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Posts posted by rcurrie
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You need to talk to your Medicare intermediary regarding these types of charges- no one here can answer this for you.
You may give short units of anything to an adult as long as the physician is aware that what they are getting does not meet the full potency standard required by the FDA. For instance, we collect platelets. Units that do not meet potency QC (3.0 x 10e11 platelets for an apheresis unit) are used if the physician allows it. On days when we run short on units that fully qualify, a physician may well decide to use that ABO-compatible unit that QCd at 2.9 x 10e11 platelets.
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We did a study on K+ as units aged, and found that 5 days was the maximum storage time we could risk on our preemies. We use CPD blood for our preemies- no adinine, which can be toxic to the kidneys when they are multiply transfused. How to keep using the same unit without worrying about K+? Simple- wash the aliquot.
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Of course, the patient plasma you use for unit screening needs to be reactive. Otherwise, you must use commercial antiserum. I always test the patient's plasma against a cell with a single dose of the antigen. If it is reactive, I trust it for screening. When I find units that are negative with patient plasma, I then test the unit with commercial antiseum to be sure it is antigen negative.
I think most of us long-time bloodbankers have had patients who hemolyzed and when we investigated we found a missed antibody due to the titer dropping off below screen detection level. So, there is always the chance that a patient with a negative screen has an underlying antibody just waiting for antigen exposure. Plus, if you transfuse enough blood, you will dilute out the antibody and have a delayed reaction if the antibody was missed on the screen.
That full crossmatch is just about worthless after you have transfused a full blood volume. We don't even bother- we just give antigen negative blood and go with that.
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My medical director, who is as skeptical as I am about the vaidity of Chagas testing, suggested a letter along the lines of the following:
Dear Donor,
You have tested positive in a screening test for a South American parasite that has never been proven to manifest itself inside the United States. There is no licensed confirmatory blood test for this parasite. We recommend that you present this information to your personal physician so that your health may be followed more closely should you be truly infected with this parasite, Trypanosoma cruzi. If you have any questions, please contact me at the number below.
Sincerely,
Sol Solly, MD
Phone: BR-549
If you choose to offer the RIPA, then you can ask the donor to come in for that test at no charge to the donor.
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In SBB school we were given 10 lashes with a transfusion set for saying "Anti-Kell". Kell is a system, not an antigen.
That said, there just aren't that many K+k- cells floating around on the average panels (or screen sets, for that matter). Whenever I have had an unidentifiable antibody (that is, everything ruled out on the panel), I suspected anti-E or anti-K, and went from there by unruling out E+e+ and K+k+ cells to see if either antibody was still possible. Usually, it was one or the other in the final outcome.
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yes we are fussy about everything. the thing is that CAP requires a leak proof bag.
We draw our blood into Terumo bags, and I have yet to have one leak ;-)
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Heck, Liz, you don't have to use any bags at all, let alone clear bags.
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Hey Patti,
Glad to see you in this forum. Since I am no longer in the Blood Banking business, I pass the QA baton to you.
As far as the FBS discussion goes, my guess is the anti-D is cross-reacting with a determinant on WBCs. As most of us old heads know, washing is quite an effective method of removing WBCs. Difficult pregnancies often result in high WBC counts for the mom.
BC
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Liz' suggestion is great, as long as you confirm reactivity on a "heterozygous" control cell. Some antisera do not store well (thus the expiration date).
I always used patient plasma to help with the screening when I had a lot of it. The positively reacting units can be eliminated quite quickly that way. It doesn't matter how diluted the patient's plasma is- you are only eliminating positively reacting units, not interpreting the units as compatible. Any that do not react with patient plasma can be tested with the appropriate antiserum.
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The Technical Manual says "preferably within 1 hour after delivery".
I had a PA (pediatric practice) deliver here who made us come back and redraw her because we got our sample about 50 minutes after delivery and she insisted upon 'exactly' 60 minutes post delivery of the placenta. Whatever - we aim to please!
Smart Alec Me would have had to ask what about the word "within" she didn't understand.
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We tried similar letters. The physician's nurse always answered with something like:
1. If Dr. Smith said she needed it, she needed it
2. Doctor's orders- always good enough for me, what's the blood bank's problem
3. HIPPA (not HIPAA) won't let us answer this inquiry
So, our medical director always dropped a dime and made it personal.
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I am with Franklyn on this. Quartz watches and clocks are so accurate, that unless it is completely defective, as long as you scrub at least 30 seconds you are good. I had an FDA inspector tell me I needed to do calibration checks on our donor room clocks, and I said "show me where it says this." She was unable to find anything. Case dismissed.
Don't make the mistake of saying that you will scrub for 30 seconds. If your SOP says that and you scrub for 31 seconds, you are not following your SOP.
