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Ward_X

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Everything posted by Ward_X

  1. This! I don't think consulting a hematologist is even on the care team's mind in terms of these bleeders, which is unfortunate, because if there is an underlying coagulopathy that isn't being treated the products will just run right in and out of the patient with little to no benefit. I guess in terms of traumas, doctors assess the needs for blood and know that's how to save them at that point. Obviously send them RBCs first, but after using x amount of products, what about tranexamic acid!!
  2. If they have a historical type on file, you do not need a current T/S to issue plasma and platelet products. For RBCs you do need a current T/S.
  3. First, I would educate the trauma team on the differences between an actual MTP (in terms of products prepared, and the fact its >10 products in 24hrs), and regular emergency release. That's not to say to ever deny them a protocol if they call for one, but from firsthand experience when I receive a call asking for the phrase "Massive Transfusion Protocol," and I verify what products they will be getting, they don't actually want the sheer number of rounds/number of products listed in our MTP. These areas just know an MTP will deliver products stat, and with relative ease. So, in that case, having pamphlets, posters, what have you, in their areas would be beneficial, as well as explaining about regular old emergency release options (i.e. maybe they only want RBCs, but they only know about MTPs, so they call for that). Just explaining to them that this is an option may reduce the amount of products you're issuing compared to the products they end up using. That being said, our MTP states our first round is 6:6:1, and then a subsequent round is set up after that, and additional rounds in the same 6:6:1 ratio as needed. We are also a Trauma I center, so our numbers might be higher than yours. However, there have been studies, particularly driven by the US Army, about the "optimal" ratio of RBC:plasma:platelets. If you're worried about platelet wastage, that is an honest concern, but in true MTPs, massively bleeding is still massively bleeding; in which case the products may just dribble out. At the end of the day, it's about pluggin' holes and treating the underlying coagulopathy.
  4. Blood Bank Guy is a great resource, although I don't know exactly how many different cases he has on his website. There are videos here and also here that go through a few.
  5. Is there a sort of alias/admission MRN that can be created upon the pt coming to the hospital, that can later be merged? We use this with EPIC, they get an alias name and MRN that we can use for issuing until it is later merged with their real ID. We have names generated that avoid using Jane/John Doe.
  6. Yup! On each sheet of the carbon copy packet. We also have a barcode replicator (BUI) to copy and make scan-able unit stickers if we needed (although seldom ever needed). I'm used to HCLL, where emergency issue is sort of a separate function from regular issuing... does Softbank not have this capability?
  7. I like the sound of the insulated bags, actually We just use high-density opaque white bags for issuing in-person pickups, and clear ziploc plastic bags for issuing products through our pneumatic tube system. The theory is that they'll get the product and issue within 30 minutes, but sometimes we do get returns and they fail temperature check because they were placed on countertops or wherever they land up in room temp...
  8. As far as my interpretation of this standard and how my facility operates, the training is not the same thing as the competency testing. Each area of the lab has an initial competency testing, then the 6 month, then the corresponding annual along with everyone else. I don't think mere completion of training without an initial competency assessment is sufficient. Training is often just acknowledging the trainee has been taught a task and can perform said test; the competency is a pre-set blind sample that already has a determined result, so you can tell if your trainee is passing/failing the competency. I would say: sign off training, sign off competency, then you can perform solo testing. There is a previous thread here, and another here about GEN.55500 that may be helpful?
  9. I'm in a trauma I center with an MTP policy that was forced to update post mass casualty. We set up MTP packs ahead of time and have them at the ready for any moment. Each pack is distinguished by gender (O NEG set up for females, O POS set up for males), and is complete with 6 units of RBC, a carbon copy form, cooler card, and pulled segments. The carbon copy form has the record of the unit numbers, but we use stickers from the unit itself. The only info really handwritten is the ABORh of the units, the product code, and the time/date whenever the pack is issued to a patient. Since the pack is set up ahead of time, one tech prepares the pack and a second tech verifies that the units are in an acceptable status to issue, and that the pack is overall assembled correctly -- therefore reducing a number of potential errors. At time of issue, we use ADT labels printed from EPIC that include the pt's information, and this sticker is applied to the carbon copy sheets and the BTRs already tagged to the units.
