Jump to content
PathLabTalk

Leaderboard

  1. Malcolm Needs

    Malcolm Needs

    Premium Members


    • Points

      232

    • Posts

      7,907


  2. John C. Staley

    John C. Staley

    Members


    • Points

      132

    • Posts

      1,458


  3. David Saikin

    David Saikin

    Members


    • Points

      93

    • Posts

      2,921


  4. Cliff

    Cliff

    The Help


    • Points

      62

    • Posts

      2,390


Popular Content

Showing content with the highest reputation since 10/25/2020 in all areas

  1. I just saw this seminar being offered by Bio-Rad with our own, infamous, Malcolm Needs as the presenter. I registered and thought I'd pass the word to all of us here. Here is the link:https://info.bio-rad.com/ww-IHD-transfusion-w-registration-lp2.html?elq_mid=48765&elq_cid=10201434&elqCampaignId=30837&utm_campaign=30837&utm_source=eloquaEmail&utm_medium=email&utm_content=Email 13ER EM-R-CM-385201-FY21-TCHS-AWEN_BR-JRNL-TRF News 19 Nov&elqTrackId=6ecbbea5f2bb46849981687404578a8e&elq=7c5f74470efa434dbd4351e512f7ae7a&elqaid=48765&elqat=1&elqCampaignId=30837
    10 points
  2. It simply means that the P1 antigen is particularly strongly expressed on these red cell samples. Therefore, if you come across a weak anti-P1, it may apparently react with these particular red cell samples, whilst apparently not with, for example, the third red cell sample shown in your antigram. Although not identical to dosage, per se, it is fairly synonymous with dosage at a phenotypical level. The strength of the expression of the P1 antigen is an inherited trait.
    9 points
  3. 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.
    9 points
  4. Ok, here we go. First is from a personnel stand point. When promoted from with in you are no longer "one of the guys". This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others. Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place. This does not have to be dramatic and should not be, but it is real. Some can do this and some find it very difficult. Now, when coming from outside your are exactly that, an outsider. Now the level of this can vary immensely depending on the situation. One time when I changed facilities it was just across town and I new many of the staff at the new facility so a lot of the unknowns were minimized. On the other hand, I also moved to another facility out of state and pretty much walked into an unknown from a staffing standpoint except for what little I could glean from the interview. As I noted in my previous post, be very judicious when using the phrase, "this is how we did it." I've had new employees who would say this at every opportunity and then go into detail about how we were either doing it wrong and that their way was just much better. This became very trying to everyone else on the staff and we finally just tuned them out. Because of that we probably did miss out on some good ideas. One last point, in either case be aware of any others staff who may have either applied for the position or simply been over looked. Depending on their personality they can either be a great help or a significant hinderance. Do everything you can to get them involved and engaged. They can be your greatest asset but it may take a little extra work on your part. For me, the personnel issues were always the most difficult. I'm assuming that you are new to the lead position and not knowing your previous experience here a couple of generalizations. Unless something is an obvious hazard to either patients, staff or the ability to pass an impending inspection/assessment don't be in a big hurry to make changes. As they say in the military, you need to understand the lay of the land. Become familiar with the blood bank/transfusion service medical director and let them have the chance to become familiar with and confident in you. They can and should be your greatest allies. Ultimately most of what you want to change will have to be approved by them. You need to understand the current processes before trying to change them. At one of the facilities I moved to I noticed that many of the staff were not following their procedures "to the letter". The way I dealt with this was at the monthly staff meeting we would go through a procedure as a group, line by line and I would ask the questions, "Is this how you are really doing it? If not, why not and how are you actually doing it?" This is when I would make suggestions for changes and generally a lively discussion would ensue. It took quite awhile to go through the procedure manual but by picking, what I considered the most important one first it was time well spent. This is getting a little long so I'll end with how I described my position as Transfusion Service Supervisor at a 350 bed level ll trauma center. My job was to provide the staff with the tools (equipment, knowledge, material and support) for them to do their jobs at the highest level possible. All this while keeping the dragons (administration) away from the door. Good luck and if I can think and anything else that others may miss I share a few more golden nuggets of wisdom with you. Above all else have faith in your self. Wow I think that's the longest post I've ever made.
    9 points
  5. An excellent discussion point. I think many others have similar questions and concerns. The have been several other threads on this forum with similar subject matter. As an Old Fart, I feel obliged to spout some (un-referenced) history. Most of the original work on clinical significance of antibodies in pregnancies was done in the absence of potentiators and definitely before the use of (semi)automated test systems. I think it was a "saline-IAT" using 22% albumin (BSA) as a diluent. Most of those antibodies were anti-D, for obvious reasons. There's not much out there in the literature in terms of controlled or organized studies regarding other specificities. There are a fair number of one-of-a-kind case studies, but most of the stuff is retrospective analysis of data. Basically, other than anti-D, nobody really knows what an antibody titer means, but as Ensis01 suggests, detecting a change in titer (increase) may be more important. In an era when basic tube shaking is going away, it only makes sense (we have no other option) to convert to the new techniques and equipment, but I suspect that it has the potential to further confuse an issue which already has enough confusion to (dis)satisfy everyone. I don't envy anyone handling this hairball. As a last thought...the high-powered potentiators (and techniques) used today don't reflect what's going on in vivo. Arguably, if one ignored the 22% BSA diluent, the saline-IAT is a better mimic of the in vivo scenario.
    8 points
  6. jojo808

