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Sonya Martinez

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Everything posted by Sonya Martinez

  1. Attached is the validation plan for the last freezer we bought in 2020 but it was not a Helmer. Also, if you ask Helmer (it might even be on their website) you can get their temperature mapping they already completed. Normally it's included on the technical data sheet. We validate the temp holds for 24 hours empty then 24 hours full of normal stock. However, we are staffed 24/7 and we use Isensix continuous temperature monitoring (which pages me and the other lab leaders if the temp is out longer than 5 minutes, again at 15 minutes and a third one at 20 minutes) so if it alarms staff know to move the stock back to our second freezer. Validation Plan NEW Plasma Freezer 05.22.2020.doc Freezer Temperature Mapping.pdf Helmer Refrigerator and Platelet Incubator Temperature Mapping.pdf
  2. Our computer system (WellSky Transfusion v. 2020R3) build utilizes the ISBT formulas to modify products. So we only had to build in the codes going from the original RBC unit to the final reconstituted one. It only requires the starting RBC and the ending RBC component information to make it work using a pooling process and it works with all our thawed plasma. You may have to to validate that all your thawed plasma product codes can be used if it's a different process/computer build. For example: Start with RBC E0224 who's component code is 002 and ISBT equation is @08C2 D4 then pool it in an open system, using process code PLS-A (add plasma) to E5797 with component code 002 and ISBT equation @08B2 C2 D4 E4. The B2 makes it an open system and the E4 gives it the 'plasma added' on the label. I hope this helps.
  3. We have a handout we created (fact sheet) and one the state of CA says that the MD gives to patient's, family, etc. prior to obtaining consent to transfuse. This might be what you are looking for. TRANSFUSION FACT SHEET ENGLISH 07 2018-no track changes.doc Blood Transfusion Brochure (1)_CA_June 2018.pdf
  4. Attached is my procedures for creating labels (we only use it for computer downtime) using Digi-Trax's HemaTrax Unity Client (111119 version) and the older version we used to have. We used to have to hand create our labels prior to moving from a very old version of Meditech to Mediware (now WellSky) in 2013, so I attached our Preparation of Aliquots from 2008 because page 10 has our log for creating aliquots, pooling and sterile docking use and page 11 has the expiration date/time grid (24 hour clock). Hopefully some or all of this helps. BBI0014 Labeling Blood Products_111119.doc BBI0014 Labeling Blood Products.doc BBC015.6 Preparation of Aliquots.doc
  5. Are you looking for reconstituted RBC from AS3 or AS1 when adding FFP? Or are you switching to using actual whole blood? Here's a list with CPDA-1, AS3 and AS1 final product codes when you reconstitute with thawed FFP, FP24 or RT<24hr Frozen <24hr. Starting RBC Product Code Reconstituted RBC Product Code Starting RBC Product Code Reconstituted RBC Product Code E0224 E5797 E4532 E7651 E0226 E6453 E4533 E7652 E0332 E6128 E4538 E6147 E0336 E6786 E4539 E6791 E0379 E6148 E4540 E6792 E0382 E6785 E4543 E6788 E0420 E6149 E4544 E6789 E0424 E6787 E4545 E6790 E0661 E6796 E0668 E6797 E0678 E6793 E0685 E6794 E0686 E6795
  6. You can store reagents and patient specimens in the same fridge as blood but you need to make sure that the range is set to accommodate both. Our fridges are set with 2.5-5.5 C which meet both blood product guidelines and those of our reagents and specimens.
  7. We use Isensix continuous monitoring system in our hospital which I verify against the chart recorder on the unit but it's probably overkill. Attached is the last plan I wrote and used. Validation Plan NEW Plasma Freezer 05.22.2020.doc
  8. I contacted AABB directly about the added standard 5.7.2.1.3 because it requires the vendors to provide expiration dates of the transfer bags even if the weld is complete which for us is a huge issue. I'm glad they are reversing this. That all being said, as long as the weld is complete we keep the expiration date/time of the product placed in the transfer bag. We only keep platelets in the mother bag and take aliquots from it for transfusion. We do change the expiration time to 4 hours when we place them in a syringe.
