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  1. 7 points
    John C. Staley

    Inspection Questions

    What I quickly realized was that no 2 inspectors/assessors focus on the same thing. As David noted, they seemed to focus on things they were either cited for or had cited others for recently. Over the years I had been cited for something that had passed all previous inspections because the inspector simply did not like the way we did it. When I challenged the citation with the inspecting organization the citation was often over ruled, not always but often enough to make the challenge worth while. My best advice is to prepare the best you can and consider the inspections a learning experience and hope that David is your next inspector. On a side note I was a Blood Bank inspector for CAP for 30 years so I had ample experience on both sides. One last bit of advice, never ever argue with an FDA inspector!
  2. 6 points
    Linda0623

    Cell-Salvage Regulations

    Hi Logan, I am an AABB perioperative assessor (and laboratory manager )that works at a facility in Boston MA that uses cell salvage on over 3,000 cases annually. We have 11 machines, and although we are not (yet) accredited by AABB, with the work we have done with our program, we are hoping to be accredited for periop by our next BB inspection. I got involved in this because our SVP for surgical services asked me, as the resident AABB SME, LOL, to evaluate effectiveness of cell salvage at our facility. She wanted us to adhere to the AABB standards and thought I was their best candidate to lead the effort. 6 years later, the past practice is truly history. To answer your question, we do QC quarterly on each machine that we have in use--- Hgb and Albumin. AABB allows you to decide what and how much is needed, but for quality purposes, you really do need something to make sure your equipment (and operator) is obtaining the best possible product for the patient in between PM's. If you would like more information on our approach, I am happy to share what we do, just message me and I will give you my work contact information. Between Cell Salvage and other specific PBM strategies, we have reduced our organization-wide transfusion ratio per adjusted patient discharge, from 0.78 to 0.17, in ~5 years time. ( Caveat: The cell salvage program overhaul took some time and was truly implemented last). I actually like to think it is because Blood Bank is involved, but honestly, it takes a village and I had to build influence up with the surgical services team and make really good use of my role as Transfusion Committee Facilitator to make things happen. Best, Linda
  3. 6 points
    David Saikin

    Inspection Questions

    You don't need to keep those records about irradiation. You are not performing it. As an inspector I almost always look at standards which I have been cited for. (I always disliked when the inspector said: "I knew I'd have to look really hard to find something in Dave's lab). That's not my style. I only dig if what I am finding merits such. I always look to verify you have corrected any prior deficiencies (these are given to us as part of the packet). I observe your staff and attempt to correlate what they are doing with what your policy/procedure says they should do. I also ask your staff (without a senior staff member accompanying me) about their work environment, employer, ability to attend CE programs. I want to see your quality stuff, especially any reports which you should have generated based on your QP. If you don't have anything it will be a long day for both of us. I will want to observe a transfusion or at least speak w a nurse about transfusions. Nursing training for transfusion and knowledge of reactions - this will be from Nursing Ed/Admin I don't want to review your procedure manual unless you ask me to look at specific items or you have added something new. I do want to see your table of contents so I can see what you do - I may take a peek at something there that piques my interest (I may also ask you if I might have a copy if it is something I'd like to bring to my own operation). There are lots of funny stories but you'll have to be inspected by me to hear them. (actually, most of them are quite sad as they involve citations). I tell your staff to relax because when I go back to work I do the same thing they do. I was an AABB inspector/assessor for 20+yrs. Still a CAP Team Leader.
  4. 6 points
    If you use DDT, you won't last long either!!!!!!!!!! SORRY, I couldn't resist it!!!!!!!!!!
  5. 6 points
    There is some truth in that, and especially from his perspective. However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.
  6. 5 points
    We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.
  7. 5 points
    ANORRIS

    Red Cell Storage Position

    It is also easier to take inventory when they are standing up. If they are flat you would have to pick them up to count????
  8. 5 points
    There was a prominent trauma surgeon who said, "Patients die from the blood they don't get, not the blood they do get".
  9. 4 points
    sgoertzen