    Transfusion Errors

    I think we need to add an OMG emoji to our selections!
    8 points
  7. I was immensely honoured to receive this through the post today (with a lapel badge).
    8 points
  8. What about RH pos plasma products or platelets? Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe. And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units. Just a thought.
    7 points
  9. Quite right John. In the UK, we ALWAYS test the previous sample with the latest sample (unless there is a legitimate reason why the previous sample is not available - sample too small, freezer broke down, Malcolm dropped it, etc!). This test is essential in my book, as antigen expression can vary hugely from one donor to another, resulting in either a falsely high titre or a falsely low titre - and either can be dangerous.
    7 points
  10. My experience is that the BB reports out the antibody identification. Never the reactivity! If a titer is ordered the only thing reported is the titer or “too weak to titer”. As the rise in titer is the most relevant result, consistency in method and technique is very important, both within your hospital system and the reference lab you use. Physicians are interested in your results not the process. Keep that simple. If they have questions your Medical Director can enlighten them.
    7 points
  11. I would treated the patient's own red cells with papain or ficin (whichever is used by the manufacturer to make their enzyme treated red cells), and then test them against autologous plasma. My guess (and from this far away, it is just a guess) is that they will be positive. I think that there is a "cold" reacting auto-antibody there. I would also suggest performing an IAT panel in tubes, bringing the reactants to 37oC before mixing them, and using isotonic saline, rather than LISS as the red cell diluent, and then washing the tests in pre-warmed isotonic saline. This should show if there are any underlying clinically significant alloantibodies.
    7 points
  12. Have you thought of hiding his glasses?
    7 points
  13. I agree with you that it does sound daft, but I am in the position to tell you why this is the recommendation, despite it apparently being contrary to BSH Guidelines, as I was still working when the decision was made (albeit, I don't agree with it!). The huge majority of hospital blood transfusion laboratories now use column agglutination technology (CAT) as their "first line of attack", and many of them use the CAT that uses gel in the column, rather than glass beads. This form of CAT is particularly adept at detecting anti-M in plasma by IAT, even though the anti-M may not actually be reacting at strictly 37oC. There are several reasons as to why this is so, but a couple of them are that "cold" reacting IgM anti-M can sensitise red cells particularly quickly (in a matter of seconds at room temperature), but can take quite a time, even at 37oC, to dissociate back off. This means that the anti-M is often still sensitising the red cells at the end of the incubation time and, of course, centrifugation is, in itself, a potentiator of agglutination. In addition, the gel in the column is at a slightly low pH, and many examples of anti-M "like" a slightly acid environment to sensitise the M antigen. This all means that this particular kind of CAT is very good at detecting anti-M, but making it appear to react at 37oC, when, actually, it doesn't. This left the RCI Laboratories with a dilemma. Cross-matching blood by tube at strictly 37oC takes a long time, and the RCI Laboratories are not, shall we say, over staffed! This meant that RCI Laboratories were being stretched to breaking point by having to cross-match for samples containing anti-M, as so few hospital laboratories could now perform IAT by tube technique (particularly with the need to demonstrate competence in the technique being used). The alternative was to test many more units for the M antigen, and to provide M Negative units to the hospitals, whether they use CAT of that type or not, so that they could perform their own cross-matching, and actually end up with compatible units. In theory, this was great, but it left the RCI Laboratories with fewer phenotyped units with which to select for, say Fy(a-b+) for a patient with anti-Fya, as the M Negative units that were also Fya Negative had been sent out to cover a cross-match in a patient who had an