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Ensis01

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Reputation Activity

  1. Thanks
    Ensis01 got a reaction from Malcolm Needs in Life Membership of IBMS.   
    Congratulations and well deserved
  2. Like
    Ensis01 reacted to David Saikin in Deviation Reporting   
    your facility should have an occurrence event form for any occurrences there.  I'd speak with your Quality folks; I would expect they would have the answer and be interested in such.
  3. Like
    Ensis01 reacted to galvania in Anti-D in Rh negative girl who has never been pregnant nor tranfused   
    So if you first saw anti-D when she was 20 weeks pregnant and she is now 30+ weeks pregnant, have you compared the strength of the anti-D then and now?  If the anti-D was due to injection it will have decreased somewhat.  If it has risen or stayed stable the chances are that it is real. 
    Also, I have to say, I do find the comment:  I am under the impression that she is homeless and have very poor antenatal care. I could be wrong though. She probably likes dressing like a homeless person  a bit flippant and very insulting.  If she is homeless, or too poor to buy decent clothes, where is your compassion for this poor girl?  I know that this is not the place to rant about inequalities in society just getting bigger and bigger but that phrase really upset me.
    Rant over.
    So let's assume that this girl has numerous problems; after all, she did not realise she was pregnant when she was actually 20 weeks and is possibly living rough.  In which case, she may well have been pregnant before and not known it; she may even have had a backstreet abortion and not been able to own up to it.  I am presuming there are no needle marks to indicate her being an IV drug user (which may explain the antibody if needles are shared)
  4. Like
    Ensis01 reacted to David Saikin in Jehovah's Witness Transfusion Policy   
    It definitely should be a part of the medical record, electronic or otherwise.
    No need for BB to keep the document - medical record.  I'd put a note on the patient record card/BBIS for future reference.
  5. Like
    Ensis01 reacted to AMcCord in Jehovah's Witness Transfusion Policy   
    I do as David does - a note to indicate that the patient is a Jehovah's Witness. If the patient has accepted plasma but not red cells, I will also note that. Saves them a bill for an unwanted crossmatch sometimes if I can notify the provider that he/she should discuss transfusion with the patient before we perform testing to set up red cells for them. (And yes, I think that providers should discuss transfusion with their patients, ideally before ordering the products, but we know that the real world doesn't always work that way.)
  6. Like
    Ensis01 reacted to John C. Staley in Labeling testing tubes/wells   
    My personal system was virtually identical to yours except for the the reverse type I used JH-RA and JH-RB.
    In the facilities where I was the Transfusion Service or Blood Bank supervisor my tube labeling requirement for the staff was that anyone in the department could set down an take over the testing and know who and what was in each tube.  
  7. Like
    Ensis01 reacted to applejw in Donor re-typing   
    The requirement to perform a donor retype also plays into whether or not the LIS is used for electronic compatibility testing.
    AABB 5.16.2.4  The system contains logic to alert the user to discrepancies between the donor ABO group and Rh type on the unit label and those determined by blood group confirmatory tests and to ABO incompatibility between the recipient and the donor unit. *
    *FDA Guidance for Industry: Computer Crossmatch"
  8. Like
    Ensis01 reacted to Darren in Cytotherm plasma thawers   
    Okay! Here's the deal. Cytotherm has gone under. A former employee has taken over the service parts and started his own business that hopefully lasts as long as the thawers do. We ordered 2 bladders from him and got them the next day! The website is called Cytosupplies. https://www.cytosupplies.com/
    First purchase is via credit card and then after that you can get set up in his system for POs. So spread the word to get this guy some business so we don't have to fork out a bunch for all new thawers.
     
  9. Like
    Ensis01 reacted to Joanne P. Scannell in Liquid Plasma   
    'Liquid Plasma' is never frozen so there's no need to thaw it therefore the outdate is not changed.
    'Thawed Plasma' is the 5 Day product which results from Thawing Frozen Plasma (in all it's various forms, FFP, FP24, etc.).
    Note: When Frozen Plasma is thawed, it is assigned a 24hr outdate.  You can extend that outdate to 5 Days IF you label it 'Thawed Plasma'.
    e.g. Frozen FFP is thawed to Fresh Frozen Plasma (24h outdate).  You can leave it that way or change it to 'Thawed Plasma' (no FFP designation) and assign a 5 Day outdate to it.  Most hospitals, if they go that route, just label it 'Thawed Plasma' with a 5 Day outdate immediately after it's thawed.  (One Step vs Two Steps)
    Note:  I'm using USA FDA rules, I don't know what they do in other countries.
  10. Like
    Ensis01 reacted to AMcCord in Validation studies   
    A magnification aid is optional for N-Hance. It could be an agglutination viewer, rather than a microscope.
  11. Like
    Ensis01 reacted to slsmith in Emergency Release   
    We have a order for emergency uncrossmatch blood in EPIC and it has an electronic signature attached to the order so no other signature needed. How the IR department built it I don't know. And a phone call is still required as there are times the order was placed in error (darn residents) and the fact that when an order prints we don't necessarily jump to see what  just printed .
  12. Like
    Ensis01 got a reaction from Malcolm Needs in BloodBankTalk:Clinical Aspects of Transfusion Reactions   
    I just answered this question.


    My Score PASS  
  13. Like
    Ensis01 reacted to DPruden in Emergency Released RBC   
    21CFR606.151(e) states "Standard operating procedures for compatibility testing shall include the following: Procedures to expedite transfusion in life-threatening emergencies. Records of all such incidents shall be maintained, including complete documentation justifying the emergency action, which shall be signed by a physician."
    We keep them regardless of whether or not the units are transfused.
  14. Like
    Ensis01 got a reaction from Malcolm Needs in BloodBankTalk:Antibody/Antigen Reaction   
    I just answered this question.


