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jshepherd

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Everything posted by jshepherd

  1. Hello! I've worked with Immucor over my entire 18 years in the BB - you should be able to reach out to your account rep for the info you are seeking regarding ABID troubleshooting. They have a collection of white papers that can help you. Regarding your Rh negative confirmation in tube - that sounds like something specific to your facility. It's not an Immucor recommendation that I am aware of, nor do we do that at my facility. The CMT plates are literally just a blank microtiter well, so the reactions are very similar to tube, and are read the same way. The trouble with the instrument reading the reactions is that it will not detect mixed field or rouleaux and can have false positives because of that.
  2. We have a Temp Check device. Temp-Check Rapid Response Thermometer For Healthcare| Digi-Trax® This is what we use to take temps of all products being returned to us.
  3. I hate those things..... in my experience, they are not very accurate and are so temperamental. We had the BT10 on all our units that went to the ED fridge a few years ago, hoping it would help us provide return privileges for those units. They too started activating on their own having never been moved from the fridge. Must you have the temp indicators? We have a TempCheck device we use here in the bank. People returning products must get them back to us ASAP (no time limit) and we take the temp with that to determine return capability. It's pretty good and has proven accurate to our reference thermometer for years. Plus, it's a one time purchase. I've heard of people using infrared temp guns as well, but I've also heard those can be temperamental because of the air temp the infrared beam has to pass through to get to the unit itself.....sounds too complicated.
  4. Sorry Malcolm! Agreed, our policy is that all females are of childbearing age until they are 50 years old, so we would give RhIg when indicated for an 11 year old. But thank you for clarifying that excellent point!
  5. RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first. Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow.
  6. Sounds to me like you should only be concerned with the fact that you might be needing 2 exchange transfusions and a bleeding mom to occur at the same time. Busy, but not unmanageable. Maybe make sure you have blood and plasma per your SOP for the exchange in house, and plenty of A pos for mom. Good luck!
  7. Has anyone found software that can help them digitize all the paperwork (antigrams, instrument printouts, etc) for patient antibodies? I have a HUGE file cabinet full of these things, and we'd like to make it electronic, but of course it has to be searchable by name and/or MRN and we would need access to it during downtimes. I'm thinking a third party software out there must have this capability by now....it is 2024 after all! We have Softbank and Epic, and I'm aware that Soft has this capability, but it will cost us upwards of $20K to complete the project, and no one has that just laying around these days.
  8. Just a few nuggets I left in BOLD above. We use solid phase here, and back up to tube (we have PEG and LISS). I personally prefer solid phase, but each method has it's pros and cons. This is why you need more than one method to utilize. Good luck!
  9. If the reactivity is only in the IS phase, and all other IgG phases are clear, you should do the things to resolve IS interference. If you can identify or think there is a cold antibody, then prewarm would be your answer. You can also wash the donor cell suspension to ensure there isn't something funny with the patient's plasma and the unit anticoagulant or solution.
  10. Agree with Dr. Blumberg. If platelets are returned in an RBC cooler "on ice", we take a temp of the unit. If out of 20-24C range, we check for swirling, and if still swirling we will ask pathology if we can keep it, based on our current platelet inventory and the temp we got. Always up to them, but in general if it's only out of range by a degree or two, we'll accept it back. The coolers we use for RBCs are only out for 4 hours max, so these units are never in there very long, and they often come back within temp range (like they tossed the unit in the cooler right before bringing back the cooler).
  11. Agree with Dr. Blumberg. The FDA guidance for CSPs states they can be used when "regular platelets are not available or not practical". This sounds like a more prophylactic use of platelets, which is also not practical. If you didn't have anything but CSPs on the shelf, and there is a request to transfuse, I guess it would be up to you as to how much you want to argue with cardiac surgeons for the sake of your inventory, given that these patients are not actively bleeding.
  12. Agreed, sounds like you're moving to a less secure option for whatever reasons, so in that case I say go low tech and put a physical lock on the fridge door. Helmer sells fridges that have built in electronic access control, but you can also drill right through the handle bit and get a combo lock put on it. No access unless they call BB for the combo..... there are definitely ways to secure this low cost, I've got experience with both of these options and they work just fine after the surgeons stop complaining about it.
  13. Level 1 adult, level 2 peds we keep LTO+WB for traumas - we give 4u per patient that has MTP activated, then switch back to component therapy.
  14. The response I got from ARC is that it is up to our medical director. There is no FDA exception needed, as the FDA doesn't have a regulation on shipping duration or transit time. They only care about temp, and since the temps are in range, there is nothing to seek a variance from. I heard from people who use other blood suppliers, and the general consensus is that if the packing is correct, ice is still present and the units are in temp range, they are acceptable, as long as there is documentation of this deviation from the hospital's normal policy. I ended up adding this tidbit to my SOP as an allowed deviation by our medical director, just need to fill out the deviation documentation form and have him sign, but this way, we can accept the units in immediately and not delay having them be available. Especially important for platelets!