anti-M, who didn't actually need M Negative blood. Having said all of that (and I KNOW I said it at length), anti-M can, rarely, cause severe haemolytic disease of the foetus and new-born (particularly in people from the Far East, even when the anti-M does NOT react overtly at 37oC), and so I have a certain amount of sympathy with giving M Negative units, even in the situation in which you find yourself with your patient, as M Positive units, albeit found to be compatible by IAT, could well stimulate the anti-M to become stronger during the pregnancy, "turn it" to an IgG production and increase its (at present, non-existent) IAT titre. I hope that helps and that you haven't fallen asleep reading it!!!!!!!!
    7 points
  14. As Joanne mentioned above, no system is fool proof and there are lots of creative, inventive fools to prove it. Keep your system as simple as possible which should minimize the need for creative people to find ways around it. Now to your question, does it actually help prevent problems? Probably a few but certainly not all! I've seen people become lax in their diligence when they assume they are protected by the system. They seem to assume that if they make a mistake someone down the line with catch it. This is something to be avoided if possible. The only way that I know of to prevent this type of mind set from developing is through education and convincing everyone involved in the process that their step is critical and by keeping it simple they will be more likely to perform their step as instructed.
    6 points
  15. All the talk about statistics is great but in the real world you never know: I once screened over 30 units for K. All were positive. As I was the night guy, the day folks were laughing until they got the same results. All we could figure is the blood center was screening for K and shunted all the +s to a shelf which we received in bulk. I've also screened for Fya in past. Once i screened 4 units and found 2. The next time I had to screen 16 and the last 2 were negative. As I said, the stats look good but reality is sometimes a bit different.
    6 points
  16. Just a thought, I have not seen anyone mention in this thread, testing the current sample in parallel with the previous sample. We would start with the very first sample and freeze what was left after the initial titration. We would then thaw and run it in parallel with the next sample. This was an attempt to mitigate the, hopefully, minor differences in technique between techs and give us an accurate picture of any increase in antibody levels.
    6 points
  17. David Saikin

    Transfusion Errors

    years ago my boss got all of us blood bank techs assigned to the same salary scale as the pharmacists (since blood is considered a drug by the FDA). Once again the lab folks were peeved but no one wanted to work in BB. Tertiary care, Very busy.
    6 points
  18. Sounds to me like an inspector who is "uncomfortable" because it's not how they do it. I recommend a nod and smile and a comment such as, "We'll look into it." As long as who is doing it, are trained and competency is documented it should not matter which department is doing it. To rephrase what Malcolm said, the procedure is more in haematology's wheel house. (It's kind of fun spelling words with more letters than necessary!)
    6 points
  19. 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 together several samples without labels and placed them in a rack. When he arrived, we presented the rack to him and told him to select the sample to label. He actually tried to feel each tube to find the warmest one and said that was the sample he sent. Obviously we did not allow the sample to be labeled. The story has been told many times!!!
    6 points
  20. 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 hand or with a 'Coombs washer' - 3 or 4 washes, with or without albumin. So perhaps not surprising that people were not too confident in their visual results. Much less knowledge then too about what was and what was not clinically significant. (I can remember when we treated cold anti-A1 as clinically significant) Thankfully since those dark ages things have improved massively - but sometimes some of the old habits stick - like using a microscope to read apparently negative results. The practice lives on (in some places) but the reasons for that practice died out long ago
    6 points
  21. MAGNUM