    2nd ABO

    Someone above commented that a 2nd sample is only required in the U.S. for computer crossmatch (which used to be true). But with the 31st Edition of AABB Standards (effective April 1, 2018), this requirement was moved so that it now applies for all pretransfusion testing for allogeneic transfusions including all types of crossmatching (IS, AHG, and Computer crossmatching). This is more in line with CAP requirements and makes more sense in order to detect possible Wrong Blood In Tube (WBIT) events. AABB Standards for Blood Banks and Transfusion Services, 31st Edition 5.14.5 Pretransfusion Testing for Allogeneic Transfusion There shall be two determinations of the recipient’s ABO group as specified in Standard 5.14.1. The first determination shall be performed on a current sample, and the second determination by one of the following methods: Testing a second current sample. Comparison with previous records. Retesting the same sample if patient identification was verified using an electronic identification system or another process validated to reduce the risk of misidentification. Standards 5.11 and 5.27.1 apply. Personal Note: If you intend to retest the same sample (by a different person or the same person), be prepared to show the AABB assessor your validation proving that your "another process" is actually validated to reduce the risk of misidentification (i.e. WBITs). CAP Checklist Requirements: TRM.30575 Misidentification Risk The facility has a system to reduce the risk of mistransfusion for non-emergent red cell transfusions. NOTE: Mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her. The laboratory is expected to have implemented a plan to reduce these risks through implementation of a risk-reduction system. Among options that might be considered are: (1) Verifying the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including the recording of the result in the institution's historical record); (2) Utilizing a mechanical barrier system or an electronic identification verification system that ensures that the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. Other approaches capable of reducing the risk of mistransfusion may be used. The laboratory should participate in monitoring the effectiveness of the system that it implements. The laboratory should also consider improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion. TRM.40670 ABO Group and Rh(D) Type Verification The recipient's ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory's records. NOTE: Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system. For laboratories that employ computer crossmatching, serologic crossmatch techniques must be employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum reactivity, apparent change in blood type post hematopoietic stem cell transplant).
  10. 4 points
    AMcCord

    Inspection Questions

    It is important to remember that inspectors are human and as John says, they can and do cite things because it's not how they do it. Don't take it personally. Their way may give you a good idea for improving your way. At the same time, don't be afraid to challenge a citation if you feel that you've met the intent of the standard and can prove it. I definitely don't recommend arguing with an FDA inspector - you are probably not going to win.
  11. 4 points
    Bb_in_the_rain

    Mock-up case 1

    Please let me know if you would like me to do more "mock-up cases" with RHCE variants. I can look for some good ones. I think it is fun to interact with case studies here. (I mean it is quite fun to pick Malcolm's brain and learn from him... cough cough).
  12. 4 points
    Townsend

    Subgroup in a Neonate?

    Agree - also, what blood type is the mother? From an operational stand-point you have a couple of options: Call the blood type "indeterminate" or "unable to determine" or call the baby AB. Either way, we would suggest repeat testing at 4-6 months and include A1 lectin typing if discrepancy still exists. In the meantime we would give group O red cells and AB plasma/platelets until resolved.
  13. 4 points
    Malcolm Needs

