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  1. 11 points
    Att All: On behalf of pathologists and laboratory professionals, ASCP is urging the laboratory community and other interested individuals to Sign the Petition urging the Centers for Medicare & Medicaid Services (CMS) to reconsider its position that nursing is a biological science for purposes of performing laboratory testing. We ask that you forward this petition to all of your colleagues. http://cqrcengage.com/ascpath/app/sign-petition?0&engagementId=239813 Here is the link to sign this important petition!
  2. 9 points
    AMcCord

    Ortho Panel Cells -Quality Assurance

    There is no 'good' way to run QC on a panel. In my mind, a better way to control a panel is to look at it and see if it makes sense with the results you get from your antibody screen. However, that doesn't seem to tick the box for QC for an inspector as well as a specific test defined in a policy. Method comparison is another of those things that we do with questionable results. I run an antibody screen (or ID panel if I can find a patient with a nice antibody and enough plasma to spare) using all the methods we use, get different results from those screens and interpret it as differing sensitivity - something I expect to see. What have I proven by doing it? Nothing much. The results I get are not surprising. Works great for chemistry and hemo but does it give blood bankers information we don't already have/know? I'm still going to use the Echo for my primary method with tube/PeG for backup.
  3. 9 points
    pstruik

    use of arrows on forms

    There is a certain delicious irony in a - very sensible - question about the non-use of arrows asking people to point you in the right direction ...
  4. 9 points
    I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient. A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients.
  5. 8 points
    Neil Blumberg

    Neil Blumberg

    And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses. In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).
  6. 8 points
    KKidd

    Retirement

    I will be retiring on August 9 and wanted to tell everyone that the forum has been a great source of information (and amusement at times). I have spent time reading Malcolm's posts trying to imagine what he sounds like (just love a British accent). Thanks for keeping the forum a place where we can all learn from each other
  7. 8 points
    I call that the "baptism of fire". Just remember that experience is the best teacher. If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to? As a newbie there really should be some kind of support for you in these situations. Just a battle story to share.... we are not a trauma center either and a while ago when I was new, we had a patient that came in as a trauma and they wanted emergency release. Blood was issued and then we found out the patient had multiple antibodies. I believe that one was a Kidd. Of course, the units that the patient was given were incompatible. Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this. I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction. They just need the oxygen. Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore. Don't be discouraged, you will gain the knowledge over time to be confident in your decisions!
  8. 8 points
    I think K2 is a mountain.
  9. 7 points
    SMILLER

    Titers

    I just read what I posted yesterday and would like to officially submit that post for longest sentence of the month. Scott
  10. 7 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!
  11. 7 points
    SMILLER

