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  1. 6 points
    If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation. If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing. The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened" Good luck
  2. 4 points
    AMcCord

    Deviation Reporting

    Our Deviation from SOP form is pretty simple.: Tracking # (a sequential # which I add when I review the form) Patient ID information Date/time of occurrence Description Reason for Deviation Action Taken - this is most often information completed by the tech who is responsible for the deviation or who discovered/corrected the deviation. Sometimes it is more appropriate for me to complete this part. I may add information to Description/Reason/Action sections. The medical director may add to any of these sections, though usually doesn't. Reported To/By/Date and Time Tech - person completing the report. This is usually the person who reports the occurrence, but not always. Signature lines for Supervisor and Medical Director Comment section - used for additional information or comments regarding the occurrence. This section is not always needed but is completed by myself (supervisor) and/or the Medical Director when necessary. This would be where I note retraining, disciplinary actions, whether or not a hospital occurrence report or safety huddle report was made, BPDR# if filed, calls to providers, etc. The Medical Director will comment on appropriateness of the deviation or contacts with providers as he sees fit. Example would be if the event was due to something like emergency release of uncrossmatched blood to a patient with an antibody. This form is one page and most of the events reported don't fill up all the spaces provided for entries. Once reviewed and addressed, I file them. I think if I was at a larger facility I would think about using a form online or at least a from that could be completed on our shared drive and emailed to me and the medical director. One of my goals is to build a spread sheet to track/trend by occurrence type - good quality project for my abundant spare time .
  3. 4 points
    mcgouc

    Inappropriate Override by a Manager

    I am retired but volunteered several years as an AABB assessor. Both CAP and AABB send the deficiencies from the previous assessment to the assigned assessor with the submitted plan of action to correct the previous deficiency. Most plan of actions have a time frame documented to correct the issue. We were supposed to make checking completion of the plan of action a priority. My first question would be if this individual had completed any work before his training records were completed. Then, I would ask for his competencies that were completed during the allowed time frames. If I performed a tracer on your FDA reportable, could you provide completed training and competency records for all the employees who worked on that patient? Your pathologist may be young, but he does not want repeat deficiencies. Document everything!
  4. 3 points
    Malcolm Needs

    Passive Antibodies

    Agree entirely David (apart from the fact that antigens and cells cannot be homozygous, heterozygus or hemizygous, only genes can be termed as such). In the UK, of course, we do an enzyme panel in most cases, but I do agree that, in reality, r'r' and r"r" red cells are, in reality, only available to Reference Laboratories, and only then used sparingly (not least because antibodies that are that weak are rarely, if ever, clinically significant, either for HTR's or HDFN). My point, however, was that, from a serological point-of-view, unless you can perform Gm and Km typing of the antibodies, you cannot tell the difference between a passive anti-D and a weak allo-anti-D (and even that is not 100% reliable), you HAVE to rely on the patient's history as to whether or not she has been given prophylactic anti-D immunoglobulin, and whether or not there was any evidence of allo-anti-D in her circulation before she was given any prophylactic anti-D immunoglobulin.
  5. 3 points
    Malcolm Needs

    Thanksgiving.

    Tomorrow is Thursday in the UK. I have the enormous pleasure of taking my wife out for her to do some shopping. Therefore, in case I forget in the fever of excitement I will be feeling tomorrow (ugh!), I would like to wish all of my friends who are either in, or are from the United States of America a very Happy Thanksgiving.
  6. 3 points
    JPSCANNELL f. CROKE

    TRM.40720

    Ditto. We haven't 'split' a unit for a non-neonate for over 20 years! I agree with the above ... we'll just state what we do if we ever do get an MD who requests a split unit. I'd only add that the usual approach is for the MD to instruct the infusionist to 'Transfuse over 4 hrs.' vs the usual transfusion rate of 1.5 - 2 hrs. Eventually, hopefully, the CAP Checklist Team get the message that splitting the unit is not the only answer and shouldn't be unless it's done often enough to maintain competency, etc.
  7. 3 points
    That is very sad. The final decision should depend upon a clinical discussion between the pediatricians, who know about babies, and the pathologists, who know about the value of the test results. No one discipline knows everything about everything.
  8. 3 points
    David Saikin

