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Ensis01

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  1. Like
    Ensis01 reacted to Malcolm Needs in Antibody identification art or science   
    As someone who was the lead in the Red Cell Immunohaematology Laboratory in Tooting, London for well over a decade, I would say that it is a mixture of the two, but about 75% science.
  2. Like
    Ensis01 reacted to AuntiS in ABO for Cord bloods   
    Always great advice from Malcolm
    I find the use of anti-A,B is helpful - especially when the red cells from cord blood react weakly with the anti-A (which we know can be underdeveloped).  We accept weaker reactions in newborn samples than we do for adult blood samples.  However, that being said, if there is any doubt - we will not report the ABO group (often the Rh is needed for RhIG requirements) and give group O blood if a transfusion is required.
    sandra
  3. Like
    Ensis01 reacted to Malcolm Needs in ABO for Cord bloods   
    The first, and most important, thing to remember is that ABO antigens are "carbohydrate-based" and are not, therefore, direct gene products (not that any antigens are, as every one of them undergo post-translational changes).  The direct gene products are, of course, the A,  B and H transferase enzymes.  At birth, it is incredibly rare for the enzymes to be "working" at its optimum/maximum, so that it is rare for the ABO antigens to be expressed maximally (or anything like) at birth.  I am certain that you know all this already, so that I am probably "teaching my Grandmother to suck eggs", as the old (and in this case, almost certainly, insulting) adage goes.

    As a result of the above, however, unless you can perform A, B and H typing by molecular techniques (NOT to be recommended - see Geoff Daniels book, Human Blood Groups), you either have to decide to ignore all serological cord ABO types, and call all of them O, or, you have to use serological methods that will enhance the antibody/antigen reactions.  Herein, there are inherent problems.

    Firstly, whatever enhancement you use, you MUST use a suitable negative control.  It is fine (in my opinion) to vary the incubation temperature from RT to 4oC, but, to so do, it is very necessary to use another cord blood from a known group O cord sample (i.e. where both parents are KNOWN to be group O themselves, and so an A or B subtype in terms of the control is not a problem).

    Similarly, the same can be said for enzyme-treating the baby's red cells, as long as the control cells are also treated in EXACTLY the same way with the proteolytic enzymes.

    Finally (at least for now!!!!!!!), it should be remembered that we routinely use monoclonal ABO antibodies these days.  These are extremely avid, which is fantastic, but are also VERY specific, which can be a drawback.  By this I mean that the old polyclonal human-derived ABO antibodies we used to use (when I was middle-aged, and Karl Landsteiner was a young boy) had the single (and probably only) advantage that they were not quite so specific, and would, therefore, detect ALL (or most) ABO antigens, including those that the monoclonal antibodies would not necessarily detect.  For an explanation of this, there was a recent paper in Vox Sanguinis (Cripps K, Mullanfiroze K, Hill A, Moss R, Kricke S.  Prevalence of adsorbed A antigen onto donor-derived group O red cells in children following stem cell transplantation: A single-centre evaluation.  Vox Sang 2023; 118: 153-159.  DOI: 10.1111/vox.13386) talking about the A antigen being adsorbed onto the surface of group O red cells in vivo.  One of the references they use is the first peer reviewed paper that I ever wrote, concerning A and/or B substance being adsorbed onto the surface of donor-derived red cells in vivo.  What I failed to say in this paper was that this phenomenon was far easier to detect with polyclonal ABO reagents than monoclonal ABO reagents (36 years, and I still regret this omission!).

