frenchie

With the COVID pandemic, my institution demoted me and resulted in a significant pay cut. I decided to leave and go where I feel welcomed and valued for my 30+ years of experience in BB and as a generalist, LIS and manager. I have been on call, even during my vacations for over 5 years, coming in the middle of the night, holidays and weekends. I am leaving a no one is trained to do elutions, Ob titers, Dara protocol and master log review. I feel bad, but administration seems to realize nor care that I am just leaving an empty opening in the schedule! I have read all the previous postings from 2018, and the shortage and lack of recognition of our profession keeps getting worst!

Hi Mollyredone, We also use Meditech 5.67. About your platelets, you mentioned that you have PPH, PPH 2... is it because they have different product code from your blood supplier? We are supplied by ARC and sometimes they are sending us 2 PPH with the same unit number but different codes. Meditech is suggesting me to create in a new product for each code, but they are several ones...! And how do you set up Meditech the different product codes so nursing/providers can order them as PPH? Thanks, Helen

We are using Cardinal Health S/P certified Blood Bank Saline and it says right on the box that saline should be used within one month of date opened. For solutions made from this saline, like pinktoptube, we use which ever expiration date is shorter.

In this case, what are you guys doing for reporting patient testing? Are you going back to tube with enhancement ? We are using manual gel, seeing false positive reactions with negative QC and patients, Ortho is supposed to send us a new lot # of IgG cards.

We are in the training process for nursing, go live date in December 2016. Nothing will really change on the BB side, other than easier access to vital signs monitoring/auditing. Good luck to you!

Hi everybody! We recently "failed" an API proficiency event for DATs: Tube DAT AHG (POLY)=positive 1+ IgG gel DAT=positive 1+ (expected result was negative) So, here's what I did: Repeated both DATs, results were the same. I washed the cells x3 and DAT gel was negative. I called API because 84 other labs reported the same positive result, and was told to contact the manufacturer because they believe there is an issue with the IgG gel cards. Before calling Ortho TS, I reviewed QC of reagents (MTS diluent, IgG cards) and MTS centrifuge and pipettes preventative maintenance, everything was satisfactory. I also reviewed the IFU, section Samples for DAT. TS informed me that the quality of the PT specimen is probably the cause... Samples for Direct Antiglobulin Test (DAT) • Samples intended for direct antiglobulin testing should be drawn into EDTA to prevent in vitro complement binding. If EDTA is unavailable, specimens drawn into ACD, CPD or CPDA-1 are preferable to non-anticoagulated clotted specimens. Red blood cells should be tested within 24 hours after collection. Clotted samples should not be refrigerated. Some samples such as cord blood, blood stored for extended periods of time, or blood that has been incompletely anticoagulated, may develop fibrin clots or particulates. The fibrin clots or particulates may interfere with the ID-MTS™ Gel Test and cause red blood cell entrapment at the top of the microtube. Testing should be repeated using red blood cells that have been washed to remove the clots or particulates. • Red blood cells that are stored for extended periods of time may become coated in vitro with complement and globulin proteins. Those samples coated with IgG will then test as DAT positive with this reagent. • Rouleaux caused by serum or plasma with abnormally high concentrations of protein (such as in patients with multiple myeloma or Waldenstrom’s macroglobulinemia or from patients who have received plasma expanders of high molecular weight) may infrequently cause difficulties in the ID-MTS™ Gel Test interpretation.9 False positive results or hazy reactions may occur with these samples but are rare. Samples exhibiting rouleaux should be washed several times in saline and retested.12 Laboratories are advised to consult their approved procedures. • Hemolyzed and grossly icteric blood samples may cause difficulty in interpretation, and test results should be used with caution. Now, I need to find the root cause and corrective action. I am thinking about a few options, one of them would be to wash all DAT positive in gel and supporting this with a validation/study. But before, I would appreciate everyone's opinion and experience.

Does Nursing look at the mother's blood type and if Negative, order one of the 2 Rhogam protocol or it is ordered no matter what?

Problem: Physicians/Nursing are ordering Rhogam on post-partum patients, but does not always include the Fetal Screen. A few inexperienced techs missed to add on the Fetal screen, consequently, Rhogam was given without the FS and I see it only during my result review. Question to my colleagues: Do you have a different way in your LIS to order Rhogam, meaning ante vs post-partum? I thought I could create a post Rhogam profile: Rhogam, FS, blood type, DAT tube(IFU recommendation). Ante Rhogam profile would only include Rhogam and TS. Thank you in advance for your input!

We do separate the plasma from the red cells, it has been a big learning curve for the techs, I had to monitor for several weeks and finally got 100% compliance for tech initials and date. We do ISXM in gel buffered card, so it is easier for us to have a clean, red cell free plasma prior to testing.

Well, I prefer to apply the methods as a standard... Here are the forms I have created, I do this once a year... Cell washer verification form.doc Centrifuge calibration form.doc

My Helmer mentions that too, but because we use the cell washer about once a week, I am deviating from the manufacturer's recommendation (with pathologist approval). Calibration (yearly function) is from AABB, method section USB card.

Scott, the wash cycle is verified when I perform "day of use QC" with a positive and negative DAT poly in tube. I do not like to use the word "assume", specially in Blood Bank, but if the QC is successful, we "assume" that the wash cycle function is performing adequately. Helen

We have a Helmer, and according to the operator's manual and AABB: -Day of use*: check tubing, drain and tubing connections, clean and dry interior after usage -Monthly: Flushing the system, Mesure saline (when changing saline cube) -Quarterly: RPM, Timer, Verify wash cycles, decant operation and physical condition -Yearly: Calibration with AHG, Function verification We do not perform cell button re-suspension check between washes. *We perform Weak D in gel, so we use the cell washer only for DAT poly in tube and for Fetal Screen. Good luck in your research! Helen

My facility is regulated by New York State Department of Health, and reinfusion procedures must be overviewed by our Medical Director, and falls back under my supervision. But thank you Smarty pants for this information...

Hi! Have you ever got feedback from this post? I am in the same situation... thanks,