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Posts posted by EAB81
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In the technical manual (pg 514, 19th Ed) it talks about Rh Negative women getting Rhig within 72 hours of being transfused with Rh positive platelets. I wonder if that would be the same for blood?
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This is just my opinion, but I would imagine that since there isn't a standard that absolutely demands that antibody screens are to be performed for the Rhogam Workup, working up a positive would be at the discretion of your medical director. We've been looking @ eliminating the absc when working up postpartum samples from mothers who are Rh neg . We contacted the AABB, and they have stated that the standard 5.30.2 doesn't speak to it (requiring the antibody screen) because it's considered medical practice. I think what we're going to start doing is only performing abscs for those mamas who have had no prenatal care or no antenatal rhogam. Of course, if they have history of antibodies we'll still do it--just in case.
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On 8/20/2019 at 8:47 PM, Cliff said:
It's not for everyone. I did it for a couple of years and did not like it at all. That was about 20 years ago. I have never felt compelled to go back and do it again.
What didn't you like about it, if I may ask?
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In the last few days, we have been talking about doing away with the AB Screen during the Rhig Workup. I've reached out to sister facilities who keep citing to me Standard 5.30.2 # 2 "The woman is not known to be actively immunized to the D antigen." My goal is to eliminate the unnecessary antibody panels and the anguish passive D can cause. But my justification will be this, and correct me if this is wrong:
We can determine whether the patient has had Rhogam with one phone call to the floor. If so, then more than likely, she would have the passive D. It's not an active immunization. If she hasn't had any prenatal treatment, then, at that point, we'll do an antibody screen.
We have docs that will give rhogam no matter what.
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17 hours ago, sgoertzen said:
To be an assessor for AABB, you have to currently work at an AABB accredited facility and be an individual AABB member as well. If you meet these requirements and you meet the experience requirements, you can apply to be an assessor. It is a big commitment, but well worth it! They expect you to make a real effort to attend the assessor day training each year at the AABB annual meeting and to accept and complete a minimum of 2 assessment assignments each year. If you have to miss the annual meeting for whatever reason, they do allow you to make it up with on-line training, but it's required that you get your initial 2 day "new assessor" training and preferred that you get your subsequent annual assessor training at the face-to-face annual meeting each year.
Looking closely at it, I do meet all the requirements. I don't think the commitment will be a problem at all. I haven't quite decided to do it for sure, but I so appreciate your input.
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On 08/16/2019 at 12:29 PM, David Saikin said:
Do you have a BS? I would say go for it. AABB does provide training (they used to anyway). If you go that route just remember that there are many ways to "skin the cat". Be open-minded but at the same time understand what the standard(s) is trying to convey. I don't know that being an inspector/assessor can help you understand all the "crazy stuff" you might encounter in the BB. It helps to be well-grounded in the basics of Immunohematology and an awareness that there's a whole lot of stuff that occurs rarely. This chat room is a great place for learning and answers (from a host of contributors).
I do have a BS. This forum has already been tremendously helpful! Thanks!
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I really enjoy blood bank and all the crazy stuff that goes along with it, but I want to learn more than just my scope of the BB Supervisor at the local hospital. Someone recommended to me that I should become an assessor. Does that sound like a good idea because they would train me? I'm not sure I meet all the qualifications from what I've looked at. For those who are assessors, former assessors, etc. , what can you tell me? TIA
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4 hours ago, MAGNUM said:
When I started here a few years back, we were repeating the ABSC along with performing the Fetal Screen. I have since with the blessing of our Medical Director done away with the second ABSC.
9/10 times we don't perform the 1st ABSC. So, we spend a lot of time working up that ABID that is just remnants of antenatal RhIg.
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On 07/26/2019 at 5:44 AM, ANORRIS said:
Emergency Released Blood.....
Does anyone wait until the trauma patient is stable before getting a blood sample to perform a screen and XM when releasing emergency uncrossed blood? NO...I don't wait...but I am being told by my Lab Manager that I need to do this. ???????????
We don't wait. If we waited, we would end up giving out our entire O Neg inventory, and the physicians would rather it be that way. Typically, we don't do massive transfusions. We do have a policy should the event arise. Our current policy states (for now) that we will give 2 O Negs, and then the patient would then either get type specific, providing the 2nd confirmatory sample has been collected and typed or they will get type O, but it doesn't specify Rh Pos or Neg. So, I'm revising.
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On 07/24/2019 at 1:13 PM, applejw said:
I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem. Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen. I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.
Fortunately, we have phlebotomists that collect 99% of our samples. I can't get them to use the sticker that says " place patient information below...." either. So, I've just resolved myself to accept any of the barcoded stickers. We have bands that also have the BBID on little stickers on the tail that do not have a barcode. I haven't rejected it if that sticker is on it, but we do prefer a barcoded sticker. With the use of Bridge, nurses have to scan the patient's BB armband and then scan a 4D box the product tag, and the info has to match. We won't be going away from Typenex as long as we're using Bridge-- and that was implemented in October 2018.
My issue does stem mostly from the nursing units (L&D mainly) who will armband their own patients and leave the date off the tube.....I could scream. I wish they would teach these nurses in orientation how to label bb tubes.
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36 minutes ago, David Saikin said:
There is no requirement for a current absc for RhIg administration. With the advent of the hypersensitive technologies, most of my abids are antenatal RhIg (when the docs order a T&S perinatally).
