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Ensis01

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  1. Like
    Ensis01 reacted to Neil Blumberg in MTP cut-off policy, or Lethal Dose of Blood Products   
    "The bottom line was, if the treating physician wanted to use up the entire inventory trying to save a life, we could not deny them the blood, even though it places other patients at risk. "
    I would call this some combination of cowardice and insanity, speaking purely personally.  Taking responsibility for difficult decisions is why physicians get paid well, and avoiding decision making is irresponsible.
  2. Like
    Ensis01 reacted to Bet'naSBB in Mixed Field on Cord Blood Blood Types   
    we see it quite a bit.  we usually take it to the bench and wash a suspension and re-run it the "old fashioned way" in tube.......if still MF then we do not report unless they get us a heel stick for repeat testing bc it could mean maternal contamination.....if no MF - then report the manual testing.
  3. Like
    Ensis01 got a reaction from Toph in Repeat of donor Antigen typing   
    To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “
  4. Like
    Ensis01 reacted to AMcCord in Fetal Screen   
    We haven't been having problems with our kits, but investigations for two survey failures for false positive results a few years ago pointed to the wash step as critical. Maybe start there. What works for us is a 12 x 75 tube filled to near the top, decant well after each of the 4 washes, make sure to break up the cell button prior to adding saline, and make sure that the saline addition is well mixed (uniform color throughout the tube). We had problems when we were using NERL saline. We now use unbuffered saline with pHix added (same that runs on the Echo). I had techs that tended to fill the tube only 2/3 full with saline for the washes and who weren't making sure the saline/cells were well mixed. Changing that habit seems to have helped. 
  5. Like
    Ensis01 got a reaction from AuntiS in Repeat of donor Antigen typing   
    To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “
  6. Like
    Ensis01 reacted to DebbieL in CAP ALL COMMON CHECKLIST COM.04250   
    I get so annoyed when CAP "experts" give different answers to different people. It seems to me they also bring in their own personal opinion on things, like some inspectors we have to deal with. She stated she "suggests" doing ID on all methods
    I would have to argue they we are testing the "method." If you get a positive AB screen using automation, do you also get a comparable positive AB screen using GEL and tube? Does the antigram for the same antibody across the 3 methods appear to be the same antibody. It shouldn't look like an anti-E on automation, a anti-K in Gel and an M in tube. They are not going to match in strength because the different methods vary in sensitivity. I would include the antigrams of each method to show it appears to be the same antibody across all methods. 
    A set of screening cells is just a mini AB panel. If you feel like you must do an antibody panel using each method, I would just do an extra cell or two on each method and say it is not a set of screening cells but a mini selected panel. If we find a patient with a good, strong, clear antibody it is sometimes hard to come up with lots of extra plasma to do unnecessary testing. (My opinion only)
    Gr-r-r-r-r!
  7. Like
    Ensis01 reacted to Malcolm Needs in CAP ALL COMMON CHECKLIST COM.04250   
    This reply also applies to the excellent post above by Debbiel.

    Do these "experts" not understand, as do most, if not all people involved in blood group serology (and even blood transfusion) that it has been known for years and years that not every antibody reacts by all techniques, however experienced the person performing the test may be.

    I once had an anti-S that reacted by tube IAT, but refused to react by gel, even though I sent it out to a large number of hospitals who I knew used both techniques.

    I also think that all true experts have either read, or are aware of Leger RM, Garratty G.  Weakening or loss of antibody reactivity after prewarm technique.  Transfusion 2003; 43: 1611-1614.  Sadly, it would appear that (SOME) of the Quality "Experts" are not as expert as they like to think.
  8. Like
    Ensis01 got a reaction from AMcCord in Repeat of donor Antigen typing   
    To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “
  9. Like
    Ensis01 reacted to Auntie-D in Facility location on SOPs   
    Hey - not all of us are like that. I operate a 'good enough' system, but one which means people aren't guessing and messing
  10. Haha
    Ensis01 reacted to exlimey in Repeat of donor Antigen typing   
    Apologies in advance to the above for using their comments as examples.
    Just to stir-up a little controversy.......if we trust our Government-regulated/approved blood suppliers to have quality systems, get the correct answer and label accurately, why are in-coming Red Cell Units re-typed for ABO/Rh ?
    And....go......
  11. Like
    Ensis01 got a reaction from Toph in Repeat of donor Antigen typing   
    If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.
    If you receive labeled antigen negative units from your reference lab then believe their process and the label.
    Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.
     
  12. Like
    Ensis01 got a reaction from John C. Staley in Repeat of donor Antigen typing   
    If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.
    If you receive labeled antigen negative units from your reference lab then believe their process and the label.
    Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.
     
  13. Like
    Ensis01 got a reaction from Malcolm Needs in Repeat of donor Antigen typing   
    If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.
    If you receive labeled antigen negative units from your reference lab then believe their process and the label.
    Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.
     
  14. Like
    Ensis01 reacted to Malcolm Needs in Repeat of donor Antigen typing   
    It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT).

    Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct.  In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups.  They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.
  15. Like
    Ensis01 reacted to NicolePCanada in Repeat of donor Antigen typing   
    We don't recheck antigen typings here in our hospital in Canada. The typings that have been performed at Canadian Blood Services, are embedded in the barcode on the bag, with all negatives printed on the End User Label. Every unit is antigen typed for K so if it isn't printed on the bag the unit is K Pos. Antigen typings we do are all linked to the unit through barcode. The reason of, "We were typing a lot of units and may have mixed them up", is not acceptable in a blood bank setting. Go work in a different department if you can't organize yourself. Anyway, there is also a full gel or whatever you use crossmatch at the end of that phenotyping, as long as the antibody is reacting, an anomaly could be discovered there. You have to have a little faith that people before you are doing their job properly, or you can cause yourself a lot of undue stress.
  16. Like
    Ensis01 reacted to exlimey in Repeat of donor Antigen typing   
    Lots of users on this Forum are in the same place and I'm sure they have some good advice on how to approach this issue. However, I would be cautious of implementing an optional process that potentially calls into question the quality of previous work.
  17. Like
    Ensis01 reacted to Marilyn Plett in Facility location on SOPs   
    I'd also like the phlebotomist to identify me correctly and label my pre-transfusion sample correctly with MY name.
  18. Like
    Ensis01 reacted to Neil Blumberg in Facility location on SOPs   
    We are inspected by FDA, NY State, AABB, CAP and FACT.  Lots of opportunities for self-important, obsessive folks to make useless work for the people trying to take care of patients.  The stories I could tell. 
    We've also had many rational, balanced, thoughtful inspectors who clearly are only focused on the important stuff, to be fair.  But a significant portion of our profession(s)' people do not realize that getting staff to focus on minutiae that will not affect patient outcomes distracts staff from doing the important things well. A well known psychologic/cognitive fact.  Keep it simple and avoid worrying about unimportant stuff. 
    The notion that documentation is more important than anything else is the most pernicious piece of rubbish in medicine, and driven by the administrative/legal model (and billing of course).  And people proudly spout this nonsense as if it actually helped anyone but those in accounts receivable.  
    I'd personally like the technologist doing my pre-transfusion testing to get the ABO and antibody screen correct as a trillion fold more important relative to them documenting what time, date or temperature all of that was done.  Not to mention what that person had for lunch or dinner before the crossmatch (coming soon to an inspection near you). 
    For the record I'm a Gemini, which I assiduously and loyally document in every interpretation and progress note I write.
  19. Like
    Ensis01 reacted to exlimey in Facility location on SOPs   
    "Pettifogging".....an 'olde worde" that is so relevant today. Thank you for reminding me. I shall try to work it into as many conversations as possible.
  20. Like
    Ensis01 reacted to jayinsat in CAP ALL COMMON CHECKLIST COM.04250   
    I suggest you challenge that citation. CAP inspectors are not infallible as proven by the response from CAP above.
  21. Like
    Ensis01 reacted to Malcolm Needs in Weak Backtype Resolution   
    We've all done it at some time - ESPECIALLY me!
  22. Like
    Ensis01 reacted to Neil Blumberg in MTP cut-off policy, or Lethal Dose of Blood Products   
    There are no data suggesting a particular limit.  Survival is very unusual after 30-50 units of red cells, but everyone has exceptional cases like those mentioned above. We have discussed futility of care many times, and our practitioners are quite amenable and forthcoming.  We have stopped resuscitation in a young man having a liver transplant go badly, when there was no surgical path to hemostasis after about 250 units, but this is unusual too.  Bottom line, a case by case decision as to whether care is futile and/or the patient's needs endanger the well being of other patients needing transfusion.  Those are the key issues in each case to my way of thinking.
  23. Like
    Ensis01 reacted to jshepherd in MTP cut-off policy, or Lethal Dose of Blood Products   
    @Neil Blumberg Exactly. We've all had the odd cases that survive when it doesn't seem they should, and I agree that it's certainly case by case and dependent on hemostasis and coagulation like @Auntie-D said above. We use TEG for coagulation eval as well. I think my trauma surgeons are looking for a prompt to make them aware of how many products they've used, so they can evaluate the futility of continuing versus stopping. Anesthesia is the group transfusing these products, and they can easily lose track as well, so we're looking for an estimate of when the blood bank staff might give them a nudge to let them know they've hit a threshold, and to evaluate the entire picture of the patient with that knowledge, rather than being tunnel visioned into fixing the damage only. I have heard 30-50 units of red cells is the sweet spot as well. We consider more than 30 units of red cells to be a super massive transfusion, so that would jive. 
     
  24. Like
    Ensis01 reacted to Auntie-D in MTP cut-off policy, or Lethal Dose of Blood Products   
    I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...
  25. Like
    Ensis01 got a reaction from Malcolm Needs in Weak Backtype Resolution   
    I seemed to use a bad example to show why I think front and back type ABO resolution is important. 
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