Leaderboard

Thank goodness it is not four letter words!!!!!!!!!!!!!!!!

This required a change to the setup of the server. The server will need to be restarted. That will happen overnight tonight, then the search index will need to be rebuilt, that will happen during the day tomorrow. Hopefully by tomorrow afternoon you'll be able to search for 3 letter words. Thanks

As a Reference Laboratory person - and in the UK - I'm staying well clear of this discussion!!!!!!!!

Yes, of course, which is why you MUST use enzyme-treated group O red cells (screening cells - not just one example of group O red cells) as a negative control. If you do, and the group O red cells give a reaction, you still don't know the ABO group, until you have sorted out the specificity, and then used reverse grouping cells - and group O - cells negative for the cognate antigen. If you don't use a negative control - you should be sacked!!!!!!!!!! Nothing personal!

If you are an Immucor customer, you can sign up for their LEARN webinars here: http://extranet.immucor.com/EN/Pages/default.aspx Then select webinars. They have the original webinar up, but not the follow up webinar, which was answers to questions about BB proficiency, competency and QC.

I am not sure, it used to be 4, but I think it was lowered to 3. I will get back to you with an answer soon.

Which webinar was this? The Immucor "Answers to Your Questions About Blood Bank Proficiency, Competency, and QC"? Anyone have a copy? We've never done lot-to-lot comparisons for fetal screens. It really seems absurd.

Hi Malcolm CAT. I repeated with positive result. Sample I remixed and centrifuged an tested again when at room temperature. ? Anti-HI cold sample issue ? Or Secretor rule ? Will read more on that topic yeleng 22 Thanks for feedback

It's a pretty interesting phenomenon. It sometimes seems like the entire hospital is run by a nursing council/committee, which can only be overruled by medical staff and even then, physicians don't always get the last word depending on the topic (though sometimes that's probably a good thing!). That is why it is absolutely essential to cultivate some key relationships with nurses in various disciplines. The team approach is preached but I think we - the lab - have to work very hard to be included in the team in a truly meaningful way. Always a work in progress. The current thinking at my facility is that everything has to be focused on easing the life of the nurse so that they have the time to best care for their patients. I have no problem with doing what we can to improve patient care, but sometimes it puts us in some interesting job responsibilities as we 'ease their workload'. There also seems to be a mindset of 'Mother Knows Best' and of course Mother is a nurse. Often Mother does know best, but sometimes she needs to listen to advice. Another issue is that many nurses do not truly know what the lab does and how, do not understand that we are tightly regulated and that we are actually well educated people. We often bump into issues where we have to say (very sweetly, of course) - I don't tell you how to do your job because I'm not educated to do your job (unless you are messing with my blood products!), so please do not tell me how to do mine.

Most EMRs with CPOE have a way for nurses to enter orders (in ours they have to choose verbal or phoned) that then show up later for the provider to sign off on. The RN isn't really ordering anything any more than they used to before CPOE when the transcribed the orders from the patient chart into the computer. We give crossmatched as soon as the necessary testing is done. Our massive protocol is unrelated to crossmatched vs. uncrossmatched. If the patient had a special need for irradiation we would have to override to issue non-irradiated units but we could do it. We don't capture irradiation need from anything except our history or the current order. If the need is in our history, we would do what we could to honor special needs and get pathologist permission to deviate if need be. If there's no time, we notify the provider and then get the pathologist in on it. One thing the pathologist can help determine is how high the patient's risk of GVHD is. I'm no expert but I know that they never seem to worry about the non-irradiated units we transfused to the newly diagnosed leukemic before they gave us the special need of irradiation. Three months post BM transplant might be a different story. GVHD is caused by live T-lymphocytes in the donor blood that are capable of multiplying and establishing that clone in the body of someone whose immune system can't destroy the foreign lymphocyte. That means any active donor lymphocytes left after all the bleeding is done could conceivably multiply and cause GVHD in a patient who is at great risk for it (say, recent post bone marrow transplant, rather than just a transplant candidate). Leukoreduction will have reduced the number of lymphocytes present in the donor units. Malcolm's point that old stored blood has fewer live T lymphocytes would also contribute to improving the odds (if you aren't having to use your newest stock). It almost seems to me that the effort might be to "save the best wine for last" and fill them up at the end of the hemorrhage with irradiated units. Of course, as other posts point out, sometimes the last unit is only the 3rd one given. Do the best you can, be able to justify your decisions, document everything and discuss it with your staff periodically because they are't reading the procedure in the middle of a massive transfusion.

In some patient events its hard to know going into a situation how its going to play out. Some waste is inevitable, but keeping it to a minimum is vital. It really pains me to have to toss O negative red cells and AB plasma. We are currently engaged in a lengthy project/process to try to fix those kinds of problems - and others. We have a new poster of a process map for Emergency Release and Mass Transfusion for the patient care areas plus a similar version that allows the entry of information for use at the bedside. We are educating everyone. Lab is focusing on faster/more efficient. Nursing is focusing on what they are actually supposed to do, communication (don't bug the lab with multiple phone calls from multiple people about the same things!) and what the lab is actually doing for the patient (and how long it takes). The physicians are being educated on the fact that there actually is a protocol (seems to be a surprise to many of them) and how it works, plus education of what products might be used and when. We have pushed ourselves into the debrief sessions following the mass transfusion/emergency release events - it had apparently never occurred to nursing that we might have something to contribute or problems that they need to help us fix. We are working on notification - when does lab need to know something is going on so we can prepare for the possibility of mass transfusion, how should they notify us, and what phrases should they use for activation so that we are all on the same page. Lab turnaround time has improved dramatically. and we are starting to see some promising results from nursing. We are planning cross-disciplinary table top drills, then live drills for later in the year to see how things are going. We are cautiously optimistic.

Hello everyone, I need help setting up a validation protocol for a Terumo sterile docking device. I assume a certain number of acceptable "welds" must be performed but beyond that, I don't have any other ideas. Any suggestions?? Thanks!

fetal screen we test controls used with current lot against new lot reagents. We do not cross check fetal stain kits. Panels we use an antibody tested against a previous lot with the new lot. This is probably overkill.

No to separating plasma from red cells because most of our testing is automated. For manual testing - very little "jostling" of the red cell layer occurs during patient testing so specimen re-spinning is usually not required if the tech is careful. We are electronic crossmatch so the majority of additional red cell requests do not require serological crossmatches. Also, for additional requests for blood that requires serological crossmatch we do not include a repeat patient front type.

We did a 'validation' and found it took about an hour for 'just thawed' plasma to cool to below 6oC in the refrigerator. Given that, if we issue Thawed Plasma within the hour from thaw time, we put a notation 'Issued Prior to Cooling'. If it comes back, it is not expected to be less than 6oC, obviously, so here's our criteria for returning the product to inventory: (Rationale: Room Temperature stored products, e.g. Cryo, are 'good' for 6hrs after thaw.) Thawed Plasma: ‘Issued prior to Cooling’ and it is less than 6 hours from THAW time.Issued after cooling to 1-6oC and meets the same criteria as for Red Blood Cells.Platelets: Between 20- 24oC.Has not been without agitation for greater than 24 hours.