  15. Our blood is shipped to us from Omaha and St. Paul (ARC), and sometimes arrives to Denver later than the transport boxes are validated for, which is 48 hours. These units are frequently still in the acceptable transport temp range, be they platelet or red cells. Historically, we have tossed these units since they did not arrive to us within the validated time frame, but I am looking for a way to stop doing that. The FDA publishes exceptions to 21CFR640, which are publicly available, and has many exceptions listed where they have allowed the use and distribution of products when they were stored outside of the required temperature ranges for a specified amount of time, ranging from a few minutes to several hours. I cannot find in any FDA regulations where I would be allowed to accept the products in the situation described above, when units are in temp, but over the validated time frame of the transport container. Has anyone encountered this before, and what do you do about it? Is this simply a decision for the Medical Director of my hospital, or does this require an FDA exception?
  16. Exactly!! The answer is because the FDA says we have to..... I have never seen a mistyped unit from any blood supplier in 17 years. ABO or ag typing.
  17. We do not recheck ag typing. One and done. If our supplier sends us antigen neg units, they are either typed in the moment by the supplier or labeled as "historically negative" which means the donor has been typed twice by the supplier and will not be typed again. As @NicolePCanada said, you're still going to do the AHG XM, so no need to cause undue stress. Also agree fervently with @exlimey that you should not make something like this optional.
  18. @Neil Blumberg Exactly. We've all had the odd cases that survive when it doesn't seem they should, and I agree that it's certainly case by case and dependent on hemostasis and coagulation like @Auntie-D said above. We use TEG for coagulation eval as well. I think my trauma surgeons are looking for a prompt to make them aware of how many products they've used, so they can evaluate the futility of continuing versus stopping. Anesthesia is the group transfusing these products, and they can easily lose track as well, so we're looking for an estimate of when the blood bank staff might give them a nudge to let them know they've hit a threshold, and to evaluate the entire picture of the patient with that knowledge, rather than being tunnel visioned into fixing the damage only. I have heard 30-50 units of red cells is the sweet spot as well. We consider more than 30 units of red cells to be a super massive transfusion, so that would jive.
  19. Hello everyone! Controversial topic coming up here: Is there a point in an MTP where the further transfusion of blood products does more harm than good? I know some facilities have published studies on this issue, and some have assigned their own lethal dose, or LD50, to blood products, to say that once a patient is transfused X number of red cells or X number of total products that resuscitation is futile and MTP should be discontinued. We are exploring doing this research ourselves, but I was asked if anyone out there has an actual policy or SOP on this topic. For ethical reasons it gets really touchy, so here's the disclaimer that I'm not trying to rile anyone up, just wondering what everyone else is doing! And......go!
  20. Excellent points from Neil and Malcolm as always! Most of us are slaves to the standards though, and/or don't have pathologists willing to take this same point. @RRay Lots of food for thought here! I think we will be implementing something similar here, adding an "antibody" to the patient file in the BB LIS only that will require an AHG XM when additional drops of plasma are used to resolve a blood type.
  21. This was an issue here as well, the full address of the hospital was in the header of all of my SOPs. I removed them all one by one as updates/reviews were required. There is nothing in JC/FDA or AABB that says you need the location of the lab in an SOP. You are correct that this needs to be on reports. I left the name of the hospital and Department of Pathology and Laboratory Services in my header, that's it.
  22. I'm working from home today, so the AABB standards are not at my right hand, but I'm pretty sure AABB requires a front and back type to be resulted to count as a full blood type for adults. There are exceptions for peds of course. No full blood type means you should be giving type O red cells and type AB plasma, which no one wants to do unless warranted!
  23. Agree with Neil and Malcolm, might adopt that here! You could have an "antibody", or some other way to require the system to prompt techs, that you add to the patient in your blood bank LIS, which will direct staff to perform an AHG crossmatch. That way, there isn't an antibody actually resulted in the HIS, but the staff will be alerted to the need for an AHG XM rather than relying on them catching that there was a weak backtype.
  24. This is mentioned as "increasing the serum to cell ratio" in tech manuals and guides, but it is SUPER vague! I agree that you should not allow your techs to do this if it's not in the SOP. I have RT and 4C incubations as things to try to resolve blood type discrepancies in my SOP. The only place we mention increased serum to cell ratio is to enhance weak antibody screen reactions by using 3 drops plasma and 3 drops PEG to one drop cells. We don't change serum to cell ratio for blood types or ISXM.
  25. There is a recommendation, or maybe a standard I can't put my finger on right now, that says that access to the blood bank should be controlled. Meaning people can't just walk in and take blood. Nothing that says it must be a separate room. My entire lab is behind badge access doors, and the blood bank is semi-separated by a counter and some swinging half doors (saloon doors) so that people picking up products would certainly be noticed if they just popped into the actual department.
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