kate murphy
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Posts posted by kate murphy
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The hell you say! Why even bother with FDA approved reagents?!?!
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We're doing pretty much the same as the majority - <1+ is presumptive Rh Neg and gets RHIG for pregnant patients.
Very rarely will we send out a sample for molecular (BCW) but we have a very diverse mix of immigrants, so we do that occasionally on a case by case basis.
My medical director and I agree that the cost of molecular does not justify testing on a routine basis. As David says, not worth the bang for the buck.
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We do 50th birthday here. Or until the supply is depleted!
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I wish CAP would put all 1 specimen results all together, then move on to the next specimen. Doing all the ABO, then all the Rh, then ABS... THAT'S what causing all the clerical errors I've seen. We're supposed to test and report just like a patient spec - and that isn't it!
- AMcCord, nmartin, Christy Spence and 6 others
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Hi Marianne,
Logistically, there were a few challenges. In our computer system (Sunquest) we defined a 6-day plt and a 7-day plt. Verax testing is good for 24 hours, and we needed to control the outdate. Also to prevent anyone from re-testing a 7-day and going to 8-day! ISBT has codes for only 5-day and 7-day, so we used different ISBT codes and defined 1 set as 6-day and 1 set as 7-day.
The techs came up with a white board display, to keep track of 5-day, 6-day and 7-day inventory. Just a simple column display with total inventory numbers. We try to standardize the time of day we test, as the outdate is a firm 24 hours. That way we have a minimum inventory available at all times.
I'd be happy to share our procedures anytime. You can email me directly at kate.murphy@bmc.org
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Trauma docs now are looking for simulated WB - component therapy in the ratio of 1:1. They would LOVE fresh WB, but that ain't happenin'!
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We use the same old system as you - paper attached with a plastic fastener - zip-tie like. We're avoiding adhesive stickers for same reason as above - hard to remove.
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The military does use "walking" donors - other soldiers who have been tested within a time frame, and are available for donation. Field hospitals are definitely much more sophisticated now than even 10 yrs ago. Field hospitals do have plasma and platelets as well as red cells available.
TXA (tranexamic acid) is being used extensively in urban trauma centers. Recombinant activated FVIIa (NovoSeven)is less in vogue at the moment due to many bleeding episodes.
Many of our trauma surgeons are ex-military - or active army reserve - and they are big advocates for simulated whole blood. Some of our trauma surgeons will be publishing soon on experience with simulated WB being almost as good as WB. They know nothing is as good as fresh WB, but understand that's an unrealistic goal.
- Ward_X, SMILLER, dragonlady97213 and 4 others
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Univ of Texas, with the military, conducted a study a couple of years ago - PROPPR study - about the proper ratios of plasma/platelets to red cells in massive transfusions. Most trauma centers have adopted the guidelines.
Generally, ratios of 1:1 plasma:red cells or 1:2 plasma:red cells is now accepted. Platelets are counted in plasma products.
So when docs notify us they are activating the massive transfusion protocol, we issue 1:1 plasma:red cells. Kind of a simulated WB. Patients mostly do better, avoiding the edema and coagulopathies associated with massive transfusions. And overall mostly use less blood. Google PROPPR STUDY for more info.
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That makes sense, Malcolm, and I agree - but then there's that pesky IS incompatible crossmatch...
Generally speaking, my techs don't like an IS incompatibility! So we give O. Or B, if the patient is AB.
- CMCDCHI and Malcolm Needs
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If the parent blood unit comes to you with the pedi bags attached, and you are just sealing them off (whether heat sealer or hand sealer clips) - AS LONG AS THERE IS NO VENTING AND YOUR SEALS ARE ALL TIGHT - you would retain the parent outdate.
I imagine the pedi bags are connected to the parent with a sterile connecting device.
So you're good to go!
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At our hospital, (medium sized level 1 trauma center) Transport, runners, orderlies, can pick up blood from the BB - they need to present patient name/MRN.
For the bedside check, hospital policy states "licensed" individuals - RN, LPN, MD, etc - to verify and sign off the double check. You are correct in that some knowledge of compatibility is needed to sign off.
