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  1. 7 points
    Neil Blumberg

    Neil Blumberg

    And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses. In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).
  2. 7 points
    Malcolm Needs

    Kell & Antibody screening

    PLEASE do not worry. Your midwife is COMPLETELY wrong, and really should not comment about something she patently does NOT understand, and about which she has a pitiful amount of knowledge. She should never have answered your questions with her lack of knowledge, but should have left it to your Obstetrician. I note that you are a fellow "Brit"! Within the British population, the percentage of people who have the R1R1 type (which is a type within the Rh Blood Group System) is 16%. Also within the British population, the K- type (which is part of the Kell Blood Group System) is 91%. What that means is that 91% of 16% of the British population is R1R1, K-, or, give or take, a few decimal points, 15% of the British population (about an eighth of the British population). On Friday, 19th October 2018, the British population was measured as 66,690,116! Let's call that 16.5 million in round numbers. This means that, give or take, 9, 975, 000 in Britain are R1R1, K-. Now, admittedly, your midwife will only be looking after women, but, even then, that means 4, 987, 500 women will have the same Rh type and K type as you! How your midwife has only come across your "rare" type four other times in her career, is beyond belief (and I genuinely mean BEYOND belief), unless, as I say, her knowledge of blood groups and blood group serology is incredibly poor, and I repeat, she should NEVER have worried you like this. Just in case you think that I do not know what I am talking about, I have worked in the field of blood transfusion/blood group serology for 43 years, have been an internationally invited lecturer and am the Chief Examiner in Transfusion Science for the Institute of Biomedical Science in the UK, and am a co-author of the British Society of Haematology's Guidelines for Blood Grouping and Antibody Testing in Pregnancy. I don't write that to "blow my own trumpet", as it were, but to try to reassure you that I actually do know what I am talking about. I should warn you that "consulting Dr Google" is equally as useless as listening to your midwife. You should really relax. YES, it is possible for you to produce red cell antibodies during your first pregnancy, but it is INCREDIBLY RARE. It is even more rare for such an antibody to cause any problems in a first pregnancy. I notice that the report from the Blood Bank was that they detected WEAK reactions with 26 of 30 panel cells, but they could not identify a specificity. They have requested three further samples of blood to send to the Reference Laboratory. Again, to give you some comfort, I hope, I ran a Reference Laboratory in London for 16 years before I retired in 2016, and we saw, quite literally hundreds of cases like yours. For a red cell antibody to cause any problems within you pregnancy, it would have to have a titre of 32 or above (this means that it would still be detectable when it has been diluted THIRTY TWO times). I can assure you that the mere fact that the Blood Bank reports weak reactions means that there is ZERO chance that the titre will be 32 or above. If a Hospital Blood Bank, however big or famous the hospital may be, cannot identify an antibody, it is almost universal practice that samples will be sent to a Reference Laboratory for further testing - AGAIN, DO NOT WORRY ABOUT THIS. There are many, many red cell antibodies that are clinically insignificant, both in terms of transfusion reactions and haemolytic disease of the foetus and newborn (which is what your midwife has left you worried about). I KNOW it is difficult, but PLEASE do not worry. PLEASE take no notice whatsoever of your midwife on this matter (I am sure she is an excellent midwife, but she is patently no expert in the field of blood groups), but DO talk to your Obstetrician, who, I hope, will have talked to your hospital's Haematology Consultant, who, in turn, will have spoken to the Consultant in Charge of the Reference Laboratory, and I am sure that they will echo my opinion that there is NOTHING to worry about. Oh, and lastly, I am R1R1, K- myself!!!!!!!!!!!!!
  3. 6 points
    Malcolm Needs

