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Posts posted by rcurrie
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I would tell him that studies often lead to improvements in products, but clinical trials must come first, and when the trials prove that the proposed change is more beneficial than it is harmful, and the cost to benefit ratio is on the side of benefit, then we may see changes in the way we store blood. Until then, the menu is still the same.
BC
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I haven't been informed to announce that I am coming an hour in advance when I inspect a lab. They know we are there when we walk in the door. But, I don't expect the same type of amenities we used to get for scheduled inspections. I am quite prepared to work with no lunch or anything else provided, but so far the hospitals have provided us with meals.
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I have been waiting for the other shoe to drop for years, just like Mabel. I suspect that a lot of research $$$ will now be redirected toward NO research. I always try to help physicians who request more info, but those who demand "this and that" research results are simply told that I am offering my product for their use as is, and it is up to them to decide how and when to use it. In other words, do your own research. That may sound cold, but the colder reality is that when a patient dies and blood transfusion is implicated, the physician will try to pass the buck by pointing to the blood bank. I have seen this happen, and been on the receiving end. It won't happen again. I don't refute any research. When one of our cardiovascular surgeons showed us some research that said that redo CABG patients needing transfusion were less likely to survive unless given fresh blood <7 days old, I didn't say "rubbish." I said that we can support one patient a week with a requirement to provide blood <7 days old. With that limitation, suddenly it wasn't the issue it was before. I have had physicians demand products we don't offer. My answer is we have what we have- this is our menu. Our blood cooks follow recipes from which they cannot deviate. Dallas is 150 miles up the road. I can certainly recommend a good blood restaurant up there if you absolutely have to have such-and-such. (The proper wine to serve with blood is a nice Merlot.)
I can see one direction this may go. In the future, we may issue a nitric acid popper with each unit of blood. "Okay, Mr. Jones, I am starting the transfusion now. If you feel any tightness in your chest, pop this ampule, wait 2 seconds, then inhale the white smoke deeply twice and hit your call button."
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10,000 Rpms
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We use DI water and change it monthly.
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We crossmatch through AHG if there is any problem with the compatibility testing.
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We define it in our SOPs. We do give an option for labeling the reverse tubes (Ac/Bc or a/b).
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You may be exposing T antigens by freezing and thawing the cells, thus destroying some antigens. Most adults have anti-T.
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I don't know. I do know that the hospice nurse notifies the funeral home right away, so I don't think there is much of a storage issue, if any.
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900 AM- Receive specimen
901 AM- Receive phone call from OR asking if blood set up on Room 3- spend 3 minutes on hold while OR finds out name of patient in Room 3, 1 minute looking up patient in computer and answering "No, no specimen was submitted for testing," 1 minute explaining why it will take 40 minutes to an hour to perform a stat workup ("it's STAT! Don't you understand!?"), 1 minute to explain that emergency release blood is always available, 1 minute on hold because the surgeon wants to chew someone out, 1 minute to explain to surgeon "no specimen- no compatibility testing, no mind readers on duty in the blood bank"
909 AM- Accession specimen into computer and place in centrifuge
910 AM- Take specimen to testing rack and begin pipetting
911 AM- Release 2 emergency release units for patient in OR 3 to angry anesthesiologist (2 minute rant), explain that testing requires a specimen (1 minute)
915 AM- Back to bench- pipet screen cells and plasma into gel card and begin 15-minute incubation
917- Phone call from Day Surgery saying that a specimen was drawn for compatibility testing on patient in OR 3 only five days earlier; spend 3 minutes explaining that specimen is good for 3 days unless waiver is signed, and no waiver (not transfused, not pregnant) on file, and no date of surgery on request, and no mind readers on duty in blood bank when request for T&C received; 1 minute giving Day Surgery phone number of medical director so they can report us for not having mind readers on duty, 1 minute kicking side of file cabinet to keep from going down to Day Surgery and throttling the Day Surgery nurse, who has an associate degree and knows all there is to know about blood.
923 AM- Issue 2 units of RBC to ICU, 1 unit to PACU, two platelet units to Hem/Onc (can someone give me a hand at the issue window?), and 15 FFP for exchange transfusion.
940 AM- Do ABO/Rh and place gel screen in gel card centrifuge (5 minutes)
945 AM- Field call from Medical Director, who has spent 10 minutes on phone with surgeon of patient in OR 3 (5 minutes saying who said what and when)
950 AM- pull gel card from centrifuge to read, then answer the phone call from 5 South wanting to know if we have a current specimen on Room 517 Bed A, explain that we have some metal shavings from the left leg of the bed, but that they were rusty and we needed a new specimen, and if she needed any blood on the patient in Bed A, then we would need a blood specimen from the patient as well, and be sure to find out what that patient's name is.
955 AM- read gel card, enter results into computer
1000 AM- Confirm results in computer for Type and screen
Any questions?
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Our hospice department transfuses blood for patient comfort, as Mabel says, while waiting on the primary condition to take its toll. This may surprise you, but not everyone admitted to hospice ends up dying. My mother underwent hospice care for the standard 6 months, then lived another year. I had one patient who was way down on the liver transplant list and not expected to make it, but suddenly was a match to a donor where no one else on the list above them was.
I train the hospice nurses, and they have never had any problems in the field.