BC
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Well, I am now out of the blood bank business and running high speed passenger and freight trains for a living, but we collected our own blood, and we usually had about 100 O neg on the shelf and an additional 250-300 O pos. Not bad for a town of 55,000 people.
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I always wanted to do a "lesion of storage" study, but never had the time. You could look at 2,3-DPG depletion, hemolysis, cytokine release from dead WBC, etc.
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There are lies, damned lies, and then there are statistics. My old hospital still uses the "first in, first out" method. My medical director refused to be intimidated, and said the study was not conclusive.
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Back when I was Blood bank QA instead of running high speed passenger and freight trains, our compatibility tag was 2-part. The nurses documented start and stop times, vital signs, whether a warmer was used, and how much blood was transfused. They were filled out correctly about 33.275 % of the time (rough estimate). My blood audits were 10 RBC units a quarter, 5 SDP units a quarter, and random audits of cryo and plasma. The FDA was happy with that.
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Rh immune globulin is definitely no guarantee you won't develop anti-D, just as the flu vaccine is no guarantee you won't get the flu.
No one said that RHIG only detects fetal cells. It will attach to certain weak D cells as well. Although there are several theories as to how RHIG works, there is no evidence that any one of the theories is the only reason for prevention of immunization. I do not subscribe to any one theory.
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How did the baby have enough maternal anti-A,B to react with the transfused cells, but not have ABO HDFN?
Mabel,
That baby was such a mess we couldn't tell much of anything. On top of that, the baby was transferred to Dallas, and I never did find out the final outcome.
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The DAT was moderately high, with the maternal antibody titers through the roof- in the 10,000 area. There were multiple intrauterine transfusions and a couple of exchange transfusions upon early delivery. Mom had anti-D,-C (not G) and -K. Baby had all antigens. Erythropoiesis was apparently depressed by the anti-K to boot.
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The DAT was 2-3+, and the plasma was dark brown from all the hemolysis.
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I seem to remember a CAP Q Probe with such data collected and distributed.
Some blood centers have gone to a "no double stick" policy, with surprisingly good return rate results.
That 2% QNS rate is a pipe dream- be happy if your rate is less than 5%.
The adverse reaction rates seem high. If your rate approaches that rate, then you need to look at programs aimed at reducing the rate. One way to reduce the rate in blood donors is to have the donor drink some water within 30 minutes of donating. Another is to keep the donor's mind occupied. TVs do a good job of this, as do chatty phlebotomists. With your apheresis donors, if your rate is high it could be that you are adding too much citrate or at too fast a rate, or you are not replacing fluids fast enough. Citrate reactions appear to be enhanced when the fluid return rate is not high enough.
RR rates depend on the donor population. You will see rates rise as your first time donor rates rise, especially if you use mobiles and go into a new collection area. If you do not do your own testing, your testing lab should be able to give you some cohort statistics. Sometimes the rise in RRs is due to entering a new collection market with a high percentage of first time donors, but you may also see a rise whenever there is a new lot of testing reagents, indicating a QC problem with the reagents. I have seen this problem occur several times.
Anyway, those are the experiences of this locomotive engineer.
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In my previous employment in a level 1 trauma center, we switched blood types ASAP in adults with no ill consequences ever noted. As Abdulhameed noted, there is so little plasma in our packed cells these days that whatever anti-A,B is there is just insignificant, regardless of the number of units given to an adult. We transfused about 20 pedi units a day in our neonatal and pediatric ICUs, and we always used O cells with no ill consequences. However, within the last year or so, a less-experienced tech swapped to type-specific in a patient with HDFN, without crossmatching to AHG, and the maternal anti-A,B was still high, with disasterous consequences. The baby lived, but it was touch and go for many days.
On a side note, I have joined Ex-Bloodbankers Anonymous. It has been 136 days since my last crossmatch . . . .
BC
Workin' on the railroad
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We use irradiation when GVHD is a concern, as is recommended by the Tech Manual. We would never rely on leukoreduction to prevent GVHD, especially when you can have up to (but not including) 5 x 10e6 leukocytes in a unit of blood. That is way too many to be relied upon to prevent GVHD.
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Gil, isn't that the Tech Manual that also said that there is no evidence that AIDS is transmitted via blood transfusion? :-)
BC
To have or have not a blood bank wristband
in Transfusion Services
Posted
Anyone who thinks that a "scissor-proof" armband will slow down a nurse bent on removing that band is sadly mistaken. A cast remover makes short work of such.
I have worked in two different trauma level I hospitals. In both places we kept nearly 1000 units of blood on the shelf and never expired anything except AB+ units. As soon as special blood bank armbands were no longer required, we discontinued the process at both institutions. I am against requiring a special blood bank armband. It is a hindrance in urgent need situations such as trauma centers. Do it right once and you don't need a second arm band.
Twice as an inspector I have found patients with arm bands with different names. Places like this couldn't get it right if they required 3 armbands. It's all in the training.
BC