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Showing content with the highest reputation since 03/25/2020 in Posts

  1. 3 points
    In which buffer do you resuspend your DTT treated cells? May be these patients do have antibodies against one or several components of this buffer (antibodies against preservatives used in RBC buffer are not so uncommon).
  2. 3 points
    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.
  3. 3 points
    Kip Kuttner

    The COVID-19 challenge

    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.
  4. 2 points
    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!
  5. 2 points
    Neil Blumberg

    The COVID-19 challenge

    In a statewide web conference, the blood suppliers in New York State and the NY metro area (parts of New Jersey) provided the reassuring news that by setting up alternate fixed sites for (mostly) whole blood collection, the blood supply has been about normal. Platelets are collected at fixed sites and the donors have been wonderful. Transfusion in our area (Rochester NY) is slightly down as we are not transplanting patients without urgent indications (myeloma can sometimes wait, for example) and elective surgery is not happening. So right now, things in New York State, the worst hit part of the country, are remarkably and thankfully reasonable for blood supply. We can thank the dedicated staff of the Red Cross and NY Blood Center, and, of course, our courageous and committed donors for this good news. Hang in there, not that there's any other place to hang.
  6. 2 points
    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.
  7. 2 points
    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.
  8. 2 points
    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.
  9. 2 points

    Deviation Reporting

    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".
  10. 2 points

    The COVID-19 challenge

    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.
  11. 1 point
    We require a second type no matter where the patient is. We rarely get push back even during an MTP or ECMO cannulation. We've been doing it this way for more than 15 years. We also don't require them to place an order or use Epic printed labels. We have them label with a demographics label on the lavender top and our processors know if they don't have an order they immediately bring it to the blood bank. Unfortunately working in a children's hospital we give a lot more O RBCs due to our patient population and the fact that we don't have the moms at all. We will also take a verbal second type from another hospital blood bank if we know where the patient was transferred from. Luckily most of the hospitals in San Diego county have Epic Care Everywhere and/or their NICUs and PICUs are run by my institution anyway so we can access the patient record if we know the MRN.
  12. 1 point

    Second blood type during surgery

    We always require a second confirmatory sample before issuing group specific units if there is no historical group. We request this as soon as we know the patient has not been seen by us before. This doesn't impact on the speed of providing cross matched blood due to the shorter test time for a forward group compared to a full group, antibody screen and cross match. The units are selected based on a rapid tube spin group and set up with the first sample group and screen. We do not do electronic issue for any patients.
  13. 1 point
    Our Blood bank Medical Director has realized that this can happen in the OR. We try our best to get that 2nd type but if we cannot, he will sign a deviation of policy for that event. Post OR we will then get the 2nd type. We do have an electronic ID system but anything can happen in an emergency or MTP going right up to the OR so we have this in place.
  14. 1 point
    John C. Staley

    Validation studies

    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.
  15. 1 point
    1:1024 is NOT a titre; it is a dilution.
  16. 1 point
    I just got a memo from the ARC. They are working on convalescent plasma supplies. No details yet.
  17. 1 point
    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.
  18. 1 point
    Blood shortages are a big problem in parts of the US. Donors are not presenting, drives are being cancelled. Those patients who normally need blood products will be affected by that. I can't speak to Covid19 patients specifically...yet. We have been asked to reduce our stock by 25% and cut usage by 25% so that blood products will be available for those who need it most.
  19. 1 point
    They are receiving anti-cd38, specifically daratumumab.
  20. 1 point
    I wondered the same thing, both about units and the samples from the patients. The only related thing I could think of are policies regarding CJD/vCJD, and those only covered samples. Besides following universal precautions and wearing the necessary PPE, seems to me the only difference is vigorous cleaning of non-disposable equipment with bleach after testing and that samples sent to micro are handled under BSL-3. Another point, you don't know the status of every single patient getting blood products, so do you even know who had Flu B before all this madness?
  21. 1 point
    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
  22. 1 point
    Neil Blumberg

    The COVID-19 challenge

    N Engl J Med. 2010 Feb 18;362(7):600-13. doi: 10.1056/NEJMoa0904084. Dose of prophylactic platelet transfusions and prevention of hemorrhage. Slichter SJ1, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, Gernsheimer TB, Ness PM, Brecher ME, Josephson CD, Konkle BA, Woodson RD, Ortel TL, Hillyer CD, Skerrett DL, McCrae KR, Sloan SR, Uhl L, George JN, Aquino VM, Manno CS, McFarland JG, Hess JR, Leissinger C, Granger S. Author information Abstract BACKGROUND: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. METHODS: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x10(11), 2.2x10(11), or 4.4x10(11) platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). RESULTS: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25x10(11)) than in the medium-dose group (11.25x10(11)) or the high-dose group (19.63x10(11)) (P=0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). CONCLUSIONS: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1x10(11) and 4.4x10(11) platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)
  23. 1 point

    The COVID-19 challenge

    We've been in short supply of RBC's and platelets for so long now it's going to be hard to notice. One good thing that has come of it is the intensified scrutiny of every order - providers have been made keenly aware and are re-evaluating their ordering practices. I guess necessity is the godfather of compliance.
  24. 1 point
    Malcolm Needs

    HX of WAA Case

    Alloasorption. In fact, having worked in Reference Laboratories for most of my life, it was VERY unusual for the patient either to have NOT have a transfusion within the previous three months - meaning that they were not a candidate for auto-adsorptions - or their haematocrit is so low that there are too few autologous red cells to perform an auto-adsorption in the first place (usually because they were sent to us because they needed a transfusion in the first place!).
  25. 1 point
    The other hospitals in our system do not require a current specimen. We don't do it at our hospital. I worry since I have seen it too often someone using a relative's Health Insurance Card and having a complete different type. We don't need a specimen though form 3 days. If they have had a specimen during the stay, we will thaw plasma.
  26. 1 point

    Deviation Reporting

    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.
  27. 1 point
    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.
  28. 1 point
    We keep them until the monthly invoice comes and then they are discarded. All documentation of unit receipt and final disposition is in the computer system.
  29. 1 point
    The other thing you have to remember is that the charges are not for the blood itself, but for the processing needed to provide the blood. These charges are the same regardless of how much of the unit is actually administered.
  30. 0 points

    The COVID-19 challenge

    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.
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