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Ensis01

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Everything posted by Ensis01

  1. ABO mixed field must be explained; find out patient transfusion history. If it is not clear what their blood type is, or if the mixed field cannot be explained (patient intubated, confused etc.) document and give type O. Interpretation of mixed field in gel is easy, harder in tube but I would expect it to be there. I would therefore suggest checking very carefully for mixed field by tube (this may be an occasion to use a microscope to confirm mixed field if needed). Sounds like this is a good sample to use for mixed field training in your lab.
  2. That sounds like an absolute logistical nightmare. Maybe I have missed something but I have visions of coolers being left in the helicopter, on the helipad (winter and summer), in bathrooms and forgotten in corridors etc.
  3. Run side by side. Does your SOP, or manager (or anybody for that matter) give a reason why it is eluate first then Last wash? It would make more sense for a policy to state run the last wash prior to the eluate (especially if there are few red cells) to ensure sufficient washing.
  4. I assume that as there are no decimal points involved there is little, if any, variability on day to day readings. Remember the purpose of daily checking the scale is to ensure it is fit for YOUR purpose at the max acceptable ranges in variability, which is why information is harder to find, each lab has to determine what is appropriate for them. Therefore if your inspectors have no problem with the range why would you. An additional advantage of the wide range is that you will/may see a drift in readings if the scale starts to malfunction and so have time to call someone in to fix it before you can no longer use it. I personally see no reason to make things harder without good reason or just because you can.
  5. There is a difference, I believe, between not being able to rule out an antibody in the context that it may be there, the answer no you state above, and not being able to rule out due to the method limitations (DTT). The DTT method limitations result in K neg units being given but once the DARA effects wears off a different, more appropriate (and better) method is used so anti-K can be ruled out and the K neg requirement dropped.
  6. My two penneth for what it's worth; when the patient is in the OR the anesthesiologist determines blood product requirements (often by verbal order) so all an OR runner needs is name and MR#. It seems your, very valid, concern is avoiding WBIT from the outset due to the issues you outlined above. I suggest the solution is that the OR processes need to be cleaned up (literally). Therefore get QA involved. I am not a manager so others here will be way better at giving suggestions on how to proceed down that path and ensure changes are made, and just as importantly maintained.
  7. If the DAT is positive I would not do weak D testing unless I could obtain a negative DAT. The primary methods I have used to do this are: EGA and CPD. I have however used 56’C heat elation for cord and neonate samples with some success, it is however time consuming.
  8. It is used to provide a negative control for the forward grouping, but is therefore only needed for AB pos patients. It is usually/often easier to require the control every time so it is not forgotten when the occasional AB pos does occur. The control's use in weak D testing is useful when the patient has a positive DAT.
  9. I am a little confused; as the process to manufacture PR platelets has the same effect as irradiation what do you want to warn your techs of?
  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.
  11. Agreed to all the above; as you say you have implemented a policy that prioritizes clinical benefit over inventory control and waste reduction, which the hospital (physicians, Med Techs and bean counters) follow. My experience, however, is disciplinary action taken over product wastage. So unless a hospital implements a policy similar to the one you outline, which the Med Techs can follow, giving only ABO specific platelets will be problematic.
  12. Hi Neil, I have been following your RBC and platelet transfusion observations, and your resulting evolution of policies with interest and I agree with ABO matching platelets (also my observations). I guess however I am one of these that see too many problems for implementation, even gradual. Yes the Med Techs select the platelet, but mostly it has to be the shortest date first to minimize waste (a major concern/factor every where I have worked). A policy to only give ABO identical to a patient (one, all, or a percentage) will result in occasions where the ABO matched platelet can not be obtained locally (and may not be obtainable at all). While you mentioned both these issues and suggested solutions my experience leads me to believe it an unsurmountable task for many hospitals unless there is agreement among the physicians and/or the transfusion Medical Director can override orders (and not just advise). I can not see that happening in most institutions especially larger ones.
  13. It makes sense to have a K neg policy while the patient is on anti-CD38 therapy, i.e. K neg units are given because DTT meant Kell antibodies could not be ruled out. Once anti-CD38 therapy is finished and if the patient never had anti-K and you can rule it out I see no reason to keep giving K neg units.
  14. Ensis01

    Retired

    My deepest condolences for your loss.
  15. Agree with Malcolm and OkayestSBB. The process I would suggest is to only investigate then call Ch/Rg once the following criteria are met: there should be reactivity on phenosimilar cells, which should titer out to your HTLA defined policy. Reactivity should be negative with Ficin treated cells and positive with 0.2M DTT treated cells. Then neutralize with plasma (and saline controls). Hope that helps.
  16. I agree with the consensus. I would however check each and every card against Meditech to ensure nothing extra is on the card, once checked (updated) make a note in Meditech and discard the card. Also keep the unused cards as they are fantastic for use during down time events and can be discarded once Meditech is updated.
  17. At my previous hospital we would accept and use a historical ABO from another lab but only if it came from within our hospital system.
  18. If you provide blood for the outpatient surgery center it makes no sense to have two separate procedures for emergency releasing blood otherwise you would need two procedures for EVERY process that you do at both sites, and that would really suck
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