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David Saikin

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  1. Like
    David Saikin got a reaction from applejw in Qualifying for the SBB   
    You do not have to go to SBB school - BUT, the test is made so that those who do attend will have a better chance at passing. Challenge it . . . I did. Remember, this specialty exam has the least percentage of techs passing, but look at the knowledge you will gain in studying for it. Also, some blood centers offer study courses and I think there are some on line also. good luck
  2. Like
    David Saikin got a reaction from simret in Who can order blood products?   
    nurse practioners and pas can order blood components.  At least any place I've ever worked.
  3. Like
    David Saikin got a reaction from Meldy in AABB Accreditation   
    It used to be that AABB accreditation meant you achieved a level of sophistication encompassing Quality System Essentials.  Today, I am not certain that is the case.   CAP has deemed status and has upgraded their standards to be at least as stringent as AABB's (some are even more so).   Probably the only selling point are the CE materials and the national meeting every year.  Hospitals I have worked in have all been AABB accredited.  My current employer, we dropped AABB about 15 years ago because there wasn't any bang for the buck to be accredited by them.  This was my decision - was an AABB member and assessor/inspector for 20+ yrs.
  4. Like
    David Saikin reacted to jayinsat in Grifols analyzer users: Roll call!   
    I would consider switching to Immuco ECHO Lumena before going to Grifols. You could also look at Bio-Rad's IH system for gel alternatives. That said, I prefer Ortho for gel and Immucor for solid phase. 
  5. Like
    David Saikin got a reaction from VTN in Preop Specimen   
    We do a week vs 3 days.  RRay is correct.  It is up to you to determine how long.
  6. Like
    David Saikin reacted to SbbPerson in Fetal Screen   
    Strange , we have never had that problem. We use immucor too.  I agree with AMcCord, washing is critical for this test.  Also, how are you counting the agglutinates?  By tube or slide? If you see agglutinates by tube, you should do it also on slide so you can count the number of agglutinates per LPF.   If you get less than 5 agglutinates in 5 fields, it is negative. 
  7. Like
    David Saikin reacted to NicolePCanada in Repeat of donor Antigen typing   
    We don't recheck antigen typings here in our hospital in Canada. The typings that have been performed at Canadian Blood Services, are embedded in the barcode on the bag, with all negatives printed on the End User Label. Every unit is antigen typed for K so if it isn't printed on the bag the unit is K Pos. Antigen typings we do are all linked to the unit through barcode. The reason of, "We were typing a lot of units and may have mixed them up", is not acceptable in a blood bank setting. Go work in a different department if you can't organize yourself. Anyway, there is also a full gel or whatever you use crossmatch at the end of that phenotyping, as long as the antibody is reacting, an anomaly could be discovered there. You have to have a little faith that people before you are doing their job properly, or you can cause yourself a lot of undue stress.
  8. Like
    David Saikin reacted to John C. Staley in Documentation of Visual Inspection at Issue with Remote Refrigerators   
    I would make the argument that the blood was inspected when it was issued to the remote storage unit.  At that point the transfusion service had completed it's obligation.  I am assuming (and we all know how that goes!) that the remoted storage unit has been exhaustively validated and monitored with documentation to confirm my assumption.  As well as any training required for those accessing the remote storage unit.  I'm always more worried about the blood going to the wrong patient in these situations than I am for the quality of the unit.
      Personally I always enjoyed challenging such citations.   

  9. Like
    David Saikin reacted to jayinsat in Documentation of Visual Inspection at Issue with Remote Refrigerators   
    I do not have any remote refrigerators but, is there a way to have an automated comment added to the unit history when a unit is removed from the remote refrigerator that states it was visually inspected? That would give you documentation. Of course, you would need to have clearly stated in your policy that visual inspection is performed when units are retrieved, and nursing training would have to have that documented as well. That's how I would resolve that issue.
    That said, I think that the inspector may be improperly applying the checklist item to your situation. The checklist item states:
    TRM.40900 Blood/Tissue Sign-Out Phase II The process for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient. NOTE: A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the product is dispensed.
    There is no blood bank staff that is "issuing" the blood so, technically, there is no "person" signing out the unit. I would argue that the inspection would have to take place when the unit is placed in the remote remote refrigerator. I would challenge the deficiency on those grounds.
  10. Like
    David Saikin reacted to Neil Blumberg in Mismatch Kidney Transplants and Titers   
    "Just curious, can one give a group A1 kidney to a group B patient who has a very low isoagglutinin titer ?"
    It's been done.  Depends on the ability to suppress the anti-A titer low enough through immunosuppressive drugs and plasma exchange, the usual preparative regimen.  Obviously ABO identical is best, but this is an alternative at some centers with experience doing these transplants.
  11. Like
    David Saikin reacted to exlimey in Mismatch Kidney Transplants and Titers   
    Thanks. Probably an unanswerable question: How low a titer is "low enough" ?
    A follow-up.....can one transplant an A1 kidney into an A2 patient with anti-A1 ?
  12. Like
    David Saikin reacted to Baby Banker in Mismatch Kidney Transplants and Titers   
    I don't know what the titer is for incompatible kidney transplant, but for hearts they prefer less than 1:4, but there are other criteria as well.  If the patient is less than 12 months old, they don't worry as much about the titer.  
    I think they won't consider a patient who is over 2 years old.
    Again though, that is for hearts.
  13. Like
    David Saikin reacted to exlimey in Mismatch Kidney Transplants and Titers   
    This is fascinating stuff. A lot of science, learned the very hard way, with a heavy dose of art. I don't envy those having to make these calls.
  14. Like
    David Saikin reacted to exlimey in Panagglutinin in eluate   
    I agree with Malcom - not much value, if any. I, too, have done many such noninformative adsorptions.
    In a recently-transfused patient, there is perhaps a very remote chance that (allo)adsorptions on an eluate would reveal a "only on the cells, not in the serum yet" newly formed antibody. This might be important if the clinicians suspect faster-than-normal red cell loss, but it would be very difficult to differentiate from the typical increased red cell demise seen in patients with warm autoantibodies.
  15. Like
    David Saikin reacted to Malcolm Needs in Panagglutinin in eluate   
    I did allo-adsorptions on eluates for quite a while and never once detected anything in the adsorbed eluate.  My own experience suggests that it is a waste of time and resources, but others may disagree.
  16. Like
    David Saikin got a reaction from saralm88 in Kell & Antibody screening   
    Awesome responses as usual Sir!
  17. Like
    David Saikin reacted to Malcolm Needs in Mixed Field on Cord Blood Blood Types   
    Hmmmmmmmmmm, that makes life more difficult!  If the mixed-field reactions were only seen in the ABO typing, that would be fairly easy to explain.  As they are in the Rh type as well, the explanation may be much more difficult, not least because Rh antigens are proteins, and so are fully expressed at birth.