    TRM.40720

    I think what you are doing is acceptable. I am in the same boat. I had a procedure for splitting units but can no longer comply w the labeling regulations. I've never had an order and would recommend transfusing rbcs the same way you do.
  9. 3 points
    You are not overreacting. You are being responsible, which is what all healthcare workers need to be. Other than discussing all of this with your department administrative director (your manager's manager -- maybe you have done this already -- at our hospital, this is at the department director level), I am not sure there is much else you can do within your department. You mentioned talking to the FDA and your risk management department. Your hospital should also have a corporate compliance fallback for things like this (that cannot be resolved through management -- you can report anonymously if you desire) For corporate compliance issues, the business must respond to your concerns and report back to you within a limited amount of time. Good luck. Scott
  10. 3 points
    Malcolm Needs

    Weak D test

    I agree with you srichar3, from the patient side, and with you David Saikin, from the donor side. I also cannot remember the last time that I either came across a D phenotype that was so weak that we only detected it by IAT, certainly since the introduction of really good monoclonal anti-D blends. We certainly, as a Reference Laboratory, had cord bloods sent to us to confirm the expression of Partial DVI, but this always worried me, for three reasons. Firstly, the evidence that Partial DVI is sufficiently immunogenic to actually sensitise a mother to produce anything but a very weak allo-anti-D is, to say the least, flimsy. Secondly, I cannot ever remember a hospital sending us in a sample from the mother, to check whether she, herself, was also Partial DVI, meaning that she would not require anti-D immunoglobulin, because the baby's Partial DVI would have come from genes that she had passed on to the baby. Thirdly, as anti-D immunoglobulin is derived from human polyclonal anti-D (monoclonal anti-D immunoglobulin has yet to be shown to be efficacious) and, therefore, is a possible vector of transfusion-associated disease, such as novel viruses, as yet unknown. If these women do not definitely require anti-D immunoglobulin, it is a moot point as to whether it should be offered to them without very good grounds.
  11. 3 points
    John - had an O Neg guy. Negative ab screen as I recall. He rec'd an O+ random plt concentrate (early 80s). I don't remember the circumstances but the next day he had anti-C,-D.-E. The next day a Kidd. We didn't think it was the anamnestic response. Too long ago but I believe he ended with 5 or 6 allos. My boss was familiar w these types of individuals. New specimen for every transfusion, even if the same day.
  12. 2 points
    bldbnkr

    Cell Phone Camera

    End result: As I reread the thread I made an error - the Pathologist was the new "Medical Director" of the laboratory, we have a different person (MedTech) who is the Laboratory Director. Sorry about that. The problem resolved when the off site Pathologist resigned, and a new Pathologist who remains on site full time took the job - he will not be asking that we email photos of cells :)
  13. 2 points
    Mabel Adams

    Passive Antibodies

    This is why we treat all those weakly reacting anti-D patients as though the screen is negative and give them RhIG. It is safer even if the antibody is really a newly forming anti-D. Most of these are detected at the time of delivery so this baby is not at much risk from an immune anti-D of that low a titer. If the baby has HDFN, then we will proceed accordingly. If we pick up a weak anti-D and the patient received RhIG in the prior months but there is no record of a negative screen before the RhIG was given we will sometimes follow the patient for a few months to make sure the titer is decreasing rather than rising. We even have a test called SAB Rh Type that is for an Rh type and reflexes an antibody screen if the Rh is negative. That way we have a baseline antibody screen before RhIG is given which increases the odds that the anti-D detected later is passive.
  14. 2 points
    Cliff

    AABB First Time Accreditation

    Depends on a lot of factors. As for the assessors, you need to approve them to ensure there is not a conflict of interest, so you'll know exactly how many are coming. How big are you, what are you seeking accreditation for? If you have a donor center, and IRL, or another accreditation, it's likely you'll get an AABB staff member, otherwise, you'll get all peer assessors. While they are all trained to assess to the Standards, there is a lot if subjectivity. How many days also depends on your size.
  15. 2 points
    Malcolm Needs

    Passive Antibodies

    The answer to your first question is no. The answer to your second question is that there is no such thing as anti-A2, either natural or immune.
  16. 2 points
    If we only do D typing on babies from D negative mothers and a weak D or Du test needs to be performed, the results of the weak D is only valid if the DAT is negative, so a DAT would need to be performed. Therefore, an ABO and DAT would be a good place to start. Just my thought.
  17. 2 points
    To the elution question: if the results of the test will never alter the patient's treatment, it is hard to justify having the policy to always do the test, even if the results are academically interesting to understand causes and what is really going on.
  18. 2 points
    Malcolm Needs

