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Carrie Easley

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  1. Like
    Carrie Easley reacted to Dansket in pre-transfusion sample aliquot   
    Why do you aliquot these blood samples? Do I assume correctly that you are separating serum/plasma from red cells?
    I am adamantly opposed to routinely aliquotting pre-transfusion blood samples for several reasons. It is an unnecessary step that does not enhance the process. It iintroduces another potential point of failure.  It takes time.  Storage space requirements are effectively doubled. 
  2. Like
    Carrie Easley got a reaction from Kandahlawi in Reconstituted whole blood alternatives   
    Unless a physician requests otherwise, we reconstitute to a 50-55% HCT.  The average crit of our CPDA units is ~75%, and the approximate volume is ~270mL.  By sterile welding about 100 mL of plasma, we get the desired HCT.  All packed cell units used are LR, HGB-S neg, <7 days old, and irradiated.  They would also be negative for offending antigen in cases of HDN.  If a physician requests a different HCT, we use the formula:. x= DTV X DH/ OH
    x= mL packed cells
    DTV= desired total volume
    DH= desired % HCT
    OH= original HCT
    The plasma needed would= total volume desired - x
    I'm sure the Technical Manual can fill-in some of the blanks.  Our LIS does all of the labeling and tracking work for us.
  3. Like
    Carrie Easley got a reaction from gagpinks in Reconstituted whole blood alternatives   
    Unless a physician requests otherwise, we reconstitute to a 50-55% HCT.  The average crit of our CPDA units is ~75%, and the approximate volume is ~270mL.  By sterile welding about 100 mL of plasma, we get the desired HCT.  All packed cell units used are LR, HGB-S neg, <7 days old, and irradiated.  They would also be negative for offending antigen in cases of HDN.  If a physician requests a different HCT, we use the formula:. x= DTV X DH/ OH
    x= mL packed cells
    DTV= desired total volume
    DH= desired % HCT
    OH= original HCT
    The plasma needed would= total volume desired - x
    I'm sure the Technical Manual can fill-in some of the blanks.  Our LIS does all of the labeling and tracking work for us.
  4. Like
    Carrie Easley got a reaction from cmontgomery in Instrumentation Turn Around Times   
    We are also analyzer shopping, and I found that the data provided by the company should only be taken w/ a grain of salt.  Some companies start the timer when the tube leaves the tech's hand, while others start at the beginning of pipetting (negating all of the sample & reagent identification steps).  Most of the ones we have looked at are within a few minutes of one another.  Some of my biggest motivators were a manual back-up method using same methodology, random access, the ability to run infant specimens, phenotyping capabilities, on-board reagent storage, and quality reagent cells.  We are moving forward with the Erytra by Grifols (currently have a ProVue).
  5. Like
    Carrie Easley got a reaction from Malcolm Needs in Instrumentation Turn Around Times   
    We are also analyzer shopping, and I found that the data provided by the company should only be taken w/ a grain of salt.  Some companies start the timer when the tube leaves the tech's hand, while others start at the beginning of pipetting (negating all of the sample & reagent identification steps).  Most of the ones we have looked at are within a few minutes of one another.  Some of my biggest motivators were a manual back-up method using same methodology, random access, the ability to run infant specimens, phenotyping capabilities, on-board reagent storage, and quality reagent cells.  We are moving forward with the Erytra by Grifols (currently have a ProVue).
  6. Like
    Carrie Easley reacted to David Saikin in Cost analysis on reference lab testing   
    At my previous employer, ~24 beds, we did almost everything possible - abosrptions, elutions, Warm auto workups (unless recently transfused), enzyme, 0.2M DTT pretreatment, ag typings . . . all my techs were generalists.  I did the more complex abids, I had 3 panels to use, did my own enzyme pretreatment (papain) - don't like the purchased enzyme panels.  My current employer is ~300 beds and also includes a 40 and 20 bed insitutions.  Just do basic abids, sends everything else out.  That is one of the reasons I am here . . . to bring on board advanced serologies. . .
    I had all the routine antisera except Lewis's but you may want to limit your stock as it is expensive. 
  7. Like
    Carrie Easley reacted to Malcolm Needs in Anomalous anti-D?   
    Well David, I see your problem, but I may be able to suggest an answer.