    Transfusion Errors

    I have even gone so far as to tell the nurse taking care of the patient that when they learned the patient's name and not the room number to give me a call back and we will discuss the patient at that time.
    6 points
  22. A new tee shirt I gave myself for my birthday. I should have had a shave and lost about 70lbs first, but hey!
    6 points
  23. Malcolm Needs

    Strange question

    I agree with exlimey. I once had an anti-E that reacted by LISS IAT, but try as we might, we could never get it to react with papain-treated red cells. We doubted the specificity, and so we sent it to Joyce Poole at the International Blood Group Reference Laboratory to have a look at it, and she confirmed both the specificity and the fact that it was non-reactive with papain-treated red cells. Anything is possible, as the antibodies refuse to read the damned text books! In the UK, it is almost a sine qua non that an "enzyme panel" is put up simultaneously with the IAT panel John, so I would almost certainly have done the same as DCeDCe.
    6 points
  24. To this I will add, pick your battles carefully. Make sure they are worth fighting. If you came from outside the facility be very judicious when using the phrase, "The way we did it"! Changing something to the way you did it else where is not necessarily a change for the better just because it makes you comfortable. Make sure you understand your new facility's processes before trying to incorporate sweeping changes. As I noted above, much of my advise would depend on if you came from outside or promoted from within. This is just one golden nugget for you to consider.
    6 points
  25. We used to have sign in our BB: The Buck Stops Here. Of course someone altered the posters to "The Buick stops here". My boss was pissed off about that. The concept being that if you have a system of multiple checks and balances you better make sure the first one works. I have seen this concept evidenced too many times in my career. People get complacent.
    5 points
  26. It would be really useful if you could tell us the ethnicity and age of the patient, and his medication regime. That having been said, I note that the antibody screen is positive, that his DAT is positive by both anti-IgG and anti-C3d, that the neat plasma contains an apparent anti-E and anti-c, but that the eluate contains an antibody that is, apparently, pan-reactive. Very often in these cases, the apparent antibody specificity in the neat plasma is a mimicking specificity, rather than a true specificity. In such cases, the apparent specificity in the neat plasma can be adsorbed out using red cells that are negative for the antigens of the apparent specificity; in this case R1R1. The true specificity of the antibody could be an anti-Rh17 or anti-Rh18. While I am not saying for a single second that the apparent specificities of anti-E and anti-c are not true specificities, it may be worth your while seeing if they can be adsorbed out using R1R1 red cells. However, as you suspect the presence of other antibodies, this should not be attempted until you have proved otherwise. This you can do, as you suggest, by alloadsorption of the neat plasma using two or three adsorption cell types. In answer to your last question, with regard to adsorption of the eluate, this was certainly a method we used in the Reference Laboratories of the NHSBT in the UK. It was usually used when the patient had a known pan-reactive autoantibody, but was requiring transfusions more frequently than previously, and/or when the expected rise in the haemoglobin concentration was not achieved. On some occasions, we were able to detect a de novo alloantibody in the eluate that we could not detect in either the neat plasma, or the adsorbed plasma, although this was not always the case, as transfusion in and of itself can sometimes stimulate the autoantibody to become more active (see Petz LD, Garratty G. Immune Hemolytic Anemias. 2nd edition, 2004, Churchill-Livingstone). Good luck with sorting it out, but this is a really interesting case. Thank you for posting it and, please, would you mind letting us know how you get on?
    5 points
  27. Malcolm Needs