    cold antibodies

    With reference to the ABO reverse grouping problems that cannot be resolved at RT, instead of incubating the tests at 4oC for 60 minutes, have you tried incubating at 30oC, or, in extreme cases, 37oC, or using cord red cells. Most of these "cold" antibodies have a specificity involving I or IH, and so, in the majority of cases these methods will resole the problems, without compromising the ABO antibodies, which, as we know from unfortunate transfusion reactions, work pretty well at 37oC! Turning to your specific questions: Q1. Firstly, we wouldn't test the plasma at 4oC. What is the point? Apart from Zombies in Holywood films, how many humans do you know who survive with a body temperature of 4oC? All we would do is test the antibody for its thermal amplitude, and if it does not react at 30oC, we ignore it (see Petz LD, Garratty G. Immune Hemolytic Anemias. 2nd edition, 2004, Churchill-Livingstone). If the antibody does react at 30oC AND is an alloantibody, we would be more proactive, identify the specificity, and give antigen negative blood. If it was an autoantibody, we would ignore it for transfusion. Q2. Apart from the above, NO! Q3. Why would you want to remove the IgM from the red cells. They will hardly ever be swamped by the autoantibody, but, if they are, we would use Rabbit Erythrocyte Stroma (RESt), which is available commercially. Unfortunately, this also adsorbs anti-B, and so the plasma adsorbed like this should never be used for cross-matching, as a group B mis-match would never be detected. Q4. I am going to be VERY cheeky here, and I say this with no evidence whatsoever, and that I will probably be slated by most members on this site, possibly rightly so, but I think that, as you are a Reference Laboratory worker, your techniques for working with these samples are more "honed" than those of the average hospital laboratory, as you see them far more often than do the hospital laboratories. I will now go and don body armour and a steel helmet!!!!!!!!
  14. 4 points
    consult with pathologist and keep in mind If you absolutely have to give incompatible plasma the ideal is to give it while patient is actively bleeding. If possible give RBCs that will be compatible with patient and the plasma so in your case O and as the bleeding is beginning to come under control start giving ABO compatible plasma to "top them off". The idea is that as long as patient is actively bleeding give them the incompatible product which is then being bled out onto the floor or wherever. Once bleeding is under control give the good stuff to help dilute the incompatible out and leave them with the most compatible antigen/antibody combinations possible.
  15. 4 points
    Considering the push to using Low Titre O Whole Blood for MTP and trauma's, i'd say the benefit outweighs the risk. I have personally seen two incidents where a panicked Blood Banker accidentally issued O FFP in emergency release situations. In both cases, the patients turned out to be incompatible blood types (one A one B). Guess what, there was no adverse effect whatsoever in either case. No sign of hemolysis or transfusion reaction weeks later.
  16. 3 points
    swede

    2nd ABO

    We have been doing second ABO/Rh types on transfusion candidates with no previous history since 2002! We use previously drawn hematology specimens whenever possible. Since nursing does some of our draws, we send a small pink top tube to the floor to be used (we are the only department allowed to order and use these tubes) for the "confirm type". We use parafilm around the cap so we can make it "tamper proof" to some extent. Before we did this step, industrious people would draw two tubes at the same time and save one, waiting for our request of a second draw. They would pour over the saved tube into our special tube....now they can't. We do second types on all ABO types, we don't exclude type O.....they too can be WBIT.....which could affect other lab departments.....we let them know if we find mistypes. We also don't exclude emergency transfusion......that is when the most errors happen because people seem to lose their minds in high stress situations. We stick with type O until the confirm type has been drawn. We tried the two signatures on the tube route, but found they were just grabbing anyone and having them sign the tube whether they witnessed the draw or not. Fun times in the blood bank! :)
  17. 3 points
    Malcolm Needs

    2nd ABO

    As the vast majority of hospitals (and Reference Laboratories) in the UK use column agglutination technology and automation, it is almost impossible to perform a second ABO without either a second D type or wasting a column or more than one column. But, my point was that, if a patient groups as O the first time, and A, B or AB the second time, then, it is obvious that either the first bleed or the second bleed was WBIT. Why should it be assumed that, if the person types as group O the first time, that is both correct and that it is automatically safe to give group O blood? If anyone does, I advise them to read the posts of Dr Neil Blumberg on ABO mismatched, but apparently compatible transfusions.
  18. 3 points
    Dansket

    2nd ABO

    Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube). You need to gather some data to show how many patients would be impacted by collecting a second blood sample. Ask these questions, "How many patient admits annually?", "How many patient admits required blood bank testing?" (at my facility the calculated percentage was 11%), "How many patient samples type as Group O?" (at my facility the calculated percentage was 55% and we don't draw a second blood sample on these patients), "Of the non-Group O patients, how many had an independently collected blood sample in Hematology that could be used for the second ABO blood sample" (in our facility that was calculated to be 16%). So for every 1000 patients admitted annually, 100 (I'm using 10% for sake of simple calculations) would require blood bank testing of whom 45 (100-55) would be non-group O, 7 (45 x 0.16) would have a blood sample in hematology, leaving 38 (45 - 7) or 3.8% (38/1000) patients requiring a second sample to be collected. Using this kind of data will give you a much better grasp of the impact of routine performance of a second ABO determination on all patients for whom a Type and Screen or a Type and Crossmatch is ordered.
  19. 3 points
    Malcolm Needs