  9. @Mabel Adams: When we pool the units in WellSky Transfusion it creates a pooled unit label. I recently added the list of product codes base on the starting RBC product code for staff to choose from. My updated procedure is attached see 6.5.2. BBI0023 Exchange Transfusion 031522.docx
  10. California requires a physics course with lab that not all people with BS in a biologic science have taken. They also require a full year of post graduate training as a CLS (clinical laboratory scientist) and you must pass an online CA quiz related to CA law mostly. Here's the link: https://www.cdph.ca.gov/Programs/OSPHLD/LFS/Pages/CLS.aspx
  11. Our reference lab only charges for the ABORH if they had to do extra work to determine it such as DTT treat the cells. We wouldn't order specific patient antigen typing but rather an entire profile which is now done using NGS. We order and result a DAT if we antigen type a patient so yes I would expect the IRL to do it as well. I had out CDM team add billing procedure codes so I can manually bill the patient for the testing that is billed to us. We have a contract with our IRL that specifically states what is charged and when. Maybe you need an agreement as well.
  12. WOW just WOW!!! Although I new it was bad everywhere reading all your comments is so disheartening. Before COVID started the state of CA was already talking about using nurses in the lab with no requirement for the post graduate training we all had. This didn't go through. But I also understand CA gave CLS licenses to international physicians without a training requirement. So these staff come in and have clinical knowledge but know nothing about laboratory work. This means we're now basically training college graduates that have no laboratory experience which takes significantly longer to train and with no experience they have no self-confidence. It's really quite horrifying.
  13. We've had staffing issues (CLS/MT less so with MLT) not just in the blood bank but the entire laboratory. With COVID on top of retirements, we lost a lot to the COVID testing in our MDL and they haven't come back. Plus we are increasing in acuity and volume of patients to the point we're now trying to increase staffing on all shifts. We have 3 travelers right now, with one working for us for many years (night shift is the hardest to fill) and 2 newer travelers that have just renewed their contracts. The younger people don't want to stay in the same place, they like being able to take as much time off as they want when they want, and they like the money. I know COVID hasn't helped but I think the problem is more the fact there just aren't enough CLS/MT's out there and there's no schools anymore that you can get a BSMT vs science BS (like biology) + post grad training. Most of us in the lab aren't vocal enough at the state and national levels like the nurses and RTs (glamor jobs of the hospital) to get the word out that lab is necessary/required and we don't have support. There is a CLS program in our area but we're so short staffed we can't bring in the CLS trainees because we can't even staff without supervisors and technical specialists on the bench as it is.
  14. Here's our policy. BBI0023 Exchange Transfusion 040221.docx
  15. I did check our IFU and they did specifically state to use glass tubes. No more arguments.
  16. CLS = Clinical Laboratory Scientist, also known as medical technologist.
  17. @jayinsat and @Ensis01: This is coming from our QA Compliance Coordinator and Safety Officer (CLS not a nurse) due to a cut on a staff member's finger from broken glass (contaminated with 1% patient cell suspension in IH LISS).
  18. This information is extremely helpful. We do use gel for all other testing but we have a fair amount of patients with WAA that we have been recommended by our IRL to use LISS tube antibody screens and crossmatches. Plus my staff complain about too much pipetting (even though we have the really light ergonomic pipetters). Also, we don't have an option for completing anti-C3bC3d testing except by tube method. I did validate the use of polyspecific gel and we already do IgG gel DATs. I've never used microplates but I'll look into it. Thanks for the information.
  19. I am being told we need to switch to using plastic 12x75mm tubes instead of the glass 10x75mm tubes because the glass is a safety risk. I have never in 25 years as a MT used anything but glass for tube testing. At a minimum for doing DATs and LISS tube antibody screens. I tried it yesterday but I can't get a good button, a positive reaction with polyspecific AHG+IgG check cells, and it seems like the cells are getting stuck on the side and bottom of the tube. Does any use plastic tubes for completing tube testing on patient samples? If so can you please help me with a validation?