    A1 lectin QC

    I attach a hybrid of my lectures on the differences between the A1 and the A2 ABO type, together with a very few slides from my lecture on lectins, and I hope that this will serve to be of some use to you. It is hugely important to remember that many lectins, including Dolichos biflorus, are not specific unless they are diluted to ensure that they only react as desired. For example, this particular lectin (Dol b) will react quite strongly with A2 red cells unless suitably diluted so that it only reacts with A1 red cells. It is because of this that group B red cells are totally unsuitable to be used as the negative control for the Dol b lectin, and the same applies for group O and other group A subtypes. Group B red cells will not tell you whether or not your grouping reagent is "specific" for the A1 antigen, or will still react with the A2 antigen. In addition, the lectin will also react with red cells expressing the rare polyagglutination antigens Cad and Tn, and so, in the true meaning of the word, it is not "specific" anyway. What is the difference between A1 and A2.pptx
    5 points
  28. Something to consider. If the charge drops at XM you might get paid for it. If it drops at transfusion and the blood does not get transfused you will definitely not get paid for the XM. Something to think about. We dropped the charge when the XM was completed. Another little story from the past. Us old guys like little stories from the past. I was called to the billing office to "discuss" a billing issue with someone from the insurance company. She wanted to know why we charged for the XM when no blood was issued or transfused. I told her that the DR. had ordered the testing in the anticipation of needing the blood because the surgery routinely required transfusion. We did the work and charged for it. Her contention was that since the patient did not use any blood the testing was unnecessary! At about this time I asked to see her license to practice medicine. She became quite incensed when I told her that insurance companies had no business practicing medicine. That's when our conversation came to an abrupt end.
    5 points
  29. Cannot post the entire article due to copyright restrictions, but most institutions have access to NEJM through their library. If not, shoot me an email at neil_blumberg@urmc.rochester.edu and I'll send along the .pdf. If you are transfusing 40-60 platelets a day, giving ABO identical to group O and A individuals should be relatively easy. When patients are changing ABO blood group it becomes more difficult. We avoid transfusion ABO antigen and/or antibody that is incompatible with either original recipient type or donor type. Usually means washed group O red cells and platelets. That's the bad news. It does require time and effort, and as you say, med techs are in short supply. Here's the good news. If you transfuse ABO identical or washed compatible platelets you will use between 30-50% fewer platelets per patient, increasing your supply and decreasing your cost/problems. You will also use next to no HLA matched platelets (we used 3 out of 6,000 one recent year), you will have fewer febrile and allergic transfusion reactions, you will have fewer red cell as well as HLA antibodies made in recipients, and you may reduce TRALI and TACO. Obviously you have to have universal leukoreduction to start with. Selective leukoreduction misses about 50% of the patients who will become refractory, probably due to missed or delayed diagnosis of hematologic malignancy, aplastic anemia, etc. But the big attraction is you will have less bleeding, although that mainly affects the patients and the docs and nurses at the bedside. When you transfuse ABO major incompatible, which seems to be the default due to fear of hemolysis from minor incompatible, you don't get any increments, you use lots of platelets and the patients bleed more. (see references below) Bleeding causes lots of harm, but also impacts the blood transfusion service for obvious reasons. So figure out a way to start giving patients with aplastic anemia and acute myeloid leukemia who are newly diagnosed only ABO identical platelets and that will be a great start for the patients and the transfusion service. Those patients will bleed less, need fewer platelet transfusions, have fewer transfusion reactions, will not have positive DATs, and will likely survive their hospitalization and disease at higher rates if our experience is typical. And if you cannot give ABO identical or washed platelets free of incompatible cellular and soluble antigen and free of incompatible ABO antibody, start out with minor incompatible platelets (e.g., O to A) rather than ABO major incompatible (e.g., A to 0). The risks of hemolysis are not negligible (about 1 in 800) but are less serious and severe than having life threatening bleeding or refractoriness which occur more rapidly with ABO major incompatible in all likelihood. There's a ton of antibody that is incompatible with antigen transfused when we give A platelets to O recipients which means each antigen winds up with a ton of antibody making huge immune complexes. When we transfuse antibody incompatible we are transfusing a small amount of antibody into a recipient with huge amounts of antigen, so the size and number of immune complexes is probably smaller. These are my best guesses that we've been making exactly the wrong decision when we give ABO mismatched platelets. Best to avoid any, but major mismatched provides no hemostasis, minimal to no increment and is associated with increased bleeding mortality in the study from Columbia (David Roh and colleagues https://pubmed.ncbi.nlm.nih.gov/33649761/). But ABO identical is not that hard for larger centers for the 85% of patients who are group O or A. You just have to start small, get the hang of it, and then extend to other blood groups and other diseases than leukemia, MDS and aplastic anemia (including transplants, particularly allo--transplants). All those tables of how to select ABO mismatched platelets for transplant recipients are well intentioned but scientifically without evidence. Avoid infusing incompatible antigen and antibody as much as possible, and delay transfusion when ABO identical will be available within hours. Give priority to patient well being over inventory management. Give reduced doses, which work just as well. Get a Terumo or Haemonetics washing device and wash with PAS. It's a big set of changes, but neither terribly expensive nor rocket science. The dogmas and expert opinion about universal leukoreduction and ABO matching of transfusions are now proven to be tragically mistaken. https://www.ashclinicalnews.org/news/from-the-blood-journals/written-in-blood/outcomes-abo-incompatible-platelet-transfusions-patients-intracerebral-hemorrhage/ https://pubmed.ncbi.nlm.nih.gov/11399821/ https://pubmed.ncbi.nlm.nih.gov/21414009/
    5 points
  30. We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient. For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.
    5 points
  31. DebbieL

