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Sonya Martinez

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Posts 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. 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

  4. 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

     

     

     

  5. 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.

  6. 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.

  7. 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.  

  8. 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.  

  9. 5 hours ago, exlimey said:

    This issue - the switch to plastic - seems to bubble up every few years (pardon the minor pun). When I was a puppy in my early years, last century, labs were already tossing around the idea to avoid potentially dangerous, sharp glass tubes. When broken, the plastic used for test tubes is also sharp, possibly worse that glass, as Malcolm suggests.

    As others have mentioned, static is always an issue with the plastic version, rather than occasional with glass. Other than that, and in my experience, plastic test tubes tubes work almost as well as glass for serological testing. However, many "tube reagents" are not formulated for, or qualified in plastic. The Directions for Use/ Package Inserts may be restrictive.

    Two points - personal opinion of a cranky old man:

    1. One event does not indicate a trend - changing the whole system to address a single cut-finger incident is unreasonable.

    2. The various safety apparatuses (however they be mis- or confusingly named) exist to limit institutional legal liability, i.e., prevention of legal action ("please don't sue us"). The workers' actual safety is often secondary.

    I did check our IFU and they did specifically state to use glass tubes.  No more arguments.

  10. 10 minutes ago, Malcolm Needs said:

    When I first started out in the profession (about the same time as Karl Landsteiner, or so my old bones tell me), we originally did indirect and direct antiglobulin tests (IAT and DAT) on opaque white tiles, and then moved on to using plastic tubes for the spin IAT and DAT.  In those days, there was no doubt that the 75x12mm tubes were made of fairly thick plastic.  It was then discovered that immunoglobulins, being proteins, would "adhere" to the sides of these tubes in preference to sensitising some red cells with weaker expression of certain antigens, and so weak antibodies may well have been missed (and vice versa, some weak antigens, particularly some of the D antigens could be missed).
    As a result, we were advised to go over to glass 75x12mm tubes (except in Dr Jan Ikin's [or EWI's] laboratory, where glass precipitin tubes were used (a real pain, as they were about 40mm in length and about 6mm in diameter - so very little volume, and the tests had to be washed by hand for a minimum of six times).  This was all okay unless you plunged your hand into a bulk supply of the 12x75mm glass tubes and found some of them had shattered (usually by finding the shards buried in your hand, and with blood dripping everywhere).  As a result, the Health and Safety Police told us that we should switch back to plastic, but a different plastic, which had some form of coating on it that meant that proteins did not bind to this particular kind of plastic in the same way, and I must admit that there was very little difference in terms of agglutination strength between the two.  HOWEVER, if you came across split tubes in the bulk supply, it was like being cut by a serrated edge, such as a bread knife, rather than a smooth edge, such as a carving knife.  It used to hurt like Hell and took a month of Sundays to heal!

    I would, therefore, thoroughly recommend that you either switch to either liquid or solid phase microtitre plates, or, better still, column agglutination technology, both of which will not only be safer for the operatives, but will also improve your sensitivity, without sacrificing too much in the way of specificity.

    JUST MY PERSONAL OPINION.

    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.

     

  11. 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?

  12. 16 hours ago, BldBnker said:

    To clarify, we sterile dock a packed cell into quads and wash one quad at a time when a transfusion is needed.  We try to dedicate one packed cell to an infant (which decreases exposure) but will use a unit for more than one infant if needed. This helps prevent wastage. Our overall wastage is very low here.  Also, we don't transfuse too many infants at our facility (maybe 1 baby per month).  Really premature/sick infants are transferred to a local children's hospital for a higher level of care. 

    What instrument are you using to wash your red cells?  I've never washed less than 250mL.  Any chance you could share your procedure?  

  13. 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.    

  14. On 1/12/2022 at 6:58 AM, David Saikin said:

    Years ago the Ortho rep told me if I didn't buy anything he wasn't coming back.  (I had requested prices which were never forthcoming).  I told him good bye.  Ortho called and told me he was their top salesman.  I told them not to send him back.

    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!  

  15. 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.  

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