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Megan - Since CAP does not offer an automated DAT survey (as far as I know), my suggestion would be a variation of the #2 option in your list: 1. Perform your regular manual proficiency testing on the CAP-DAT Survey samples (and report your results to CAP.) 2. Then perform the DAT testing on the CAP-DAT Survey samples on your Echo instrument. 3. Don't submit your Echo results to CAP. Rather, keep the results in a file. When you get the results report from CAP, compare the report with your Echo results, document whether your Echo results were satisfactory, and have your Pathologist Medical Director sign and date this (and return it to your file.) Donna

Thanks Malcolm We waited on the Oneg platelets. Delivered in 90 minutes despite minor snowstorm. R

I would give the group A, D Positive platelets. The amount of anti-B in the plasma will not affect the patient, and platelets do not express the D antigen. However, the danger with this is that there may be a few group A, D Positive red cells in the plasma and, as the patient has already been sensitised to the D and the E antigen, these may boost the antibodies (as a secondary response can be stimulated with very few red cells). It is a slight danger, unless the platelets "look red". If the patient can wait for the group O, D Negative platelets, then this "danger" would disappear completely, and any danger from the anti-A, anti-B and anti-A,B in the plasma in which the platelets are suspended would be minimal.

Welcome back to the neighborhood! - 1- 2 ft predicted for tonight.... I'm definitely retiring to the Caribbean!

I think that a lot of this "fixing problems that don't exist" stems from the change with CMS/CLIA when they combined all the subsections. Immunohematology used to be separate, but now we are lumped in with Chemistry and Heme, and CMS can't quite get that blood bank is different. Just my opinion.

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Wir sind Berlinern Scott

and Turks and Syrians and too many more to count.

I see your point SMILLER/Scott. It's a fair argument. I'm not advocating "less oversight", but merely acknowledgement that an immunohematology work-up often has a lot more "grey/gray" than the other pathology disciplines. As we all know, "antibodies don't read books" and sometimes it takes all of your resources and experience to resolve a serological problem, including the prudent use of expired materials (or frozen inventory). One could argue that absolute prohibition of using expired reagents in such cases could potentially put a patient at more risk by leaving an issue unresolved. Using all of your tools, in-date or otherwise, to get a good answer might outweigh the regulatory implications. As I alluded to earlier......I don't recommend front-line techs use expired reagents willy-nilly - they should be used surgically and by those skillful enough to recognize the limitations.

Sometimes I think that the "regulators" feel obliged to fix problems that don't exist. Does anyone recall a rash of patient morbidity/mortality due to the use of expired reagents in the blood bank arena? That being said, the use of such material should be restricted to those with the appropriate knowledge and expertise.

Well I had my AABB/CAP inspection last week...did great, thank you, but she never once brought up the subject of expired panel cells....and neither did I. LOL

My AABB/CAP inspection is in 2 weeks...I'll let y'all know. LOL

I just got inspected by JC and got hit on my Ortho panels. They recommended I do QC with a diluted anti-D on each panel to ensure the panel is working according to manufacturer recommendations. I've been looking into this for a bit now and I plan on making the the following change to my process. This process is the same for both my in date panel cells and expired cells. Ultimately, the reason for all of this is to prove red cell viability. We all perform quality control on our screen cells; I use a QC kit. We then test a patient that happens to demonstrate one or multiple reactions on the detection phase. This patient sample is now used to QC our panel cells. We basically validated our patient with cells that were QC'd. When running the patient (QC sample) against the panel cells, we will detect positive reactions, proving the viability of the cells. When doing additional rule outs, I will also select a cell that is positive for the suspected antibody, to ensure I also get a positive reaction there. Basically, every panel I use will have at least one positive reaction to prove red cell viability. If no reactions are noted, I will have a troubleshoot guide (repeat testing, try a different panel, repeat AB screen, antigen type panel, etc...). I plan on using this same process to prove red cell viability in expired red cells. I think this is safer than doing random QC for a limited number of antibodies, you are ensuring the reactions on the QC'd screen cells are reacting on the panel each time you have a positive antibodies vs. "Should periodically perform quality control on panel cells" as stated by the manufacturer. As far as the disclaimer goes, I think I will wait for something more concrete for these inspectors. I am currently working on responding to JC with this process and see if they are in agreement.

Time Out........ Yes, our computer automatically checks all current ABO/Rh results against pts' ABO/Rh previous results and alerts us if the results do not match. (Our computer records go back almost 20 years.) So that is not a problem for those of us who have a computer system. Am I the only one that thinks the CAP checklist item refers to checking for ABO/Rh testing for each pregnant patient (not just the pregnant patients that have current Blood Bank testing ordered)? In other words, we (in our Blood Bank) don't always know if a patient is pregnant, we often don't have access to their prenatal testing (done by a reference lab), we don't handle Rh-Immune Globulin (it is issued by our Pharmancy Dept.), etc. So our Blood Bank Dept is not in a good position to oversee this important patient care issue. I think this checklist item dictates that your institution must have some policy/procedure in place that guarantees that the OB (and Emergency Dept) personnel check the ABO/Rh results (and administers Rh-Immune Globulin appropriately) if a patient is pregnant. (Am I a "Lone Ranger" with this interpretation of CAP's intent?)