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Sonya Martinez

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    Blood Bank Coordinator

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  1. Malcolm Needs - Thanks so much for the quick response. There's no ethnicity on the patient yet but I doubt she is Japanese by her last names (very Hispanic). We are not planning on antigen typing the red cells for M at this point since it only showed up at immediate spin. We didn't do the workup on the mom so although the other BB said they ruled M out we don't know for sure if they use the 3/3 homozygous rule that we use. You are definitely correct about the M still possibly being IgG, I do realize, thanks for correcting me. It's been a very weird year, since last July when we had our first true anti-U, then an huge increase in the number of extremely strong WAA, an anti-hrB at Christmas, and now this newborn. I hope this doesn't become standard for us but with our Hematology/Oncology clinic growing each year and all the solid organ and HPC transplants I'm sure we're only touching the surface. I miss the days when a children's hospital blood bank worried more about making smaller aliquots than dealing with rare antibodies.
  2. We have a newborn (2 hour old when the sample was collected from the patient) term infant who's mom is confirmed to have anti-E and anti-c. Being a children's hospital we have specimens collected on all our patients and do not use the mother's sample. Our workup shows the anti-E but instead of the anti-c we have a confirmed cold anti-M that reacts in gel and only at RT in LISS (tube method) and shows dosage. We do 3 homozygous cells to rule in and out each antibody. We completed a back type on the patient just to see and the patient has a 4+ reaction with A cells and negative with B cells (he's type O). DAT IgG by gel is 2+ (not surprising). We will be giving the baby E negative and c negative (since mom has it) crossmatch compatible units. Has anyone else ever seen a newborn with a naturally occurring cold anti-M?
  3. Yes we are having similar issues in San Diego. Being the only children's hospital between Mexico, Arizona boarder and Orange county we are doing a majority of all testing on children (even for Kaiser) plus we have contracts with multiple hospitals, the Navy and the county of SD and Riverside!! We are trying to hire staff but state of CA is a pain with licensure of CLS (generalist) vs molecular diagnostics (limited license that can only do human genetic testing - stupid since it exactly the same testing just on a virus). We're a small hospital lab and by Monday we're supposed to be able to run 2,000 tests per day!! Our max so far was 717 yesterday and we don't have the staff to run our high throughput assay 24/7. Plus our other 2 platforms don't have the reagent supply to keep up with demand either. It's absolutely ridiculous. We can't pull any more staff off the bench and still meet our TAT for routine and stat testing and instead of doing my office job most of the time I'm having to either cover the bench in the blood bank or do someone else in leadership's job or attend extra meetings just so others can take a day off. We have staff that have been working every single day, no day off, since March when CA shut down initially. I just don't see how we can keep up this pace.
  4. 86644 is the CPT code we use to charge for CMV seronegative cellular products.
  5. We have been on Epic with HCLL (now WellSky Transfusion) since 2013. I like HCLL and they have user groups just for those of with Epic integration. We're starting our 2nd upgrade to the newest WST 2020 version next week. Do not wait too long between upgrades. We do not see much of a delay (seconds) with out interfaced orders and results. Unfortunately we are not on the Epic BPAM (Blood Producat Administration Module) with the matching so we still have paper transfusion records to document our clerical checks. I really like their analytics software and it makes my monthly reporting easier. Being a children's hospital with a large Hematology/Oncology department, Heart surgery and transplant, liver and kidney transplants, bone marrow and stem cell transplants, and multiple levels of NICU I like the safety measures built into HCLL especially for crossmatching and issuing products. There are a few glitches with dividing and modifying (irradiating, washing) and pooling but they only happen once in a while since we went live with the 2016 version. I highly recommend you purchase all the packages WellSky has to offer when it comes to build and maintenance. Oh and their customer service is top notch. I'm one of WellSky's customer resources/references so you can ask for me directly if you'd like. Or you can reach me at samartinez@rchsd.org
  6. Our IRL suggests we use LISS for crossmatching when we have a WAA. Most everything else we do is in gel because we don't get enough sample being a children's hospital. Also we do LISS antibody screens when we're dealing with an anti-M since kids get a lot of cold M antibodies. This way we can tell if it goes all the way through AHG and requires M neg products or if not then just LISS crossmatched red cells. When I changed to the N-HANCE it was the same time I changed our red cells for antibody screens so that made my validation simpler. We now do method to method correlation between gel and LISS but only at a qualitative level for obvious reasons although when we did our validation we matched within 1+ an all our testing.