    who reads your KBs?

    We no longer have L/D but when we did, Heme performed all KB and would enter the patient results in the computer system. We would base our number of RhIG injections based on the result and the package insert. As far as PT, the BB would get it first and perform the Fetal Screen. We would enter our results on the forms and then give the PT to heme to perform the KB. That way we both performed the portion of the PT we actually did in our departments. Since heme did the majority of the work, the department lead would enter the results into the CAP website. I agree with John. Some inspectors think if you don't do it the way they have been doing it, you are doing it wrong. There are lots of roads to the same destination, but some are better paved.
    5 points
  32. During the majority of my professional life, Blood Bank has read the Kleihauer tests. I have NEVER understood why this should be so. It was INCREDIBLY rare to come across a case that was not, to all intents and purposes, negative (or certainly required no more than the "typical vial", as you say). This meant that those working full time in Blood Bank were most UNLIKELY to be competent in accurately counting a minority of cells on a smear under the microscope. On the other hand, the Haematology Laboratory staff were used to looking at slides to accurately assess, for example, reticulocytes and, come to that, malaria slides. I always thought, therefore, that their staff would be much more competent at looking at Kleihauer slides (this, of course, was before reticulocyte counts were performed by automation), but I still think that those who are used to performing a particular test should be the ones who actually perform the tests on a routine basis, particularly in these modern times when the "measurement of uncertainty" is such a popular reason to give "a fizzer".
    5 points
  33. You have to change your refrigerator alarm settings to activate at 2.2C (or whatever you choose). It doesn't matter that your refrigerator never gets too cold; if you are going to store reagents (and RhIg) in a BB refrig, it has to be able to alert you when then temp is out of prescribed range.
    5 points
  34. or mum is a surrogate or baby is the result of an ivf with external donors
    5 points
  35. 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 acquire an additional salary % for techs working full time in the transfusion service. When other department techs thought it was unfair, I asked them to apply for a BB position (no takers). Might be worth a try if you need techs. Thanks to all who are sharing your experiences.
    5 points
  36. 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.).
    5 points
  37. 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.
    5 points
  38. 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!
    5 points
  39. Not sure about just one answer - We had a labeled Rh negative RBC from the ARC that retyped as Rh positive. Upon investigation, it was found the Immucor anti-D reagent we use for retyping had anti-Crawford while the ARC automated process for D typing used an Ortho reagent which was from a different clone. Not very unlikely but certainly more than one answer.
    5 points
  40. 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 problem? Can someone else make the same mistake?" before you go after the person who made the mistake. As someone said earlier - get familiar with the standards of whatever inspection organizations you will be responsible for. Read all of your procedures with those standards in mind and line them up. That will make inspections so much easier and always gives you a "reason" if you have to change something. Keep your sense of humor and be adaptable. Nothing will stay the same forever - change comes along frequently and you have to roll with it. Make friends (with distance - not "buddies") with your techs - stay friendly with other techs in the Lab and make friends with other administrative personnel - you will be on the front lines with other personnel in the hospital more than other Lab supervisors - think ER and OR. Best of luck.
    5 points
  41. There is absolutely no scientific or clinical reason that a vaccine could not be stored with frozen blood components. That doesn't mean you won't get some overly officious inspector who will decide it's a bad idea. But currently there are no regulatory or accreditation issues that I am aware of.
    5 points
  42. Maintaining enough staff. Too many people use a large facility as a stepping stone to another job for more money. Having Senior Management understand the difference between a Blood Bank and Clinical Lab - we're not the same. Maintaining inventory. There is always a shortage of something. Competency Assessment - huge pet peeve of mine. You go to a talk by _____________ and hear them pontificate on how we all make competency assessment so hard on ourselves. Then say something silly like, all you need to do is watch them do a _______ proficiency testing sample, they will be processing regular samples at the same time. They'll do equipment maintenance, QC, and result entry. See, it wasn't that hard... Drives me nuts. In reality that never happens, we have 40 other staff we need competency for and obviously we can't share the PT sample. And then the Joint Commission wants competency every 365 days +/- 30 days. For a lab our size, it takes a tremendous amount of time. Sorry, this really does drive me nuts with the inspectors.
    5 points
  43. The age old problem of how do you make people pay attention to the details...If you figure this out, let me know. I haven't yet. Do you not have an "IRRADIATED RBC" product in your dictionary that the physician could have chosen? That puts the responsibility on them, where it should lie. A comment is not an order and, if they are relying on that, they are forcing your techs into a position of failure. I would suggest you add an irradiated product order to your dictionary. If the physician wants that product, they must order that product that way.
    5 points
  44. While reading one of the threads today it got me thinking, does the University of Michigan still hold their annual Blood Bank Symposium the last of May or early June? It's been a very long time since I was able to attend but for quite some time I was able to convince the powers to be to allow me to attend every other year. Every year was a little too much to hope for. I learned a great deal, met many terrific people, and made a number of friends. I was able to meet and learn from a few of the greats in the blood bank world at the time. I certainly hope it has carried on and is still available. Thanks to John Judd and Suzanne Butch and the many others who made it possible. I hope their legacy continues.
    4 points
  45. Wow, just wow. I can't even imagine a blood banker in the US considering this as acceptable. Our usual assumption has always been, if we didn't do it then it's probably wrong. Our paranoia runs deep and swift. Now, before anyone gets too upset with me please know that I was one of you for 35 years so I can play the what if game with the best of you. I'm just noting what I observed over many years. If anyone in the US is actually accepting the results from other facilities at face value and acting on them, please let me know, I would love to be wrong.
    4 points
  46. Cliff