BC
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I have coolers that will keep blood at 3-4C for 48 hours with no ice added. I use them on my helicopters. They are the Minnesota Thermal Science GH4 (Golden Hour, 4 units) containers developed for use on the battlefield. I have considered using them for my heart rooms, but at the present I have a full-size BB refrigerator in the OR. The refrigerator is 12 steps from my issue window in Transfusion Services. Go figure. I used to have a smaller BB refrigerator in the CCU. I finally drug it out of there one day after another report of noncompliant usage. As I was rolling it out on a dolly, one of the nurses said wait- my lunch is in there! It is now my MT student refrigerator.
As far as the OR refrigerator, the biggest problem I have is getting unused blood returned to the BB. I know of no patient mixups that have occurred.
Larry, it is a 30-second trip through the tube system from BB to the OR, and a 1.5 minute trip to my trauma bays. I have validated the system twice. I can't get them to use it.
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I gave my first surprise CAP inspection last week. It was a small lab. I did Lab General and Blood Bank (naturally). It was a very, very thorough inspection, and they did quite well. There was no one in the lab under 50. Not that the kids can't keep up with us old folks, but, you certainly aren't going to pass us up ;-)
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You said: "Assume the specimen is collected by the OR and the patient has a negative antibody screeen in gel."
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We do computer crossmatches, so we can have 2 units ready in 5 minutes. I have done it in less than 2 minutes, with the longest part of the procedure being the printing of the ticket.
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Le(a+b+) is rare because Leb antigens are preferentially adsorbed to the precursor molecule over Lea antigens. So, if you have the Le gene and the Se gene, your red cells will phenotype Le(a-b+) rather than Le(a+b+). You could perform adsorption and elution studies and possibly detect the Lea antigens on the red cells. The person that types Le(a-b+) will have soluble Lea antigens in their plasma.
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Tell me about that alarm system. I am looking at putting a small BB refrigerator between my two trauma halls. We have 6 level 1 trauma suites, with a supply hallway between them. But, I would like to know when someone opens the refrigerator. I am looking for a system to alert me.
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I am glad my experience pointed to something you could use.
Marilyn, that is very interesting about the human and rabbit anti-Lea not working in the Black population. Sounds like a mutation in that population that changes the configuration of the antigen or the precursor. Maybe there is a a change in a linkage, or a different sugar in the chain. Maybe it branches differently. Who knows. Since it is the Lea antigen that is affected, then it is probably an Le gene mutation rather than an Se gene change (which would affect the Leb antigen). I know enough biochemistry to last about 60 seconds in a crowd of molecular specialists (as long as I don't open my mouth). But I do find it interesting.
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I run anywhere from 75 to 80% computer crossmatch (the official term used by FDA and AABB). The rest are patients with antibodies, on whom we have to set up 2 units ready to go if they are in-house.
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Larry doesn't set up units until they come to pick them up. He will always have a perfect CT ratio. I tried talking my bunch into doing the same thing, Larry, but it was a no go.
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Their formula is correct, but their application is incorrect. The formula has to be applied to a range before it will work. The first number pair in the range cannot have a zero in it, or you at least have to disregard it until you have a number pair that is greater than zero. I have attached an Excel spreadsheet that shows the logic. Notice on my formula that I have anchored the source fields, B2 and C2 by making them $B$2 and $C$2, so that all you have to do is fill the formula down and it will always include B2 and C2. You will end up with a raw number rather than a ratio, but all you have to do is convert it to a ratio in your mind. So, if the result is 2.85, then the CT ratio is 2.85:1, and if the result is 3.33, then the CT ratio is 3.3:1. Basically, the formula is telling you to add every number in column B and divide it by the sum of the numbers in column C.
I left you some blanks to fill in. Add some more doctors to the list and add in some numbers and watch the results change.
I hope this helps.
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I sure hope that checking the weld is good enough, Stephanie. That's all we do.
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Checking on our wording for the testing, but I asked one of our pleb. and she said 30 sec. air dry then lay a piece of guaze on site if not sticking immed. (no pressing allowed)
Yep. That's standard practice. See Method 6.2. Arm Preparation for Blood Collection, in the Tech Manual. The operative instructions here are, ". . . let it stand for 30 seconds or as indicated by the manufacturer. Cover the area with dry, sterile gauze until the time of the venipuncture."
Tim, your inspector must have seen something that caused an alarm to go off, such as pressure being placed on the intended venipuncture site through the gauze. I always tell the phlebotomists to have two gauze pads ready in case one falls off on the floor. They can then open the second one and cover the prepped arm.
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Perforated diverticulitis can indeed cause the Lewis antigens to shed. I speak from personal experience, having had perforated diverticulitis with complications, resulting in the loss of about a foot of my colon. I had a colostomy for 5 months because I had to have emergency surgery. I, too, had sepsis that took massive amounts of IV antibiotics to resolve. I am a secretor and normally type Le(a-b+), but typed Le(a-b-) when my colon ruptured. I had my student at the time phenotype my blood. That is the first time I noticed this phenomenon. Too bad my blood type is O, because had I been type A, I probably would have seen the acquired B phenomenon as well.
BC
ISBT Label Samples
in Computer Systems / Software / ISBT128
Posted
Good luck, Heather. We went live with ISBT 128 last week at the same time we validated our SafeTrace upgrade. Only minor problems.
BC