    Red Cell Storage Position

    It is true that haemolysis can most easily be seen if the unit is stored in an upright position (note the phrase "most easily" - I am NOT saying that haemolysis cannot be seen if the unit is stored flat), however, more units can be stored in an upright position WITH the expiry date showing, than can be stored with them flat. If you have to move an upright unit to see an expiry date (or, in the UK, an Rh and K type - available on ALL units), you can easily do so without disturbing the red cell - plasma/SAGM interface, so that haemolysis is still easily seen, particularly as the units are usually in a cardboard box type thing to keep them upright. This is not so easy if the unit is stored flat and, in addition, it takes up more space in the average blood bank refrigerator, most of which are designed to take upright units.
  20. 3 points
    John C. Staley

    Cell-Salvage Regulations

    The key here is they came to Linda and asked for help!
  21. 3 points
    This is well known and there are indeed other threads concerning this. Transfused cells may have different densities to the patient's own cells and therefore when you spin the tubes in the centrifuge you may find that the transfused cells and the patient's cells separate. Then, depending on where you sample from in the tube, you will either get only transfused cells, only patients cells or a mixture, giving a mixed field. Typically instruments will select cells from the bottom of the tube, whereas pipetting by hand, one normally samples from the top, giving a discrepancy between the two methods.
  22. 3 points
    Malcolm Needs

    Subgroup in a Neonate?

    David is completely correct. Do not forget, also, the A, B and H antigens are not direct gene products (they cannot be, as they are sugar-residue antigens). The direct gene products are transferase enzymes (proteins). These enzymes are not working at their maximum efficiency at birth (hence the weak antigen expression), but, in addition, the "A transferase" and the "B transferase" are competing against one another. Sometimes the A transferase starts by "beating" the B transferase, in which case the A antigen is expressed more strongly than the B antigen, and, sometimes the reverse is true (as in this case). They eventually "even out", as long as no true subtypes are involved. Test again at about six months.
  23. 3 points
    If your patient is Kell Negative (Ko) you have real problems. If your patient is K Negative, you, and your patient, have more chance!
  24. 3 points
    One possibility is state regulations on who can do what testing and the decision to train someone has been taken out of their hands. Now I'm going to get on my soap box and please don't take this too personally. There is a very big difference between training and teaching. Over the many years I have trained more people in blood bank than I care to remember. Every one of them had the basic knowledge and understanding of what was going on in the testing and knew at least one way of doing the testing. I was training them to do it our way, not teaching them the principles and background of the testing. It is simple enough to train some one to add A and B to tube C, spin for 15 seconds, shake the tube and see if it clumps but that is not teaching them anything about the testing or what to do if it doesn't work as expected. With out the basic knowledge behind the testing and processes you would find it nearly impossible to pass the BB test. I am curious, just exactly what have you been doing in the Blood Bank for the past few years? I know organizations that will allow only MT/CLS registered staff work in the Blood Bank and exclude even MLTs. My suggestion to you would be to find a program that fits your needs and complete at least the MLT level education. Another option would be to find a facility that still offers internships if there are any. They are set up to provide the training and education you are requesting from your current employer. I'm afraid this is probably not the response you were hoping for.
  25. 3 points
    The size of the patient can be a factor in how much incompatible plasma you can safely give, but in an MTP you are poring the blood products in, and often it is poring right back out. The comment on giving platelets is well founded.
  26. 3 points
    Malcolm Needs

    Gold Medal.

