jhaig

Many JW patients will accept their own blood via a cell saver because it is never exposed to the air. Our facility usually will work with each individual patient and work out a customized plan for their care as it pertains to blood products. Some JW's will accept blood products, and some will not. I've heard of things like "If it's yellow, yes, if it's red, no" but that doesn't necessarily pertain to all cases. It is very much an individual's choice. The few JW's we've worked with say that members that accept blood products will not be ostracized as it is widely believed. I would say to have the cell saver ready, make sure that the patient's directives are widely known and present on the chart, and consult with the surgeon to discuss other bloodless options (IV therapy, hemodilution, etc.).

We run full IgG gel crossmatches on any patient with a positive antibody screen that is going to be transfused. How does this affect single vs. double dose rule-outs? Will a full crossmatch lessen the need to rule out on homozygous cells only?

Same problems here in upstate NY. It seems like every third lot or so I get some type of 'scratchy' results, usually only one cell in the Ortho A and B 0.8% panels. I've also seen it enough in the pre-diluted screening cells, so I've looked into switching to Immucor's Panoscreen cells. These have to be pre-diluted to use in gel, but it's pretty easy. So far, I've run 50 patients with known antibodies and have had excellent correlations. Dumping Ortho's 'improved' formulations could always be an option. Any else have experience with Immucor's Panoscreen cells?

Did anyone see a recent "House" episode where Dr. House obtained a urine specimen by jabbing a screaming patient directly in the bladder? Maybe he was trying to cut costs by not using those expensive catheters. Reminds me of my old lab manager who was so frugal he would centrifuge pens to save every drop of ink.

Sounds like a pathologist issue to me. I'd evaluate the patient for post-transfusion hemolysis (haptoglobin, LDH, urine dipstick) before any Rhogam would be considered, male or female. We probably wouldn't waste Rhogam on a male patient anyway. Make all the Anti-D you want, buddy!:cool:

This is all handled outside of the blood bank. The emergency physician must make the call and check for any directives either on the chart or from the patient's family. We get the physician's signature before any blood is released on the blood bank's emergency release form or we'll get the signature from the physician after the emergency is over. Any other consent for transfusion is obtained by nursing.

This may sound like rambling, but I'm in rare form today, so here goes...:mad: Boy, this sounds like a whole bunch of trouble which you don't want any part of. Set aside the regulatory issues, procedures, inspections, etc. They don't want their patients coming to your facility, but they want you to provide transfusion services? What about patient care? I don't know what kinds of surgeries they will be performing, but what's going to happen if one of their surgery patients goes into DIC and they need plasma, cryo, and platelets? They'll want your help then, I'll bet. Unless they can come up with a blood banker on staff to handle the multiple regulatory issues, inspections, and so on, I wouldn't make any committments. I wouldn't feel comfortable with any type of satellite set-up unless the other facility has a dedicated blood banker that can be relied upon to handle pesky matters like antibody identification (which you say they have no idea about) and everything else involved. I'm actually amazed that the Red Cross has allowed them to store blood on site without any evidence of written policies or procedures.

Absolutely. Once a patient develops an antibody, you always need to give that patient antigen-negative blood for that antibody. Otherwise you could stimulate production of that antibody again. Full crossmatches are also necessary. This is especially true for Kidd antibodies which are notorious for 'disappearing'.

I wish it were that easy. It would be fantastic for every phlebotomist / tech to draw the right patient the first time, every time. Anyone that needs multiple reminders that a misdraw could lead to a patient's death should find another line of work anyway. But I don't see a redraw as a further complication. I see it as a necessity to ensure that the right patient has been drawn. Why not take an extra step to prevent possible complications and enhance patient safety? Our hospital's risk management and medical exec. committees fully endorsed our redraw policy and it has worked out great, not to mention that CAP may require it in the future. Everyone should be accountable for their actions and for following protocols as they are written. But by the time someone is held accountable, the damage could already be done. Save some room in that pasture. If I can find a way to retire at 39, I'm there:cool:

Our policy is as follows: Any patient that is to be transfused with blood products needs to have their blood type verified by two separate draws at separate times, preferably by separate phlebotomists. If the patient has a verified blood type history in the computer, that counts as the first type. If there is no history, then the patient needs a separate draw. Many times the hematology department has a tube we can use from a previous draw, so our actual number of re-sticks is minimal. If there is no time to get a redraw, the patient is given group O products until we get a second draw. As far as your O.R., a fingerstick would work just as well. Explain to them that it is a patient safety issue recommended by the lab's regulatory agencies and be sure you have your pathologist on board with your new policy. I'm sure they'll see it your way:cool: I wouldn't have a different procedure for hand-helds vs. non-hand-helds just so you can keep everything the same for every draw. The idea is to have two specimens from two separate draws so you can verify the patient's blood type twice before transfusion. Just because your hand-held read the barcode on the patient's wristband doesn't mean that the band is on the right patient. Another set of eyes doing a second draw will take care of that.

