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Posts posted by Ward_X
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On 3/5/2020 at 3:59 PM, Malcolm Needs said:
Anti-Vel is such a nasty antibody, I would give units that are known to be molecularly tested (SMIM-1 Negative), unless the cross-match is performed by 2-stage IAT with monospecific anti-C3d on a clotted sample, as it is renowned for complement activation, even when virtually undetectable by normal serological techniques - not that I want to be sensationalist!
Reminds me of a recent forum post I read elsewhere about someone who wanted to give a patient with an anti-Vel phenotypically negative units from family members that actually were still genetically variant. The consensus was molecular negative donor units only!
- Yanxia, Malcolm Needs and exlimey
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If you're talking about resolving an ABO with the presence of a cold, I've seen using warmed cells/plasma, adsorbed plasma, or cord cells.
Did they use the anti-IgG for the workup, and not the discrepancy?
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On 1/31/2020 at 9:18 AM, jayinsat said:
We require a current ABORH for all plasma products. The reason is not because of the possibility of a blood type change due to bone marrow/stem cell transplant, it is because of the probability of an erroneous admission. Every facility I have ever worked have had instances where admitting has registered a patient as someone with a similar name or merged a record with a similar name, resulting in an inaccurate blood type on record. We mitigate that risk by requiring a new blood type each admission before giving plasma products. Once the type has been verified, we will issue plasma products until discharged, regardless of how long ago the type was done.
How does your facility comply with the newer AABB standard 5.16.2.2? Wouldn't compliance with having two determinations of an ABO group prevent erroneous admission?
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On 2/1/2020 at 11:59 AM, John C. Staley said:
Things must have changed dramatically as they so often do over the past 42 years but I recall that immunoheamtology received no less emphasis or time than the other disciplines when I was studying in a MT program. Maybe the program I was in was the exception at the time but I hope not. Having already completed a BS in Microbiology when I entered the MT program I assumed that would be my area of expertise but after one year after graduation working as a Generalist, I found myself as a full time Blood Banker and never looked back. While the bulk of my knowledge in Blood Banking was attained "on the job" I always felt the foundational information I received in class certainly prepared me for my future.
Wow, we sure hijacked this discussion!!
I graduated from an MLS program in the last 5 years and I had two semesters of clinical chemistry, two semesters of clinical microbiology, one semester hematology, and one semester immunohematology. You can imagine my surprise when I came around in my clinical rotations and tried to grasp what an adsorption was, ha! Anyway, students tend to have a harder time going through Blood Bank for that reason.
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From what I've seen, these patients normally have type-specific instructions for all products listed in their file. For example, for current in-process transplants, an OtoA Pos patient may have an O Red Cell Products instruction, an A or AB Plasma instruction, and an A, AB, or washed platelet instruction. If they have fully switched over to the donor type, their file notes that instead, and then it's type specific from there...
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I have heard of facilities using TEG or ROTEM.
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My facility uses Helmers and we have racks manufactured by Astron Systems. They store units vertically in sets of two or four. You can fit 4 across the length of a Helmer fridge in 2 rows (so 8 racks of 4, 32 total). In the Helmers with a higher bulk of products, we have some sort of plastic/acrylic dividers that section of units. We also have longer/heavier plastic "sleeves" that go down the length of the shelf, and those fit ~15 bags and go three across. So, I guess we have a lot of options!
Intrigued to hear others!
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On 12/25/2019 at 1:50 AM, irshadaad said:
If there is any reference about expiry of thawed FFP pooled (open system).
If pooled(open system) and stored at 1-6C what will be the expiry,
Looking again at the Circular, FFP should be infused immediately after thawing, or discarded after 24hrs if not refrigerated. The Technical Manual references that components prepared in an open system require a reduction in expiry time from the time the system was opened. But, use of approved sterile collection devices maintains a closed system instead, allowing actions such as pooling or sampling to maintain the original expiration date/time.
Thawed plasma is derived in a functionally closed system. I do not see any mentions of pooling in an open system -- only for platelets and cryo, with cryo having a 4hr outdate for an open system. The only mentions of pooled plasma was in regards to pathogen-reduced plasma, which had a 24 outdate from thaw. There is a section in the Technical Manual called Pooling under the Whole-Blood Collection and Component Processing chapter. You can also reference Table 9-1 Requirements for Storage, Transportation, and Expiration to see all the product types and their expirations.
Are you talking about pooling for fractionation?
