rcurrie

Mabel, the false positive FBS comes from crosslinking of the mother's antibody-coated cells, not due to a reaction with the indicator cells. It will look just like a rosette under the scope. You can use a sample of diluted mother's blood to help you tell the difference. It is a form of negative control, except you don't add anti-D or indicator cells, which could have the antigen to which the antibody is directed. If you see the same number of "rosettes" on the untreated patient sample, you probably have interference due to the positive DAT. Happy New Year, everyone. I was engineer on the New Years Eve special last night, with about 200 revellers aboard. I have run the New Years Eve Special as engineer or conductor for the last 5 years. I learned quickly to mark up as engineer rather than conductor. Although I don't get all the good food that the conductor has access to, as engineer I don't have to deal with the over-indulgers. BC

I wonder how the trauma data square with cardiovascular surgery data that suggest improved outcomes when you chill the patient? Mark Twain had it right about statistics. BC

Mabel, remember- we are talking about a neonate, so there is no further concern other than the antibodies already in the baby's circulation. We don't care what the mother's blood type is, or what antigens she has. Our only concern is with circulating antibodies directed against the baby's antigens. BC

John, I don't have access to it any longer, but I had an article provided by my Terumo rep at one time. Ask any label company if their adhesive is approved for direct attachment to blood bags. If you are talking to the right person (i.e., not that high-schooler hired to answer the phone, but someone with knowledge), I don't think you will find anyone who can say "yes" other than Shamrock (which makes approved pre-printed labels) and similar companies. BC

About the only things I saved when I resigned were the SOPs I wrote and my teaching materials. However, there is mention of not using blood warmers routinely in the AABB Transfusion Primer, which can be downloaded from the AABB site. BC

Anna, I can't, but maybe someone else on this site can. I retired from the laboratory medicine business and went back to work for the railroad. BC

Let's reason this out. Wouldn't your concern be for circulating maternal antibodies? If so, then it makes no difference that I can think of if the mother is biological or surrogate. BC

I am here- I do not think you will find anyone willing to say their label adhesive is approved under FDA regulations for direct blood bag contact other than those who have pre-printed labels especially made for blood bags. That was one of the last problems I dealt with before going back to work for the railroad. So, we use the tie-tag for the labels we attach. The issue is leaching of adhesive chemicals through the blood bag into the blood. Apparently, the issue is real rather than theorized. BC

There is a nice little AABB book that has all of the FDA regulations in it. It is a nice reference, although it would be even better if it had an index (it is just a compilation). It costs around $100 and is a good investment. BC

Obviously they misinterpreted the literature if they warm all blood for traumas. Too bad. BC

I suppose you could check the total protein of the donor plasma to verify that it is low. Some of my very old donors reverse typed weakly. But, I don't see that as a reason to exclude a donor. BC

They sure have, John- now I am dealing with the FRA instead of the FDA. BC

My advice: keep the panels. They may come in handy when a patient develops a new antibody 10 years later. This policy has helped me many times. BC

Back when I was a bloodbanker, we did the same thing. We created a deferral code in our computer system (SafeTrace), sent the donor a letter explaining why they can't donate, and deferred them permanently. I was the lab director of a lab that (I have been told) was the first lab in the Great State of Texas to become 100% leukoreduced. I noticed way back in the early 90's that many filtration problems were associated with donors who were positive with the hemoglobin solubility test. I mentioned that to the filter manufacturer, Pall, and was blown off. Oh, there couldn't possibly be a link between sickle cell trait donors and filtration problems. BC Workin' on the railroad, all the live-long day

On one of my last observations before I changed careers (again), I noticed that the ICU nurse transfused not only through a blood warmer, but also through a rapid infuser. A unit of RBCs was squeezed into a normovolemic patient in about 15 minutes. I happened to get there just as the transfusion was ending. I questioned the nurse, and she said it was common practice in the ICU to transfuse through a warmer and using a rapid infusion. I told her all the reasons why both practices were dangerous, and my warnings were duly noted using the nursing method (in one ear, out the other). About an hour later, her patient went into acute respiratory distress. We worked up the reaction, and the medical director called it circulatory overload due to rapid infusion, with moderate hemolysis due to rapid infusion and use of a blood warmer. I am SURE this was an isolated incident. ;-) BTW- I have already had my first surprise FRA inspection. Just as with my FDA inspections, I knew the inspector well, and I knew the regulations well. As we say on the railroad, "No defects found." BC

