kate murphy

Thank you all! Quite a choice! Always amazes me the wealth of knowledge from the members of this site!

Thanks!! We do subscribe to CAP J series, but I was looking to expand to some other antibody ID specs to keep everyone on their toes. I will investigate API. Many thanks!!

I'm trying to find out if there is another source for proficiency specimens other than CAP? We had been spiking some specs for testing, but I'm finding less time to do this. Any thoughts? I've google'd and bing'd to no avail!

Hi Bev, we only have one on the wall next to the irradiator. Satisfies some government standard. Radiaiton Safety changes monthly, no exposure ever - for nearly 20 years.

Hi Linda!, I've been in touch with Cliff, I was thinking of coordinating and picking a convenient venue, as we're locals!! There is no $$ to speak of, so it'll be pay-your-own-way. Let's kick around a few spots and maybe come to a consensus. Thanks!! Kate

Maybe we could all chip in $5 for a "bring Malcolm to Boston" fund!

Shucks - I was really hoping that would work and we could actually lure you over!!

I would be very remiss not to attend! I live in Boston. Please count me in and I'd love to meet you all. Have we heard from Malcolm if he's definitely attending? And I know there are a few New Hampshire people here who'd hopefully take a short drive down! I'll try to get in touch with Cliff and see if we can coordinate something. Sam Adams brewery tour, anyone??

Could the pregnant patients have received RHIG from another source? There is such variability in anti-D reagents now to different epitopes of the D antigen by different manufacturers, that another lab could have typed them as Rh Neg and they could have received RHIG from another source. So the anti-D you are seeing could be passive. The non-pregnant patient may really be a D partial that made her own anti-D.

[ Regarding coolers that keep blood <10o for x # of hours, I have always felt that if a cooler is sitting around in an OR or on the ward awaiting possible use, then it is storage, not shipping, and should be kept <6o. We had a recent AABB assessment and were told that the AABB considers blood in coolers going to the OR for possible use to be "transport" (it was explained that the blood "takes a little trip to the OR, stops and enjoys the scenery for a while, then continues the trip back to the lab...") and the <10o rule applies. The FDA, however, (and this is also from the AABB home office), says to consider the intent of the cooler use: if it's going from point A to point B to be moved into another storage medium like an OR fridge, it's transport (<10o rule). If it's going to sit around for possible use, then return from whence it came, it's storage (<6o rule). So there's a dichotomy here.

We've always had phlebotomist or tech performing thera phleb. We make our own flow sheet to track the vitals we take as well as Hgb or crit, as applicable. Also a place to keep the scrip from the ordering MD. BB med director reviews each BB chart after the fact. We do several/week. Never had a deficiency. The standard does not specifically state that RN need to do this. I think it applies more to the fact that in some hospitals, ther phleb is NOT performed in the BB, so is not covered by the CAP requirements.

okay - John, I'm stumped - boil a frog?

Or perhaps the technique they are using has no intermediate steps that would show an IgM antibody. Capture sandwich technique will not show an IgM antibody. Or maybe they're using PeG and only have an anti-IgG reading.

I'm glad to hear that some Echos are operating well - we are swapping ours out for a new Echo and we'll see how that validates. I agree that Immucor has had some growing pains in the recent past and may not have had all the key staff necessary. Our Galileo is running great - very few issues there. Capture technology is good - sensitivity and accuracy is good and operating expenses are reasonable. So we'll give it another go, and I'll keep you all posted. Thanks for your help!

We follow all that has been written - careful loading of reagents, checking all specs for hemolysis/foam prior to running, etc... After the last post, we ran several known antibody specs repeatedly till spec was exhausted. Watched the instrument perform, made sure all reagents pipetted as expected and all steps ran as expected. Some variation in positivity is expected - no matter what methodology. But we did not expect a 3+ to repeat as a 0 with the same exact cells run only 90 minutes apart. Immucor now advocates manual reading of all negative screens (!) Not really the reason we want automation!! Immucor is now addressing some of these issues - more robust camera, incorporating process control steps, etc. However, the above cited positive specimen - when manually reviewing the negative screen, all staff polled would also have called it negative. I'm not sure why the same methodology utilized on Galileo works like a charm, but on Echo does not. I really was looking to see if other Blood Banks were experiencing the same issues which points more to a design flaw, rather than something we are doing.