    Kell & Antibody screening

    Thanks ELondon. Could I just say again, even if the Reference Laboratory does detect an antibody (or more than one, come to that), it is not a particularly abnormal thing in pregnancy, but it does not mean for one minute that the pregnancy will be affected; Mother Nature has seen to that. There is another Blood Group System named Lewis. The antigens within this system are soluble in the plasma part of your blood, and are adsorbed onto the red cells from the plasma (they are not intrinsic to the red cell membrane). During pregnancy, the concentration of plasma lipoproteins (fatty proteins in the plasma) can increase enormously (about four-fold). These plasma lipoproteins "mop up" the soluble Lewis antigens, and a pregnant woman, who would normally be, for example, Le(a-b+), can become Le(a-b-), and may even, temporarily, produce antibodies against the Lewis antigens (an individual hardly ever produces antibodies against an antigen that they express - but strange things happen in pregnancy!). In addition, ALL babies are born as Le(a-b-), so any Lewis antigens Mum produces will NOT affect the baby! There are many, many other antibody specificities that will not affect the pregnancy at all. Now, I should say two things. Firstly, I cannot say, from a distance, what is the antibody in your plasma (that can only be done by the laboratories at the Hospital and the Reference Laboratory, but it does not sound at all serious). Secondly, i am what is called a Biomedical Scientist, not a doctor, and so I am, by Law, not allowed to diagnose (as far as I know, neither is the midwife), and this is why I am so glad that you are going to see an Obstetrician, who, I hope, will be able to reassure you even more. Mean while, sleep easier, and enjoy your pregnancy!
  4. 5 points
    Awesome responses as usual Sir!
  5. 5 points
    David Saikin

    Emergency Release Blood

    You may have exchanged your pt by that time - then what type are you giving? I want a sample ASAP. I worked in a large tertiary care hospital, we would only give you one O= and then only if you gave us a specimen. We opened that hospital brand new and set up the rules like blood bank should be run. It was great - no one could say "we've always done it this way."
  6. 4 points
    Neil Blumberg

    Patient Blood Management

    Patient Blood Management is a comprehensive, multi-modal approach to reduce/prevent anemia prevalence and reduce transfusions to only those that are life saving or absolutely essential. While the AABB has some materials and interest, they are relatively less likely to explain to you that the primary rationale is that anemia and transfusions are mostly harmful to patients in current practices. The pre-eminent organization in the USA in this matter is SABM. The founders of PBM include anesthesiologists such as Aryeh Shander at Englewood Hospital and Tim Hannon at St. Vincents, who saw that (1) Jehovah's Witnesses who refused transfusions actually had better outcomes than similar transfused patients and (2) transfused patients had dose dependent increases in nosocomial infection, thrombosis, multi-organ failure and mortality in the literature and their own practices. In other words, less is better. None is best when possible. Needless to say, the initial reaction in the blood banking and transfusion medicine community was lukewarm at best when these ideas were first put forward a couple of decades ago. But preventing anemia by doing fewer lab tests, and less frequent lab tests has begun to catch on in some places. See: https://www.sabm.org/patient-blood-management-programs/ Good place to get some initial education and join if of interest. A typical PBM program will include a part-time medical director (often an anesthesiologist, intensivist or hematologist, but also surgeons, transfusion medicine physicians, and other specialties) and one or more full-time nurses or medical technologists who focus on educating practitioners about current practices. You need a clinical champion at the bedside who other practitioners respect and will listen to. Changing practices is arduous and sometimes rather unpleasant work. When Bernard Fisher showed that the Halstead radical mastectomy for breast cancer was harmful to patients, the initial reaction was anger, disbelief and pushback. So it sometimes is with PBM. Physicians change their practices slowly or not at all. At our institution, PBM is heavily weighted towards collaborations between specialties, including, for example, an anemia management program prior to cardiac surgery, advocating restrictive transfusion practices where there is evidence (and there is tons of evidence that liberal practices are lethal at worst, wasteful at best). Happy to answer further questions.
  7. 4 points
    Mabel Adams

    Picky anti-C?

    The antibodies didn't read our books???
  8. 3 points
    cswickard

    Management Question

    A - to find out the specifics of the problem - personnel may not talk in front of supervisor, so this needs to be done 1st. B - to get the other side of the story - if there is one. Don't spring a meeting on the supervisor with other personnel present without discussing problem 1st. 3 - to work things out - if possible.
  9. 3 points
    tbostock

    Specimen Expiration

    3rd day at midnight, with day of draw being day zero.
  10. 3 points
    AMcCord

    Neil Blumberg

    Congratulations! and thank you for your contributions to modern blood banking practice.
  11. 3 points
    Neil Blumberg

