance for comments which would require bacterial contamination testing for plts on day 4 or day 5 if the product was in your control and was going to be transfused. This guidance was put on hold the last I knew (which was also in 2016). I'll see if I can find any further info.
  15. So, a vendor showed up this week talking about the "new FDA Guidance for platelet bacterial testing." All the info I've found thus far doesn't state that there would be mandatory testing for platelets. Does anyone have any other information regarding this that they would be willing to share? TIA
  16. Sorry Scott, but there are a myriad of tests available do demonstrate a haemolytic transfusion reaction that are far more accurate than haemoglobin in the plasma, which may be present for a large number of reasons other than a "rough draw". To give but one example, I would defy even a very skilled phlebotomist to produce an absolutely "clean" sample in the case of a patient with a very strong "cold" auto-antibody, either pre- or post-transfusion.
  17. True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab. My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used. I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though. I have learned never to respond in the heat of the moment if it isn't absolutely necessary.
  18. The only previous listing on this topic was by SMILLER in 2017. I wonder NOW has anyone moved to using STORED whole blood in a tertiary care urban hospital. The Story so far: Our supplier has an inventory of whole blood (some of which is used by the Fire dept or first responders at site of trauma). They would like the hospitals to use whole blood for massive transfusions and are trying to convince the surgeons about the advantages. Question is: What are the advantages (if any). What are the disadvantages. What would be the indication to use whole blood (instead of the massive transfusion protocol that we currently use). What about the logistics of matching blood types? (also I know most whole blood are obviously not leuko reduced). I realize there are many questions, but I appreciate your time and any response. Thanks, P.S. I just saw Jayinsat write updates about the conference in san antonio in 2019. I read the online presentions, but still didn't get convince about in hospital use of the product. Lablion
  19. We also use Epic BPAM for administration, so if provider orders are not in the system correctly and nursing doesn't release those orders, BPAM won't work. They've been learning that the hard way. Some nurses still like to point the finger at Blood Bank, but their IT folks can see when the problem is user error rather than a lab issue. They educate nursing staff accordingly. There are still problems, but at least nursing management knows where the problems originate and some of the front line nursing staff is getting pretty tuned in to BPAM. When blood products are in a 'completed' status in Epic at my facility, a little red blood drop shows up at the top of the nurse's screen in Epic, something like the 'new test results available' notification works. They still call sometimes, but that little drop has helped tremendously. We do communicate by phone if the patient has antibodies or there is some other reason for delay. We might also notify surgery or the ED that blood products are available in some situations, but not routinely. When the provider signs the Transfuse order in Epic, a copy of that order prints in Blood Bank. When the transfusionist releases the Transfuse order, a copy prints on the floor and in Blood Bank, so we know that they are ready to start the transfusion. The nurse who comes to check out a blood product brings the Transfuse order that printed on the floor when the order was 'released', which serves as positive patient ID for us. Works well for us even if it does kill trees.
  20. We do a positive and negative control for our IgG cards daily. Of course, that's with a 37C incubation. So, what's the best way to do QC in the gel without the 37 incubation?
  21. OK. But for a possible hemolytic transfusion reaction, do you not have to compare plasma pre- and post-transfusion? We do (maybe its not required?) If the pre-transfusion specimen starts out hemolyzed, it's not going to matter that your automated analyzer completes it's testing-- the comparison in the case of a workup would be useless. And I would agree with those who say it is generally bad lab practice to test hemolyzed specimens for any test. It indicates that there was a rough draw and the quality of the specimen is questionable for many analytes. Scott
  22. The Echo won't like a specimen w/ hemolysis at 3-4+ when graded. That's actually quite a lot of hemolysis, so the specimens we reject for hemolysis are few and far between. The majority of our hemolyzed specimens tend to come from IV starts collected by nurses - they are 'supposed' to be saving us time by collecting specimens that way.
  23. Mabel - our patient is wearing a medical alert bracelet which says that she has the antibody. Not sure exactly what it says about transfusions as her provider dealt with the details. The patient (former nurse) and her husband are both very aware of what her problem is so are able to communicate effectively about her situation, which is very helpful. We were contacted by another facility not too long ago w/ questions about her as they were making plans for a surgical procedure - did we actually test for the antibody? (we did), symptoms of her reaction, etc. She is now, understandably, very reluctant to consent to transfusions.
  24. Last week
  25. I don't reject samples based on visual inspection, I let ProVue decide. If ProVue can't read the gel card and if the user can't read the card manually, then we reject the sample and get a new sample.
  26. There is older literature referring to the concept of hemolysis as a positive reaction interpretation. I believe this is relavant only to tube testing. There is also the fact that using EDTA samples complement does not come into play and therefore no hemolysis of test cells? I believe our cutoff is random, going along with our chemistry laboratory cutoff.
  27. It seems to me that the only time hemolysis comes with an acceptance/rejection gradient is with washing RBCs (at the institutions I've seen). At least for that there is a color hue chart to match. If the gel can't discriminate between the layers, it tends to just call it DP and it gets sent for tube testing. I've never seen a sample rejected based on hemolysis... Is there literature to dictate a cutoff?
  28. We are still doing it the old fashioned way -- manual gel -- but if the plasma is so dark that you cannot tell the difference between it and significant hemolysis (thinking possible transfusion reaction comparison), I would think you would want to have it redrawn. We let sight hemolysis pass with a comment added to the specimen when it's checked in. Not sure but I would think that would be around 50 mg/dl or less. For an automated platform, can you not consult specimen requirements from the manual? Scott
  29. We have always used a cutoff of 50mg/dl hemoglobin concentration (Visual color chart). We use EDTA tubes and Provue analyser. Are we overdoing it? Sounds like many places take everything but gross hemolysis, and even those on an urgent case.
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