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Platelets are in adequate supply largely due to hospitals (in my service area) enforcing restrictive transfusion measures and postponing elective surgeries. Most blood centers except in New York, Washington state, and California are treading water with respect to RBCs. As usual Rh neg units are in short supply. Most of the hospitals in my service area are also freeing up beds to treat respiratory infections. These will require fewer transfusions, although patients needing ECMO are of concern. Looking ahead, it is difficult to predict what will happen. This is a long term event. My current concern is that blood donors will be fatigued 3 weeks from now and avoid giving blood. That is what happened after 9/11. It could be that you might need that unit of O neg on your shelf 42 days from now. In my opinion the goal is to provide blood for everyone who needs blood. Measures to restrict are prudent (and the literature indicates this is good medicine). After this is all over and we are criticized for being too conservative, but no one died for lack of blood, I can live with that.

My best guess and it is nothing more than a guess, is that if these patient's require any support from the transfusion service it will be due to a preexisting condition and not the direct result of the corona virus. I don't recall in all my years, of any patients with pneumonia requiring a transfusion due to having pneumonia and I understand that pneumonia is the primary reason for hospitalization here. Now I may be way out there on this but only time and experience will tell.

From the management side; involve the tech. Meet with them and have a conversation about how/why the think the error occurred.. Make them feel involved in QA and PI by asking if they have any suggestions that may prevent a recurrence. Front line staff often have great PI ideas, but won't speak up. During the conversation you will also be able to get a good feel for whether the tech knows the procedure and is committed to following processes as written, needs some re-training or whether they purposely deviated because the had "a better way".

Since all elective surgeries have been postponed and restaurants/bars have closed the BB has been incredibly slow which is rather scary in itself (the calm before the storm?). Due to this we have voluntary reduced our inventory to help with the blood supply.

Hi Rich, I am not a clinician but as far as I know IVIG can be given to obstetrical patient in diff. conditions (autoimmune disorders, recurrent pregnancy loss, ...). I thought about IVIG when I saw the DAT becoming positive plus additional reactions coming up over the time. Anti-A and Anti-B are indeed the most prevalent antibodies in plasma derived products but other specificities of low titre can be present sometimes such as anti-D, anti-K and a bunch of antibodies of undetermined specificity reacting with several to not say all RBCs. Just a thought that can be doublechecked with the clinician..? Hereunder is a very great (not recent though) paper to be read and re-read again: Problems Associated With Passively Transfused Blood Group Alloantibodies George Garratty, PhD, FRCPath American Journal of Clinical Pathology, Volume 109, Issue 6, 1 June 1998, Pages 769–777, https://doi.org/10.1093/ajcp/109.6.769

When the reason for a deviation is determined we can decide how it needs to be addressed. In some cases, the deviation was an acceptable response to a given situation. No follow up required. If education or training is required, that is provided and documented on the same form. If the deviation is the result of continued 'bad behavior', training/education issues, or egregious disregard for policy, then our next step is an 'Opportunity for Improvement'. This is something we use throughout our lab. The tech and a lead sit down together to discuss the deviations and the problems identified to determine what the tech needs to do to remedy the problem. The tech is also asked what he/she feels is needed to help him/her resolve the problem. Once the lead and the tech have come to an agreement, the resolution to the problem is spelled out, including any education/training the lead will provide and the expectations for the tech's future performance. An end date for the required improvement is also determined. When that date is reached, the lead evaluates the tech's progress. If all is well, that is documented. The End. If there are still issues, the lead can re-evalute the situation. Additional training or education can be provided, with another periord of evaluation. If need be, the problem can be referred to the lab manager for possible disciplinary action.

Yes, but the validation does not have to be exhaustive and unreasonable. All you need to do is prove that it works as advertised in your lab.

I just got a memo from the ARC. They are working on convalescent plasma supplies. No details yet.

You would need to research available studies or file your own eIND. Approval can take as little as 4 hour I am told. Then you would either collect it yourself, or work with you blood supplier to collect appropriate donors. Requires excellent communication. You can only use it for your study. It is not an off-the-shelf product.

Sonya Martinez, Where are you going to get the COVID-19 convalescent plasma? I had a physician inquire about that this morning. I don't think our normal providers will have that as it is still considered "experimental." Thanks!

