jhaig

Viewing this situation from the outside, this sounds like trouble waiting to happen. This is a much larger can of worms being opened by this facility. At a very minimum they need to consider having a blood bank employee as an integral part of their team ON SITE to handle their transfusion needs. What happens when a surgery goes bad? Your 2 O neg's may not be enough. If your main blood bank is 25 miles away, a patient could find themselves in real trouble. That's assuming there's no antibody problems. Picture an OB patient going into DIC and having no cryo, platelets, PC's or FFP immediately available. I don't know what kinds of surgeries you're looking at, but anything can happen. Your O.R. needs to consider a lot more that just having more blood ready. Your administration should be concerned about this setup.

STAT XM - 60 minutes, but usually finished in 45 minutes. STAT Type and screen (after receipt into BB) - 45 minutes, provided there's no antibodies or other problems. Keep a "fudge factor" of about 10-ish minutes for paperwork, phone calls, etc. Plus, getting things done before your deadline makes you look good:cool:

If you have a properly maintained and reliable cell washer, you'll never want to be without it. The manual method leaves too much room for either error or variation. What model do you have?

I'm a recent SBB failure - does that count?:cool: Anyway, I took the exam and did not pass on the first try. I made a couple of mistakes: a) Not having an actual med tech degree but 16 years experience, I thought 6 months of self-study would be enough. WRONG. see above Some of the questions were so obscure and so irrelevant that I almost think no amount of studying can accurately prepare you for this horrible exam. Yes, you'll need to know the technical manual inside and out AND standards (yes, they're as dry as my grandpa's scalp), but also you need extensive knowledge of ALL major and minor antibody groups. And this is only the proverbial tip of the iceberg as far as 'book knowledge'. I found that most of my questions had nothing to do with daily blood banking. It was mostly about things most blood bankers will never see in the course of routine hospital work. I do understand it, though. By passing the SBB, you are held to a higher standard and are considered an expert in the field. So before I take the test next time, I am considering enrolling in a study course to help pass. I'll be looking for helpful hints as well since the exam chewed me up and spit me out the first time. But next time will be different!:mad:

Even though I haven't got my Echo yet (and may not get it at all), I've prepared for training our generalists. I have no worries about them getting it. Most of them were here when we switched to gel many moons ago, and I have no doubts about them being able to handle solid phase. If anyone has proven to be adaptable to changing situations in this crazy health care industry, it's the med techs. Don't sell your generalists short. And even if they have trouble, you can threaten them with morning phlebotomy rounds. They'll learn it real quick:cool:

Our PA's order blood products at our facility, but I've never seen a blood bank order from a nurse practitioner. I'm not sure on our actual state regs, but PA's do it all the time.

We have transfusion criteria for transfusion of RBC's which states that any patient with a Hgb of 8 or less or a Hct of 24% or less get transfused without question. Patients with a Hgb of 8.1-9.9 or a Hct of 24.1%-29.9% can still get blood, but will be reviewed concurrently. Any patient with a Hgb of 10 or more or a Hct of 30% or more that is not either actively bleeding or in the O.R. need pathology approval for RBC transfusion. We have just opened a new dialysis unit and my question is: do dialysis patients need to follow the same transfusion criteria regarding H&H levels or do they fall into a different category?

For traumas we have 2 units of designated, uncrossmatched O neg in the fridge. In a trauma, we grab the units, an emergency release form for the doc to sign, and we're off to the races (our ER is two floors down and no pneumatic tube system). So far my best time is 47 seconds:cool: If somebody is bleeding out so bad that they need an emergency transfusion, the doc's not going to be worried about antibodies anyway. Antibodies concerns are secondary to keeping the patient alive.

I did the same thing a few years ago when we got Meditech. The only thing off of the cards I entered in were patients with known antibodies or other transfusion issues. Just manually enter the patients that aren't already in the system, then stick the cards in storage. You won't miss 'em.:cool:

There isn't any benchmark that I know of that relates to rate of expiration of RBC units. It depends upon your institution's usage, patient population, and other factors. A couple of questions first: 1) How big is your institution and how much of each blood type do you keep on hand? 2) Are you expiring more of a certain blood type? 3) Does your supplier credit you for units that expire at your facility? We are a 290 bed facility that transfuses around 2500 units a year. We expire less that 50 units annually. At this time, we do not stock group AB or B negative since patients with these types would receive alternate groups. Our rate of waste would increase if we kept rare types like B neg or AB on hand.