    Firstly, the anti-D seems to be quite weak (which is what made me think of my proposed answer).
    Secondly, of the "common" Rh types, the R2R2 type has the highest number of D antigens per red cell (15 800 to 33 300), and so will tend to give stronger agglutination than will an R1R1 (which may explain why you are getting agglutination with all your R2R2 cells).
    Thirdly, and turning to the R1R1 red cells, some of these may, of course, be R1r', rather than R1R1, and, therefore, have fewer D antigen sites per red cell (about 9 900 to 14 600, compared with 14 500 to 22 800) and, unless the donor is genotyped, or you can do an informative family study, you may never know (but remember the Cepellini effect).  In addition, the number of D antigen sites expressed on a "normal" R1R1 can vary quite a lot from one individual to another (and, indeed, from one cell to another, in the same individual).  In other words, those R1R1 red cells that react with your patient's anti-D could be near the "22 800" end of the spectrum, whilst those that do not react with this anti-D may be nearer to the "14 500" end of the spectrum.
    All figures are taken from Geoff Daniels' book, Human Blood Groups.  3rd edition, 2013, Wiley-Blackwell, page 205.
    I am not saying for one moment that this is the only, or the most logical explanation, but it is, at least, one explanation!
  8. Like
    Carrie Easley reacted to Michelle120 in Blood Storage in Trauma/EMD   
    I'm pretty sure applies to all of the systems.  They seem to run off the same basic software.
  9. Like
    Carrie Easley reacted to Michelle120 in Blood Storage in Trauma/EMD   
    I'm pretty sure you they have an interface with most LIS systems.  Not sure if you need an interface for Emerge.  Most ER/trauma patients are unknown.
  10. Like
    Carrie Easley reacted to BBR in Reconstituted whole blood alternatives   
    Thank you so much CarrieM for detailed explanation.
  11. Like
    Carrie Easley reacted to Teristella in Blood Storage in Trauma/EMD   
    We used Meditech and it worked fine. As I said, it was not interfaced.
  12. Like
    Carrie Easley reacted to Marianne in Blood Storage in Trauma/EMD   
    it interfaces with cerne millenium as well
  13. Like
    Carrie Easley got a reaction from Malcolm Needs in Reconstituted whole blood alternatives   
    Unless a physician requests otherwise, we reconstitute to a 50-55% HCT.  The average crit of our CPDA units is ~75%, and the approximate volume is ~270mL.  By sterile welding about 100 mL of plasma, we get the desired HCT.  All packed cell units used are LR, HGB-S neg, <7 days old, and irradiated.  They would also be negative for offending antigen in cases of HDN.  If a physician requests a different HCT, we use the formula:. x= DTV X DH/ OH
    x= mL packed cells
    DTV= desired total volume
    DH= desired % HCT
    OH= original HCT
    The plasma needed would= total volume desired - x
    I'm sure the Technical Manual can fill-in some of the blanks.  Our LIS does all of the labeling and tracking work for us.
  14. Like
    Carrie Easley reacted to David Saikin in Blood Storage in Trauma/EMD   
    I am attempting to get some Blood Safes for use in my EDs (3 hospitals) and one OR.  They can provide emergent release, e-xms when possible, and documentation of who the unit is going to  . . . of course, that will not prevent the unit from physically being given to another patient after it is "signed out" of the box.  You need a BBIS.  There are a few versions of these around . . . they pretty much are aligned with the BBIS vendor.  I call them the blood bank vending machines . . .
  15. Like
    Carrie Easley reacted to Teristella in Blood Storage in Trauma/EMD   
    Copying a reply I made to another post concerning this, and I'll add some more info as well.
    We used the Haemonetics Emerge kiosk for our trauma bay at my previous hospital... it worked well as long as the nurses were trained, but our trauma department had difficulties with high turnover. If they aren't trained well they ended up panicking and opening the fridge and not scanning out the units. As long as there was only one trauma at a time we could track everything easily; if not, and we were not familiar with the nurse working the kiosk, we would go down to manage it ourselves. A lot of it did depend on the physicians as well, some were very vocal about getting blood quickly and would bully the nurses into shortcuts. The Emerge will let nurses scan a patient label to link products to (they have to scan it once for each type of product and then scan out the required number of units). This was not interfaced to our LIS but we could find the patient name based on the account number they scanned. The computers in the blood bank had software that linked to the kiosk and would alert us when the fridge was opened, so we could monitor what was removed.