    neonatal transfusion

    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.
    4 points
  47. Please don't apologise; I found your question (your question - not the question) quite stimulating. I totally agree with your opinion re the question setter.
    4 points
  48. Perhaps the monoclonal anti-D reagents had been taken out of the fridge, and not allowed to come to room temperature before being used. Most, if not all, monoclonal anti-D grouping reagents will detect an I-like or i-like antigen on D Negative red cells (see Thorpe SJ, Boult CE, Stevenson FK, Scott ML, Sutherland J, Spellerberg MB, Natvig JB, Thompson KM. Cold agglutinin activity is common among human monoclonal IgM Rh system antibodies using the V4-34 heavy chain variable gene segment. Transfusion 1997; 37: 1111-1116, and Thorpe SJ, Ball C, Fox B, Thompson KM, Thorpe R, Bristow A. Anti-D and anti-i activities are inseparable in V4-34-encoded monoclonal anti-D: the same framework 1 residues are required for both activities. Transfusion 2008; 48: 930-940). What it should NOT be, under any circumstances, is that the anti-D reagents at the Central Blood Bank fails to detect an epitope that is detected by the hospital's anti-D reagent.
    4 points
  49. As long as humans are involved in a process there will be human error! You best option, as suggested above by jinsat is to have the product ordable by the physician. Remember, complicating a process never makes it better.
    4 points
  50. I would just replace the battery and not tell anyone.
    4 points
×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.