Gel cards for antigen typing sounds nice, but nothing's stopping Ortho from raising prices on those cards if they see people switching over to them. What anti-sera do you keep in-house? We eliminated keeping any anti-M or anti-S because we rarely see them in our lab. I'm not spending $1000+ for a 5-ml vial of anti-S just to watch it expire. Let the reference lab do it and charge me as needed. You could evaluate your patient population and eliminate some anti-sera, altogether ("You could evaluate your patient population and eliminate some anti-sera" - sorry, "Airplane" reference, if you've seen it, you'll get it):cool: We only do front types on our ABO retypes and have never been cited, but I guess I should double-check our regs. as well.

I had a situation very similar to this just recently. A patient came to the ER actively bleeding from esophageal varices and received 5 units of uncrossmatched O neg. It just so happened that he had a history of anti-Jka and three of the units transfused were (eventually) typed positive for Jka. We monitored the patient for a possible transfusion reaction, but nothing ever happened. He probably went through such a large volume of blood that there was no time for a reaction to occur. The priority is getting the patient volume, either by packed cells or crystalloids. Transfusion reactions can be dealt with once the danger has passed. It never feels right for a blood banker to give out least-incompatible or known incompatible blood, but sometimes you gotta do what you gotta do to save a patient's life.

I can think of two reasons why we do it: 1) We use the Ortho 0.8% Resolve A. The package insert says to run an autocontrol. 2) Rule out auto agglutination seen in CAD, WAIHA, multiple myeloma, etc. Other than that I don't think it serves much purpose...

It seems like there would be less confusion overall by keeping the patient Rh-negative. You've got to watch Meditech - it' sneaky and thinks it's smarter than you:cool:

I wouldn't expect anything at least until later in 2009, if you're lucky. Quite frankly, the ARC's lack of communication with their facilities in regards to ISBT is a little distressing. Having to get ready to implement a huge change in our blood banks with little guidance from the mothership doesn't inspire much confidence. Our individual facilities need to be ready, yet our supplier doesn't. Hmmm... We have bought an ISBT printer, the software is in place, and we only need to do validations. The ARC has also been unable to provide us with materials and/or labels to do validations. I've got some barcode examples from the ICCBBA website, but are there any other places I can get actual ISBT labels to perform validations?

It looks like the automation (and financial) gods have looked poorly upon my institution and the Immucor Echo will not be coming to my department any time soon. So.... I need to evaluate another antibody ID panel to try and reduce the number of reference lab send-outs we do. Right now we use the Ortho 0.8% Panel A and use the Immucor Panocell 10 as a backup and for rule-outs. I want to replace the Panocell 10 with either the Ortho Panel B or the Immucor Panocell 20. The Ortho B would be the same methodology as we use now and has an RzR1 cell so I can rule out Anti-E from Anti-c. Panocell 20 would give me more cells to rule out on, but is also more expensive. Any thoughts on what direction I should go?

We just had a patient taking WinRho for ITP last week. The patient was O Pos with an Anti-D. There was some initial confusion until we saw the diagnosis. I think it's also possible to carry an autoantibody with Anti-D specificity, but I've never actually seen this. Partial D is also possible, but unless you have the correct anti-sera for testing, you may never know for sure.

We get massive transfusions so rarely that any type of review wouldn't be feasible. However, our protocol states that, after every 10th units of packed cells transfused, the patient is to be drawn for coag profile (PT, APTT, FIB, platelet count), K+, and ionized CA. A full summary of the incident, including chart review, is to be done by the blood bank supervisor, reviewed and signed by the pathologist, and reviewed at the next transfusion committee meeting.

From all of us that complement random strangers on the quality of their veins for blood donation and consider Lutherans as antibodies instead of church-goers, welcome:cool:

Well, I had my CAP inspection today, and my only citation was for this standard TRM.45268. I called CAP and they indeed said that this standard only applies to products that will yield a platelet product. The standard is going to be clarified in the next CAP checklist revision. If an inspector cites you for this standard and you don't collect blood for platelet products (such as only auto donors, like we do), you can formally contest the citation and CAP will remove it.

Weekly topics for educational purposes are great, but questions to go along with them might start to wear on some people. As long as they're informational info only, sounds great. I'll assume that these questions would not be required for competency. A Lutheran, huh? Most antibodies we get are non-denominational:cool:

Got it. It'll take a month of Sundays to go through it, but I need something else to do anyway. Thanks.

Does this apply to auto donors or to allogenic donors? I've never heard of diverting volume from an auto donor.

Sounds good. Send it to St. Joseph's Hospital, Elmira, NY 607-737-7019, attention Blood Bank. Thanks a lot.

Anyone have a link to the JCAHO info? I sure could use another migraine...