Same here. If the patient has a T&S upon admission, I will not perform the ABSC again for the RhIg workup. A couple of years back we tried to get the OB docs to all send their prenatal workups to us so that we could at least get baselines on their patients because every OB in town delivers at our hospital. Unfortunately, we have 2 groups in town--1 that is affiliated with the hospital system , and 1 that is not. Its really a struggle with these patients that you can guess had antenatal rhogam but their ABSC is all over the place. The blood banker in us wants to work it all up, but its so aggravating--esp if we have no history to compare to.
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Honestly, I'm not sure how they get it accomplished, but the OR folks usually can produce a sticker from the patient's bb armband. We haven't had an issue where it didn't match.
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We use the Typenex bands. I guess the scaredy-cat in me feels safer using the bands. Our current transfusion program, Bridge, requires the use of a barcoded band.
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On 07/20/2019 at 6:59 AM, SMILLER said:
Can you get a copy of the policy from your supplier that they use to validate their shipping containers? Type up a letter for your pathologist to approve explaining it and give that to your Quality people. Then if they want something more, ask them to show you the regulatory standard they are worried about.
Scott
Well, that's what I originally called and asked them-- if I could have a copy of their policy. I've left an email again today because I've yet to receive anything from them. In the mean time, we are going to start taking temps of the coolers ourselves at random and documenting. We are within our inspection time for CAP and AABB. Hopefully, a last minute effort is better than none. I will, however, be contacting quality to see what standard they are concerned with. My money will be on probably Joint Commission.
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Well, the issue came about from our Quality Department. They wanted to know that our supplier was shipping products at the appropriate temperature and wanted documented proof. So, our pathologist wanted me to update and cite the standard in the policy <insert confused shrug>. Our current policy just states that RBCS should be shipped at a temp between 1 and 10, and there's no need to verify temperature unless a temperature issue is suspected. I contacted the supplier for their verification of coolers, and they told me that their method was to have the courier delivering products have a blood bank tech verify a temp. They would document that on a 3-ply sheet for which we would get a copy. Well, we did that when we were an exchange hospital, but we haven't been an exchange hospital in a few years. None of the techs can recall being asked to verify temps. So, I'm not exactly sure where to go from here.
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I'm updating policies, and I'm trying to find exactly what AABB or CAP states about taking temperatures upon receipt of blood from the blood supplier.
I need to know if the agencies state that the temp has to be taken each time or exactly how often with coolers being validated by the blood center. Can anyone help?
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Our blood supplier does all of the bacterial testing for platelets. We're a relatively medium-sized hospital, and we only order platelets when the physician is going to give to a patient. So, they don't typically stay in our possession longer than 24 hrs. We don't order to keep on hold.
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So, a vendor showed up this week talking about the "new FDA Guidance for platelet bacterial testing." All the info I've found thus far doesn't state that there would be mandatory testing for platelets. Does anyone have any other information regarding this that they would be willing to share? TIA
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On 7/12/2019 at 4:53 PM, Dansket said:
I think you need to demonstrate in Day of Use/Daily QC that the Anti-IgG Gel card reacts properly with positive and negative control, not only in the Indirect Antiglobulin Test (indirect agglutination with 37C incubation), but also in the Direct Antiglobulin Test (direct agglutination without incubation).
We do a positive and negative control for our IgG cards daily. Of course, that's with a 37C incubation. So, what's the best way to do QC in the gel without the 37 incubation?
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Our cards are IgG. I was thinking what we're doing would work, but wanted to get other opinions. Thanks, David!
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We are implementing a procedure to perform our cord blood DATs in gel. The procedure itself is simple, but what the best way to do QC? We are currently using the Ortho-Clinical Confidence to perform QC. Will those procedures cover the gel DAT or will we have to do something separate? TIA
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I would love to say that there is a fix for this, but there is not. So, in general, if a patient's armbanded has to be cut off, the blood bank tech will go up and cut it off. We, then, would use a band extender to relocate the band.
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We will do it for every new order. Our form has a place to put unit stickers on them. So, essentially, the physician signs for however many units we put a sticker for. Any more after the initial units, we require a new form. This also kinda serves as a reminder to physicians that their patient has special blood bank circumstances.
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2 hours ago, BankerGirl said:
One thing I would add to Dansket's post is that the standard says group O, it does not say O Neg. If your specimen types Rh Positive, you may, according to the standard, switch to O Pos and save your O Neg inventory for actual Rh Negative patients.
I was thinking the same thing. Our local supplier frequently is low on O Negs, and we keep 4-6 units of O Neg. We have a policy for transfusing O Pos units to patients in times of shortage following what slsmith just stated. Good idea.
Post-Inspection Questions
in Accrediting Agencies
Posted
So, we were inspected a couple of weeks ago, and I have some questions regarding a policy that I need to write and/or change.
Standard 5.15.4 Selection of Compatible Blood and Blood Components for Transfusion
The transfusion service shall have a policy in place concerning transfusion of significant volumes of plasma containing incompatible ABO antibodies or unexpected red cell antibodies.
Question: What does everyone else's policy state for this? We did not have a policy that necessarily outlined all of this. I'm unsure where to start. Is this referring to emergency releases where we've discovered the patient had antibodies and the units were positive for the antigens? We wouldn't knowing do this, and we give ABO-compatible blood even during emergency releases.
Thanks!