    My Score PASS  
  15. Like
    Ensis01 reacted to Arno in Daratumumab patients positive with DTT treated cells   
    In which buffer do you resuspend your DTT treated cells? May be these patients do have antibodies against one or several components of this buffer (antibodies against preservatives used in RBC buffer are not so uncommon).
  16. Like
    Ensis01 reacted to Kip Kuttner in The COVID-19 challenge   
    Platelets are in adequate supply largely due to hospitals (in my service area) enforcing restrictive transfusion measures and postponing elective surgeries. Most blood centers except in New York, Washington state, and California are treading water with respect to RBCs. As usual Rh neg units are in short supply. 
     
    Most of the hospitals in my service area are also freeing up beds to treat respiratory infections. These will require fewer transfusions, although patients needing ECMO are of concern. 
     
    Looking ahead, it is difficult to predict what will happen.  This is a long term event. My current concern is that blood donors will be fatigued 3 weeks from now and avoid giving blood. That is what happened after 9/11. It could be that you might need that unit of O neg on your shelf 42 days from now. 
     
    In my opinion the goal is to provide blood for everyone who needs blood. Measures to restrict are prudent (and the literature indicates this is good medicine).  After this is all over and we are criticized for being too conservative, but no one died for lack of blood, I can live with that. 
  17. Like
    Ensis01 reacted to Marianne in Deviation Reporting   
    From the management side;  involve the tech.  Meet with them and have a conversation about how/why the think the error occurred..  Make them feel involved in QA and PI by asking if they have any suggestions that may prevent a recurrence.  Front line staff often have great PI ideas, but won't speak up. 
    During the conversation you will also be able to get a good feel for whether the tech knows the procedure and is committed to following processes as written, needs some re-training or whether they purposely deviated because the had "a better way".
  18. Like
    Ensis01 reacted to AMcCord in Deviation Reporting   
    When the reason for a deviation is determined we can decide how it needs to be addressed. In some cases, the deviation was an acceptable response to a given situation. No follow up required. If education or training is required, that is provided and documented on the same form. If the deviation is the result of continued 'bad behavior', training/education issues, or egregious disregard for policy, then our next step is an 'Opportunity for Improvement'. This is something we use throughout our lab. The tech and a lead sit down together to discuss the deviations and the problems identified to determine what the tech needs to do to remedy the problem. The tech is also asked what he/she feels is needed to help him/her resolve the problem. Once the lead and the tech have come to an agreement, the resolution to the problem is spelled out, including any education/training the lead will provide and the expectations for the tech's future performance. An end date for the required improvement is also determined. When that date is reached, the lead evaluates the tech's progress. If all is well, that is documented. The End. If there are still issues, the lead can re-evalute the situation. Additional training or education can be provided, with another periord of evaluation. If need be, the problem can be referred to the lab manager for possible disciplinary action.
  19. Like
    Ensis01 reacted to Malcolm Needs in Adsorption/elution studies for null phenotypes   
    I can see no reason why this would not work as a method.  We used to use something very similar when testing individuals expressing the "McLeod" phenotype.  However, these days it would be easier (and certainly more accurate) to perform gene sequencing on both the KEL and the XK genes.  Don't forget that a true Duffy null phenotype (FY/FY), as opposed to a "GATA-1" type Fy(a-b-) is, these days, established by molecular techniques.
  20. Like
    Ensis01 reacted to Ward_X in Titer controls   
    My facility's previous control was running the previous sample in tandem and the results had to agree within one dilution. This process is currently being remodeled.
  21. Like
    Ensis01 reacted to Malcolm Needs in HX of WAA Case   
    Alloasorption.  In fact, having worked in Reference Laboratories for most of my life, it was VERY unusual for the patient either to have NOT have a transfusion within the previous three months - meaning that they were not a candidate for auto-adsorptions - or their haematocrit is so low that there are too few autologous red cells to perform an auto-adsorption in the first place (usually because they were sent to us because they needed a transfusion in the first place!).
  22. Like
    Ensis01 reacted to Oniononorion in Emergency Released RBC   
    It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
    Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.
  23. Like
    Ensis01 reacted to David Saikin in Emergency Released RBC   
    if I sign out emergency release, I am keeping the request regardless if rbcs are used or not.
  24. Like
    Ensis01 reacted to Malcolm Needs in Patient with Anti-D   
    In that case David, I would do serial titrations "in house", otherwise you will be paying out for a load of tests that you do not need.  However, do I presume that, as the first two titres were performed by ARC, and you did the third, you were unable to perform a parallel titration on the second sample, when you did the third?  If this is true, then there is even more of a possibility that the change from 4 to 8 in results may, itself, be the result of a small experimental error (with no offence meant, and I hope none taken).
  25. Like
    Ensis01 reacted to Malcolm Needs in Patient with Anti-D   
    In that case, I have to disagree with John for once (sorry John!).
    The reason I disagree is that a dose of RhIg will not give a very high titre, BUT, the titre of a pre-formed anti-D can rise very rapidly, and very dangerously, in the third trimester (much higher than the titre seen with just a dose of RhIg added to a low titre of allo-anti-D), and so, despite the complete idiocy of the person who gave the shot, I would still monitor the pregnancy by titration (well, I wouldn't, but only because in the UK we monitor anti-D in pregnancy by quantification).
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