    Just for fun

    LOL! We would send it to our reference lab! We have other things to do here... Scott
  12. 7 points
    Based on an observational study of ABO grouping in Gel I reported at the 1997 AABB Annual Meeting, ABO Plasma Grouping discrepancies occurred in 0.8% (26/3183) adult ABO grouping tests in Gel. Anti-B was not detected in 24/26 patients, anti-A was not detected in 2/26 patients, and anti-A1 was not detected in 3183 patients. In comparison, anti-A and anti-B was detected in 19/26 patients by the immediate-spin tube test, and was detected in 7/26 patients after 10 minute incubation room temperature incubation and centrifugation. Based on this study and 20 years of gel testing since that time have shown me the anti-A1 is rarely detected in Gel and that 70-80% of ABO plasma grouping discrepancies are resolved using the immediate-spin tube test. Centrifugation is used quite differently in gel versus tube testing. Centrifugation is used to separate agglutinated cells from un-agglutinated cells within the gel column, but is used to enhance agglutination in standard tube tests by forcing cells together at the bottom of the tube. This may contribute to the increased sensitivity of tube testing in ABO Plasma grouping tests.
  13. 7 points
    I am going to make myself VERY unpopular here. Firstly, there is no such antigen as Kell (the closest is K5 or Peltz), and there is no such antibody as anti-Kell (the closest is anti-K5 or Anti-Peltz). The blood group system is Kell Blood Group System, but the first antigen within that system is K, and the antibody directed against that antigen is anti-K. The ONLY individuals who can be described as being Kell Negative are those incredibly rare individuals who have the Ko phenotype. Secondly, ONLY genes can be either homozygous or heterozygous (or, in some cases, hemizygous). Antigens CANNOT be described as either homozygous or heterozygous (or, in some cases, hemizygous). As red cells do not contain a nucleus, but merely express antigens, as the result of the individual inheriting certain genes, red cells CANNOT be either homozygous or heterozygous (or, in certain circumstances, hemizygous). The correct way of describing such red cells is to describe them as having either homozygous expression, or heterozygous expression (or, in some cases, hemizygous expression). Having got that off my chest (BUT, IT IS VERY IMPORTANT), I will now address the underlying question of this thread. Without doubt, the reaction between an anti-K and the K antigen CAN show "dosage"; I don't think anyone would dispute that these days. However, the more important question is, over the years and years and years that we have been using antibody screening cells that are K+k+, and have, therefore, NOT detected an anti-K that only reacts with red cells that have (supposed) homozygous expression, and do not forget, some of those cells may actually have come about as the result of a genotype of KE02/KEN, which means that the red cells actually have hemizygous (or "single dose"expression), how many patients have actually suffered a haemolytic transfusion reaction that has been clinically significant, causing morbidity or mortality? I would contend that, having looked through as much of the available literature as I have been able, the answer is zero. Obviously, if there is an anti-K present in the first place, albeit, it is undetectable by routine serological techniques, then transfusing the individual with either K+k+ or K+k- red cells will boost the anti-K, but it has not, as far as I know, resulted in mortality or morbidity, but will, almost certainly, result in an increase in titre and avidity of the antibody (I recognise, of course, that this could have disastrous results in a pregnancy, but only if the pregnancy is not properly monitored). On top of all the above, it is well-known that there are mutations of the KEL1 gene, resulting in "unusual" amino acid substitutions, resulting in weakened expression of the K antigen, are not unknown. It is well known that almost all blood group systems have their "quirks", which means that nobody can rely 100% on their antibody screening cells, BUT WE ALL DO! I would politely suggest that an anti-K that is only detectable with red cells that are (genuinely) K+k- are not that important.
  14. 7 points
    snance

    A neg OB with anti-Yta

    I offer the following based on experience with the MMA and antibodies to antigens of high prevalence and should not be taken as clinical recommendations. The National Reference Laboratory for Blood Group Serology for the American Red Cross has performed Monocyte Monolayer Assays (MMAs) in over 200 cases of patients with anti-Yta in order to determine which patients have antibodies of potential clinical significance. The MMA has been performed for more than 30 years. The reason to perform the MMA is to conserve the supply of Yt(a-) units for patients who have had either had decreased survival of transfused RBCs or who have a positive MMA. But the MMA is only useful for determination of transfusion recommendations for the mother, the MMA for prediction of Hemolytic Disease of the Fetus and Newborn has not been found to be useful in studies performed in George Garratty's Research Laboratory in Los Angeles. For cases like these, an MMA is recommended if blood is thought to be needed for the mother at delivery. Then if a physician determines that the mother can donate autologous units that would be useful. In some cases, 3 different donations can be made with the first two being frozen, one into two aliquots for possible use by the infant and one as a whole unit for the mother's possible use. The final unit can be drawn in order that it will be in-date at the time of the planned delivery. Autologous units do not generally have to follow the same rules as allogeneic donation, and can allow for more frequent donation and at a lower hemoglobin in accordance with the physician order. Alternatively or in addition, a request can be placed by an American Rare Donor Program member for potential units for delivery if autologous units cannot be obtained. And, after delivery, when the woman is eligible for donation, she should be encouraged to donate, not only for herself, but for others. Her siblings should also be tested as they have a 1:4 chance of being Yt(a-). It is assumed that pregnancies like these are monitored by non-invasive means. Most often, antibodies such as anti-Yta, seldom clinically significant for HDFN, are monitored by titer, reviewing for increases in titer (although not mentioned), and then, by clinical protocol. Opinions vary on critical titer value in non-D antibodies, but most agree that increases in titer are reviewed for further studies or early delivery. Perhaps not especially needed in this case, but in cases of antibodies to high prevalence antigens, knowledge of the father's ABO and D status, especially prediction of zygosity of the father's D type might be useful in the very rare event of HDFN because O D negative Yt(a-) blood may be challenging. Sandra Nance, MS, MT(ASCP)SBB, Senior Director, American Rare Donor Program
  15. 7 points
    David Saikin