  7. San Diego Blood Bank (SDBB) is our primary blood vendor an they sent out information just this morning that they are working on their process and it will require an approved eIND number for each patient and each order or an approved organizational IND which will cover all CCP requests moving forward. SDBB is starting with collections labeled with same product codes as frozen plasma products with a tie tag identifying them as CCP. I do have the CCP codes that were given to me by our software vendor, WellSky, so eventually I will build them (after I finish the added PAS platelet build and my new reagent QC for our reagent switch). ARC sent out information late last week with product codes as they will be collecting with the new codes.
  8. That seems over the top. What area of the country are you in?
  9. We require a second type no matter where the patient is. We rarely get push back even during an MTP or ECMO cannulation. We've been doing it this way for more than 15 years. We also don't require them to place an order or use Epic printed labels. We have them label with a demographics label on the lavender top and our processors know if they don't have an order they immediately bring it to the blood bank. Unfortunately working in a children's hospital we give a lot more O RBCs due to our patient population and the fact that we don't have the moms at all. We will also take a verbal second type from another hospital blood bank if we know where the patient was transferred from. Luckily most of the hospitals in San Diego county have Epic Care Everywhere and/or their NICUs and PICUs are run by my institution anyway so we can access the patient record if we know the MRN.
  10. I'm currently working on building the convalescent plasma product codes into our computer system in case it is needed/wanted. But I'm in a children's only hospital so the only thing we're seeing right now is the normal stuff like urgent heart, spine, cranio and orthopedic surgeries plus our chronic transfusions for the rare anemia patients. We are no longer doing non-urgent surgeries and I anticipate to slow down further but according to the news California had the first death of a child (person under 18 yo) with COVID-19 but I haven't see if that's why the patient died. It would be nice if anyone knew lab personnel in Italy, Spain, etc but I think they may be a bit busy right now!! Unfortunately for us the flu is still going strong and we have had HUS and CAHA cases from it.
  11. Hi John, No we did not do every antigen. Hemo Bioscience makes a validation kit that contains 8 positives and 2 negative specimens plus they make MedTEK kits that contain vials with a single antibody in them including D, C, c, E, K, Fya and S. I'm using both to validated our new Bio Rad IH manual gel this quarter
  12. Since it's the same vendor I don't think you need a validation. When I changed from Immucor to BioRad for our tube panels I did performance validation covering avidity (strength of reaction), accuracy and precision (predictability). The FDA liked it and that's my plan now that I'm changing over to BioRad's gel reagents as well.
  13. If you filter the syringe the nurse does not need to filter again at transfusion. Our nurses uses a syringe pump for all transfusion 60cc or less which doesn't allow for a filter set.
  14. Per AABB 31st edition of BB/TS standards: 3.5.1 Calibration of Equipment: Calibrations and/or adjustments shall be performed using equipment and materials that have adequate accuracy and precision. At a minimum, calibrations and/or adjustments shall be performed as described below unless otherwise indicated by the manufacturer: 1) Before use. 2) After activities that may affect the calibration. 3) At prescribed intervals. However,it further specifies: Calibration procedures shall follow the MANUFACTURER'S WRITTEN INSTRUCTIONS and shall include: 1) Instructions for performing calibrations. 2) Acceptance criteria. 3) Actions to be taken when unsatisfactory results are obtained. We currently do calibrations once per year with bi-annual RPM checks on our Serofuges but quarterly on our CW2+ cell washer (both per manufacturer recommendations). However, we are getting new Bio-Rad IH-centrifuges next month so I'm sure this will change. I think you should probably determine your own prescribed interval for completing the calibrations if the manufacturer doesn't specify. Maybe before use, after repair and if results are not satisfactory as opposed to annually?
  15. I work in a children's hospital and we do aliquots on 95% of our products. We either fold the 4x4 label at the bottom or we write the sticker around the other side of the aliquot bag. We primarily fold the label for the syringe units. I don't think the 4x2 label you are showing is in compliance with ICCBBA standards since it doesn't have a DIN and no Product code plus how would you differentiate the parts of the product (i.e. Aa, Ab, Ac, etc.) if you don't have the product code? Besides its cheaper to have one label stock.
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