    I just wonder if, in the cases you see, there is a noticeable difference between the D type of the mother and the baby.  For example, is the mother D Positive and the baby mostly D Negative, with just a few D Positive red cells in evidence?  This could be explained by there having been a foeto-maternal haemorrhage, largely from the maternal circulation to the foetal circulation.  Obviously, If the mother is D Negative and the baby types mostly as D Positive, with just a few D Negative red cells in evidence, the same applies.

    Am I going completely down the wrong street?????????????
  18. Like
    David Saikin got a reaction from SbbPerson in Greetings From New Hampshire   
    Having supplied a few answers on this site, I have found it to be most helpful and informative. I work in a small, but very active insitution in northern NH. We do reference work for some of the smaller facilities around here and, hopefully, are raising the blood bank consciousness of the folks we interact with. There is life outside the metropolitan areas and a GREAT quality of life is important, esp to me.
    Dave Saikin
    Littleton, NH
  19. Like
    David Saikin reacted to AMcCord in Fetal Screen   
    We haven't been having problems with our kits, but investigations for two survey failures for false positive results a few years ago pointed to the wash step as critical. Maybe start there. What works for us is a 12 x 75 tube filled to near the top, decant well after each of the 4 washes, make sure to break up the cell button prior to adding saline, and make sure that the saline addition is well mixed (uniform color throughout the tube). We had problems when we were using NERL saline. We now use unbuffered saline with pHix added (same that runs on the Echo). I had techs that tended to fill the tube only 2/3 full with saline for the washes and who weren't making sure the saline/cells were well mixed. Changing that habit seems to have helped. 
  20. Like
    David Saikin reacted to goodchild in CAP ALL COMMON CHECKLIST COM.04250   
    We wrote in our policy that we don't expect 100% concordance, cited several publications regarding the differences between the methods, and made a note that the blood bank supervisor and medical director will both review the results to determine the significance of any observed discrepancy.
  21. Like
    David Saikin reacted to Neil Blumberg in Facility location on SOPs   
    We are inspected by FDA, NY State, AABB, CAP and FACT.  Lots of opportunities for self-important, obsessive folks to make useless work for the people trying to take care of patients.  The stories I could tell. 
    We've also had many rational, balanced, thoughtful inspectors who clearly are only focused on the important stuff, to be fair.  But a significant portion of our profession(s)' people do not realize that getting staff to focus on minutiae that will not affect patient outcomes distracts staff from doing the important things well. A well known psychologic/cognitive fact.  Keep it simple and avoid worrying about unimportant stuff. 
    The notion that documentation is more important than anything else is the most pernicious piece of rubbish in medicine, and driven by the administrative/legal model (and billing of course).  And people proudly spout this nonsense as if it actually helped anyone but those in accounts receivable.  
    I'd personally like the technologist doing my pre-transfusion testing to get the ABO and antibody screen correct as a trillion fold more important relative to them documenting what time, date or temperature all of that was done.  Not to mention what that person had for lunch or dinner before the crossmatch (coming soon to an inspection near you). 
    For the record I'm a Gemini, which I assiduously and loyally document in every interpretation and progress note I write.
  22. Like
    David Saikin got a reaction from John C. Staley in CAP ALL COMMON CHECKLIST COM.04250   
    I don't perform comparative studies on antibody IDs.  Only ABORh and Ab Screen.  Never been a problem.  I do compare my primary gel with PeG and LISS screens since I have been known to use these reagents sporadically.  (CAP Team Leader, 20+ yrs).
    Who's opinion?  I think you are correct in your interp of that standard.  I'm not comparing the different techniques used in abids.
  23. Haha
    David Saikin got a reaction from John C. Staley in Facility location on SOPs   
    i had an AABB inspection years ago. At the summation the inspector said:  "I know I'd have to dig to find something in Dave's lab."  That should have been a warning.  My only deficiency (which was cited by the Area Chair, who determined the deficiencies based on the Inspection report form) was that I did not have my facility ID on my antibody panel sheets.  I immediately called my area chair and told him I wanted to inspect his lab (UT@Knoxville), which of course is not allowed.  I became an AABB inspector/assessor after that fact.
  24. Like
    David Saikin reacted to Neil Blumberg in Facility location on SOPs   
    Just the person you want operating on your brain or reading your prostate biopsy, no doubt.  Makes one proud to be a part of the same profession.  Not.  Pettifogging fool.  Perhaps he is nice to his dog and children.
  25. Like
    David Saikin reacted to exlimey in Facility location on SOPs   
    "Pettifogging".....an 'olde worde" that is so relevant today. Thank you for reminding me. I shall try to work it into as many conversations as possible.
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