Leaderboard

I just saw this seminar being offered by Bio-Rad with our own, infamous, Malcolm Needs as the presenter. I registered and thought I'd pass the word to all of us here. Here is the link:https://info.bio-rad.com/ww-IHD-transfusion-w-registration-lp2.html?elq_mid=48765&elq_cid=10201434&elqCampaignId=30837&utm_campaign=30837&utm_source=eloquaEmail&utm_medium=email&utm_content=Email 13ER EM-R-CM-385201-FY21-TCHS-AWEN_BR-JRNL-TRF News 19 Nov&elqTrackId=6ecbbea5f2bb46849981687404578a8e&elq=7c5f74470efa434dbd4351e512f7ae7a&elqaid=48765&elqat=1&elqCampaignId=3

Ok, here we go. First is from a personnel stand point. When promoted from with in you are no longer "one of the guys". This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others. Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place. This does not have to be dramatic and should not be, but it is real. Some can do this and some find it very difficult. Now, when coming from outside your are exactly that, an outsider. Now the level of this can vary immens

I agree with you that it does sound daft, but I am in the position to tell you why this is the recommendation, despite it apparently being contrary to BSH Guidelines, as I was still working when the decision was made (albeit, I don't agree with it!). The huge majority of hospital blood transfusion laboratories now use column agglutination technology (CAT) as their "first line of attack", and many of them use the CAT that uses gel in the column, rather than glass beads. This form of CAT is particularly adept at detecting anti-M in plasma by IAT, even though the anti-M may not actually be

To this I will add, pick your battles carefully. Make sure they are worth fighting. If you came from outside the facility be very judicious when using the phrase, "The way we did it"! Changing something to the way you did it else where is not necessarily a change for the better just because it makes you comfortable. Make sure you understand your new facility's processes before trying to incorporate sweeping changes. As I noted above, much of my advise would depend on if you came from outside or promoted from within. This is just one golden nugget for you to consider.

Maintaining enough staff. Too many people use a large facility as a stepping stone to another job for more money. Having Senior Management understand the difference between a Blood Bank and Clinical Lab - we're not the same. Maintaining inventory. There is always a shortage of something. Competency Assessment - huge pet peeve of mine. You go to a talk by _____________ and hear them pontificate on how we all make competency assessment so hard on ourselves. Then say something silly like, all you need to do is watch them do a _______ proficiency testing sample, they will be pro

I would just replace the battery and not tell anyone.

Congrats! Become very knowledgeable in all things BB. Read everything you can get your hands on and go to outside meetings. Learn why we do the things we do. Don't be afraid to change things that were always done that way. Get to know other BB leads/supervisors in other hospitals, they are a great resource. Don't let the staff push you around, you are not their mother or babysitter. Know the difference between anti A and anti A1 (pet peeve of mine). You got this!!!

The British Society for Haematology (BSH) have just issued an updated version of their "Guidelines on the use of irradiated blood components" (actually on 9th October 2020). The recommendations for patients who have received allogeneic haematopoietic stem cell transplantation (HSCT) is as follows. "All recipients (adult and paediatric) of allogeneic HSCT should receive irradiated blood components from the time of initiation of conditioning chemo/radiotherapy. The recommendation applies for all conditions where HSCT is indicated regardless of the underlying diagnosis. Irradiated

Infamous??????????????????????????

First question, were you promoted from within the organization or did you come in from the outside? Believe it or not it can make a significant difference n how successful you will be. I've experienced both in my career. After I see your response I'll provide my very wise advise. Rest assured you will find it worth every penny it will cost you.

I would familiarize yourself with whatever regulations your lab is accredited with (AABB, CAP, TJC). That helps get you an understanding of what needs to be done and why.

We used to do universal irradiation but then became aware of two things. One, irradiation of red cells causes increased hemolysis during storage. That's been known for some time. But in recent years, the toxic effects of infusing free hemoglobin or increasing hemolysis in vivo have become evident (e.g., sickle cell anemia; levels of hemolysis correlating with morbidity in surgical patients). So we stopped irradiating everything at that point. Just per protocol. Leukoreduction reduces GVH in the British data.

The age old problem of how do you make people pay attention to the details...If you figure this out, let me know. I haven't yet. Do you not have an "IRRADIATED RBC" product in your dictionary that the physician could have chosen? That puts the responsibility on them, where it should lie. A comment is not an order and, if they are relying on that, they are forcing your techs into a position of failure. I would suggest you add an irradiated product order to your dictionary. If the physician wants that product, they must order that product that way.

Lookit wiseguy, I was responding to a comment about platelets. We have had docs request plasma when patients had severe reactions in the past and washed product restrictions. No, we have not figured out how to wash plasma yet.

I will be there

I'm signed up and I can't wait. We are implementing electronic issue in April of 2021. Malcolm you rock!

I would have used Notorious!!

To be honest, I don't know, BUT, given that it would be almost impossible to know whether the donor of the red cells is a single dose En(a+), as it is with most of the 901 Blood Group Series antigens, I would have thought that any donor with a normal MNS phenotype would do, but that the pregnancy should be monitored by MCA Doppler.

One of my many too!

The script that runs Welcome Bot is under repair. There have been new members, they just missed out on their welcome post. https://www.pathlabtalk.com/forum/index.php?/search/&type=core_members&sortby=joined&sortdirection=desc

Agreed; hugely reduced, but not entirely eliminated.

i stopped buying lewis antisera years ago. No sense.