    MT vs MLT

    You are a blood banker - you have the guts. Just present the changes you are requesting in a logical, professional way. I always found the biggest hurdle was the staff and "we've always done it this way" mentality. If you explain your "why's" it may make change go smoother.
  16. 7 points
    Mari, you have been through the fire. I am certain you and the rest of your staff did us proud. There are times when you have to shut out everything but what is in front of you and do the job to the best of your abilities. There is always time later to reflect, and tremble, grieve and cry but the true professional manages to get the job done. From you post it is obvious your training was well done and your plan well thought out. It reminds the rest of us why we go through the exercises. Well done young lady. You are all a credit to the profession.
  17. 7 points
    dothandar, you are absolutely correct in saying that are known Jka variant antigens. Under the circumstances, DO NOT give this unit to a patient with anti-Jka! It is easy enough to find another Jk(a-) unit, without taking the risk. I am going to attach (I hope!!!!!!!!!) a lecture I have recently written on the Kidd Blood Group System, which may explain why, BUT, be warned, I have yet to check this lecture for complete accuracy, so treat it cautiously. In Depth Lecture on The Kidd Blood Group System.ppt
  18. 7 points
    We routinely receive red cell units from donors with antibodies. They are transfused to patients who have the same antibody (saves time screening for antigen negative units) or to patients who need a one unit top off and who are unlikely to be seen again within the next 2-3 months (avoiding the possibility of having to do an antibody ID for a passively aquired antibody). The O Neg units with antibodies are considered for trauma patients, based on the 'rules' below. You do want to make sure you get a specimen prior to infusion or as the first unit is just starting to run to avoid a possible positive antibody screen. We do not transfuse these units to children or OB patients because we don't want to risk the possibility that there is enough antibody present to harm a patient with a very small blood volume (child or fetus). In adults, the small volume of antibody in an Adsol unit from one donor is going to be very dilute. We also don't give them to frequent fliers and oncology patients - again, we don't want to have to do an antibody ID workup for a passively aquired antibody. We've been using these units for maybe 3 years. In that time we've gotten one patient back soon enough that we got a positive antibody screen (and we are using an Echo, so very sensitive method in use). We make sure that we document when patients receive an antibody positive unit with the identity of the antibody present, so we know what we've got in cases like that. Otherwise, no issues. See Large-scale use of red blood cell units containing alloantibodies, Immunohematology, Volume 16, Number 3, 2000. This was published by folks at Duke University.
  19. 7 points
    L106

    Urgent Requirement for RBCs

    I will start the ball rolling with how we handle some of the issues you have addressed: 1. Antibody is present, but not ID'ed yet, and crossmatch is compatible: We have a form that states that the antibody has not been identified, and although the crossmatch is compatible transfusing it does carry some increased risk because it has not been screened for the corresponding antigen. Ordering physician has to sign the form. (Pathologist is not usually notified.) 2. Patient has a history of a clinically significant antibody and the crossmatch is compatible: We have a form that states that, plus the comment that transfusing it does carry some increase risk because it has not been screened for the corresponding antigen. Ordering physician has to sign the form. (Pathologist is not usually notified.) 3. Antibody is present, but not ID'ed yet, and crossmatch is incompatible: We have a form that states that the antibody has not been identified and the crossmatch is incompatible and carries an significant risk of a possible hemolytic transfusion reaction. Ordering physician has to sign the form. Pathologist is notified that we are issuing incompatible blood. The above situations are spelled out in our policies/procedure manual. In any of the above situations, if the supervisor or assistant supervisor is present they are consulted and get involved in the situation (to make sure we are doing the best/safest thing for the patient.) If supervisor or assistant supervisor are not present, whether they are consulted/notified depends on the expertise/experience of the tech involved. All staff are certainly welcomed to call us at any time, but a few of our experienced techs are comfortable handling the situation. Donna
  20. 7 points
    John C. Staley

    Price of RBC unit

    I would suggest your best option would be to contact other blood suppliers and see what they are willing to do for you. Most of us do not have the option of shopping around. I would love to get into a discussion about CFOs but I'm afraid Cliff would burn my membership so I think I'll refrain.
  21. 6 points
    Ward_X

    Give E and c negative units?