    Neil Blumberg

    Malcolm, my sincere appreciation of your kind words. I've enjoyed and learned from your comments on this website.
  12. 3 points
    We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it. We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.
  13. 2 points
    Dansket

    positive dat w cord blood

    An important aspect of this conundrum to remember is that physicians do not treat newborns just because of a positive DAT, they treat infants who are anemic or hyperbilirubinemic regardless of the DAT results.
  14. 2 points
    John C. Staley

    Management Question

    Actually, if you look back at the responses you will see that the best answer is all three in the proper sequence.
  15. 2 points
    I would think it would need a pretty significant bleed to find a macropositive DAT from a fetal bleed in utero. I've had patients pregnant develop an autoimmune process. Never impacted the baby.
  16. 2 points
    Malcolm Needs

    Neil Blumberg

    A fairly short, but very interesting interview with Neil Blumberg in the July 2019 edition of AABB News, as he his one of three new inducts into the National Blood Foundation's Hall of Fame. Congratulations Sir and, from what I know and have read, thoroughly well deserved.
  17. 2 points
    AMcCord

    Lot Verification

    Before you set a specific number across the board, I would suggest that you check you package inserts. Some of the human source rare antisera have positive agglutination defined as 2+ or greater and don't usually give much stronger reactions. The monoclonal rare antisera usually seems to react 3-4+. I would also expect stronger reactivity for anti-A or anti-B, depending on what you are testing them against. I would see 2+ reactivity for them as an indication that the reagent is not OK. We look for reactivity consistent w/ previous lots - +/- one grade of agglutination.
  18. 2 points
    thank you Malcom and Scott for you responses! We spoke with the clinicians, who seem to understand the anti-S titer number will not tell them much of anything, and they had already realized the Jk and the C were useless to titer (which saved us a lot of grief). They could not provide any references or good reasons for needing the anti-S now, but pretty much insisted, and we acquiesced on this patient ONLY since her situation is quite unique. So we are treating the clinician rather than the patient this time; I've been covering clin path long enough to know that sometimes this is just the way it goes. Anyhow, we have at least opened a line of communication to the clinicians in the case and they feel we are trying to help them (even if we think it's silly), and that may be all the reassurance they need. And was better to know about this patient sooner rather than later, b/c if she does make it all the way to delivery with a chronic anemia we were gonna need to plan for her anyway. At least she's now on our radar in BB. Again, thank you all for your expert opinions! LCH
  19. 2 points
    Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!
  20. 2 points
    Two reasons. The first is that severe HDFN caused by anti-S is very, very rare, but it does happen. The second, and much more importantly, is that a titre is a snap shot that tells the obstetrician ABSOLUTELY NOTHING in isolation. Supposing the titre is, for example, 512, the pregnancy can be monitored (as it can be anyway, whatever the titre) and there can be clinical intervention, if required. On the other hand, supposing the titre is 2, what does that mean prior to conception? Again, the answer is ABSOLUTELY NOTHING. The baby may not inherit the GYPB*S gene from the father, so the antibody will not increase in titre, or the baby may inherit the GYPB*S gene, but that doesn't mean the titre will automatically rise during the pregnancy, although, of course it can. It sounds to me that the clinicians are fishing, but without either a rod or a net (they haven't got a clue)! I know that the UK Guidelines do not apply in the US, but it might be worthwhile suggesting that they at least read "British Committee for Standards in Haematology (BCSH): White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S. Guidelines for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine 2016; 26: 246-263 (doi: 10:1111/tme.12299) and/or Royal College of Obstetricians and Gynaecologists (RCOG). The management of women with red cell antibodies during pregnancy. Green-top Guidelines No.65; May 2014. https://www.rcog.org.uk/globalassets/documents/guidelines/rbc_gtg65.pdf.
  21. 2 points
    ELondon