I believe that once ventilated, due to the risk of DIC, some COVID19 patients are requiring extensive platelet support. Thank fully not seeing this at present in Scotland, however numbers of patients testing positive are increasing daily.

Really sick patients needing ECMO will use blood. I don’t have a way to gauge the utilization at this time though. All the best.

I'm currently working on building the convalescent plasma product codes into our computer system in case it is needed/wanted. But I'm in a children's only hospital so the only thing we're seeing right now is the normal stuff like urgent heart, spine, cranio and orthopedic surgeries plus our chronic transfusions for the rare anemia patients. We are no longer doing non-urgent surgeries and I anticipate to slow down further but according to the news California had the first death of a child (person under 18 yo) with COVID-19 but I haven't see if that's why the patient died. It would be nice if anyone knew lab personnel in Italy, Spain, etc but I think they may be a bit busy right now!! Unfortunately for us the flu is still going strong and we have had HUS and CAHA cases from it.

They are receiving anti-cd38, specifically daratumumab.

Here is our procedure for dry ice. Safe Handling of Dry Ice v2.docx

Scott, Here is our procedure. I removed our "identifying" information, so feel free to use anything you need! Dawn Liquid Nitrogen and Dry Ice.docx Dry Ice Quiz.docx

The DAT is easily explained, with an anti-D level that high! Even after a double exchange transfusion, there will still be approximately 5% of foetal/neonatal red cells in the circulation, which is quite sufficient to give a positive DAT, but with an IUT, you are not removing an foetal red cells from the circulation (or minimal amounts) and should be considered more as a simple top-up transfusion (with profuse apologies to people who work in the Fetal Medicine Units, as I fully realise that there is nothing remotely "simple" about an IUT). As far as the reactions with the anti-A,B, the anti-D and the control is concerned, while the anti-A and anti-B are negative, it must be remembered that there are potentiators in monoclonal antibodies, such as albumin, that will possibly lead to them giving "false positive" reactions (although, I would suggest, that the reaction with the anti-D is anything but false - unless the anti-D is blocking the D antigen sites, which, with an anti-D level of 847IUmL-1 [it is NOT 847IU, which is an amount, rather than a concentration] would not be in the realms of impossibility). The amount of potentiator in each specificity will be different, depending upon what the antibodies are designed to detect (for example, what A and B subgroups, if any). However, the anti-D will most certainly contain potentiators, to ensure that most weak, and some partial D types are detected. This means that the control, which will have the same make up as the anti-D reagent - but without the anti-D, in other words, it would contain potentiators that would detect "false positives", which is the whole point of the control.

I took my SBB a hundred years ago (OK, maybe early on when it was first computerized). I self-studied. Did not go to SBB school, did not take an online class. I had, and still have, the great fortune of working at a world class hospital. What worked for me: Read Transfusion cover to cover for at least a year. Regardless if I was interested in the article or understood it. Read the AABB Technical Manual, at least once, I think I read it twice, maybe three times. Memorize all of the common antigen frequencies, and some of the odd ones too. Read where the concentration of questions would be. For example, there was anticipated to be 1 HLA question on my exam. A person could get their PhD in HLA, I only read that chapter once. Memorize AABB Standards. Memorize the relevant FDA CFRs. Read a good hematology text book. That is a lot of reading and will have you well versed in most things related to blood banking. You will easily pass your BB. If you are taking your SBB, the only thing I was not anticipating was the management questions. I did not study anything about that. If I were to take it again (that will never happen), I'd read a book or two on employee relations / management. I was one of the lucky few who passed (barely) the first time. But you know what they call the person who finishes last in their class of medical school...

Our saline mfg recommends a daily check of saline for non-hemolysing and a negative DAT of cells washed with it, so that's what we do.

ARC (American Red Cross) has issued a statement that almost 5,000 blood drives were canceled and a few hundred donation sites due to quarantines. They're trying to get people to start donating at hospitals and other "essential" sites. The physicians have ramped up elective surgery instead of delaying them. I think it's super selfish to waste blood products during a crisis of this nature when you don't know what the outcome will be or how long the quarantines will last, it's beyond frustrating.