    I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year. It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK. Sorry if this sounds egocentric, but I am very excited.
  27. 3 points
    I think it depends on what is going on. Look at the history of liver transplants. When they started, pts were getting upwards of 400u rbc. The first 20 and last 20 were abo compatible. in between it was whatever was available. I've seen massive transfusions where the patient was mistyped, receiving 20+u incompatible rbcs. Everything was fine for a few days - until the dilution factor was overcome by the pt's own immune system coming back on line. Patient doesn't survive that. Maybe, if you have to go with significant ABO incompatible plasma (O) you could switch the pt to O rbcs to reduce hemolytic activity. Have to remember the ABO abs are going to be diluted by the volumes of other solutions which are usually being infused at the same time. If the need is for coag factors, pharmacy should be able to provide recombinant products. It's a tough nut.
  28. 3 points
    R1R2

    Cell Phone Camera

    have your lab director talk to the pathologist, His is not a tech call. THis is why your lab director gets paid the big bucks.
  29. 3 points
    Cliff

    Cell Phone Camera

    I'd think it's also a privacy issue. Where I work, we can only use phones encrypted by our hospitals approved encryption software for sending patient information. I do not believe we are allowed to use text for patient info (not sure on that as I never would), we can only use our email that is also encrypted. HIPAA terrifies me. Violations at our hospital provide two options, final written warning or termination. It's always at least one of those and depends on the level of the violation. I suspect knowingly sending patient info on a non-encrypted phone would result in immediate termination.
  30. 3 points
    Malcolm Needs

    IFU Anti-D

    I have NO idea who are HFAP, but I would say that, whoever they may be, they are complete idiots. Your way of treating the patients as D Negative until proven otherwise (i.e. the patient is D Positive or is Weak D Type 1, 2 or 3) is EXACTLY what is suggested by people who actually know about the subject on both sides of the Atlantic (Daniels G. Variants of RhD – current testing and clinical consequences. British Journal of Haematology 2013; 161: 461-470, and Sandler SG, Flegel WA, Westhoff CM, Denomme GA, Delaney M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD. It’s time to phase in RHD genotyping for patients with a serological weak D phenotype. Transfusion 2015; 55: 680-689). I have, as I said above, no idea whether this was an HFAP ruling, or the ruling of a rogue inspector from HFAP, but, either way, I would be appealing against the citation, or changing the organisation who inspects my laboratory, if the appeal is rejected. From my point-of-view (and I have a bit of experience) you have done no wrong, but the inspector/inspectors have not got a clue about the Rh Blood Group System, and, in particular, the vagaries of the RHD gene. My own wife is D Negative, and if this lot forced her to be assigned as D Positive on such minimal reactions, I would be suing immediately. Sorry about the rant!
  31. 2 points
    Baby Banker

    30 minute rule

    Something that most people don't think about is the size of the unit. I am in a pediatric facility and we have units of all sizes. The smaller the unit, the more vulnerable it will be to temperature change. There is also the issue of the time the unit is out being made into an aliquot, and the fact that, in most institutions, the processing into an aliquot will be done close to the time of issue. So if you have an aliquot that is close to RT when it is issued, and then it comes back, what do you do? I think the only way to adhere to the spirit of the regulation is to measure the temperature directly. However, in that case, you are going to see your rate of expired units go up. There are no easy answers here, and in my experience, most inspectors know this, and many of them do not pursue it too vigourously.
  32. 2 points
    MAGNUM

    2nd ABO

    We instituted the practice of retyping the patients if their histories could not be proven. To do so, we instituted the practice of performing the retypes on a different specimen collected at a different time within the previous 24 hrs or within 1 hr of the blood type verification in the LIS. The histories are checked on every patient in the blood bank, if they do not have a historical type, the phlebotomist is sent to the patient room to collect a new lavender top tube. It does not matter the type of the patient, if they have no history, they get retyped. This practice ties into CAP TRM.30575. We have actually "caught" incorrect collections by the RN's that collected the incorrect patient and labeled the specimen with the wrong patient information. This is our practice and we are sticking to it! The other Scott
  33. 2 points
    Malcolm Needs

