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carolyn swickard

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Everything posted by carolyn swickard

  1. We use the Fisher Scientific borosilicate glass tube cat # 14-961-26. it does not have this statement anywhere on the individual box, the carton or the website catalog description. We also write on them with Sharpies. Anyway - what does that statement "For Research use only. Not for use in diagnostic procedures." even mean? What context/use does the manufacturer mean? Have you found anyone to ask?
  2. We always get or have an historical Blood Type and frequently get the (roughly) 28 week antibody screens from our outpatients, but we do not require the antibody screen results before giving antenatal RhIG. On any of the numerous(!) positive antibody screens on Rh Neg moms, we always have to call and ask about the last known RhIG injections. With an ECHO - you can detect RhIG for months. We almost always get a Type and Screen for all new admits on L&D too - almost all of them who are Rh Neg have a positive antibody screen for anti-D. Much of our Rhig is now given in the Dr's offices and clinics. In the ER, we have a computer reflex test that adds the Antibody screen to any ABORh ordered in the ER that comes out Rh Neg. This has worked out well for our OBs because otherwise, by the time they see the pt and ask for the antibody screen - it is positive from the RhIG given in ER. We went to the hospital OB committee and asked to do this (once we could get the computer programmed to guarantee it would happen) and they happily agreed.
  3. If we have the pt's blood type in our computer records - that is what we use for pltph and FFP. We do not BB ID band for plasma - only RBCs. We are able to give type specific pltphs so rarely in this region anyway, this has worked for us. Of course - the Drs often order a Type and Screen or Type and Cross anyway when they want just plasma, so we frequently get a new specimen then. If we need a specimen for the Blood Type - it must be a new and unique (re-identified) draw from the pt - we will not share a prior Lab specimen for Blood Bank for an ABORh.
  4. Our problem would be to even get the pt phenotyped for k - we don't have the reagent and no other hospital in the area has it. Also, our local blood distribution system doesn't have it and we will be sending to a reference lab to get the phenotyping anyway. That said - these pts really worry me. It is going to hard for us to bring in DTT testing for the few pts we have, (absolutely no idea how many we would get in a year or in the years to come) but I am not happy not being able to see the antibody screen either. The reference lab that can do the DTT screen - wants to do a full antibody workup everytime they get the pt (not just the DTT screen)- that's expensive! Still working on the process here.
  5. My - how things have changed since this thread started in 2011. We no longer get a paper copy of the Dr's request - they now have to do electronic orders and we built several questions in that make them enter the justification for the transfusion. We do require them to bring a photocopy of the signed page of the Transfusion Consent form every time they pick up a unit. That has lead to 100% compliance with the signed consent form being in the chart (now all scanned in electronically). Even in emergencies - they know to bring a small pickup slip with a patient demographic label on it. For our Emergency Release form - we do eventually require patient demographics so we know who the unit went to. We can release without it, but require it later. As above (from mollyredone) if the patient was on the floor - we could enter electronically for uncrossmatched units because the patient will be in the computer. We are being pushed by the hospitalist physician's to give them uncrossmatched, Emergency Release blood too - very rarely I hope. The one time they thought we weren't "fast enough", we discovered that they did not even know that a STAT Type and Crossmatch takes about an hour and that there is no way to shorten the incubation time. We had to teach them the whole uncrossmatched, emergency release procedure and the correct way to request it and that they would have to sign the Emergency Release form as the requesting physician. We will have to see how that all goes, all of my techs know to offer "uncrossmatched" now if everyone is "excited" about the "blood is taking too long!!" In the past - Emergency Release only went to ER or OR and they were familiar with the procedure - the floor RNs had never even heard of it. Might be worthwhile to find out why the "floors" suddenly need your Red tag units. May be a training issue. Good luck.
  6. Apologies to all - this is, of course, incorrect. This would in no way replicate the molecular variations of the D antigen known as Weak Ds. Don't know where my brain was this am. I think my brain went back to what we did for validation of the Fetal Screen test when they brought out the newer models a few years ago. Again - apologies to all.
  7. Yeah - I knew that, but you are going to need a whole year (or even two) to get enough real specimens for validation without some help from a manufacturer or a reference lab - maybe?
  8. Best Theratronics makes one - the Raycell. We have used one for many years now. They are expensive and require dosimetry checks twice a year and the service contracts are costly, but parts would be very expensive. You do not need key security and fingerprints and photos of everyone or a locked (secured) room for one. That said - once it is set up correctly - FOLLOW ALL the recommendations for water temp and pressures and filter your water source too - it works quite well and has one service/maintenance visit a year. See www.theratronics.ca 1-866-792-8598 - company is in Canada.