But pick up from the BB is simply a clerical check - that we are issuing blood for pt X.
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You guys are all cracking me up today! thanks for the smiles!
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I'd be careful defining a "normal" range for even those tests. You might have to adhere to critical alerts and call back workflows, as well as ranges for different age groups, racial groups, male/female, etc.
I know I'm a dinosaur, but I always thought a normal range refers to results that may vary in a normal population and what you would compare patient results against - numeric values. There really isn't a "range" of values that we compare BB results against. Even an atypical antibody, while atypical, is not "abnormal". Kind of gives the impression that eventually, the result will revert to "normal".
- dragonlady97213, Marianne, exlimey and 3 others
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Alas, we're almost all full, so no empty tanks to use that way.
But I did get a response from the AABB celltherapy list group - and there are companies that specialize in moving full LN freezers. They have trucks with power, so that the freezers are plugged in, and will attach the freezers to LN dewers. They shrink wrap the locked freezers and minimize bumps while moving the tanks in/out. And 1 company is even local to us!
We are not going far - maybe 1/2 mile away. But we'll still need trucks to do this.
thanks for you suggestion! I thought we'd have to buy/rent an extra freezer and ferry the frozen stem cells by hand in dry shippers! With about 600 frozen tins, it would take months! Thank goodness for niche markets.
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It sounds like a money issue. Everybody's tightening their belts and the blood line item is usually quite high, so admin and purchasing think it can be treated like any other consumable.
My advice is to have your community center also involved and submit a proposal. You might be surprised that the community center may match or beat ARC pricing. Or suggest a 50/50 split - that way you have 2 suppliers and less likely to see shortages.
My experience with ARC is not as glowing as the others here. They were never able to consistently supply us to our satisfaction, and we were constantly worried about having enough on the shelves for multiple traumas. Several years ago we had to delay elective surgeries due to blood shortages. One of the major reason we switched to the National Blood Exchange, the other pricing. Local ARC was very expensive.
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30 yrs ago, we used plastic tubes at Dana Farber. They are not as clear as glass, but maybe have improved in the recent years!
One big problem was static - labs are typically very dry and when you used a pipet to drop spec/reagents into the plastic tube, the drop would "jump" out and not go in. We had to wipe the tops of the tubes with saline dampened gauze to get things into the tubes.
Hard plastic tubes would still be considered "sharps" and need to disposed just like glass.
If there's a choice, I'd advise sticking with glass.
- John C. Staley and exlimey
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For what it's worth, here's the grid we follow to validate our EXM process.
Please note, this needs to be done annually or whenever you change/upgrade software or hardware.
We use Sunquest, here's some abbreviations of functions/test defined so it'll make sense:
ABR = test code for ABO/Rh
BAD = BB Admin Data, patient's permanent record
AS = Antibody screen
EXM = Electronic XM
BPI = Blood product issue
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Electronic XM should be part of your crossmatch procedure. EXM is just another option for crossmatching, like IS or an AHG/IGG crossmatch.
If you're doing a whole new procedure - the purpose is to use the computer to determine ABO compatibility. That's all you're really doing - using the computer logic instead of a immediate spin XM to determine ABO compatibility. That's why you need multiple ABO's on the patient to qualify.
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jshafer - yes, the docs use only partial units for a little kid.
From the medical staff side, they appreciate rapid response and having "enough" blood. There's a comfort level is having a whole unit they can start/stop over a 4 hour period.
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I agree with CarrieM. In an MTP, nobody wants to wait.
We issue full units, and full FFP units. Pedi docs can transfuse partial units - we tell them if there is any blood left at 4 hours, to discard.
On a general note, it's really hard to maintain competency in something that's only done rarely.
Keep it simple for your staff.
platelet availablility
in Transfusion Services
Posted
We're level 1 trauma center, no donors. We use the Blood Exchange - all our blood is flown in. We are about 15 miles from the local supplier that we rarely use. Cancer care. We are about 2 miles from Cliff and several other large hospitals. We stock 5. Though we are smaller bed size than our neighbors, our trauma is busier. MTP activated at least once a month.
Verax PGD testing is helping us - we can extend plts to 6 & 7 days.