  10. We don't ignore the "weaker" agglutinations -- we still record M reactions... however, the result of the titer is the last dilution that is graded >M (i.e. is graded 1+). We have a test result called "below titerable levels" for a titer that doesn't have reportable results similar to what you are describing.
  11. Is there a way to verify that information is correct? You're otherwise relying on a third-party data collection service, so I'm just curious how we can use sites like Ancestry or BillionGraves
  12. If you have resources, I'd still be happy to take them.
  13. My lab is also partnering with a transport transfusion service and I've wondered the same thing. Perhaps you'd need to register the pt regardless just to document the use of units or, The chopper should only have blood on it from the particular hospital that it would transfer pts. or, Operate like you suggest and make transfers to that service (however, how do you document proper transfer physically?) I would say if you're transfusing in the chopper (sort of a middle ground, under the jurisdiction of your hospital), you need to document that a pt was transfused under your control, just at a satellite location. The pt being moved after transfusion to another facility doesn't mean Facility #2 has to deal with the units/transfusion... does that make a sort of sense for sake of discussion?
  14. You're mainly going to receive input on the laboratory side of things, not so much the nursing administrative side. There's really only guidelines on the timing of the start of transfusion post-issue from the Blood Bank, and that's really just for temperature acceptability & storage conditions...
  15. We've caught misdraws twice the last month from samples that required a 2ABORh/didn't abide by proper electronic collection... it's safe to say the hassle is beneficial!
  16. Anyone can have their own individualistic ethical standpoint (for example, in my day-to-day life I'm an act-utilitarian), but in the scheme of healthcare you have to abide by Hippocratic/care... therefore you just can't give blood positive for a clinically significant antigen to a pt with that antibody for giggles. It would have to be life or death, or under the jurisdiction of the BB MD to decide. Of course, sometimes in emergency situations, or if you have an unknown pt getting released blood and it turns out they do already have an antibody, that's all down to the ordering physician to adopt the responsibility of knowing the risks. On a tech basis, I don't see any of us just being like, "welp here you go, have some antigen positive blood!" I'm not sure if this anti-K argument can apply, because that is already a pre-identified, reacting antibody. Of course you would try to give them BKN blood. When we antigen type for a pt and have a batch of 10 units for example, and 1 of those units is K+, the pt with an anti-K wouldn't be getting it. The unit is marked with a tag that lists positive for K, and you move on. The difference in this thread here is that we'd be trying to assume this anti-K pt could make an antibody to another antigen along the way, and whether to screen for this unformed antigen before giving them a unit. It's guess work, and almost retrospective. The point about anti-V/VS is an interesting one, and definitely dependent on the population... but I agree with @Malcolm Needs in the sense that it's extra work for an unknown benefit (at least in Western countries).
  17. Although this mainly covered the preparation/reasoning and less so the conceptual basis, the latter slides from 60 on were quite helpful. Thanks!
  18. Polyclonal anti-sera (IgG and C3d) on the post-reaction specimen. Positive results then require performance of a differential DAT.
  19. We started doing reports for each time an electronic collection was not performed correctly, and it's significantly reduced these errors. As far as requesting a necessary 2nd specimen, we tend to call the floor/OR once the first test/specimen is resulted (especially in cases when the pt needs blood). So to respond to your question, I'd call them if a 2nd is needed, or they may just start sending two tubes at a time. If the OR cannot draw it through your collection system right the first time, you'd really just need two tubes drawn at two different times -- the tubes cannot have the same time listed on the label. Whether they draw it two minutes apart is their issue, and it doesn't avoid the WBIT... whether they're "controlled" or not, they're still human and human errors can occur.