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I can reply to this now that our Christmas Eve MTP has calmed down
- Malcolm Needs and donellda
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On 12/16/2019 at 7:56 AM, SMILLER said:
It seems that there is simply a difference in terminology here betwixt "collection" and "issue". In the US (and perhaps some other countries), the term "issue" is for that process whereby the crossmatched unit is being sent out of the laboratory for transfusion. (In our lab, a tagged unit in the blood bank waiting for issue is in a "crossmatch" status.) Here, "issue" reflects what the Lab department is doing.
I would ditto this, and add that after a certain amount of time (I don't recall how long), the unit electronically will move from "issued" status to "presumed transfused" status. So in our system, "issue" is the time of time stamp and sending it out of the Blood Bank. Whenever the care team wants to spike it is their problem.
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On 12/13/2019 at 6:20 PM, UTECH said:
Thanks Ward_X. Yes you r right about taking notes, it helps. I’m still taking some.
But sometimes I overthink and ask questions (straight forward), which makes other people sometimes think that I don’t know the stuff.
If they're on topic and relevant to what you're being taught, I say ask them anyway. Trainers are there to teach, and questions are a huge part of that.
If you're afraid that they think you don't conceptually comprehend the material, you can try reading the procedure first and then ask the question if you still have it.
Additionally, I would suggest browsing MLS/med tech Facebook groups -- they can help a lot, even with questions you think are "silly." They're also pretty informal and sometimes have chat rooms.
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Welcome! Learn all that you can, and take lots of notes
. Eventually you will gain enough confidence to start contributing back to your lab. Help out where you can, volunteer to do the extra mile. Coming from another new MLS, I can acknowledge that our generation is brilliant, intuitive, and exquisitely savvy. However! We don’t know more than our coworkers who have been there for decades — use them!
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On 12/9/2019 at 3:25 PM, Mabel Adams said:
BTW, can we debate why they changed "absorption" to "adsorption" 20ish years ago (ad is Latin for "to"; ab is Latin for "from")? It seems like we are usually trying so absorb antibody out of a plasma sample so "ab" makes more sense to me. Here we are trying to adsorb it onto the patient cells. I was using "absorption" because it is opposite of usual, but I had the Latin prefixes backward in my mind. I vote for a patient-sample-centric universe so "absorption" for the usual warm auto workup and "adsorption" for this sort of testing. Or less highfalutin use of language altogether and just use "absorption" because it is a more common word. I'm also interested in input from blood bankers from countries where English isn't the primary language.
In a grammatical sense, and from one who has studied Latin, isn't the usage dictated by the indirect object of the sentence? You're adsorbing bound antibodies to phenotypically known cell lines, and therefore interpreting the product that had antibodies pulled towards it. The whole point is to take off the antibodies (direct object) in a way you could identify them to selected RBCs (indirect object). Up for debate
- Malcolm Needs, Mabel Adams, ANORRIS and 1 other
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@SMILLER and then how do you encourage staff improvement sans punishment based on your form process?
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My facility seems to have a similar process in regards to gel screens. The only difference is that we perform the repeat screen before* proceeding to panels on patients with no previous history. Only when the repeat is positive or there is history is the panel performed. That ended up being a workflow decision that took some time to resolve, but moving to the performance of the tube screen first prevented gel-sensitive positives (that are only going to result as negative on panel) going straight to panel and getting fully worked up.
As far as our result entry, positive gel screens do trigger an ABID test bar that has to be resulted. Our repeat screens in tube with negative reactions are resulted as No Antibody Detected (NAD), which keeps them EXM eligible. If the repeat screen is positive, and the workup moves to a panel, the ABID is resulted as the result of the panel. The repeat screen is billed as a "subsequent antibody screen with enhancement media," and we have two billing codes for standard panels (one billing for panels with 3 or less cells, and one billing for panels with 4 or more cells).
TL;DR:
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Perform gel screen
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If positive...
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Does the patient have a history of antibodies?
- YES... proceed to panel rule-out.
- NO... proceed to step 2.
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Does the patient have a history of antibodies?
- If negative... result as negative.
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If positive...
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Perform PEG screen
- If positive... proceed to panel rule-out.
- If negative... result as NAD.
Basically, the NAD to me seems like a dummy negative result to file. It means like a, "hey we did some reference work to see if there was anything, but there wasn't, but because we did a little more than just routine we can't just call it negative." Oh well.
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Perform gel screen
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I will preface my reply by saying I am not in a managerial position, just a tech in the lab. My facility has "Occurrence Reports" that record intentional deviations, reported errors, any workflow influence, etc. You can write them anonymously online or by hand. It's helpful at some points, but there's a fine line between people filling them out to report coworkers for silly things, or just filling them out when they feel "inconvenienced." I have a few problems with this process, but the form itself is outlined decently enough. It mainly just records the time a deviation is recorded, what area of the lab, what happened, corrective action, and future flow.
