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lpregeno

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    Blood Bank Supervisor, MT (ASCP)

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  1. lpregeno

    Therapeutic Phlebotomy - H and H limits

    Thank you all for your input!
  2. We perform therapeutic phlebotomy by appointment only. Occasionally a patient will come in and have his/her H and H drawn to see if he/she needs to have it performed and then schedule the phlebotomy for another day. Does anyone have any information on what the length of time this H and H is considered "good" for performing the procedure? Two days later? A week? Are there any rules about this? What is your facility doing if this occurs? Thank you all for your help!
  3. lpregeno

    Feto-maternal Screen Lot to Lot Testing

    Same as above. Here is the form I made in case you need it. l to l to send.docx
  4. Wow! I'm thinking that, even though this happens rarely, that this has been handled incorrectly here. Whenever we send blood with a patient, we issue it in our LIS and we're done. The patient gets charged whether they receive the blood or not. The LIS also changes them to "transfused" after 48 hours. I assumed (which I'm always told "makes an ### out of you and me") that it was up to the receiving end to document anything further. So I will be keeping up with this post to see what I need to do differently. Any and all suggestions are welcome!
  5. lpregeno

    Infrared Thermometers

    I was told that unless a time out of the Blood Bank has been validated, we can't use time as an indicator of whether or not a unit is acceptable for re-issue. Only temperature can be used. If the unit is being transported within the facility, this is still considered "storage" and the upper level allowable would be 6 degrees, not 10 degrees. We attach Hemo-temps (switching to Safe-T-Vue 6 once validated) to the units as well as checking the temp when it returns. The indicator is necessary because if the transfusionist left the blood sitting out, it could have reached an acceptable temperature again once it has been on the cold pack a while. For units not sent on cold packs, we use a Traceable Mini IR Thermometer by MarketLab that is ISO calibrated that has been really reliable. I don't recall them being super expensive either. How on earth did they condone returning units to inventory when the indicator had turned red!?! Inspectors haven't noticed this? My question would be: to what use is the indicator being used if it is being ignored?
  6. lpregeno

    FDA reportable Question

    Is this a typo or do you seriously have that many FDA reportables per year!?! From ONE transfusion service?!?
  7. lpregeno

    Consultation Charges for Antigen Typing

    You took the words right out of my typing fingers Malcolm!
  8. lpregeno

    Consultation Charges for Antigen Typing

    mollyredone stated: Yes, we charge for all units, positive or negative, we type looking for antigen negative units. Obviously we don't type 10 units to find 1 K-negative unit, but base the number typed on the compatibility percentage. We are lucky to have a historical antigen database from our blood supplier, but sometimes we have to "wing" it and just grab a bunch from the shelf and type away! I want to discuss this with the person that does my billing. She led me to believe that unless the patient received the blood, we couldn't charge for any antigen typing on other units. Is there a way to charge for all the units screened that will be accepted by insurance? This would be great for when we order special blood from our supplier and then the MD changes his/her mind. We could charge the patient for the special blood but not the transfusion. (Yes? No?) Obviously I'm new at this charging stuff!
  9. lpregeno

    Consultation Charges for Antigen Typing

    Question: We charge for the antigen typing in 3 groups and we only charge for the ones that the patient actually receives the blood for. Does anyone add on a cost that includes the number of units that have to be antigen typed to find antigen negative units? Seems like we waste a lot of money looking for them and that it is often cheaper to just order the antigen negative units from our supplier. Any thoughts on this?
  10. lpregeno

    Antibody Titers Gel vs. Tube

    We were doing titers in the gel and kept failing our CAP surveys for titers. They were always one titer too high (CAP gives you a 3 titer range the results can be within to pass). After investigation (I was new at this job at the time) I found where the Technical Manual says that they shouldn't be performed in gel. (Like SMILLER says above). It goes on to state that there is a danger with interpretation by the physician and the higher results of unnecessary invasive procedures performed due to that combination. They, strangely, do not tell what studies they base that comment on. We switched to the tube method and haven't failed a survey since. We are in the process of deciding on new Blood Bank automation. When we saw the Vision, that seemed to be one of the "hot" selling points - the ability to perform titers. We questioned them about how they felt about it being contrary to AABB recommendations to do titers in the gel. The response was something like, "Do you want it to be faster and more hands-off or more exact? We would rather see it be more hands-off." (Not a direct quote, but you get the picture.) Personally, I would prefer the "exact" results to one that may or may not be too high. I would also prefer to pass my CAP competency surveys! Just saying.
  11. lpregeno

    Repeat Testing for FFP and Plts

    We get a sample that is good for 3 days following the draw. If the account number changes, as long as the patient still has the armband on, we use that sample. We just transfer the results to the new account number and credit one of them. It's a pain, but better than redoing all the testing. We require a current sample for platelets and FFP also. I think the chances of someone using someone else's name/insurance are too high to take a chance not to do this, not necessarily for the platelets but for the FFP.
  12. lpregeno

    Issuing Emergency Release/MTP Packs

    I agree with the above post. Case in point: We had someone call for emergency release blood and then someone came to get emergency release for a different patient. Thinking it was the patient they had called about, the tech issued the blood. It gets worse (nobody died) but suffice it to say that this went to risk management and the results were not pretty for the employees! A few days later, the nurse got upset because a different tech would not give her any emergency release blood without a name and DOB. They want it both ways! This final case was dropped as the tech was correct.
  13. lpregeno

    platelet availablility

    We are somewhere between 15-20 miles from our supplier. We are a Level III trauma center. We do not keep platelets in-house but if ordered emergency our supplier guarantees they will have them here within 1 hour. The only time it takes longer, other than a major traffic problem (wreck), is if the unit needs to be irradiated. (We have a large cancer center here.) If we kept platelets in-house we would be tossing them all the time because they have expired and that's a bigger cost to eat than we are willing to bear. In formulating our MTP we have made it clear that they will receive all products as quickly as possible and once the MTP has been initialized, the platelets should be here by the time they need them. Quite frankly, I doubt if we use the MTP that often. If by chance we get a trauma, if it's a really bad one, the ER hangs 2 units PRBC and we ship them to the Level I that is about 15-20 miles from us.
  14. When Zika first began being tested, only some of our units were tested for the virus so we had a comment built into our LIS to attach to those units that were tested. Now that they are all being tested, does anyone know any reason why we have to continue with this (cumbersome) task? We certainly don't comment for everything else they test for, such as Hb, HIV, etc. Just CMV. I haven't been able to find any information on this being a requirement or not. Thanks!
  15. lpregeno

    Gel Titer on Ortho Vision endpoint

    We discontinued doing titers in gel last year because we kept failing the CAP surveys (our results were always too high). After research, I found this in the Technical Manual: "The AABB-recommended method is the use of saline antihuman globulin (AHG) incubated for 60-minutes at 370 C. Other methods, such as using albumin AHG or gel, may result in higher titers than the recommended method and should be validated with clinical findings and laboratory data to ensure appropriate interpretation by the obstetrician and avoid inappropriate referral of patients for high-risk obstetric care." We also retain the titered specimen and repeat it along with new titer requests to allow for possible operator differences.
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