  20. In that case, we had a bombing that happened to be at shift change, so we had two shifts worth of techs. You didn't want too* many techs at once, because then it turns into a "too many cooks in the kitchen" sort of deal, but plenty from the first shift stayed, and the second shift was arriving. They didn't call in many extraneous people because they had no idea how long it would last, and you'd need staffing for after the initial rush. That being said, there were plenty of staff, and the supervisors were helping on the floor. Our blood supplier even called and offered to ship blood. In reality you only need 2-3 people to handle an MTP if your inventory is set, but in a situation where you have dozens of bleeders and the inventory needs to be maintained, everyone has a job to do. Again, large trauma hospital here.
  21. Just from a man-power standpoint, you don't always have the time to "extra" antigen type. I've seen pts with anti-E that receive products on a weekly basis (that happen to be cancer pts) that have yet to make the anti-c. What about the extended billing for antigen typing? It just seems like a gross assumption to believe a pt with an anti-E acquiring a unit of red blood cells will form an anti-c from it (going back to Malcolm, who initially replied that the anti-E could have been made for reasons other than transfusion). I agree with the serological science of why these are seen together, and why the anti-E can lead to the anti-c, but I have trouble justifying the cost of tech/time, reagents, and billing, to go off a hunch that the anti-c is probable.
  22. Not all pts form antibodies each time they're transfused, and not against every antigen to which they are phenotypically negative. Futhermore, you wouldn't even know the pt is c= unless you phenotyped; otherwise, you would have only tested and found the anti-E at the time of workup, and stopped there. What prevents you from matching units that are phenotypically matched, even just the Rh group? That would require the extra resources and tech power to antigen type units. If they only have the anti-E at the date of product order, I don't see why you'd need to tack on additional testing. My lab tries to avoid extra testing if not needed
  23. My lab (for trauma I center) does just that: our MTP prep. work includes having sets of O+ aside for male traumas, and O= aside for female traumas. For these untyped pts in emergency situations, the Rh is essentially determined by their gender. For platelets, male/women BCBY do not require Rh= receipt. You're right @Kari Reichenau in saying that giving O= to everybody really burns the inventory...
  24. I've been in blood banking for about 15mos now, and have interests in IRL later on in my career. One thing I still have yet to wrap my brain around are adsorptions, and I've only performed a het. twice. Conceptually, they are not covered much in the MLS program at university (they barely even mentioned an eluate) and I've been told at my lab that one day the science of adsorptions will just "click." Autologous seems to make a bit more sense; it's using a pt's own cells to remove an autoAb from pt plasma, then manipulating that plasma to test for allos. However, heterologous testing is trickier, especially in the sense of picking the correct phenotypically expressed cell lines. You have R1R1, R2R2, and rr, but within each of those are an additional R1R1, R2R2, and rr tested? Even the worksheet I've seen has blocks of color all over it and just looks foreign. Are there any resources or particularly helpful explanations some fellow blood bankers can help me utilize to figure out these guys? Sometimes a peer explanation reduced to colloquialisms and less jargon help it stick. Thanks in advance!
  25. Are there reagents currently used for Bench QC that could also be used in these cases? A set, pre-made vial that could be validated and tested (perhaps, yes, by a "panel" of people... or perhaps made by one tech, validated by another, or two)? A diluted anti-K, perhaps? Perhaps you could do this colorimetrically. Have a premade set of tittered out tubes with colored dye and a chart, and the check has to be between a certain hue/degree listed on the chart? Not sure if that is too complicated... It's unfortunate to even consider the first testing was performed incorrectly, but if it's a recurrent issue, it could also come down to training -- are people pipetting correctly? going to the first stop or second stop of the pipette? How dramatic are these discrepancies in reading -- is it between an M and 2? Or, does this actually come down to needing to verify/QC the performance of a titer? No two techs will ever pick up the exact same population of cells, no. But I'm sure you could find a standard practice to work for a few weeks at a time, or something along that lines to verify titers are legit.
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