    Just from a man-power standpoint, you don't always have the time to "extra" antigen type. I've seen pts with anti-E that receive products on a weekly basis (that happen to be cancer pts) that have yet to make the anti-c. What about the extended billing for antigen typing? It just seems like a gross assumption to believe a pt with an anti-E acquiring a unit of red blood cells will form an anti-c from it (going back to Malcolm, who initially replied that the anti-E could have been made for reasons other than transfusion). I agree with the serological science of why these are seen together, and why the anti-E can lead to the anti-c, but I have trouble justifying the cost of tech/time, reagents, and billing, to go off a hunch that the anti-c is probable.
  22. 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
  23. 6 points
    If you use DDT, you won't last long either!!!!!!!!!! SORRY, I couldn't resist it!!!!!!!!!!
  24. 6 points
    I am a little worried about the fact that there is no serological cross-match if the mother has made an atypical antibody. The reason I say this is because it is well-known that when a person makes one antibody, they often make more than one. If a mother makes, for example, an anti-K, which is easily detected, she may well also make another antibody specificity, such as an anti-Dia. As the Dia antigen is a low prevalence antigen in most populations, it could well be that the Dia antigen is not expressed on either the screening cells or the antibody identification panel cells - in other words, it may not be detected. Even if the baby does not express the Dia antigen on its red cells, the maternal anti-Dia will still go through the placenta, and so this anti-Dia will still be in the baby's circulation. If, the unit to be transfused is K-, but Di(a+), the baby could well have an unexpected haemolytic transfusion reaction, which could be avoided by a serological cross-match against the mother's sample. Once the unit has been cross-matched, and found to be compatible, then aliquots from the same unit of blood can be safely transfused without a further cross-match, but I feel that, for the first transfusion from any unit of blood, a serological cross-match should be performed.
  25. 6 points
    I've been pretty much off the grid for the past month and thought I would check in. We're driving around Alaska enjoying retirement. Hope all you folks are holding down the fort. I'm sure you are doing a great job.
  26. 6 points
    Just a couple of days before I fly out. I am sooooooooooooo excited!
  27. 6 points
    My impression is Ortho used the "periodically" term as a CYA. I think it's sufficiently vague to be defensible by Ortho when there are problems with the reagent: "well, did you do your periodic QC?" and also vague enough that people like me can completely disregard it without being out of compliance, technically: "I define periodically as the 7th of never, unless inconsistencies are noted."
  28. 6 points
    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.
  29. 6 points
    Yes Terri we are OCD, but we are the kind of people you want crossmatching your blood, labeling your tubes, etc. If we were nurses, mislabeled specimens would be a thing of the past . No offense intended to any nurses that may be lurking in the background .
  30. 6 points
    There is good reason for that Scott. Firstly, the reaction well at the top of the cassette will be at room temperature when you add your cells and palsma, and so a "cold" reacting anti-M will sensitise the red cells prior to the cassette being put into the 37oC incubator, but the incubation time is insufficient for the anti-M to dissociate from the M antigen. Secondly, even if you warm your cassettes, prior to adding the plasma and red cells, it will still not be at 37oC, as you have to take the cassette out of the incubator before you add the plasma and red cells. Thirdly, the gel/glass beads in which the AHG is suspended is slightly acidic, and anti-M just LOVES acidic conditions, and so will react more strongly with M+ red cells in such conditions.
  31. 6 points
    Well Karrieb61, you are correct in knowing my opinion on microscopic reading of ANYTHING to do with blood transfusion (with the obvious exception of a Kleihauer), but, if the DAT is positive, and there has been a transfusion within the last three months (unless the DAT was positive before the transfusion and has not got stronger since the last transfusion), I would perform an eluate - UNLESS, the patient has an auto-antibody, in which case it is a complete and utter waste of time. It sort of depends upon the circumstances - but certainly not every time you have a sample.
  32. 6 points
    SMW