    With the Emerge you have to program what types will be in the fridge, and as I recall, they did not allow for more than two choices per product type. That meant when we first started storing plasma there, the nurses had to select plasma, then select AB pos or AB neg. You could not remove the Rh on plasma and it drove us insane. We would make every effort to store only AB pos there, and train the nurses to only select AB pos... but the AB neg option was still there, and if they selected it, the kiosk informs them there are no units available and to contact the blood bank! You can imagine this got us a lot of frantic phone calls... we also ran into this problem when we switched to using group A liquid plasma and we would have to request only Rh pos from our supplier to try to avoid this problem.
    Eventually we were storing 2 O neg packed cells and 6 A liquid plasmas, plus 2 pediatric units on the bottom shelf. We kept two thawed AB plasmas in the blood bank for pediatric use which they were to call us for.
    The Emerge also does not have any checks in place to question the staff of the gender/age of the patient... for this reason my blood bank supervisor chose not to store O positive units in the kiosk. We surveyed a lot of hospitals in our system and many did keep O positive in the fridge. I was personally of the opinion that we needed O positive units down there, and had suggested that we get two bins, one pink and one blue, with signs on the top describing the indications. The trauma docs did not want the responsibility of telling the nurses operating the kiosk which type to grab so it was up to the RNs. We were a level 2, however, so the majority of our traumas were using O positive. If you were a level 1, I think you'd have to decide this for yourself -- do you let them figure it out or only give them the option of O negative? We were always so short on O negatives that we reduced the number of units in the fridge to 2, so that when they all panicked and transfused them to a 70 y/o male (they were supposed to call us for O positive), we wasted fewer Rh negs! They rarely gave products from the fridge unless it was a massive transfusion, and we would bring them the O positive (we kept 6 pre-labeled in the blood bank) with a platelet for their first batch, to use with the plasmas from the fridge. They could move the plasmas into the cooler we bought with the O pos and haul it off to CT or OR or wherever.
    This seems awfully long so I really hope it makes a little bit of sense. Please feel free to ask any questions, I probably missed some important points.
  16. Like
    Carrie Easley reacted to Malcolm Needs in R1R1 patient with only anti-E: R1R1 RBC?   
    Yep - and about 150 to 200 units that are fully phenotyped up to Jk(b) - just to make your jealousy more intense!!!!!!
  17. Like
    Carrie Easley reacted to AMcCord in blood boxes delivered straight to O. R. & they want to give it!   
    I would say that it is also a CBER reportable event, potentially in multiple categories:
    QC-96-02 or -04 Product arrived at unacceptable temperature or no documentation that product was shipped and stored at appropriate temperature. (Was any inspection done/documented to prove the units were OK? would surgery even know what was OK?)
    QC-96-07 Product not packed in accordance with specifications or no documentation that product was packed appropriately. (would surgery know what was appropriate packing? would they keep the packing slip and give it to blood bank?)
    QC-97-13 Procedure for issuing not performed or documented. (I'm sure you don't have a procedure that says incoming units go straight to the OR for issue with nothing done prior to sending them to the OR.)
    QC-97-14 ABO and/or Rh retype of unit not performed.
    QC-97-15 Visual inspection not performed, not documented or inadequate (would surgery even know what they were looking for or know that they needed to do that? or document it if they did inspect the units - its a bear getting them to document what units were actually given when they are dealing with a mass transfusion event much less other 'silly stuff' they don't see the point of doing)
    QC-97-19 If not issued in computer - includes emergency release.
    I'm sure I've missed something.
    If this was reported more than as a one time event, I would wonder if that would pique someone's interest enough to send an inspector?
    I would think that the facility quality department and risk management would be having a cow along with Joint Commission.
    Double Yikes!!
    As to  stories - how about the young girl that got a heart transplant of the wrong type because nobody bothered to check the blood type, just assumed everything was A-OK. She died. That's not blood, but the same process/error would apply to the assumption that a box full of blood is always going to be the right type for the patient in question. Blood centers are staffed by humans who can make mistakes. I'll bet everyone who's worked in blood bank for more than a few years has unpacked a shipment of blood at some point in their career that had units that were not the type you ordered. I have. Dump those straight into a patient without questioning? - recipe for disaster!