Welcome to Temple! I will try to stay up with what is going on in blood banking, but the longer I am away from the blood bank, the less I will remember. Thus, my opinion won't be worth much after a period of time, as things change. Plus, I will be quite busy with my new job. You will probably run into Patti at KDH- she used to work there full time, but jumped ship and came to work at S&W in the blood bank. She still works at KDH parttime, though. You may want to see about working PRN at S&W. There are so many S&W people that work parttime at KDH and vice versa, it is almost like family. BC

Thanks, Karen. I consider myself to be average-but-hard-working rather than brilliant ;-) BC

Good luck with the validation, Bev! I always dreaded new installs and upgrades. In my new position I am going to have to worry about upgrades to our our high-speed train control software. We don't want two 90 mph passenger trains running toward the same point from different directions! BC

No problem! I am still here- just running trains instead of a blood bank QA department. I am definitely going to keep my certification current, do CMLE, etc. Thanks for your kind words. BC

Thanks, Mabel. Sure- ask away. If I don't know it off the top of my head, I can probably put my fingers on it quickly. BC

I will be working for Veolia Transportation. Veolia is the contract company for Capital Metro in Austin. We will run the commuter rail system and the freight rail system (with Watco as the freight subcontractor). Watco took over freight operations last month, and I was part of that process. I will train the commuter train operators and dispatchers (called rail controllers in commuter rail terminology), and be over the rail controllers once the operation begins full time next year. My responsibilities are supervising field supervisors and operators, training, special projects, troubleshooting, and general operations control. I have been a certified locomotive engineer for 35 years, running high speed freight most of the time, and passenger trains for the last 6. I have run high speed passenger trains at 90+, and had a turn at the throttle of our 150 mph train between Baltimore and DC. Here is a link to Capital Metro's website telling about the MetroRail commuter service. http://allsystemsgo.capmetro.org/capital-metrorail.shtml Watco will operate as the Austin Western Railroad: http://www.watcocompanies.com/Railroads/AWRR/AWRR%20main%20page.htm I also run excursion passenger trains: http://www.austinsteamtrain.org You can see some of my pictures on my blog: http://locomotiveengineer.blogspot.com/ I am more well known in the railroad industry than I am in blood banking. I have been the engineer in several movies, including Smokie and the Bandit II with Jerry Reid and Burt Reynolds (I give Jerry Reid top billing because he came up on my engine to talk to me and ask questions, while Burt stayed in his trailer) and more recently Infamous, with Sandra Bullock, who rode with me and talked to me for several hours about Jesse James' little railroad he has on his property. My train is seen in two scenes in the movie- once when Sandra Bullock as Harper Lee comes to "Kansas" (it was filmed outside of Elgin, Texas) to stay with Truman Capote while he wrote In Cold Blood, and once when she left "Kansas." Anyone who comes to Austin should look me up and come ride on my passenger excursion train, the Hill Country Flyer. BC

Thanks, everyone. I will check in from time to time. I have BloodBankTalk in my favorites, and always check for new posts before I shut my computer down at night. John, you may have something there. I would make it a turn-around local. We collect blood on one leg, do component prep and testing, then on the return leg drop it off to hospitals that need it ;-) If only it were that simple. This is a great group of dedicated professionals on this site. It has been my pleasure to be a part of it. BC

Well, folks, I have been in the laboratory medicine business for 17 years now, and in the blood bank for much of that time. But, as many know, my background is railroading, and I have been an active locomotive engineer for 35 years. I still run passenger trains on weekends. The railroad has called me back and made me an offer I cannot refuse. I am going to be rail operations controller for all passenger, commuter and freight service in Austin. My hospital has always undervalued medical technologists, and they could not even begin to match half the salary I will make working for the railroad. I will also work less hours than I have at the hospital. This is ironic because the main reason I took early retirement from the railroad was because of the long hours and the many nights I spent away from home. But, under federal law, rail controllers can only work 9 hours a day. As a locomotive engineer, I can (and did) work 12 hours on, 8 hours off, up to 365 days a year. So, it is with regret that I bid farewell to bloodbanking, which I do love, and to all the fine people I have talked to over the years, many of whom are members of this site. I can be reached at my home email: rt.currie@gmail.com . Best regards, Bob Currie

No. It is not a consideration for us at all. BC

Our medical director gives a pretty good consultation for each antibody ID (he is RGU-aware). He mentions percent compatibility in the general population as part of the consultation. The doctors love it. BC