    2nd ABO

    Sorry, but to my mind, these patients should also be typed twice. Yes, they can be given group O blood (almost always safely), but what if it is a WBIT, and the D typing is wrong because of it, or an antibody is missed because the "real" patient is group O with, say, an anti-K, while the other patient bled is group O, with no antibodies present. In addition, and incredibly rarely, what if the "real" patient is an Oh, while the patient bled is an ordinary group O.
  34. 2 points
    Malcolm Needs

    Eluate

    No is the simple answer, however, NOTHING in blood transfusion/blood group serology is ever simple! I would thoroughly recommend you listen to the latest Podcast by BloodBankGuy (Dr Joe Chaffin) and Dr Stella Chou, which may shed light on the subject. It could well be that your patient has a Partial C (not unlike a Partial D, but not absolutely identical, as the E or e antigen is frequently also involved), particularly if your patient is of a Black ethnicity. One mutant Rh haplotype that is found not infrequently within the Black populations is (C)cdeS. With this , the C antigen is not detected by all anti-C reagents and so can appear to be C Negative. Such individuals also have a mutation causing a partial e antigen, and these people can produce an anti-hrB. Anti-hrB is relatively clinically insignificant (as opposed to anti-HrB, which is very definitely clinically significant), but mimics an anti-C+e, with the apparent anti-C element being considerably stronger than the apparent anti-e element. In addition, warm auto-antibodies classically mimic Rh specificities, and this could be such a case (the patient does not necessarily have to be diagnosed with WAIHA). While the auto-antibodies normally have a mimicking specificity within the Rh Blood Group System, this is not universal. I remember following a patient for years who was K Negative. He was never transfused with K Positive blood or blood components, and yet we were able to eluate what appeared to be an anti-K. This finding was confirmed by Joyce Poole at the International Blood Group Reference Laboratory, who was convinced that it was a mimicking specificity. I would be really grateful if you could keep us up-dated on your findings - purely because I am nosy!!!!!!!!!
  35. 2 points
    Sorry all; I was supposed to post a paper about this myself, and forgot all about it (mind like a sieve). I also thought it derived from the Netherlands, but got that wrong too- it was a paper from the USA. Anyway, it was: Santhanakrishnan M, Tormey CA, Natarajan P, Liu J, Hendrickson JE. Clinically significant anti-KEL RBC alloantibodies are transferred by breast milk in a murine model. Vox Sanguinis 2016; 111: 79-87. DOI: 10.1111/vox.12387.
  36. 2 points
    Ensis01

    Blood Bank Armbands Issue

    They should have, or create a policy to replace/reattach the armband. Get your pathologist and QA involved.
  37. 2 points
    Check with your blood supplier. During transport (up to 8-12 hours), platelets are not agitated.
  38. 2 points
    I don't think so. It's not like charging for a antibody ID after getting a positive screen. It would be more like repeating a charge for, say, a potassium because the analyzer failed on running it the first time. So I would say no, you cannot bill again. Scott
  39. 2 points
    TreeMoss

    DARALEX/DARATUMUMAB PATIENTS

    We will do a pre-darzelex blood type and antibody screen as well as antigen-type the patient for all antigens that we have anti-sera for. When transfusion is needed after the darzelex is started, we will use phenotypically-matched packed cells. If the patient specimens don't come until after the patient has received the drug, we send the specimens to our Red Cross Reference Lab buddies to work up for us. They use the DTT (not DDT!) and antigen-type the patient to provide information for our future use.
  40. 2 points
    I think you will find that dichloro-diphenyl-trichloroethane will destroy a lot more than just the Kell Blood Group System antigens!!!!!!!!!!!
  41. 2 points
    cswickard

