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Sonya Martinez

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Sonya Martinez last won the day on June 16

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    Blood Bank Coordinator

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  1. There is no HPCS code for washing RBCs. We bill for the procedure itself using CPT 86999 and for the RBC once transfused using P9016.
  2. We have a very large heart transplant program which includes the possibility of giving an ABO incompatible (ABOi) heart to patients under 2 YO with low IgM and IgG Isohemagglutinin titers (generally <32). Luckily all but one of the patient's listed for ABOi transplant have been given either type specific or type compatible hearts. We have 4 different orders for isohemagglutinin titers; a simple backtype that we only perform during surgery to access the plasma and/or exchange transfusions by the perfusionists have dropped the antibody level down prior to the end of the transplant surgery,
  3. Working in a children's hospital we only give ABO compatible platelets or type AB but our first choice is identical. In most cases we use ABO identical and we have a very detailed Selection of Appropriate Component policy. For patients who received or will be receiving BM/HPC transplants we give compatible based on matching donor and recipient types, or type AB only (example patient type A receiving type O transplant gets either A or AB platelets). Also our listed ABO incompatible heart transplant candidates we will only give type O RBC and type AB plasma containing products until transplan
  4. Hi lalamb That's a typing error, sorry. It should read we don't accept cold storage platelets. We didn't accept pathogen reduced platelets because our NICU was worried about the lower volume of platelets in each unit but we had them talk to those working at UCSD who's been 100% PRT for a while and they changed their minds. Then it was just getting the build done which is tedious and extremely time consuming in our computer system since we divide and change to an open code for syringing. Luckily we decided not to irradiate them or that would have been even more codes to build and valid
  5. For open heart surgery our perfusion team washes the red cells in the OR (faster than we can) and uses those with a small amount of FFP (for babies usually < 1 year especially those < 4kg). Our policy is to provide 1 fresh, <6 day old, irradiated (<24 hours) AS3, CPD, CPDA-1 or CP2D packed red cell for post CPB but we give then two <= 10 day old unit (irradiated, AS3, CPD, CPDA-1 or CP2D) and mark them "To Be Washed" for priming the CPB. For non-pump cardiac surgeries we wash if the patient is <4kg. I would love to get away from washing RBCs for surgeries (we also wash for
  6. Here's our plan from 2010 for the equipment validation. Hope this helps. Here's the variances we noted during the validation which you might need: The centrifuge will not spin if the drawer is not latched. Do not press the START button while the centrifuge drawer is open or the time display will automatically start counting down from 10 minutes. The centrifuge time is controlled by a pre-programmed timer that applies power to the motor for 10 minutes. Time and speed are pre-set at the factory and cannot be changed. If the START button is pressed with the centrifuge
  7. I agree with slsmith, we weigh each bag and write the volume on the unit or the transfusion record (we're still using paper). We don't have a set age where they can't order by volume so on some kids we end up doing a full unit plus a partial unit. For example if they order 425mL we give 1 full RBC that's 310mL + a partial that's 115mL. As far as setting infusion guidelines our standard is 1-2 units cryo per 10kg as fast as tolerated, 10-30mL/kg for FFP at a rate indicated by clinical situation (normally as fast as tolerate), 10 ml/kg RBC at a rate of 2-5mL/kg/hr or as ordered by physi
  8. For the second ABO we use a specimen collected at a different time like a CBC but we won't use one collected at the same time as the type and screen. It's rare for us to request a specific draw for this testing but it does happen. We're a level 1 Trauma in a Children's Hospital but can take adults during disasters and pandemics (new one for me). We just changed our emergency issue and MTP policies adding in liquid plasma to start the MTP and we gave our computer the ability to give Rh POS to Rh NEG RBC and plasma products to males (policy stated if >1 year old with prior approval fro
  9. Dave Saikin and JeanB. My policy actually lists that the MaxQ coolers are validated to hold a storage temp for X hours and a transport temp for X hours (dependent on each cooler) but we choose to call them transport coolers. All the coolers are back in 12 hours and their ice packs changed which is within the validated storage and transport temp so we should be safe. Also, FDA and AABB have both reviewed our policies prior to the use of MaxQ coolers multiple times and never said a word. I think it's the very lengthy validation we do at RT and >30C monitoring the temp inside the cooler, u
  10. That's a great idea. Do you print the labels yourself or did you have them made by a printing company (like Shamrock)?
  11. lalamb: Sorry for the delayed response I'm going live with a computer upgrade this week and I've been neglecting everything else!! We will be accepting pathogen reduced platelets starting May 1. Mostly it's because our physicians on the transfusion committee are extremely conservative (and rather dated) and wanted more data. But we don't really have a choice since our secondary vendor for platelets is ARC and they are going 100% PRT later this year. Besides most of the other area hospitals that have NICUs and PICUs in SD county are run by Rady Children's Hospital and they use PRT now
  12. I wish we could get some of our physician's (heart transplant mostly) to understand that leukoreduced = CMV safe and that it should be equivalent to CMV NEG but they insist we keep giving CMV NEG RBCs. We still mostly get CPDA-1 RBCs (fresh, < 6 days old) but we added AS-3 to the list of what neonates can receive a couple of years ago when there was the shortage on CPDA-1 collection bags. So now we use CPDA-1 interchangeably with AS-3. It's weird because our HPC (including bone marrow out of ABO and/or Rh type) transplants don't get CMV NEG but our heart transplant candidates and recipie
  13. We still use a clerical check on the paper Transfusion Record then all records come back to the blood bank for review. If they don't fill the clerical check on perfectly (2 medical staff signatures, full date and time completed) I put in a safety report. It's one of nursing's performance improvement plans to be >95% each month. I would rather they do the 'double check' in the computer but we don't have Epic BPAM (blood product admin module) set up to match the results filed when we issue the product to the barcodes they enter at the beside before transfusion.
  14. We recently switched to MaxQ coolers which are pre-validated by the company at storage temp. Then we validated at transport temp and storage temp and use that for when the cooler needs to be returned for fresh ice. Our policy specifically states this and that we consider them transport coolers. We really like the MaxQ coolers and have seen a huge decrease in waste due to temp issues on return of the coolers. The lids close by themselves. They even have coolers that have temp monitoring integrated but they're super expensive.
  15. I've attached our policies for preparing aliquots in general and our platelet policy. Hope this helps. Oh, we decided all aliquots in syringes expire 4 hours after being made to make it easier for both blood bank and nursing staff to remember. We used to let the RBC and FFP syringes expire in 24 hours but nursing in particular would think all syringes expire 24 hours and we wasted a lot of syringe aliquots until I changed it. BBI0015 Preparation of Aliquots.04.03.2020.doc BBI0017 Platelets 04.03.2020.doc
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