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  1. jojo808

    Transfusion Errors

    I think we need to add an OMG emoji to our selections!
    6 points
  2. galvania

    Micro only reactions

    to be fair techniques in the early 80s were not what they are today, neither for blood grouping nor for antibody screening/identification. Methods were not standardised. The number of drops of serum (almost always serum) to the amount of red cells could vary from 2:1 to 8:1. The concentration of the red cells could be anything from about 2% to almost 10% - and often pooled. And pooling was one of the main reason for checking under the microscope. Incubation time varied too - often depending on the length of your coffee break or lunch break. LISS was in its infancy. Washing was done by ha
    6 points
  3. mrmic

    Transfusion Errors

    Definitely enough story lines for a mini-series! These are all possible stories that could happen to any of us. Being in direct contact with physicians (who know everything) and nurses (who believe policy is not practice) and providing products that could be life saving or harmful to patients and parts of the process is out of BBs control can be very stressful for technologists. And sometimes is hard to get new technologists to work in our field. With providing administration with some of these "real" scenarios and the possible medical-legal-pr implications I was able to acqui
    4 points
  4. exlimey

    Transfusion Errors

    This is the best thread, EVER !!!! Keep it rolling, please.
    4 points
  5. I've been searching for the powerpoint I made of the occurrence I wanted to share but I must have stored it on an external hard drive that crashed and was unrecoverable. (That's my excuse anyway.) Consequently it was long ago and my memory is fuzzy on the details but in this case the details is not the point I'm attempting to convey. Bottom line was that 2 units of blood were sent via pneumatic tube to ICU for 2 different patients. No, the units were not in the same tube, they were sent 10-15 minutes apart. The units went to the wrong patients and the proper patient identification protocol
    4 points
  6. or mum is a surrogate or baby is the result of an ivf with external donors
    3 points
  7. I'm chuckling reading all of this because it's like the question, 'If the parents are both Group O, can they produce a Group A baby?' Ask a student, they'll say 'No way!'. Ask a BB fanatic, they'll say, 'Sure it could happen ... and here's how ...' And in this forum, there is never a simple answer!
    3 points
  8. Sandi

    Transfusion Errors

    I just had to share this story...When I worked in a large teaching hospital we had a team of Transfusion Nurses who were responsible for drawing most samples and administering the transfusions. Occasionally, however, physicians (or interns/residents) would draw the samples. One afternoon we received an unlabeled sample drawn by a physician via courier. We contacted the physician and informed him a new sample would have to be drawn. He said he would come to the transfusion service and label it right away. We told him that was unacceptable, however, he insisted. While he was on his way, we put t
    3 points
  9. Thank you Malcolm. Our prenatal titer procedure calls for reading microscopic solely for the purpose of scoring, but I guess there isn't an associated score . Looks like the procedure should be updated
    3 points
  10. "Sure it could happen ,,, and here's how... one of the parents perhaps has the Bombay phenotype"
    2 points
  11. Easy, give group O only. We used to allow directed donations and we would do a back type on the baby. We stopped allowing directed donations years ago and only give O Neg to our neonates.
    2 points
  12. Great feedback. Thank you.
    2 points
  13. We've been using 2 Hettich centrifuges for quite a few years now. They have been very reliable and run quiet. The down side is that I find them a little tricky to program, which fortunately I don't need to do that after the initial set up. (The upside to that is that my mystery tech who feels urges to tinker with stuff can't figure them out, so they leave them alone.)
    2 points
  14. Oh, I forgot we discard are returned products in syringes regardless of how long they've been out since we can't take the temp.
    2 points
  15. Marilyn Plett

    Transfusion Errors

    Back in the 70's, two patients with identical names and identical hospital ID numbers except for one number were in rooms across the hall from each other. The O patient received the red cells intended for the B patient. I discovered the error when I accidentally entered the wrong room to collect a transfusion reaction specimen and did my due diligence on patient identification. Subsequent new admission rules forbade having two patients on the same wing with the same name.
    2 points
  16. Check the product insert for the RgIG that is issued at your facility. Rhophylac and RhoGAM both say to collect the Fetal Bleed Screen/Kleihauer Betke one hour after delivery. You don't want to make your policy too rigid to comply with however, so ours says that we draw specimens as close to 1 hour of delivery as possible. As Carolyn said, the most important thing is to make sure that the specimen gets drawn.
    2 points
  17. Macroscopic every time.
    2 points
  18. Arno

    neonatal transfusion

    Hi! I do not know which gel card supplier you are using, but the one I “know” use 50ul of A1 and B cells with 25ul of plasma and an incubation at 37°C for 15 minutes. And all of this in an AHG gel card of course… having previously checked as well there is no additional antibody that could interfere (result from mother if available/antibody screening result). Hope it helps.
    2 points
  19. GAFFER

    S.C.A.R.F.