  9. I can't think of a way to manufacture a true weak D specimen. Maybe try an RH neg specimen and add one drop of Rh pos cells until you get a weak reaction with your AHG phase testing, but still can't see it at Immediate spin - ??? Some manufacturers have a Weak D Pos cell for testing - but that would still take a while to have more than 1-2 donors.
  10. What kind of label verification are you referring to - donor labeling or bedside pre-transfusion labeling? Meditech has an entire Donor Module -probably something in there, but I don't use it so can't help you with that. Meditech has the BCTA module (bar-code enabled Transfusion Administration) for bedside verification of labels and pt ID before transfusion. Massive program with a lot of dictionary work and IT work - you would have to contact you IT units and Meditech for help with that install and set-up. Does that help?
  11. yes - I am after the basics - anything other than type specific - but still compatible. We have Magic HCA Medictech, version 5.6.7. thanks for your response.
  12. Does anyone use any type of spray cleaners? We tried a Virex spray and had to take them outside to avoid inhalation hazards!! Or just the wipes? What kind of tape? We have LabelMaker tape on ours with instructions and cooler ID #s - but no one time use type of tape for the pt's name. Only the units have ID on them - a paper label attached to unit. The cooler itself has no pt. name on it.
  13. This rule would apply if you were applying for ISO accreditation(? - not sure they call it that). ISO started in manufacturing firms and is a completely separate group of rules and inspectors. Your blood distributor may be ISO - I think United Blood Services is, in the states. The inspection would be with ISO qualified inspectors. and yes - it undoubtedly costs money to apply and be inspected and accredited.
  14. This is the way to go, because otherwise - as you correctly suspected - the 37C and AHG phases have no exposure to the plasma/serum with the alloantibody. you would have replaced it with non-reactive (one hopes) saline.
  15. You would think they would want the Iron values before the transfusion - not after it. That would be part of what they were basing a transfusion decision on. I wonder how long it takes for all of that to reach a stable state after the transfusion of 2 units? Not as fast as the HGB/HCT - nice article - thanks. We get that question all of the time - but not for iron values.
  16. If this is for Meditich 5.6.7 - could either of you share what you did to get it to warn when you are crossmatching non-type specific units? Meditech used to have it and then they took it out - last I was able to see. Never understood that reasoning! carolyn.swickard@lpnt.net
  17. Believe it or not - if you are in a hospital - check with your own pharmacy. Ours stocked glycerol in the pharmacy for use on dry skin.
  18. Well, you can see the reasoning with patients with rare, weird antibodies that never show up on even a 3 cell screen. Match your practices to the needs of your patients - it isn't a one practice fits all kind of service we do.
  19. Sorry - did not mean to pick up a quote - We send our molecular testing to United Blood Services reference lab in Tempe AZ and they send it on to a Grifols Lab in San Marcos TX - 855-600-7101. UBS said they had the best pricing and turnaround time. The Grifols report states RH genotype and UBS interprets it as to RhIg or not / Rh pos blood or not.
  20. And what part of the Red cell does this cross-react with? Anything like DARA?
  21. If you wind up sticking with paper - it might be faster if you use tagger guns to attach your paperwork.. These are the same type of tagging guns that are used for clothing labeling. You can get both the guns and the tagger tails from a place like Staples (Monarch SG Tag Attacher). Hold up and punch through the paper 1st and then go through one of the little holes on the unit (or very carefully, through some of the outside edge on the unit above the interior area) and then press the trigger. Works fine for us and stays with the unit. One word of caution; the needles - when new - are extremely sharp. I always take a new needle outside and dull it down by swiping it back and forth over some concrete walkway first, prevents finger sticks. Sounds gruesome, I know, but we have no troubles with the needles (after dulling) and have never harmed a unit.
  22. We are trying to get this started here, though we usually test the ones that are negative on the ECHO and then have a positive Weak D and are usually positive (weak) in tubes. Have sent out 2 patients so far, both came back OK for RH pos units and no RhIg.
  23. How does even the military keep a "Fresh" whole blood stock that would be any good for platelet or coagulation factor replacement? Maybe in the field it comes from live donors (what about testing??), but what about elsewhere? There is not a prayer for us to keep useful whole blood on the shelves, so we are doing the 1:1 RBC to FFP ratio for a massive transfusion protocol also.
  24. I seem to remember being required to do yearly QC on microwave thawed units involving measuring several coagulation Factor survival levels (probably VIII and IX?) - is that still required? Do you still have to send out this QC once a year on a microwaved thawed unit to keep your unit validated?
  25. We have begun to see recommendations to give phenotype specific units for Rh and K to patients with warm autos - is that a new recommendation that is gaining ground and would that help the patient?
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