    Anyway, IF I HAVEN'T SENT YOU TO SLEEP YET, my point is that, as long as you use suitable controls, particularly NEGATIVE controls, there is no reason why you should not use any modification to any technique (GIVEN THAT IT IS IN YOUR SOP, with all the qualifications given above), and, even then, if you feel it safer, GIVE GROUP O BLOOD.
  4. Like
    Ensis01 reacted to jayinsat in Blood administration   
    CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
    The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.
  5. Like
    Ensis01 reacted to AMcCord in Blood administration   
    Our nursing policies state that infusion should begin within 15 minutes of checkout. This ensures that the transfusionist and patient are 'ready' for infusion before the nurse comes to Blood Bank to check out the unit: pre-transfusion vitals have been taken and evaluated; IV looks good; infusion set is at bedside; consent has been signed; etc. etc. We implemented this policy in cooperation with nursing service to reduce blood product waste due to inadequate preparation and unexpected patient issues. Fifteen minutes gives them just enough time to come down and check out the product, take it to the bedside, have a buddy ready for the 2 nurse ID process, and to start the infusion. If something unexpected pops up and they have to return the unit, we check the temp. If its over 6.0 C we ask them to take it back to the floor if they think they will be able to start infusion soon and remind them they have 4 hours from the time of original checkout to complete the transfusion. If transfusion is a 'no go' or will be delayed too long, the unit is discarded. This is working well for us - very few wasted units since implementing this policy. Quality includes the 15 minute start time in their transfusion reviews.
  6. Like
    Ensis01 got a reaction from SbbPerson in Nursing verifications done at bedside before transfusion   
    We vertically audit ten transfusions a month, reflecting different departments and floors. We ticked each criteria box as it was done correctly. If missed or done incorrectly another box was ticked and we educated the RN. The form was signed by us and RN. The BB kept a copy and original went to the RN supervisor. Not sure what they did with it. Not ideal system but showed us willing. 
  7. Like
    Ensis01 reacted to Mabel Adams in Specimen collection system & rejection rate   
    Our specimen rejection rate was 1-2% when we still used a separate banding system.  We dropped that last year for full use of the Epic electronic ID system.  I need to pull statistics now, but I am sure it is much lower.  Our main rejection reason before was almost always that the band number was left off.
  8. Like
    Ensis01 reacted to ffriesen in Same Day Survery ABO Confirmation process   
    We have the ABO/Rh confirmation order built so that it can only be ordered by lab staff when needed. We don't allow surgery staff to put the order in. Blood Bank knows when we get an order if a second type is needed and this prevents OR staff from drawing two tubes at the same time and trying to say they were drawn at different draws.
  9. Like
    Ensis01 reacted to AMcCord in PEDIATRIC MASSIVE TRANSFUSION PROTOCOL   
    We used to have a weight based formula but recently switched to sending the same cooler of products regardless of patient age/size. For kids the red cells would be O neg and AB liquid plasma. It is up to the surgeon/pediatrician to determine what and how much is transfused. We just make sure they have plenty of what they need. Any unused product comes back in the cooler and is returned to inventory.
    We receive very few pediatric trauma cases that need blood products over the course of a year so we (Blood Bank and our Medical Director plus Trauma Coordinator, with pediatric consult) decided to keep things simple on our end and let the medical folks do what they need to do. It's hard for us to get timely basic info in a trauma situation - male/female, kid/adult - much less weight. Using the one size fits all response instead of pulling a chart to check for specific requirements minimizes confusion for our generalists who may only have to respond to MTP orders a couple times a year. It keeps our TAT for cooler delivery fast and doctors happier. We aim for <10 minutes and our median time is 6 minutes over the last 2 years, regardless of where the cooler needs to go. 
  10. Like
    Ensis01 reacted to MAGNUM in Same Day Survery ABO Confirmation process   
    We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.
  11. Like
    Ensis01 reacted to jayinsat in Same Day Survery ABO Confirmation process   
    We order and perform ABORH confirmations as needed. 
    In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.
  12. Like
    Ensis01 reacted to SbbPerson in Specimen collection system & rejection rate   
    At my hospital we don't use bands. I think this is great, because our rejection rate is pretty low.  There are too many travelling nurses we need to train if we were to use the bands.  And even when trained, nurses still get them wrong. 
    Now all they need to do if to make sure the specimen has at least 2 unque identifiers , along with collectors's info, date, and time. Simple. Also for each type and screen, a testing request form is filled out. All patient information must match between the form and the specimen.  That's it.  Nice and simple. 
     