We all struggle with this. We are a very busy level 1 trauma center. We require a new spec any time a name or MRN changes. I believe many standards require that the specimen is labeled and compared to the wristband at the time of drawing. Relabeling later is not allowed. And if the name/MRN on the unit tag is different from the spec, how certain are you that the intended recipient is correct? Joint Comm standards require that 2 unique identifiers be used for transfusion (and other things). Usually it's name/MRN. Since "John/Jane Doe" or "Unknown Male" is not unique, many times transfusion happens with only the MRN and account number. Though I do know nurses that will hang a unit on the "gunshot in bed 1". Hard to adequately identify the patient specimen and during transfusion when you have 3 "Unknown Male" patients in the OR at the same time. Or worse, post op in SICU.

That sounds like an IT issue - loss of network. Isensix set up correctly would alert you to loss of network. You can have the Isensix alert go to any text receiver - email, text pager, cell phone. We have ours go to a text pager in the BB for alarms 1 and 2. Alarm 3 goes to a supervisory pager. Isensix is a great remote monitoring system. It sounds like your hospital uses it other than BB - someone on site should be able to show you the features, how it works and the best way to configure it for you.

But if you are crossmatching for the baby with mom's serum/plasma, wouldn't you match all her antibodies? otherwise, you'd have incompatible crossmatches. Could be that for an antibody of low titer, all antibody is bound to baby's rbc and the antibody screen on baby's venipuncture is neg. You may only recover this antibody from a baby's eluate. And you need a quantity of rbc to do that - which you'd have with a cord sample. I would advocate not bleeding the baby, use mom's blood whenever possible and match all mom's antibodies.

We do K-B on quite a few Rh pos moms - traumas and fetal demise being the main indications. K-B (and flow) detect fetal hemoglobin and has nothing to do with mom's Rh. The rosette screen is a different matter - it's dilute anti-D and should not be done on Rh pos moms as it will always be pos.

We use the cord spec for ABO/Rh, DAT of the baby. Cords are collected on every baby, but we only test those from Rh neg moms, moms with antibodies or if the clinical condition of the baby warrants it. Most mom/baby ABO incompatibilities do not adversely affect the neonate. If you're have a problem with mislabeled cords, you should address that with your Quality department rather than keep sticking the babies. All babies get O Neg rbc, we only crossmatch with mom if she has an antibody. Otherwise, no crossmatch. Dedicate 1 donor unit to 1 baby to reduce donor exposure.

We also use Thermosafe - this model has a telscoping handle and wheels - both OR staff and BB like them. Comes with baskets for the blood bags. When we validated, we found 3 frozen polar paks plus 2 refrigerated gel packs kept the interior <6C for 8 hours. Polar paks and gels come with them. Durable - we've had ours 3 years. http://www.thermosafe.com/model/930.html?Pr10=Science

Yes, we require a 2nd spec at a separate draw from all 'new' patients. Instiuted July 2010. We have a special tube not available on the floors that the BB controls. We order the ABO confirmatory test and send the tube with label to be drawn. We give group O's if necessary befroe the 2nd spec, but we make the ordering doc sign for them, like an emergency release. We have seen our rate of 'wrong blood in tube' (WBIT in the terminology of Sunny Dzik) drop gratifyingly. We instituted electronic XM Sept 2011. Boston Medical Center, Boston, MA

Yeah, those tabs break off fairly easily. We don't do anything special - as you said the frames work just fine without the tab. When we notice that plates are loose in the frame, then we toss them. And spend $$$ to replace. Can you believe the cost of them?!?

Our validated 6 month old Immucor Echo has produced 4 false neg antibody screens in the past month. The first 2, after intensive investigation, we concluded were due to contaminated strips form one pouch of strips. All other repeated results agreed with testing with a different lot of screening strips and testing with another method. Now we have 2 more. Not the lot. Not the strips. Echo functioning as expected, all maintenance up to date, QC passes. One sample was 0, then 4+ when run with the same lot over a few days - a known Anti-E. We've taken Echo off line, and we're not confident we'll reinstate it. Our Galileo is up and running, no problems with that. It seems that a process control we thought was in place to verify sample addition is not part of Echo's programming, as it is on Galileo. We were told there was a process control, and in fact, the Operator's manual has this process control. Immucor has addressed this issue with Technical Communication to explain that bubbles/foam may cause lack of sample pipetting. We already do this, but it's a poor process control. My question: are other users seeing these issue on Echo?

We used data loggers to validate each cooler. We found we needed 3 frozen polar paks, 1 on the bottom, 1 each side, plus 2 refrigerated gel packs in the basket with the blood to maintain acceptable temps. Using only the frozen polar paks, they only held temp for 4 hours. Inital temp 1.5C, 12 hour temp 4.5C, 18 hour temp 6C. We opened the cooler 3 times throughout the test to simulate getting the blood. We haven't have issues cleaning - we use a spray Virex TB.