    Group O thawed plasma usage

    Since group A plasma is compatible with group O and group A patients, group A plasma will be compatible with ~ 85% of your patients (US Caucasian, but even higher % for other ethnic groups). For that reason, I know of some places that do not even inventory or use group O plasma. Looking at the efficacy of the products, since group A plasma has higher levels of Factor VIII than group O plasma, you're actually getting more bang for your buck by using group A plasma products for group O patients. Group O red cell products would continue to be compatible with group O patients receiving group A plasma and group A and group O red cell products would continue to be compatible with group A patients receiving group A plasma. If anyone is still trying to justify the use of 5 day thawed plasma, group A plasma at 5 days has higher FVIII levels than group O plasma at 24 hours. By using group A plasma at 5 days, the O patient is getting an equivalent or greater dose of FVIII than they would if they received group O plasma within 24 hours of thawing. Have you ever had a physician ask what blood type the patient was before they determined how many plasma products they needed to order? There were some interesting discussions at the AABB meeting about the routine use of group A plasma for massive transfusion protocols when the patient type is unknown but that's a whole other discussion topic.
  33. 5 points
    One thing I would say is that the baby should be treated on clinical symptoms, rather than on laboratory results, particularly when they are so weak that you have to do all this testing to show an abnormality in the Blood Bank. A slight rise in bilirubin is normal in a newborn baby. This situation is very similar to the difference between a haemolytic transfusion reaction, where, for example, there is a positive DAT, antibody can be eluted and there is a SIGNIFICANT rise in bilirubin and a SIGNIFICANT drop in Hb, and a serological transfusion reaction, where there may, or may not be, be a positive DAT, antibody may or may not be eluted from the red cells, a new antibody specificity may be detected in the plasma, but there is NO SIGNIFICANT rise in bilirubin and NO SIGNIFICANT drop in Hb. Your cases remind me strangely of the latter.
  34. 5 points
    SMILLER

    PREPARING SCREENING CELLS

    Or you can just eyeball it! Scott
  35. 5 points
    R1R2

    Blood Utilization Suyvey

    I was not going to say that I promptly threw it in the circular file because I was afraid of being "shamed" for doing so but I threw it in the circular file promptly.
  36. 5 points
    No, and you won't Scott (or, at least, you shouldn't!), because changes in storage affect the serum that allow non-specific uptake of proteins on to the red cells, causing false positive DAT results - something that does not happen (never say never!) with EDTA plasma.
  37. 5 points
    AMcCord

    Microscopic Examination

    The only caveat I would add...consider your staff. I have all generalists. I require them to use a microscope because they are not all equally skilled with shaking off and seeing weak reactions in the mirror. Without the scope, we would miss some things we need to see. If I had a dedicated blood bank staff, I would give you a different answer.
  38. 5 points
    TreeMoss

    antibody to reagent cells

    We first started thinking about this when we had a patient with positive reactions in all 3 screening cells and all panel cells, but the auto control and two packed cells were negative in gel. How could units be compatible when all screening and panel cells were positive? We then diluted up our Immucor cells to test in gel, and amazingly, there were no reactions. We do report ours as an antibody to the preservative in the Ortho cells. We've seen several times that these patients are on Sulfa drugs, and we wonder if there is a connection there.
  39. 5 points
    This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired! Doc1.docx
  40. 5 points
    We had one once that was sent in to us because it was getting a bit battered and bruised, and the lady wanted a new one. The original was signed by a certain Dr Ruth Sanger!!!!!!!!!!!!!!!!!!!
  41. 5 points
    When we come across these, we use the term: "Antibody of undetermined specificity and unknown clinical significance".
  42. 5 points
    Malcolm Needs

    To LISS or NOT to LISS

    Agreed Terri, the pre-warm is a dangerous technique in inexperienced hands. In experienced hands, however, it is a VERY useful and SAFE technique. We have used it in our Reference Laboratory day in, day out for years and years as a back-up technique, and STILL have not killed anyone.
  43. 5 points
    Karrieb61

    Malcolm is coming to town.......