    Still running, co-incidentally received a sample this morning here in RCI (Oh). Still log on to monitor for any new posts/offerings once a month (or so).
    2 points
  20. I would say have compassion and flexibility, but don't let people walk all over you. Don't be afraid to ask for what you need, like 5 minutes to finish a task before addressing their issue. If people are complaining, I will often ask them to come up with a solution. I definitely agree that stepping into a leadership position internally is more difficult than starting as a leader in a new facility. One of the most helpful things that I was told early in my career was to vent up, personnel management can be frustrating, but go vent to a supervisor or manager away from the lab, this can ofte
    2 points
  21. During the time at the Immunohematology Reference Lab I was at in the 80s-90s era we had to use microscopes to confirm negative reactivity. What!!? Why?? Specimens sent to us with multiple 2+ and 4+ reactions to panel cells were sent to us for investigation. We observed 0 reactivity! The hospital techs would get very upset with us because they were absolutely sure of what they observed and we found nothing! As it turned out, some hospitals, using microscopes, were grading their microscopic reactivities on a 1+ to 4+ scale but just not informing us it was microscopic reactivity. Fortun
    2 points
  22. DPruden

    Transfusion Errors

    Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units. this was during a time when many people were donating autologous units and having them frozen (early 1990s). There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS. To further complicate the error, the patient didn't really need to be transfused, 30-someth
    2 points
  23. When tube testing was all we had, my moto was; "when in doubt, shake it out!" One of the first things I did as transfusion supervisor at a new facility was convince the medical director that we needed to stop using the microscope for routine testing. It was much harder to convince the rest of the staff. I couldn't remove the microscopes from the department because we were doing KBs at the time and I'm pretty sure a few of the "older" staff still used them for routine testing when I wasn't looking. Once again inertia is proven to be the most powerful force in the universe!
    2 points
  24. I have never understood this obsession with looking at reactions down a microscope in blood bank, except looking at things like a Kleihauer or when teaching, to show mixed-field reactions. The great Peter Issitt, not a bad roll model to have, wrote, many years ago now, a passage that I attach from page 69 of his "Applied Blood Group Serology" book, 3rd edition, 1985, Montgomery Scientific Press. That having been said, all reactions seen MUST be recorded, it is just that macroscopic reading is almost all that is ever required.
    2 points
  25. I am getting ready to install an ECHO Lumina. Just had our initial set up meeting yesterday. Switching from gel to solid phase. Looking forward to a bit more standardization in this department. We use DI but the ECHO also comes with its own middleware (or so I believe).
    1 point
  26. I just answered this question. My Score PASS  
    1 point
  27. I suggest you try any high potency IgM anti D which these days is a monoclonal and thus not high protein. The anti D on your bench right now ( immediate spin) should work.
    1 point
  28. AMcCord

    Barrier method

    We also use BPAM and collect all specimens with electronic ID. I don't believe either of these two methods is regarded as a barrier method, though they are certainly an improvement for patient safety.
    1 point
  29. jayinsat

    Barrier method

    We use the BCTA (Barcode Enabled Transfusion Administration) module in Meditech.
    1 point
  30. Sonya Martinez

    Barrier method

    We still use a clerical check on the paper Transfusion Record then all records come back to the blood bank for review. If they don't fill the clerical check on perfectly (2 medical staff signatures, full date and time completed) I put in a safety report. It's one of nursing's performance improvement plans to be >95% each month. I would rather they do the 'double check' in the computer but we don't have Epic BPAM (blood product admin module) set up to match the results filed when we issue the product to the barcodes they enter at the beside before transfusion.
    1 point
  31. Cliff

    neonatal transfusion

    We used to CMV test our units and not add an additive solution. Our inventory (I suspect like most) is 100% leukoreduced, so that takes care of the CMV for us. We also allow Adsol units now, so we can easily get these from our supplier, just a regular O Neg less than 7 days old.
    1 point
  32. Cliff

    Blood Bank Testing Equipment

    We have two IH 1000. BioRad has been great to work with. They are workhorses. They are complicated and tend to have a fair amount of downtime. Many years ago when we first introduced automation it was solid phase. A lot of our patients were then coming up D positive (D neg history) as the methodology was a lot more sensitive than tube. The same thing happened a few years ago when we switched to gel. You'll also pick up more colds and junk with gel. Overall we're happy. We might consider an IH 500 someday for the titers.
    1 point
  33. We just switched to the MaxQ MTP coolers and love them! My validations showed it held temps for 24 hours, even when opening the lid every 15 minutes for the first 2 hours and hourly after that. Plus, we filled the cooler with warm FFP (4 units @37C) and cold RBC (4 units @4C). The cooler cooled down the FFP units to 6C within 3 hours. The RBC'S never went above 5C.
    1 point
  34. Just a thought. With an issue like this you have to come to a point of realizing that you can only do so much especially when much of the process is out of your control. You can drive yourself crazy playing the "what if " game! Once you've done the best you can for your situation then accept that there will probably be a fallible human somewhere in the process who will come up with a creative work around. A nurse will put a unit in the medication refrigerator until she's ready for it or they will put it back in the cooler in OR after it's been setting next to the patient during the procedu
    1 point
  35. We use one from Fisher. It is certified and we replace it every 2 years when the certificate expires. I am curious, for those who have the 15 minute limit, did you validate that in all scenarios in your hospital?
    1 point
  36. Quick summary of my question: Our organization is transitioning to Epic/Beaker for the main LIS and SafeTrace TX for the Blood Bank module. I understand that Beaker does not have FDA 510K clearance as a Blood Bank LIS, so we can't do "Blood Bank tests" there. However, does anyone have any resources on what is defined as "Blood Bank" when evaluating what can go into Beaker? In specific terms, do you think having Beaker built to automatically calculate the volume of a fetal bleed based on a Kleihauer-Betke stain is acceptable? What about automatically calculating the dose of Rh Immune
    1 point
  37. yan xia