    Kell & Antibody screening

    @Malcolm Needs: Thank you very much for your response, I can not describe in words how grateful and relieved I am. I have been so incredibly worried that I've not even slept since speaking with the midwife, and that was 36 hours ago. I really wish Google had a 'Pregnancy filter' that blocks any attempt to look up medical information. I am under 'Midwife care' at the moment but will request a referral to an Obstretician for reassurance. This is my first pregnancy so I am still figuring out how the system works. I'm not familiar with the set up in other hospitals but the one I am registered with uses an app to send out test results. In my case I first had a message saying 'Abnormal blood test results, with no further details or comments" followed by a call from the midwife. I'm not sure what scared me the most, knowing that something abnormal had shown up on the blood test but not being able to see exactly what it was, or the call from the midwife saying how rare my blood type and antibodies are. I sincerely hope this is not the future of NHS medicine as I could very well have had a heart attack had a been a bit older. I went to the hospital again today and submitted three further samples. Hoping and praying that they will come back normal. Thanks again for your input. I feel like a great weight has been lifted off my shoulders just from reading it.
  22. 2 points
    Malcolm Needs

    Picky anti-C?

    Most antibodies identified as "anti-C" are, in reality, a mixture of anti-C and anti-Ce (with the anti-Ce portion often being in the majority). This is because many of the antibody producers are R2R2, sensitised by the DCe or dCe haplotype - not all, of course, but many. According to my mentor, Joyce Poole, this was true even of monoclonal antibodies that are considered to be "anti-C". This is why you often get weak reactions with RzRz red cells with most examples of anti-C. As you are getting variable reactions with your panel cells, it could be that you have a rare example of a pure, monospecific anti-C, or an "anti-C", made in an R2R2 or R2r individual, who has been who has been sensitised by a DCE or dCE haplotype, and that you have an "anti-C" that is a mixture of true anti-C and anti-CE. All that having been said, I can't see that the above information would necessarily give a reason for your patient's odd reactions, but it might just be one of several reasons. What those other reasons may be, I don't know!
  23. 2 points
    SMILLER

    Emergency Release Blood

    You may want your lab manager to talk to your trauma docs. I am pretty sure that they are going to want to know that you can provide type-specific blood ASAP before the Blood Bank runs out of O negs. Scott
  24. 2 points
    ANORRIS

    Neonatal transfusion

    Same here, entire unit...except well over 30 years.
  25. 2 points
    I agree with Dr. Blumberg that pathogen inactivated platelets are probably safer than the "cultured" platelets and that the psoralin compound used in the process currently approved by the FDA crosslinks DNA/RNA thus preventing proliferation of most organisms and WBCs. However, to my knowledge the FDA has not given blessing for pathogen inactivation to supplant irradiation yet. Reading a copy of the "prescribing information" from Cereus would answer this question. However, it is expensive, $150-$200 premium on the current cost of the products. It is not yet approved for pooled platelet concentrate products. (six-pack) It is not yet approved for three products collected from a single donor (triple product). It is not yet approved as a 7 day product. There is about a 5-6 % decrease in the donors that qualify for giving two or three products at a time. This is because the pathogen inactivation process decreases the platelet count by 5-6%. This means that blood centers will need to replace this number of donors in order to keep up with current product demand. There are some who suggest the platelet efficacy of these products is diminished at as the product approaches day 5. Whether or not this is seen clinically, I do not know but this would have a bearing on whether or not the product will be approved with 7 day out-date labeling, There is a third option that can be entertained by the providers of these products. That is "delayed high volume culturing". This process makes it standard to obtain both aerobic and anaerobic cultures from each product. This process has been used quite successfully in Great Britain to interdict contaminated platelet products. I understand this process would be approved for labeling the product with a 7 day expiration date, without the need for the consignee to do point-of-release testing (Verax). I believe it is important for hospitals to discuss the product desired with their blood supplier. Opening the discussion now will make for an easier transition when the guidance becomes final. We expect to hear from the FDA on this topic later this year.
  26. 2 points
    Can you get a copy of the policy from your supplier that they use to validate their shipping containers? Type up a letter for your pathologist to approve explaining it and give that to your Quality people. Then if they want something more, ask them to show you the regulatory standard they are worried about. Scott
  27. 2 points
    I disagree with this statement unless pathogen reduction will prevent lymphocyte activation.
  28. 2 points
    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.
  29. 1 point
    David Saikin

