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carolyn swickard

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Everything posted by carolyn swickard

  1. What about RH pos plasma products or platelets? Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe. And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units. Just a thought.
  2. We run our eluates on the Immucor Echo now, most of the time. I run the panel for the eluate and the RS3 trio for the last wash - in parallel. Works for us.
  3. I tend to work them the way "galvania" works them too. I just start with the high frequency antigens and work down to the low frequency ones. That is the way we screen too - eliminate the high frequency antigens and screen only the negative units for the lower frequencies as you get to each antigen. (mostly we just call our distribution center (Vitalant, El Paso) for units like that - they are doing an outstanding job getting units for the "messy" patients!!)
  4. We require the RNs (or another aide) to bring a small pickup slip with the patient admission label on it. This label includes the pt's full name, MR# and Acct# (financial #) and the BB ID band number when they are picking up RBCs. We do not require a BB ID band # for plasma transfusions. They also must bring a copy of the current "consent to transfuse" form - filled out correctly. Outpatient RNs bring a copy of the transfusion order and the consent form - with the Pt's BB ID band # if picking up RBCs. O.R. is required to bring one of the small pickup slips with the Admissions label and and the BB ID band # if requesting RBCs. They are not required to bring a copy of the consent form. E.R - in an emergency situation, uses an Emergency Release form (handwritten by us) based on information in the computer or that the E.R. fills in. They do not have to bring a consent form until everything is caught up and the TS is completed and the pt is off Emergency Release protocols. Because we still use and require a unique BB ID wristband for blood (RBC) transfusion - both the floors and the O.R. have to prove we are all working on the same patient. Until we get some kind of system that fewer people (I won't say none!) can screw up - I prefer the use of an independent BB ID wristband where the Draw - to XM - to Transfuse circle has the best chance of not being corrupted. We also require a second specimen (independent draw) for all ABORH confirmations. Doing the best we can to not make a mistake.
  5. If this works - this is, I think, a proposed observational study to determine how standard Blood Bank practices may affect the transfusion of infants. Someone is looking at the age of irradiated units and what it might mean to infant safety. Interesting. Does red blood cell irradiation and/or anemia trigger intestinal ... https://bmcpediatr.biomedcentral.com › articles by T Marin · 2018 · Cited by 6 — Our overarching hypothesis is that irradiation of RBC units ... The majority of premature infants receive transfusions for anemia of ...
  6. I've always thought that 1 week post irradiation would be the ABSOLUTE maximum for a unit to be used on a baby. I actually thought 5 days was almost too long. Anything longer and you do run into Potassium leakage problems that can make the unit dangerous for a Neonate. We had a potassium overload reaction on a neonate once with only a small volume transfusion. So - absolutely watch the length of time your units have been irradiated when transfusing to infants. We no longer have an irradiator on site and will be buying fresh, irradiated, CMV- units from our distributor for small volume transfusions. I am worried that, over time (we only transfuse these babies about 2X a YEAR), the team will forget to move the leftover unit over to adults and will use too old of a unit on a baby. I am retiring, so won't be here to watch out for it - so I will just have to worry. I just can not figure out how to fix things so that 10 years from now, something that esoteric gets remembered by the poor tech stuck with it, for the first time in 5 years or so for them, in the middle of the night! Such are the nightmares of an old blood Banker!
  7. Can anyone share some of the specifics for establishing a backup computer like this? Especially if you have Meditech? How do you get a routine backup downloaded to a computer that is not connected to the network? I am asking my IT folks, but suggestions would be appreciated.
  8. To answer your first question - Yes, we have seen several antibodies On ECHO/LUMINA) that we can not see in the titers (saline only / 2 fold dilutions/ 30 min inc). Especially Anti-E. I once talked to a reference Lab about titers (we had an anti-G - such fun) and they felt it was most important to try and replicate the In-Vivo condition in the mother for clinical significance - therefore - no enhancement medias and heterozygous test cells, where possible. That is what we have done since and we just have the Med Director answer any questions they might have (after a through briefing, of course!). Hope that helps. Titers in gel are always higher than titers in tubes (see CAP results for the various titer methods if you can). Consistency in method and full disclosure on method and clinically significant ranges should be the most important part of titers. We restrict ours to only daycrew techs with proven competency testing (and still hope for the best!). There was an article: W. John Judd for the Scientific Section Coordinating Committee of the AABB, Practice Guidelines for Prenatal and Perinatal Immunohematology, revisited Transfusion 2001,41:1445-1452, that answered a lot of my questions - if you can find it. It was supposed to be revisited each decade, but I never found anything in or around 2011. May have missed it...
  9. It certainly does not hurt to stop the unit causing the transfusion reaction, start Benadryl and, if the pt needs more units, start a new unit that they probably/maybe won't have a reaction to - especially if it is FFP being transfused (which is what you have the most "urticaria only" reactions to anyway). We work them up with an abbreviated Transfusion Reaction workup and issue a new unit.
  10. Especially since hospital systems seem to be a favorite target of these bad players.....
  11. Make sure that the Blood Bank history backup computer is on generator (emergency) power in case your network downtime is due to an extended power outage. Those happen too.