    Transfusion Errors

    It was decade ago, a nurse kindly gave the blood crossmatched for A to B after A passed away without having it . Because she thought they were both type O pos. Luckly, B had no transfusion reaction.
    1 point
  38. We crossmatch the A or B cells(the red cell itself) to the babies plasma, using the IgG gel card.
    1 point
  39. Ensis01

    Transfusion Errors

    Several years ago we had a call from the OR asking if there was any history on a patient X to determine if one collection or two separate collections were required. The BB tech who answered the call did a history search and said we have no BB history on patient X. Ten minutes later two samples for a patient Y arrived. The same BB tech called the OR to clarify why samples on patient Y were delivered when we were expecting patient X. The OR said patient X samples had been delivered. Not said the BB tech; and demanded two recollections by different people. What had happened was patient X was
    1 point
  40. I saw a discussion once that said draw it as soon as you can post delivery (ours is at 1 hour) - but that drawing it is more important than the time of the draw. I think I remember that they discussed up to one week post delivery (sort of ridiculous to think about). I have never really seen a maximum time for drawing. Make sure your procedures allow for double checking RH neg mom's with Rh pos babies - make sure L&D has some checkpoints and that your techs have some checkpoints to make sure tubes get drawn and tests get done. Make sure the testing gets done and documented and the
    1 point
  41. noelrbrown

    Student Specimens

    Add some Dextran to a plasma sample, it should do the trick and will save you a lot of time and effort freezing and retaining samples etc.
    1 point
  42. DPruden

    Liquid Plasma

    Technically, it is only indicated for treatment of patients who are undergoing massive transfusion. because of life-threatening trauma/hemorrhages. We use it for MTPs in our OR as well as trauma patients coming into the ER.
    1 point
  43. When we first started using Gel, my techs would point out the shadows or 'jumpies' as they called them. I'd suggest 'Run the screen again using maxtime.' If they still saw the shadows, I'd just let them run a panel (maxtime) and go crazy with the results. After a while we all learned to ignore those reactions. Keep in mind, there are always a certain percent of any given cell population (especially stored reagent cells) that are just not going to make it smoothly to the very bottom solely because of steric hindrance (broken, aged, crenated, tagged for destruction, etc.).
    1 point
  44. Malcolm Needs

    Micro only reactions

    For all I have said above, and I think I have said this before on here, when I was first working in Red Cell Reference, when the International Blood Group Reference Laboratory was in London, and the Department was run by Carolyn Giles and a very young Senior Technician by the name of Joyce Poole, I also had the problem of seeing "weak agglutination" that wasn't actually there (totally negative, in other words), and Joyce coined this as a "Malcolm Weak". This was way back in the early 1970's. I understand that, now and again, some 50 years on, the term is still used in the department for ove
    1 point
  45. Decades ago I worked w a tech who worked w Peter at NYBC. I had always looked under the scope (as that was how I was trained). I'd ask her to look at 2 or 3 or 4 cells stuck together microscopically. Her comment was always, "If you want to call that positive go ahead, but I'd call it negative." High anxiety to give up the scope but I did.
    1 point
  46. Beyond any shadow of a doubt - personnel will always be the greatest challenge. Not enough, not well enough trained, will they follow the SOPs (in spite of the continuous Competency - truly a pain!), will they show up, will they get along with each other........... Be prepared for that challenge and take advice from a good manager, if you are blessed with one. Always consider that mistakes may stem from a misunderstanding of what is written in the procedure or the procedure might need a tweak to eliminate a "process" problem.. Approach mistakes from the point of view - "Is it a process
    1 point
  47. 1 point
  48. Let me play the devils advocate when it comes to using the historical type. What happens if the patient is not really the patient that the original ABO was performed on? What about the times when the ID number is bought and used by multiple people especially where there is a large community of people who are not necessarily legal to be here? For these reasons and a few more, we require a current type.
    1 point
  49. Our QC was minimal several years ago based on the fact that the first ABO back type would confirm the antisera. The standard says the Anti-IgG reactivity is checked during crossmatching. I think our QC only had about 6 tubes and 1 gel card. Very minimal! But I started thinking that we didn't actually have proof the AHG worked on a particular day. (If it isn't documented you didn't do it) I thought proof needed to be added or some tech working that day would need to remember to mark the form hours later. I knew this would get missed multiple times in a year so I added these to the QC form. I e
    1 point
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