Ruling out using negative cells is the way to go. You want to get rid of any panel cell that is positive to effectively "rule-out" that antibody. Also, it is preferable to rule out using homozygous panel cells for Rh, Kidd, Duffy and MNS groups. Kell groups are tough to rule out based solely on a homozygous cell. With Kell, and certain other groups, several heterozygous rule-outs should be fine, especially if you have a clear pattern on the panel and a good idea of what the antibody ID is. Other low frequency antigens, like Kpa, Jsa, Lua etc., usually can't be ruled out because of the lack of reactivity. But every patient is different and I've been fooled before. Rule-outs will usually give you a very good idea of what you're dealing with, but they're not fool-proof. Take it from a fool...:cool:

Is there a limit to how far are you allowed to travel to an assessment?

I remember that one. Wonder if the people involved kept their jobs:cool: Usually 'ER' and 'CSI' get it right because they have actual medical consultants. In fact, I remember a CSI episode a while ago where a murder suspect was a genetic chimera. I remember it because it was one of the few episodes where I called the diagnosis before the end of the show...

I have some information from the AABB website on becoming an AABB assessor. I was hoping to talk with anyone who has become an assessor about how they did it and what it takes to become one. Any info will be greatly appreciated. I'm sure I'll have some intelligent questions as well as some stupid ones, too. Thanks.

I was watching the movie "Bruce Almighty" this weekend and found a glaring error involving a blood transfusion. For those who haven't seen the movie, Bruce had just been run over by an 18-wheeler and woke up in the hospital. He was receiving a transfusion of AB Pos RBC's. The problem - the unit was hanging upside down as it was being infused, but the unit's AB label was rightside up. Of course, this was so the viewer could easily read the unit's blood type. But seen through a blood banker's eyes, this was an obvious error. So I was thinking - are there any other ridiculous errors in movies or TV shows that you have seen that show blatant, and sometimes hilarious, errors involving blood? Yup, it's a slow day here today...:cool:

I have heard of many blood banks now taking over their institution's tissue departments. Our O.R. and Medical VP has suggested moving the tissues into our blood bank. Is this part of a national trend? Is it because they (whoever THEY are) think the blood bank will do a better job keeping up with regulations, especially since we are used to keeping up with all of the various regulatory agencies? Maybe I've been out of the loop on this one, but the blood bank does seems like a good place to handle tissues (job security:cool:)

Is it possible that these reactions are caused by complement or an IgM? If I remember right, Lewis groups are almost always IgM and their reactions can disperse at 37C.

Why is your supplier so worried about expiration dates? The 5-day limit has been is use forever and it's not like they're going to expire on your shelf. They're going to be used so there should be no concern about the units going to waste. I was going to mention splenic sequestration, but I was beaten to the punch:D

The only way someone would need blood for a tonsillectomy / adenoids is if the surgeon accidentally drops his scalpel down the patient's throat. Don't even bother with anything more than an ABO/Rh for these patients.

Is the patient refractory? Have you done a corrected count increment (CCI)? You could also set up a standing order with your supplier if getting the correct product is an issue.

Same here with my Ortho rep. I was doing comparisons between the Immucor Echo and the Ortho Provue and after mentioning I had done a site visit with the Echo, I was contacted by my Ortho rep (this was news because I didn't know who it was to begin with) about seeing a Provue in action. I had given the rep dates of availability and waited for a reply. Well, I'm still waiting. My attempts at e-mail and voice mail have been in vain. I'm not going to go chase them down either. If Ortho wants to sell me something, my number's in the book:cool:

I see the info in the Circular, but the AABB manual seems to contradict this statement. On pg. 530 of the 15th edition of the technical standards, it states " AABB Standards for Blood Banks and Transfusion Services and the Circular of Information for the Use of Human Blood and Blood Components are explicit in stating that medications must not be added to blood or blood components". While it also goes on to state that other solutions may be added as long as they're cleared by the FDA, the AABB manual seems to prohibit medications being added. Is this a matter of semantics or an actual rule and what are we supposed to go by?

Good luck in retirement, and don't forget about those of us who have to work more years than we've been alive to even sniff retirement:cries: And don't forget about the optomistic blood banker's outlook on life: B Positive

I understand your frustration about this CAP requirement and need help. That's what we're here for. To me, mistyping a sample is the same thing as misidentification of the patient. The sample and the patient have to be correct or you're going to have a problem. A historical blood type counts as the first 'type'. A current specimen on the same patient can be used as the second type. To address this requirement, we adopted a policy to re-draw patients for a second sample drawn at a separate time if the patient does not have a historical blood type on file. If the patient has a specimen in another department which is correctly labeled, we can use that specimen for the second specimen. If there is no time to get another specimen, the patient would get transfused with group O until a second specimen can be drawn. There have been many threads with long discussions regarding this new CAP requirement which you may find very useful in this forum.

As of right now we have wasted 66% (23/35) auto units collected. Almost all of these patients were either knee or hip replacements. I did a study 2 years ago involving the rate of transfusion in relation to the patient's pre-donation Hct level. In patients that had a pre-donation Hct of 40% or greater, 92% of their auto units were discarded. This fell on deaf ears and the program's numbers have continued to decline. Is there any incentive that I don't know about for administration to hold on to a program that is not viable anymore? Other than it's one less patient service to offer, when do we cut the cord on this thing?