    Specimen Expiration

    3rd day at midnight; draw day is day 0.
  30. 1 point
    Neil Blumberg

    Patient Blood Management

    As for pediatrics, we have an attached children's hospital, Golisano Children's Hospital of the University of Rochester. We have a blood management program but it has proven difficult to find evidence based transfusion criteria for the main blood components, red cells, platelets and plasma. There has been some reluctance to change practice lacking evidence, which is understandable. Pediatric practice, with perhaps the exception of anesthesiology and critical care, seems based upon older understandings of transfusion that it was "very effective and not very risky." The reverse is almost certainly true in most clinical settings, other than life threatening bleeding and/or anemia. Therapeutic minimalism, rather than maximalism is called for, in my view. Witness the use of 20-30 ml/kg of red cells or whole blood in the recent NEJM trial in Africa. These doses would be fatal to a substantial number of adult patients. Thus changing practice in pediatrics should probably focus initially on appropriate dosing to start with. Our typical adult doses for red cells are in the range of 3-5 ml/kg and for platelets and plasma not much more, and certainly not more than 10 ml/kg. Since there is a dose dependent increase in nosocomial infection, thrombosis, inflation and mortality with red cell transfusion that is in part causal, these practices are likely not in the patient's best interest, despite representing "state of the art 1985 expert opinion." There is not a shred of evidence that WHO's guideline of 20 ml/kg is effective and safe, to my knowledge. The general guidance of hemoglobin 7 and hematocrit of 21 as boundaries for numbers (as opposed to clinically) driven red cell transfusion has reasonably strong evidence based (randomized trials) in children. Platelet transfusion and plasma transfusion have minimal evidence base, but the prophylactic threshold of 10,000/µl for non-bleeding children with hematologic malignancies seems reasonably evidence based. There is essentially no evidence to guide plasma transfusion, so my general approach is "don't do it" unless there is life threatening bleeding not treatable by anything other than massive transfusion.
  31. 1 point
    ELondon

    Kell & Antibody screening

    Me too! He's such a fantastic source of knowledge.
  32. 1 point
    I just answered this question. My Score PASS  
  33. 1 point
    the majority of our OB pts do not have T&S ordered, though we do receive a JIC tube. After delivery, if they are an RhIg candidate, we only perform the rosette test. There is no standard which demands a current antibody screen for the post-delivery RhIg. We did away with that many years ago.
  34. 1 point
    I just answered this question. My Score PASS  
  35. 1 point
    We don't. It doesn't change the patient's treatment so why expend the resources? If the screen is positive with anti-D we give RhIG. If the screen is negative, we give anti-D. If the baby has HDFN then we would be looking at the strength of the mom's anti-D. That would be our evidence of sensitization that I think a standard still refers to.
  36. 1 point
    applejw

    Transfusing Blood in the OR

    I have had this conversation numerous times with Anesthesia manager - do we really have to have 2 people verify? Yes. Stop asking. As for scanning, we have Epic BPAM which does not function in the OR. OR has their own process that does allow scanning of units during massive transfusion but it isn't perfect. If they scan the units from the cooler and somehow the unit isn't transfused and is returned to the BB, there seems to be a glitch where unit status in Epic thinks the unit was transfused when it actually was not and did not update when returned to the BB. Later, when trying to scan for another patient, BPAM gives a warning "Unit not intended for this patient". This statement is an almost guaranteed nurse "freak-out."
  37. 1 point
    9/10 times we don't perform the 1st ABSC. So, we spend a lot of time working up that ABID that is just remnants of antenatal RhIg.
  38. 1 point
    The correct terminology (according to Geoff Daniels, who was, for many years, the Chair of the ISBT Working Group on Red Cell Immunogenetics and Blood Group Terminology) is as follows: The gene governing the expression of the antigen in RHD. The protein, or carrier molecule, upon which the antigen is expressed is RhD. The antigen itself is just D, with no brackets, and, as you say, no "Rh". The bit about the "brackets" was confirmed many years ago now by Dr Patricia Tippett, who first put forward the (correct) theory that there are two RH genes - RHD and RHCE, but it was not in a peer-reviewed Journal, and I can no longer find my copy. All that having been said, when the numerical nomenclature is used (e.g. for Rh29), then the "Rh" prefix is used, but this nomenclature is rarely used, except when using "computer-speak" for antigens and antibodies.
  39. 1 point
    Sorry no, I'm not that clever Mable. Came across it a while ago (2009) researching best practices on consents to update our P&Ps. Obviously it's much older with that language (wantonly!). Maybe some youngster can find out. My search engine is tired.
  40. 1 point
    Malcolm Needs