    The band is great, but not everyone knows how to use it, and training takes up alot of time, especially with all the travelling nurses we have. 
  13. Like
    Ensis01 reacted to DPruden in Emergency Issue / MTP   
    Most of our MDs order the MTP in Epic fairly real time, and if they don't the Blood Bankers enter the order with a required co-sign.
  14. Like
    Ensis01 got a reaction from JJSPLAYHOUSE in Emergency Issue / MTP   
    While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 
  15. Like
    Ensis01 reacted to Mabel Adams in Wrong ABO typing by Gel   
    Also, fetal bleed screen testing on a spun sample.  Those giant fetal cells will be on top.  Mix well before testing!
  16. Like
    Ensis01 reacted to John C. Staley in Emergency Issue / MTP   
    What I noticed over the years was that many times when faced with signing for uncrossmatched blood the physician would take a second to reevaluate the situation.  Often they would then respond with something like,  I want it crossmatched so hurry.   Not always but it was not uncommon or rare.  When they did sign the form it was most often when the crisis had resolved and the dust settled.
     
  17. Like
    Ensis01 reacted to Malcolm Needs in Emergency Issue / MTP   
    I can fully understand what you are saying (and agree almost 100%), but I do have some sympathy for them signing the forms "after the event" as it were, because when they do have to use the uncrossmatched blood that quickly, then they are going to be pretty busy doing things like preventing the demise of the patient - if you see what I mean!!!!!!!!!
  18. Like
    Ensis01 reacted to John C. Staley in Emergency Issue / MTP   
    Malcolm, I meant that statement not as a criticism of them but just a recognition of reality.  Frankly I was excited to get the forms back most of the time and fully understood the pressure they were under.  When I was in school I worked in the emergency room on night shift so I was very familiar with trauma situations and fully understood the, "do it now and worry about the paperwork later" mentality. 
    Cheers  
  19. Like
    Ensis01 got a reaction from Baby Banker in Emergency Issue / MTP   
    While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 
  20. Like
    Ensis01 reacted to Mabel Adams in "Critical values"   
    We do it.  We were texting the RN to tell the MD but that kept failing to be documented so this week we are starting to contact the providers directly.  I don't think it is very smooth yet.  The system we use is an app that is only on supervisors' and providers' personal phones.  Otherwise it is on hospital issued phones and workers sign into them when on shift.  The calls/messages go to the app for the provider which then rings/texts their personal phone.  The text messages are only within the app, not on our regular phone SMS.  It is tied to the Epic patient database so you can select the patient within the app and find their current caregivers.  It's pretty slick.  I think the company/app is MH Cure and Mobile Heartbeat.  We renamed it Whistle. 
  21. Like
    Ensis01 reacted to applejw in EPIC Rover and AABB   
    Because there are work arounds to the Rover collection process, we still require a second sample or historical lab-reported result before RBC products can be issued (or issue Group O).  Our hospital uses the Rover but some floors are designated nurse-collect and with this comes the non-Rover process where the electronic ID verification can be circumvented (circumvention is not nursing specific by any means).
  22. Like
    Ensis01 reacted to AMcCord in EPIC Rover and AABB   
    Yes, that is an electronic ID system. Just make sure that you write your specimen collection procedure very carefully.  The phleb should still be verbally IDing the patient and comparing that with the patient armband (full name, birthdate) and matching the Rover info with the patient armband. The procedure should also state that the label will be printed at bedside and the tube labeled at bedside. You will also need policy for what to do if the phleb is unable to scan the armband (Rover not working, emergency specimen collection and no armband present, OP collection if Rover not used for patient ID, etc.). There may be some specimens that can't be collected under the electronic ID process, which would require another process (2nd specimen collected or Blood Bank armband or ???). 
  23. Like
    Ensis01 reacted to Mabel Adams in EPIC Rover and AABB   
    There is an Epic report for scan overrides.  We had to tweak it so it covered patients who were already discharged but our phlebotomy  leaders used it to increase compliance and they made great progress to the point where we dropped our separate BB banding system last year.  It does require that your organization have a strong policy for using the electronic ID and doesn't tolerate extra ID bands lying on the desk etc. Our phlebotomists are now reporting instances of ID bands being misused and one recently got a hospital award for her efforts.
  24. Like
    Ensis01 reacted to jayinsat in Emergency Issue / MTP   
    We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 
  25. Like
    Ensis01 got a reaction from BldBnker in Emergency Issue / MTP   
    While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 
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