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!

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!

I'm a huge fan of dedicated BB staff for larger facilities. Currently, only day shift is comprised of dedicated staff and 2nd and 3rd shift manned by generalists who work in at least one other specialty. With a 6 on/8 off schedule, some of the 3rd shift work only 1-2 days per month and are VERY uncomfortable given that we are a Level 1 trauma center, large outreach services and serve as the "reference" Blood Bank for 7 other satellite hospitals.  Turnover is a problem on 3rd shift because of the extra stress caused by only being scheduled 1-2 days per month and being responsible for at least half of the massive transfusion activations.
My Medical Director wants dedicated BB staff but with the current administrative/financial climate it is a steep hill to climb.

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!

That's awful Frenchie.
So much for all the talk about our 'valued public service workers'.

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!

I too am the only dedicated Blood Banker .  I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists.  I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training.  They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school.    It takes years to become a seasoned tech. Between training new techs, 6 month competencies, annual competencies, meeting changing standards, and dealing with shortages I find it a little overwhelming. Unfortunately I believe this is the new Norm and agree we are in a staffing crisis which needs addressed now.

I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes.  You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.
BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!

That's the truth John.  Us small places are at the mercy of the blood suppliers. 

See this large study https://www.ncbi.nlm.nih.gov/pubmed/3137672 regarding use of rh positive blood for untyped trauma recipients.
Abstract
The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.

The simplest solution and the clinically superior one is to use pathogen reduced platelets (at the cost of $100+ more per transfusion).  Bacterial testing will not prevent all bacterial contamination events in any case, and pathogen reduction pretty much will do that.  In addition, pathogen reduction is the future of transfused blood (and no lesser expert than Harvey Alter, the co-discoverer of both Hepatitis B and C, has stated this).  There will be viruses we don't know about and cannot immediately test for that come around the way HIV did, and pathogen reduction addresses these future pathogens, including present realities such as babesiosis, malaria, etc.  We then could stop testing for pretty much everything if we wanted to, including useless tests like syphilis, Zika, etc.  (These diseases are not known to be transfusion transmitted with current practices). That would save a little money, but awaits (1) pathogen reduction technology for whole blood and (2) the FDA and various states agreeing the redundant testing makes no sense from a clinical standpoint.  Good luck with the latter :).
We are close to 100% pathogen reduced for platelets in our center, and the cost was about $500,000 per year.  Of course, one or two cases of post-platelet transfusion sepsis in a patient with neutropenia will pay for that in avoiding ICU stays, etc.  

If you are a small hospital and transfuse a few platelets per month, the extra few thousand dollars per year for pathogen reduction is easily recouped in reduced staff training time for bacterial testing, logistic nightmares and other complexities. Plus it's a superior approach to reducing risk to patients.  To me, it's a no brainer, but your mileage may vary.

This flow chart is not dedicated to electronic crossmatch but does address it in section B.
ecxm flowchart.docx

Too bad you live across the pond or we might need to validate your statement by taste testing that lasagna!

Now y'all are just making me hungry!

No, and to be honest, and at the risk of being accused of being big-headed, I am not too bad in the kitchen.  For example, when making a lasagne, I do everything from scratch, including making my own pasta and bechamel sauce.

An excellent post JHH1999, however, if I made the cake today, with milk that had a use by date of tomorrow, there would be grave doubt as to whether the cake would be edible today, let alone in a few days time!!!!!!!!!!!!!

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.
 

The AABB Technical Manual.

We are still having problems.  We are on our 4th lot of gel cards and screening cells.  These faint, weak positives are happening with panel cells as well as BioRad 3% cells diluted to 0.8%. What are you all doing?  I don't want to revert back to tube but when we've tried every lot we have here - then what?
I can't even get through to technical service this morning

It would be interesting to hear exactly why the new paediatrician wants to go back to this testing regime, considering that it has been known for decades that the DAT in a case of ABO HDN can be negative for a couple of days from birth, and only then become positive.  May I respectfully suggest that this new paediatrician relies on his or her ability to look at the baby's symptoms, rather than his or her ability to read laboratory results.  This way, more babies may survive.

One thing that I have not understood throughout this thread is, in the case of antibodies/antigens that show dosage, and I know that the number of antigens for a particular specificity varies with the human source of the red cells, if the antibody/antigen reaction is showing dosage, surely it doesn't matter how many examples of red cells expressing "heterozygosity" are used, they are still going to have negative reactions.
Surely, cells expressing "homozygosity" is the way to go, if they are available?
:confused:

I will attempt to attach an image of the sort of reaction that is giving a question mark on our Vision.  Remember that these are magnified and you can't really see the dots with the naked eye.
false pos IgG card image.docx

To say we are having problems is an understatement.  This seems to only be an issue for Vision users; the camera is very sensitive and is picking up weak reactivity that the instrument is calling "?" reactions.  Because the image is enlarged on the Vision screen, you can actually see specks in the column on reactions that should be negative (including negative QC).   Multiple reports have been filed, and we have gone through about half a dozen IgG card lots.  We are beginning to see these in our manual testing now as well (although you have to look VERY closely).  It appears that the problem is something that changed with the gel card production, although nothing official has been released by Ortho yet.  Older lots of IgG cards are fine, which proves that it is the gel cards.  Hopefully this is resolved soon...

When I came to my current hospital they were using expired panel cells.  I got rid of the practice because of the QC issue and having to maintain a policy for when to use and not use expired panel cells.  I am glad that I did because this issue looks like it is turning into a problem.  So as of about 6 months ago, we do not use expired panel cells for any reason.  I would rather give antigen negative blood for an antibody I cannot rule out or send the specimen out to the reference lab if we have multiple antibodies that cannot be ruled out.
How did the CAP and AABB reps answer this question?

I have found that occasionally the IgG card will react to complement sensitized survey cells.  I think that CAP has finally realized this phenomenon and has samples produced that reduce the incidence of this.  I saw this first when I was lucky enough to have a research only DAT card that was used in Europe.  I had the same results, IgG and C both reactive.  I showed my boss and told her that we would take a hit on this because I knew that CAP was looking for only C reactivity.  We took the hit but I had pictures that I could send to defend my results. 
Have to remember that the folks making the survey may only have checked out their sample with tubes.  Also, many respondents tend to know what the survey is intended to detect and respond accordingly even though their serology differed.  Don't want to take a hit.
That's what I think