Ward_X

My old lab used to do something similar! Just a dummy slide with the probe wedged in the well and putty sealing around the opening. 
For those wondering if a thermometer will fit -- there are some that do, and the wiring threads out under the cover using a small notch 

Your score is 86.28, higher than 89.25% of the people who have completed this task
Every word I thought of I could somehow trace to another word I had already logged! Very tricky

Anemias and Myeloid Malignancies
Anemias and Myeloid Malignancies
https://academic.oup.com/book/24332/chapter/187167821
Submitter Cliff Category HemeLabTalk Submitted 02/12/2024  

I can reply to this now that our Christmas Eve MTP has calmed down

I just answered this question.


My Score PASS  

I don't see why you'd reject a sample just for not being full, that seems a bit unnecessary. QNS or a short sample, obviously, but most patients come through for their T/S, the screen is negative, and that's it.  If you had to wait for a new sample, their old sample could have been done by then. Additionally, calling for "fuller tubes" isn't really the way to ensure higher quality in patient care. 
Overall, not worth the effort. The care teams on the floor are already quite unhappy when they have to redraw for other reasons, I can't imagine what they'd say if I called requiring a completely full sample! Their fragile stick patients may not be happy either...

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!

 

Protein problem patients, especially a cancer population, maybe? 

My facility also has HCLL/Epic. We have manila folders/envelopes to keep full workups on patients with antibody histories. You can always refer to the full panels and order of testing when doing crossmatches or new workups. Filing cabinets sort them alphabetically, and recently we purged folders of patients who were pretty old. Theoretically, anyone could go fully digital, but it's a downtime record for now. We have a backup server that stores preliminary testing data that we check periodically throughout the day to see if T/S information crossed over. That way, if HCLL is down, you can see typing results there. No paper records exist for patients without antibodies. 

Can I just point out here that no one serological test, or even combination of tests will detect all weak / variant Ds .  And that includes women who test D+ but actually have a partial D and may make anti-D antibodies.  It is SO important to know your reagents, and know what your anti-D reagents will and will not detect

Protein problem patients, especially a cancer population, maybe? 

Anti-D is an antibody directed against the D antigen of the Rh Blood Group System.
Anti-S is an antibody directed against the S antigen of the MNS Blood Group System.
Anti-D has often caused severe haemolytic disease of the foetus and newborn.  Anti-S, on the other hand, although it has caused severe haemolytic disease of the foetus and newborn, it only does so in VERY rare cases.  These days, with the vast improvement in foetal medicine, neither antibody should cause real problems to either the mother or the baby.
Antibodies to antigens other than ABO in the circulation are not that rare.  About 3% of patients in hospitals have antibodies, although the number falls in donors.
I am not going to say that blood transfusion laboratories do not make mistakes (everybody makes mistakes), but it is still highly unusual, and to assume that this situation is due to a laboratory error, before all other avenues have been explored, is highly insulting to the intelligence and professionalism of the people who work in these laboratories.

We use COBE 2991s, and use protein dipsticks to test the supernatant. The positive control is diluted plasma and we dilute it to get a level of 30, the negative control is saline, and the samples are collected from the wasteline after the washing is done. The washed sample should test for negative or trace protein, following Standard 5.7.4.6, which lists that washed cells should be prepared in a way that removes almost all of the plasma. We don't look at the crit for these.
There are some other threads on here that also discuss washed QC -- I would also search for those!
 

That's a great point, and my lab operates the same way with our software. I did notice we actually have an order for an MTP that will crossover to us from them, but doctors seldom use it. The few times I have seen it, they verbally order and then file it electronically ex post facto. The mere fact this exists means that hopefully there can be a way to adapt it in the future or stress to use it more.