Overall, I would say it comes down the culture of your lab. Who takes responsibility, and who places blame? If it's a workflow adjustment or something that takes less than 5 minutes to explain, or doesn't affect a patient in any way, emphasize communication between techs and talking to individuals directly to fix process kinks. Doing a whole roundabout where you report it and they find out weeks later about it through a form -- it's a little off-putting and not direct enough for cause and effect adjustment. If it's a real punitive-required situation, that's another problem. Complacency, which seems to be your mention, is something that starts to get into warnings, re-training, responsive action. If someone keeps incorrectly doing a test "their" way, force a re-train (people will want to avoid a whole session of teaching them how to do something they already know how to do, so maybe that's incentive).
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Blood Bank abbreviations start to ruin everything
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11 hours ago, YorkshireExile said:
If an automated blood group is ever edited for any reason, does that disqualify from doing the EXM?
My facility uses HCLL 2016. If a type has to be manually edited or adjusted, the type turns red and they're no longer EXM eligible until the type "discrepancy" is resulted -- which, has to be corrected by a senior technologist. Logic wise, the software is missing two matching blood typings that would allow the patient to be electronic crossmatch eligible.
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Independent entities. For example, if a sample is pending an eluate, but the screen is negative, you can still EXM.
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1 hour ago, TypeO4life said:
Earlier someone said there was verbiage about any time over 72 hours being by day instead of time; I was really hoping the current Technical Manual said something similar.
The 16th manual does say that, yes, but it seems like an outdated guideline as this limitation does not exist in following publications. I would just stick to the latest edition and keep to what it says in the Whole Blood Processing chapter. The two most recent publications do not have as specific of a definition anymore.
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24 minutes ago, TypeO4life said:
Thanks for this information. I was hoping there was specific verbiage in either the AABB Technical Manual or the Circular of Information that talks about the expiration "time" for 5 day plasma. We are currently doing 120 hours, but I would like to change it to 2359 on the 5th day.
I skimmed the AABB Technical Manual (18th Edition) and read: "5 days from date product was thawed or original expiration, whichever is sooner." --> pg. 19 Storage, Processing, Distribution, and Inventory chapter.
However, I also saw that there being no strict definition may be because thawed plasma is not licensed by the FDA, according to a paragraph on pg. 221: "These products must be relabeled as 'Thawed Plasma' if they are stored for longer than 24 hours. Although not licensed by the FDA, Thawed Plasma is included in the AABB Standards for Blood Banks and Transfusion Services and the Circular of Information for the Use of Human Blood and Blood Components... expires 5 days after it was originally thawed..." Cryo is specified by the hour, so I would follow the logic that plasma is going by days (i.e. the midnight expiration) because it does not specify by hour like other products.
Midnight is much easier
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The AABB circulation booklet states, page 31, under Liquid Plasma Components: "...and maintained at 1 to 6C for up to 4 days after the initial 24-hour postthaw period has elapsed." Since the first 24hrs distinguishes between FFP, PF24, and PF24RT24, even the circulatory specifies days after this first period. However, their measures for coagulation factor activity and their corresponding data is all in terms of 120hrs. If it's any consolation, my facility uses the midnight deadline.
I haven't seen anything about a product <72hrs dictating per hour, unless it's something like cryo? Even irradiated NICU units go out at midnight on the 3rd day from the irradiation date. Is there a current version of this floating around?
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On 10/17/2019 at 2:08 PM, cswickard said:
Are you asking about which labels can be placed on the bag and which have to be on the base label?? Some irradiation indicator tags - both Rad-Sure and Rad-Control - have a type of adhesive that can touch the actual bag. Both can go above or below the base label (or at least that is what I have always been told). Most little labels/stickers, like the original Irradiation label in this thread, do not have this type of approved adhesive and are not allowed to be placed directly on the bag. You have to find somewhere to stick it on the base label without covering anything else up.
Piggybacking this comment that yes, the FDA dictates which adhesives can actually touch products meant for human consumption. A wise man once told me of specific CFRs (21CFR175.125 and 21CFR175.105) that detail said restrictions, so it's not as easy as just finding a new sticker that you can just slap on blood products after modifying them, unfortunately
. Eventually you will gain enough confidence to start contributing back to your lab. Help out where you can, volunteer to do the extra mile. 
History Check in Care Everywhere
in Computer Systems / Software / ISBT128
Posted
You could be neglecting potential transfusions in other facilities; what is the rationale for not checking this tab in Epic?