    I plan to take him out for a pint after his presentation. Are we lucky in Rhode Island or what?????
  44. 5 points
    We have transitioned to using group A FFP and liquid plasma for our trauma patients who are emergency released blood, and for all MTPs (we still use AB if we have an abundance of it thawed or if we are only able to get AB liquids to restock). My supervisor worked with the trauma program medical director and the CMO and we developed new SOPs for this. We have discussed putting together a short paper, as we've been collecting data on all emergency release patients. Since September we've had about 40 trauma patients receive group A plasma, and we've only had three B/AB patients in that group. On each of these patients we ran some extra post-transfusion labs (renal panel and LDH, DAT), nothing really notable so far. We've also been doing an abbreviated titer on the liquid plasma units we receive and setting aside anything with a titer of 64 or greater (only about 10%) for use on A or O patients only, if possible (which is most patients anyway!). FFP is not titered. So far we've had no problems and it's been much less stressful than trying to restock AB after multiple traumas. In fact we had a day last month where we had 7 bleeding traumas in one shift, we would have been in a pickle if we'd used AB for them, so it was a huge help.
  45. 5 points
    The answer to the question is "way too often"! I agree with Brenda that, all things being equal, the panel should show parallel reactivity with the screening cells unless the antibody was teetering on the edge of detectability. Also, you mention that the E-positive ficin cells reacted. What I didn't see was the rest of them did not react. Please forgive me if a full ficin panel was performed - but be careful about just taking selected cells and testing them with a different methodology. The reactivity you see may not necessarily be due to the antibody you're suspecting - something else could be popping up that was not observable with the first method. Phil
  46. 5 points
    AMcCord

    Warm Auto's and the "New Insurances"

    Speaking with our small neighbors in mind (and a few not so small), many of the small facilities probably don't have a technical supervisor with proficiency in these kinds of methods, much less maintaining staff with competency. Many have such a tight staffing situation that just doing a basic antibody ID is stressful (it can be a stressor here if it's a busy day). In fact most of our small neighbors don't do any kind of antibody workups - if the antibody screen is positive or the crossmatch doesn't work, out it goes to the reference lab. I know of quite a few facilities that don't even do moderately complex antibody IDs. They don't keep the antisera or multiple ID panels on hand to do them as a cost cutting measure. Reagents for advanced methods aren't even on the radar screen. I don't keep DTT, though I do have WARM and chloroquine. I'm the only one that uses these methods - keeping other techs proficient would be very difficult/expensive with the volume of special testing we do. The money crunchers may take that away from me before too long. The only reason they haven't up to now is that we are a long way from our reference lab, though our transport options have improved. It's not just the cost of reagents, either. You have to have surveys, if they are available. Those can be very pricey - I'm thinking that the elution survey alone is $800ish per year. If you don't do surveys you have to have some other way to prove you know what you're doing - like sending a split sample to a reference lab a few times a year. That could be even more expensive than a survey. If your patient is a Medicare or Medicaid patient, you aren't getting reimbursed now. Their diagnosis (DRG) is worth a pre-specified amount of $$$. If they have extra expensive tests done, too bad for your hospital...no more money. Most insurance companies are following the same game plan. So, after rambling on, in answer to your question, if you don't have much volume for these kinds of tests, it is not cost effective for your lab to try to do them. If you do have the volume, it may still not be cost effective. If you don't have much volume, its probably better (safer) for the patients if your lab doesn't try to do them.
  47. 5 points
    Dr. Pepper

    Happy Birthday!

    Good for you! I had to bring my Mom into the hospital several years ago. I was mid-fifties at the time and in good shape. Mom was mid-eighties, small and shriveled, and at the moment looked like she'd been dead for a decade. The nurse asked me, "Are you her husband?" I said, "You know, if you were a waitress you wouldn't get a tip."
  48. 5 points
    tbostock

    Least Incompatible units

    I agree with David. I dropped the term "least incompatible" a long time ago. It gives the physician a false sense of security. They have done studies that a 1+ incompatible unit will do a patient no more or less harm than a 2+ incompatible unit. In vitro grading/results do not correlate what will or will not cause harm in the patient. I know of some labs that use the term "serologically incompatible" when it's just the warm auto activity and all underlying alloantibodies were ruled out. This is more realistic than "least incompatible". At my place we just call them all incompatible and have the MD sign a release, whether or not the allos have been ruled out. We like putting a healthy fear out there so they watch the patient more closely.
  49. 5 points
    Let me know when you find a solution or an answer . . . 'cuz I don't have one. Neither does my insitution.
  50. 5 points
    Dr. Pepper

    Phenotypic Unit Selection

    If they caused a fatal reaction, would they be killer bees?
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