  18. Like
    Carrie Easley reacted to amym1586 in Temp Indicator devices   
    We only use HemoTemp II stickers on units in coolers as well.
    AABB says the 30 minute rule is out!   They told me if we are going to continue the 30 minute rule we have to validate.  They want the temperatures to be checked when a unit is returned regardless of how long it's been out.  I asked them if we should start putting HemoTemps on every unit if we start doing that.  She said she wouldn't because they are expensive just wrap around a thermometer if they come back.
  19. Like
    Carrie Easley reacted to goodchild in Labels on reconfirmed units   
    We still use the labels even though we've had an LIS which prevents release of un-typed units for two decades, our blood supplier already double types them, and we keep unprocessed units in an entirely different refrigerator. Anytime I discuss getting rid of them there's intense fear and paranoia. "What if there's a downtime? How will people know the units on the shelf are REALLY retyped?"
    I'm hoping to hear from more incredulous people who didn't even know others still used them to inspire me to forge ahead and suffer the backlash.
  20. Like
    Carrie Easley reacted to Brenda K Hutson in Any one look at Grifols Erytra?   
    We have had 2 ProVue's but are now in the process of purchasing the Erytra.  Just liked the features and equipment better (Vision was also pretty loud). We will only be purchasing 1 Erytra, but will also get the Manual Workstation and DG Reader which will also be interfaced with our computer system.  Barring any "long" downtimes by the Erytra, we can handle our workload with 1.    I will be going to training in Sept. and that is when the machine will be brought in "and the fun will begin....."
    Brenda Hutson, MT(ASCP)SBB
  21. Like
    Carrie Easley reacted to mollyredone in KB stains... in-house or referral?   
    The rosette test, or fetal screen, is only for use after delivery of all products of conception, and then a venous sample is collected 1 hour later (or it can be longer).  We use the FMH RapidScreen by Immucor, which is the same one Teristella mentioned.
  22. Like
    Carrie Easley reacted to Eagle Eye in Epic and Sunquest BB Standalone   
    EPIC does not have 510K approved blood bank module so test orders and results can be processed from EPIC CARE to BEAKER to BB system and back to same route.
    Product orders has to come directly from EPIC to BB system and crossmatch results from BB system to EPIC. (Product order can not come through beaker).
    I totally agree that you need to be involved in EPIC beaker build...most IT department do not care for blood bank and they will do whatever they want without involving Blood Bank. They like control!!! total control!!!
     
  23. Like
    Carrie Easley got a reaction from amym1586 in Gestational age for fetal screen   
    Liz & David~
    Will the fetal screen kit you use detect the cells of a weak D+ fetus?  Ours (Immucor FMH RapidScreen) doesn't, so we can't do it until after delivery & Rh is known (or we would risk a potential sensitization on the off chance the fetus was weak D+ and a large bleed was missed).  If your kits do detect them, I'd love to hear about it so we could reduce the K-B we perform.  Thanks!
  24. Like
    Carrie Easley got a reaction from amym1586 in Gestational age for fetal screen   
    I'm wondering if you use a different kit than us (Immucor FMH RapidScreen)?  Our package insert states that it can only be performed after delivery of all products of conception (so not after an obstetrical event mid pregnancy) and only on a known D negative mother and recently delivered known D positive child (but not a weak D infant).  In the event of an event <20 weeks, we give one vial.  If >20 weeks w/ unknown infant type (so most amnios), we have to do Kliehauer to quantitate a potential bleed.  We routinely have student interns and our mantra w/ them is "if you don't have a baby, you can't do the rosette test".  If there is another kit option that permits it, I'd love to hear about it!
  25. Like
    Carrie Easley got a reaction from amym1586 in Gestational age for fetal screen   
    For what it's worth...we really don't do that many.  We are a large hospital (450+beds) w/ trauma center, and we average maybe 1 per week.  We don't even have our 3rd shifters maintain competency. Most of the miscarriages are early enough that they don't need quantitated so we just give one vial.  We just get the occasional amniocentesis or late loss on an Rh negative mom & trauma/fell down and bumped belly to perform the K-B's.  It is on our fetal demise & pregnant trauma order set, but it's just not that common.  Take care
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