    Weak D test

    Oh yes David. I did not mean that individuals who are Partial DVI cannot make anti-D; far from it - they often do when stimulated. What I meant was that the evidence that these individuals can stimulate anti-D in a true D Negative individual is pretty sketchy.
  19. 2 points
    Are you asking about which labels can be placed on the bag and which have to be on the base label?? Some irradiation indicator tags - both Rad-Sure and Rad-Control - have a type of adhesive that can touch the actual bag. Both can go above or below the base label (or at least that is what I have always been told). Most little labels/stickers, like the original Irradiation label in this thread, do not have this type of approved adhesive and are not allowed to be placed directly on the bag. You have to find somewhere to stick it on the base label without covering anything else up.
  20. 1 point
    David Saikin

    Passive Antibodies

    Agree entirely
  21. 1 point
  22. 1 point
    It does bowerj1, except you are doing yourself, and the rest of us down. Peds never did "do" the babies of O moms. Most of them wouldn't have a clue how to "do" the babies of O moms. It is people like you, me and many thousands of scientists within the Blood Bank who "do" the babies of O moms.
  23. 1 point
    David Saikin

    Passive Antibodies

    Whether it is residual RhIg or a developing allo-anti-D we (on the front lines) still have to r/o C and E with the heterozygous cells. Granted, we can run w PeG or enzyme pretreated . . . to increase the sensitivity.
  24. 1 point
  25. 1 point
    David Saikin

    Passive Antibodies

    Except that you don't have much choice to r/o anti-C or anti-E but r'r and r"r cells. We're talking RhIg anti-D, which is usually 1+ in gel
  26. 1 point
    Malcolm Needs

    Passive Antibodies

    Sadly, it is not that easy. It is incredibly rare for an anti-D to show dosage, however, there can be noticeable differences in the strength of expression of the D antigen, even between individuals with the same Rh phenotype and, indeed, genotype.
  27. 1 point
    I voted, but we actually do DAT only if the baby is positive for an antigen mom could have antibody to--Rh+ babies of Rh- moms and non O babies of O moms. I have tried for years to get them to drop the testing of babies of O moms but can't budge them.
  28. 1 point
    Mabel Adams

    Passive Antibodies

    We don't use just the cells that Ortho marks as an abbreviated panel for ruling out other specificities in the presence of passive anti-D. We add whatever other cells are required to have double-dose expression of the usual suspects. That said, we don't require double-dose K for ruling out anti-K on antibody screens so would not require it here. Also, we don't require use of double-dose E or C positive cells in the presence of anti-D, whether passive or immune, due to the low statistical risk to the patient.
  29. 1 point
    Ward_X

    Deviation Reporting

    I will preface my reply by saying I am not in a managerial position, just a tech in the lab. My facility has "Occurrence Reports" that record intentional deviations, reported errors, any workflow influence, etc. You can write them anonymously online or by hand. It's helpful at some points, but there's a fine line between people filling them out to report coworkers for silly things, or just filling them out when they feel "inconvenienced." I have a few problems with this process, but the form itself is outlined decently enough. It mainly just records the time a deviation is recorded, what area of the lab, what happened, corrective action, and future flow. Overall, I would say it comes down the culture of your lab. Who takes responsibility, and who places blame? If it's a workflow adjustment or something that takes less than 5 minutes to explain, or doesn't affect a patient in any way, emphasize communication between techs and talking to individuals directly to fix process kinks. Doing a whole roundabout where you report it and they find out weeks later about it through a form -- it's a little off-putting and not direct enough for cause and effect adjustment. If it's a real punitive-required situation, that's another problem. Complacency, which seems to be your mention, is something that starts to get into warnings, re-training, responsive action. If someone keeps incorrectly doing a test "their" way, force a re-train (people will want to avoid a whole session of teaching them how to do something they already know how to do, so maybe that's incentive).
  30. 1 point
    Ward_X

    Wondering if it's just me .

    Blood Bank abbreviations start to ruin everything
  31. 1 point
    mcgouc

    TRM.40720

    Our blood center could provide units with one or more bags attached. (We did not perform many neonatal transfusions and ordered these for the neonates). The empty bags had labels and our computer was set up for the aliquots. We were fortunate that this only took a few hours. If an urgent need, your process sounds acceptable.
  32. 1 point
    We had to use tube lifters in some of our centrifuges to prevent the tubes from sinking down into the holders. If we didn't use the tube lifters, the cap of the tube would hit the lip of the holder and pop the cap off. Once we used the lifters, we stopped having caps pop off.
  33. 1 point
    We use the Hettich and have separate programs set up so only the wash program has the longer break time included. We also have a site that set two wash programs (one for larger cell suspensions and one for cell button only) allowing only one program to be affected by the increased break time.
  34. 1 point
    I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers. Why do ABO and DAT routinely on these babies?
  35. 1 point
    ECabana