    DARALEX/DARATUMUMAB PATIENTS

    You should probably get used to the DTT procedure. Hemo-BioScience offers the reagent in small aliquots that can be used easily without bothering with trying to manufacture the stuff. There are several threads on this already on this site. Do a search and see the discussions. I had posted our procedure in one - let me know if it is not accessible now and I can send it to you. The cord panel method would be nice if you are doing a lot of pts, and at least the cells will last a while. DDT treated cells will not last long at all.
  42. 2 points
    Thank you for answering in such an explanatory way, John and Scott. Nothing more needs to be added, in my opinion. Many folks just don't have an understanding of the education level required for our jobs as Medical Laboratory Scientists.
  43. 2 points
    Agree with John's points, above. I am not sure I have ever heard of a person doing ANY non-waived Lab testing without having earned a degree specifically in medical lab science. Even with that, you would have to have passed a national board exam in the US. Possibly there have been people grandfathered under certain circumstances? Regardless, the thing about training is, I can train a high school student to perform the steps to start a test or do routine maintenance in a Lab. But they would not have the education required to understand what "it all means", which is essential in pretty much any healthcare profession--especially one so technical as Lab Science. You may, indeed, have earned credits in inorganic and organic chem, microbiology, etc, but if you look at a certified program for a MLS (or MLT for that matter) you will see that beyond basic biology and chemistry, there are a load of specific courses that must be completed as the professional part of such a degree. A general biology degree (or any other type of degree for that matter), whether AAS, BS, MS or PhD, does NOT qualify a person to perform most of the functions done by a Lab Tech. Scott
  44. 2 points
    A few things as far as human reagents. Firstly, you never know what else may be in them in terms of antibodies directed against low prevalence antigens, because there is absolutely no way that the producer has the ability to test for all such specificities (I can remember once a human-derived anti-D reagent produced at one of the places I worked, also had a Gm antibody in it that we didn't know about. It is highly unlikely that this would have caused too many problems, but there is, nevertheless, a small chance that this could have caused a false positive). Secondly, you never know what else may be in them in terms of viruses, some of which may, as yet, be unknown to us (remember, HIV, used not to be known). This is a danger to the producer and the person using the reagent, rather than the patient. Thirdly, the avidity of human reagents is, in general, pretty poor (particularly anti-D). A few things concerning monoclonal reagents. Some of them cross-react with other specificities (although not many), but, famously, monoclonal anti-D reagents will react with the I and i antigens if used straight from the fridge. They have to be blended by experts to ensure that the desired epitopes are detected, but certain Partial D types (e.g. Partial D Type VI) are not detected (unless required). They are very specific and very avid (both of which are greatly to be desired). Virally, they are almost certainly sterile. Hope that helps.
  45. 2 points
    If at all possible, they would have to consult with our pathologist. Then beyond that, the physician in charge of the case would have to provide documentation that it is an emergent situation and that they are aware that they are transfusing incompatible product. Having said that, it seems like it would be a really bad idea. Giving A plasma to an unknown is one thing, but O plasma? Scott
  46. 2 points
    Malcolm Needs

    Anti-Inb

    She very possibly can (although two things; it would most certainly depend on the titre of the anti-Inb prior to EACH transfusion [and that would have to be 1) a doctor's decision and 2) a bit of a guess, as anti-Inb is so rare) and also, I would suggest IvIgG, rather than methylprednisolone (or, possibly, both). However, having said all this, there is NO DOUBT that anti-Inb is clinically significant in terms of haemolytic transfusion reactions, although the same is not the same for HDFN.
  47. 2 points
    SMILLER

    Cell Phone Camera

    Now that I think of it, perhaps the pathologist is simply offering to help ID a particular cell (they are not really reviewing the entire CBC) that a tech has an issue with. In that case, as long as the patient is not identified, I see no problem--other than the universal precautions thing. Scott
  48. 2 points
    SMILLER

    Cell Phone Camera

    I agree with all the comment above. You should not be sending HIPPA protected info from a personal smart phone. And most labs ban smart phone use in the Lab due to universal precautions. Scott
  49. 2 points
    Report as Rh Indeterminate and treat as Rh+ for RHIG coverage of the Mom
  50. 2 points
    John C. Staley

    IFU Anti-D

    In other words, who accredits the accrediting agencies? There you go Malcolm living in that imaginary perfect world.
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