Yes, it makes me sad to throw away the remainder of the unit. But....the filter syringes have to be purchased by the case, which for us would be a near life-time supply and they are expensive to throw away every couple of years when almost all of them would be outdated. You have to demonstrate competency yearly for preparing aliquots and I don't know how you would do that without sacrificing units, plus for me to access competency when I would barely know what to do would be a joke. We would have to pay for the appropriate licensing yearly to relabel the syringes once split. We would have

This is the plan we use for the 1 -2 units we transfuse to infants each year.

Experienced this. We backup the backup on an encrypted flash drive. If it happens again we would have IT give us a laptop (not connected to internet or network) to use just to pull the files.

I'd contact the manager of the collecting facility. This does not sound right. We also allow ours to sit for 10 minutes to an hour before placing on an agitator.

Treat as a transfer between hospitals. When we were asked to send product with a patient to another facility we would fill out a transfer form to go in the box and pack per our suppliers instructions.

In the UK, we give cross-match compatible blood in both situations. NHSBT do not give out typed blood for Lewis antibodies.

For both situations we would give IAT and immediate spin crossmatch compatible blood, would not worry about finding antigen negative units.

I was immensely honoured to receive this through the post today (with a lapel badge).

I use Meditech and do not have any paper. As to histories, we look up each patient history when we get specimens on the patient. Normally on Monday, Wednesday, and Friday, I download a copy of patient histories onto a DVD in case of Ransom Ware Attacks. The file is downloaded and saved as a Word file that is accessible from any PC.

I just answered this question. My Score PASS  

if you have a BBIS you should stop using a paper log and just enter your results directly into the system. Eventually you will miss something important. I've seen this multiple times when doing inspections, complete with errors due to back entry of data during the inspection.

Is this a regulatory requirement? We never reconcile. We do pull daily short date lists, expired lists and reconcile new shipments with invoice and LIS . We rarely have a unit go missing and we can always backtrack and find it.

I am going to make an assumption, (which I hate doing) and assume the part you saw shaken was the actual collection bag, which is surprisingly small. Shaped like a long rectangle? If it was an amicus system the manual actually calls for 2 re-suspensions before mixing into the plasma collected. The phleb will hold the bag firmly, with no slack between their hands and shake it lengthwise rather vigorously. The first time I saw this I curiously asked about it since I knew we usually treated them gently. Once it is suspended in plasma it sits "x" amount of time then is sent down to process lab. If

.

Yikes, I can't imagine. Our RBC inventory is about 1000. We run a short date list daily. We find units with X days remaining (I believe 3) and put them in a special place for immediate use. We also release units from patients nightly. One of those two processes finds units that may be a failure to issue in the computer. With usage as high as we have, invariably units go missing. About once a year we lose a unit or two. We have an investigation process, and if that fails, we make them as lost.

We're a large facility with many oncology patients. We made the decision to move to 100% irradiated cellular products a long time ago. Not an issue for us. We put in patient instructions for special requests like irradiated, I do not believe we have ever removed that instruction from a patient.

i agree with Cliff

that's all i ever have are ABO incompatible plts (usually).

Even though computerized you should have a backup system that allows you to identify previously encountered patients. How will you know if there is a patient w special needs (irradiated, CMV=, etal). Some places have a dedicated laptop which updates w patient info; I use paper records. I'd worry more about the special needs than if I need another specimen. (if you used a barrier protection ID you wouldn't need a 2nd specimen).

Neither new nor revised for us. We do have a compliance review for new or revised and will be adding on an annual technical review.

Malcolm Needs - Thanks so much for the quick response. There's no ethnicity on the patient yet but I doubt she is Japanese by her last names (very Hispanic). We are not planning on antigen typing the red cells for M at this point since it only showed up at immediate spin. We didn't do the workup on the mom so although the other BB said they ruled M out we don't know for sure if they use the 3/3 homozygous rule that we use. You are definitely correct about the M still possibly being IgG, I do realize, thanks for correcting me. It's been a very weird year, since last July when we had our fi

As a smaller hospital with 2-4 MTPs a year anticipated - you might find it easier to go with smaller loads in the rotations. I will try attach our policy. Smaller loads let you respond faster - when you probably do not want to keep this stuff "ready to go" as a Level 1 trauma center has to. You also lose less when they stop the MTP, but you don't hear from them in time to stop thawing the FFP and/or Cryo pool. Massive Transfusion Protocol -MTP- - Blood Bank Procedure - Adult.pdf

Is your pathologist also worried about all of the antibodies to low-incidence antigens that aren't present on your screening cells? Although I've not heard reports of any clinically significant transfusion reactions to those, they are also theoretically possible and missed by not doing AHG crossmatches for all units. Maybe some information like this could be used to "calibrate" the pathologist's worry meter. The fact that the Brits have not had any reports of patient impact to make them change their national policy might serve as a sufficient "research study". Nothing in this business is p

If current antibody screen is positive and Lewis antibody identified, do immediate-spin and anti-igG crossmatches, issue crossmatch-compatible random donor units. If current antibody screen is negative and there is a history of Lewis antibody, do Computer Crossmatch with random donor units.

We always added some saline when pooling cryo. A moot point nowadays.

Unfortunately in Canada, we cannot get pre-pooled cryo from our supplier. AABB Tech Manual does mention adding saline to aid in the pooling process which is what we do. I haven't done studies, but I would guess a substantial amount of cryo would get left in the bags without the help of saline to "rinse" it out.

We get pooled cryo now too, but we did have a procedure where we added a little saline (10 mL) to the first bag and then over time, for the subsequent bags, only added a little of the pool back (10 ml or so) to help with recovery from the subsequent units (instead of a lot of the diluted unit or transferring the whole volume to each new unit, if that is what you are saying). That could save you some time. One does worry about whether either procedure is worth it. Ask you distributor if they have pooled units - marvelous product!!

Why would you want to read either under a microscope?