    Cold agglutinin procedure

    Well, that is rather what I meant!
  41. 1 point
    seraph44

    PPID in the OR

    Hi Scott, This is what they are stating here. Which tells me that they are not checking the blood before it gets hung. They say they use a white board but I'm almost certain they are not checking the blood with the white board and I don't think that's acceptable (I can't find literature on this at least). I'm concerned because several times they send a courier that is not involved with the case to pickup blood and if there are two patients receiving blood and the courier takes it to the wrong room, this can lead to some serious issues if they don't properly check the patients and the blood.
  42. 1 point
    Pathogen reduction prevents lymphocyte proliferation and thus is practically speaking equivalent to irradiation. Whole blood platelets are pathogen reduced in some parts of Europe, but the manufacturers have not put forward these methods for FDA approval in the USA. A serious mistake and waste of resources. In any case, apheresis platelets carry a higher rate of some transfusion adverse events (TRALI, for example) in French hemovigilance data, so why one would preferentially use pathogen reduced platelets that are single donor rather than pooled whole blood is beyond me. We used to use 100% whole blood platelets as a socially responsible use of donor resources, particularly as apheresis platelets carry no proven health benefits for patients (donor exposure is a straw man in this instance, given the low risk of infectious disease transmission, and it's irrelevance in the pathogen reduction era). We are using close to 100% apheresis simply because that's the only pathogen reduced platelet product available. As I said, a terrible mistake in my view. But better apheresis platelets than non-pathogen reduced is our decision. We'd welcome use of whole blood pathogen reduced platelets as a much more responsible use of donor's time and safety given that whole blood platelets are essentially now a wasted, low cost scrap product. Much less expensive, and we think safer than apheresis platelets for most patients.
  43. 1 point
    BankerGirl

    Nursing Order

    We set our blood product orders to reflex off of the transfuse order. This accomplishes two things for us: the physician only has to enter one order, and we don't have staff calling us and asking if they need to order irradiated, cmvn, leuko-reduced, etc. We perform electronic crossmatch (sorry Malcolm, that's the term) so we do not set units up unless they have a transfuse order unless they have a clinically significant antibody (or history of one) or the patient is in OR and the physician requests units be packed in a cooler for quick access.
  44. 1 point
    pbaker

    Nursing Order

    We have the same set up for basically the same reason - a patient was transfused with no transfusion orders. However, blood bank only gets notification of the product order. Also, no specimen collection label will generate if only a transfuse order is placed. We had a case where a transfuse order was placed on one patient and a product order was placed for a patient with a VERY similar name on the same floor. RN came to pick up blood for the patient with the transfuse order and couldn't understand why we did not have it ready. "Patient was bleeding!!!!!" Our transfuse and product orders are going back to being linked together so you can't order one without the other.
  45. 1 point
    It would be interesting to see the commentaries on that guidance. Will be a burden for small labs (like mine).
  46. 1 point
    BankerGirl

    Nursing Order

    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.
  47. 1 point
    This may help (or may not, of course!).
  48. 1 point
    David Saikin

    Emergency Release Blood

    If we are giving unxm'd rbcs to a pt with an unknown type, O Pos unless a female of child bearing potential (up to age 50 for us).
  49. 1 point
    EAB81

    High Risk transfusion form

    We will do it for every new order. Our form has a place to put unit stickers on them. So, essentially, the physician signs for however many units we put a sticker for. Any more after the initial units, we require a new form. This also kinda serves as a reminder to physicians that their patient has special blood bank circumstances.
  50. 1 point
    SMILLER

    Emergency Release Labeling

    I do not see anyone here defending the idea that you need to know, with absolute certainty, where each human blood product goes and who ends up with the transfusion. Every transfusion is a transplant. Do we really need to review why we cannot issue products willy-nilly no matter how 'universal donor' they are? There are several suggestions here already for policies to ID John/Jane Does and the units they receive. It takes consultation and cooperation between multiple departments; and yes, its going to take some work. Once implemented, an appropriate system will satisfy regulators without any loss to patient care. (Blaming regulations that may be "inconvenient" when pointing out our deficiencies does little to help our patients.) Scott
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