  12. Try this - most of it might work for you. The link will only work for 30 days. I could not get a separte copy of the form. Maybe it will come up for you anyway. Good luck. TS-110 COOLER VALIDATION.pdf
  13. We have a transfusion consent for just the Blood components. We do not require one for RHIG from Blood Bank, but Labor and Delivery has a fairly comprehensive form for what a pt will or will not accept. We don't see that form usually. Pharmacy has the rest of the derivatives - I don't know what they require.
  14. For us - it is our Phlebs as much as possible. They draw as soon as the Blood Bank generates the order and notifies them. Not particularly optimal for a real messy trauma probably. We are a Level 3, trying for level 2.
  15. Just a question - along with mrmic - What is the average daily temperature in your lab? If this antibody is, at least partially, a "Cold" and you have a LOT of reactions like this, as you stated, it just may be too cold in your lab. Try a strict Prewarm test, as suggested by Malcom and if that helps, consider reducing the amount of Room Temp exposure your average specimen encounters and see if you can cut the reactions down. We have almost no RT exposure in our testing anymore (Immucor ECHO) but we used to have more extraneous reaction problems in the winter when our lab grew colder (think blue fingers!). Just a suggestion. Does anyone think this (second panel) may be an anti-P? It is not showing the whole pattern, but I have seen several that didn't.
  16. Currently we are just holding on to it. We can't relabel it ourselves for FFP use - not allowed. Our distribution center is not taking them back nor are they testing them. The units apparently belong to the govt agency that organized the whole program. We can choose to use them if our distributor can not supply a High-titer unit (in very short supply), but titer values have not been good in our region, so it wouldn't have a good chance of being a High titer unit with just a random pick from current CCP units (not tested).
  17. I saw a discussion once that said draw it as soon as you can post delivery (ours is at 1 hour) - but that drawing it is more important than the time of the draw. I think I remember that they discussed up to one week post delivery (sort of ridiculous to think about). I have never really seen a maximum time for drawing. Make sure your procedures allow for double checking RH neg mom's with Rh pos babies - make sure L&D has some checkpoints and that your techs have some checkpoints to make sure tubes get drawn and tests get done. Make sure the testing gets done and documented and the RHIG gets given - that is the most important part. good luck
  18. Oh - absolutely - I have enjoyed his help so much.
  19. Since we have both manual procedures and QC and automated procedures and QC, we have left our manual QC with just the recommended "positive" controls. Since the ECHO runs 3 QC reagents and winds up with a "positive" and a "negative" for all of the reagents (usually the same lot numbers in both sets) we thought that was enough. We are FDA and Joint Comm. and they have been happy so far.
  20. To answer the original question - we use "mi" and the computer interprets that as "positive" and we can choose our "weak positive" answer. Works for us. Yes ,we still read the occasional tube under the scope - still in the tube and rolling the tube. Everything else is on the Immucor ECHO - eliminates the problem! Weak DATs on cord bloods are sometimes found - never know how that works out for the infant. Reading Fetal Hgb Screens requires microscopic reading - you never see the positives in the optical aids (convex mirrors). We try to keep it to noticeable agglutination/clumping in the tube - "kissing cells" are not considered "positive". It's a job to get the MT students to loosen up with microscopic reading, but it seems to be a good exercise for them to learn what it looks like - agglutination vs. rouleaux, etc. We never know what will be the methods used in whatever hospital they finally wind up in, if not ours. And yes - everyone sees things differently. I had one tech who must have had "microscopic" eyes. She would take her glasses off and look at tubes and always "see" stuff that the rest of us just could not see macroscopically. Especially on titers! Best of luck.
  21. No - we do not have that procedure and I do not anticipate adding it.
  22. TS- Dithiothreitol -DTT- Treatment of RBCs.pdfThis is our procedure for the HemoBioScience product. it will be open for 30 days only. (I think) Don't worry about thawing it too many times - there is only 2-4 mls in each tube, so it doesn't last for that many pts. We have just thawed ours at room temp. We wrote the procedure using both the HemoBioScience procedureand the one in the AABB Tech Manual. Best of luck
  23. Beyond any shadow of a doubt - personnel will always be the greatest challenge. Not enough, not well enough trained, will they follow the SOPs (in spite of the continuous Competency - truly a pain!), will they show up, will they get along with each other........... Be prepared for that challenge and take advice from a good manager, if you are blessed with one. Always consider that mistakes may stem from a misunderstanding of what is written in the procedure or the procedure might need a tweak to eliminate a "process" problem.. Approach mistakes from the point of view - "Is it a process problem? Can someone else make the same mistake?" before you go after the person who made the mistake. As someone said earlier - get familiar with the standards of whatever inspection organizations you will be responsible for. Read all of your procedures with those standards in mind and line them up. That will make inspections so much easier and always gives you a "reason" if you have to change something. Keep your sense of humor and be adaptable. Nothing will stay the same forever - change comes along frequently and you have to roll with it. Make friends (with distance - not "buddies") with your techs - stay friendly with other techs in the Lab and make friends with other administrative personnel - you will be on the front lines with other personnel in the hospital more than other Lab supervisors - think ER and OR. Best of luck.
  24. I'm sorry - we still just have our employees sign the facesheet of the printed copies of the manuals they are responsible for. Everything is in Policy-Stat for us, but we also still have printed copies for downtimes (and the computer challenged!) - it is just easier than fighting with a computer system.
  25. CCP for covid-19-ccp-considerations-for-clinicians.pdf hope one of these will work for everyone.
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