    Aliquot Labels

    You still need to have all four quadrants of the ISBT 128 blood label. If the 100mm x100mm label does not fit on the aliquot bag (or on an aliquot syringe), you can remove just a portion of the paper backing from the label and let part of the label hang off of the container (or syringe). This is just another option and there is no preferred or recommended option. The label example above is not compliant and it leaves out the two crucial pieces of information required for traceability, which is the DIN and Product Code. Erwin Cabana Technical Manager ICCBBA
  36. 1 point
    Anyone I know?
  37. 1 point
    I have to agree w John on this based on results you state. It seems she should have received at least 3 RhIg doses after that delivery. RhIg dose covers 30mL whole blood bleed, so there is the need for 2 doses. In my experience we always give +1. Doesn't sound like very good prenatal care especially if you have documented anti-D in the past (and not due to RhIg).
  38. 1 point
    If at all possible, define a pre-admission process so that a T&S can be drawn prior to the day of surgery. No one is happy when they find-out that the patient on the table has an antibody that will significantly delay packed cell availability. I would also "make friends" with your Perfusion team. Ours are the TEG experts in the OR, and help to guide the component utilization. We still reserve two platelets for a CAGB, but rarely transfuse these patients.
  39. 1 point
    Ward_X

    Aliquot Labels

    We apply the 4x4 horizontally and wrap the bottom part of the sticker around to the other side of the aliquot.
  40. 1 point
    New sample pretty much gets the whole nine yards. Only exception for me is a pt w an antibody. We'd repeat the screen, If it was consistent w the previous testing we would abrogate another abid. Unless of course we were dealing w a super responder, in which case we would get a new specimen every day the patient was going to be transfused - not even if done the day before.
  41. 1 point
    John C. Staley

    What in your MTP?

    I think I missed something. Did you really imply that you are putting platelets in the same cooler as the RBCs??
  42. 1 point
    Cliff

    Analyser Validation AABB

    In the long ago past, we had to make up our own validations. While not realizing we were doing so, we based them on risk assessments of the process. For instance, what is the risk of switching your Anti-A from one vendor to another? If you follow of the manufacturer's instructions, and they are both licensed by the FDA, the risk is close to zero. In my humble opinion ABO QC is a waste of time. In the tens of thousands of times I've seen it performed in our organization, it has never failed. Regardless, yes we perform QC. Now, you buy a complex analyzer, it is nearly impossible to develop a good risk assessment without the assistance of the vendor. I always start by asking the vendor for a validation plan. Some provide Word docs that you can edit for your own facility. We always do what they recommend at a minimum, and usually more. We've been lucky in that our vendors provides these plans. Moving forward, that will also be part of my negotiation for new equipment, that I will ask for them to include a validation plan.
  43. 1 point
    Question. If the patient is registered, why can't you use the SoftBank emergency issue function prior to the Type and Screen being completed?
  44. 1 point
    Malcolm Needs

    Cell Phone Camera

    Could not agree more.
  45. 1 point
    It was so hard when teaching students not to reach over and flip open that lid. Remember changing broken clips on the immufuges? Or the Dade Cell Washer that added the antiglobulin? I think that is why manufacturers started makng green antiglobulin.
  46. 1 point
    Ah...but you have to carefully calibrate the use of that finger or fingers. And bare fingers worked better than gloved fingers. Of course, that was before we really had gloves.
  47. 1 point
    Malcolm Needs

    Rh Pos or Rh Neg?

    NO! I am a professional blood group sereologist!
  48. 1 point
    shelleyk482

    Thawed plasma outdate

    It is easier for inventory management if all thawed plasma expires at the same time. When the expiration times stagger, the techs have to be more aware of when a particular product may expire. We have recently had 2 instances where a product expired during a shift and less than 30 minutes later we had an order and could have used the product if we were using the 2359 expiration. With a 2359 expiration, it is less likely that this type of scenarion will happen during the night.
  49. 1 point
    shelleyk482

    Thawed plasma outdate

    You can use either. For products with an expiration of less than or equal to 72 hours, you must use the exact time. For products with an expiration of more than 72 hours, you can use the number of days @2359 (Technical Manual, 16th ed, pg 219). We have been using the 120 hrs but are in the process of changing to the 5 days @2359.
  50. 0 points
    exlimey

    Rh Pos or Rh Neg?

    An EXCELLENT question Darren ! I look forward to some interesting debate.
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