I think there is a good point made here regarding the assumption that the request for uncrossmatched blood has been documented in the EMR by the provider who requested it. In my experience with chart reviews for patients who've received emergency release and/or uncrossmatched blood products, I've seen multiple examples of notes by nurses regarding emergency release w/o a corresponding note by the provider. We do not have a specific order set for uncrossmatched blood products in the HIS (though I wish we did). All our orders are received verbally and the products are released from our BB LIS using the emergency release functionality, which pushes the information over to the HIS. If we don't get the signed document, it's quite possible that we would have no documentation that the provider requested the release. If you have an order set specific for uncrossmatched products that the provider enters into the HIS, I would think that that's a different story. The order has captured an electronic signature. I would think that a brief statement could be added to the 'uncrossmatched' or 'emergency release' order set (thinking in terms of Epic here) that states that the provider is aware of the risk, etc. etc. I would think that would cover what needs to be covered...BUT then I'm not a lawyer.

What programmers should really add to systems like EPIC and the like is signature capabilities under an emergency release record. If a record can say the units were EI and it's already in the patient's file, how convenient would it be if a doctor could sign the consent off that? 

The amount of times that I have encountered a doctor that refused to transcribe critical information to a Blood Bank paper record is astronomical. 
We usually send a form with the emergency pack and if it's not signed when its returned, we send it back to them and someone signs it. 
It would be easier to get rid of the whole paper signing business, but it serves as a downtime record in and of itself if you cannot issue the units or cannot pull the care team that ordered the emergency. Just a thought.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

Is it possible that a sample was drawn in a different tube/additive then poured into the pink top?

I don't see why you'd reject a sample just for not being full, that seems a bit unnecessary. QNS or a short sample, obviously, but most patients come through for their T/S, the screen is negative, and that's it.  If you had to wait for a new sample, their old sample could have been done by then. Additionally, calling for "fuller tubes" isn't really the way to ensure higher quality in patient care. 
Overall, not worth the effort. The care teams on the floor are already quite unhappy when they have to redraw for other reasons, I can't imagine what they'd say if I called requiring a completely full sample! Their fragile stick patients may not be happy either...

I don't see why you'd reject a sample just for not being full, that seems a bit unnecessary. QNS or a short sample, obviously, but most patients come through for their T/S, the screen is negative, and that's it.  If you had to wait for a new sample, their old sample could have been done by then. Additionally, calling for "fuller tubes" isn't really the way to ensure higher quality in patient care. 
Overall, not worth the effort. The care teams on the floor are already quite unhappy when they have to redraw for other reasons, I can't imagine what they'd say if I called requiring a completely full sample! Their fragile stick patients may not be happy either...

I don't see why you'd reject a sample just for not being full, that seems a bit unnecessary. QNS or a short sample, obviously, but most patients come through for their T/S, the screen is negative, and that's it.  If you had to wait for a new sample, their old sample could have been done by then. Additionally, calling for "fuller tubes" isn't really the way to ensure higher quality in patient care. 
Overall, not worth the effort. The care teams on the floor are already quite unhappy when they have to redraw for other reasons, I can't imagine what they'd say if I called requiring a completely full sample! Their fragile stick patients may not be happy either...

I believe this is the item you may be looking for: http://www.wescottlabs.com/bldbnk/labaccessories/la-ttv.php
I do not believe in routine microscopic readings but I do find it helpful to detect weak mixed field reactions.

I'd parrot the same sentiments listed above. As long as you have ruled-out all other clinically significant antibodies, call the identification a low frequency and call it a day. You'll have to perform any future crossmatches with the same methodology. The chances of it being some crazy rare antibody is, of course, low.
There was also another thread listed here with a similar question.

No, I meant ABO identical. Giving A plasma to O patients is not a good idea, despite 100 years of practice, give or take.  A plasma contains soluble A antigen glycolipids and glycoproteins, and these interact with the anti-A in the group O recipient, forming huge immune complexes.  We and others have observed that patients receiving "compatible plasma" have increased bleeding, increased lung injury and increased risks of infection.  The studies that suggest this isn't true are fatally flawed by characterizing the patients receiving platelets or plasma by their first transfusion (ABO identical or not), regardless of what subsequent transfusions they received. Stick with ABO identical if at all possible.