  20. What instrument are you using to wash your red cells? I've never washed less than 250mL. Any chance you could share your procedure?
  21. To all, we use Least Incompatible because that's what the physicians understand. The result is incompatible and a signed waiver from Standard Protocol is required by the MD prior to transfusion. No further antigen typing was reported in the preliminary report by our IRL and the patient was recently transfused. There transfusion recommendations are for type compatible, least reactive with patient serum/plasma and to order a red cell genotype (NGS). We do not routinely have the IRL complete crossmatches with their adsorbed plasma but I could order it. I will update our chart to accept the ABO and Rh with B POS, I was just leery because of the report from the outside hospital being incomplete.
  22. We don't use blood bank armbands at all (never have as far as I've been told). For our specimens during downtime we require 2 sets of initials, the date and time of collection on a demographics label that they can generate during downtime. Or if no demographics label then the full name, MRN and DOB plus the 2 sets of initials, date and time of collection would work as well.
  23. I recently switched everything (over a couple of years) to Bio Rad because the Ortho rep wasn't responsive and they were more expensive for us. We're not automated because we don't have the power and space but hopefully one day!
  24. We recently had a female teenage patient that was previously reported from an outside hospital to have a WAA, CAA and low incident allo antibody (not identified) about a month before being sent to us. The original hospital blood bank was gracious enough to send the ABO genotype report from New York Blood Center which showed the patient is type B but nothing regarding Rh (D) typing or antibody identification. Both our gel and tube ABORh reactions had positive controls and were completely inconclusive (we tried washed and prewarmed as well). Our gel screen and LISS screen were 4+ positive as well. We sent to our IRL for workup and it came back with WAA, no underlying allo, and they had to DTT treat the cells to come up with the ABORh of B pos. We decided to result our ABO as NTD (no type determined) and Rh as IND (indeterminate) and have instructions to give least incompatible (DAT IgG and auto control both 4+ so anything less than 4+ is considered least incompatible) type O pos or O neg RBCs for transfusion. Luckily she didn't need transfusion during this admission but I'm questioning my own logic. We can't determine the ABO or Rh type but we also can't determine the WAA so we rely on the results from our IRL to result the ABID. Should we also rely on the IRL for the ABO and Rh result, change the patient's type to B POS, and give least incompatible type B POS (instead of using type O) if necessary? Can we rely on one Rh type from our IRL to give Rh positive RBCs and platelets? She's now being seen in our hematology clinic weekly.
  25. Although I agree with @Neil Blumberg regarding CMV seronegative blood we had 2 heart transplant candidates patients in our Cardio Thoracic ICU that were originally CMV negative by pcr and came up CMV positive while inpatients and both had severe infections. Our infectious disease physicians decided it was due to the multiple blood and platelet transfusions (both were put on ECMO and had multiple surgeries) and now they order CMV seronegative products on all heart transplant candidates regardless of CMV status and those with DiGeorge Syndrome (due to their immunodeficiency - per my med dir not CTICU). They refuse to listen to reason or science and they didn't even bother testing any of the staff, parents, or other people working in the unit. (This is me rolling my eyes). Our bone marrow and stem cell transplants don't require CMV negative products but the kids in CTICU do. As far as transfusing pRBCs, we wash (and waste) a considerable amount of RBCs for any <4 months old, < 4 kg neonate that is also going through open belly surgery, open chest procedure (not on CPB), kids with K issues that have current elevated K+ levels, HUS due to Strep pneumo (and before ID of the cause). Our heart room washes the blood during CPB so we don't have to. We also have a <6 day old RBC, <24 hour irradiated, policy to keep the K down if >4 months but <1 year or >4 kg but it's for surgeries and any transfusion >20cc/kg. Most normal, non-surgical transfusions for neonates are done with irradiated, CPDA-1 or AS-3 RBCs but the volume is normally 10cc/kg at a rate of 2-5 mL/kg/hr. In order to keep the patient on the same unit as long as possible we normally start with 6-10 day old unit as well. I really don't want to switch to washing for all neonatal transfusions. Our wastage rates are already too high.
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