rcurrie
Content Type
Store
Profiles
Forums
Blogs
Events
Frequently Asked Questions
Gallery
Downloads
Glossary
Links Directory
Questions
Jobs
Vendors
Posts posted by rcurrie
-
-
Yes, it was indeed a joke, just as I said. Lewis antigens can be lost during pregnancy, if the patient has infectious mononucleosis complicated with hemolysis, if the patient has alcoholic cirrhosis, and if the patient has alcoholic pancreatitis. Lewis antigens share precursor molecules with several blood group systems including ABO, I, and Sp-Pr. But not Duffy.
BC
-
Sounds like an anti-Le3 (that's a Duffy system joke!).
He could have something going on that is causing his Lea antigens to elute from his RBCs, thus allowing him to make a transient anti-Lea. This happens with pregnant women, and they make a transient antibody. Yes, you can make both antibodies (see page 305 of the Tech Manual, 15th ed). Even if they wanted blood, you can disregard the antibody if the donor cells are compatible at 37C, as transfused RBCs readily assume the phenotype of the recipient by shedding their Lewis antigens and very rarely cause in vivo hemolysis.
BC
-
Yes, we automatically do a baseline titer on pregnant women when we identify a significant antibody. All antibody identifications generate a pathology consultation from our medical director. For OBs, the MD will recommend that the patient be followed serologically with subsequent titers every 4-6 weeks.
BC
-
What was the trick?
BC
-
I sent an email to the FDA, and the reply is a firm "No" to allowing anyone to donate who has had sex with another male since 1977, regardless of the circumstances. In addition, the FDA gave me this link to explain their policy:
http://www.fda.gov/cber/faq/msmdonor.htm
I went to a seminar by Michael Bush on TTVs (transfusion transmitted viruses), and it was quite interesting. It seems that any virus that is transmitted during the window period is quite virulent compared to a virus that has been weakened by patient antibodies. Even though we have shortened the window period considerably, it is that period during which the virus is most likely to infect the recipient.
BC
-
Sounds like a case-by-case basis with a specially crafted consent for each patient may be the way to go. Thanks for the info.
-
Angi,
We don't have a procedure, but hemodilution has been around for a long time. Some people think it is great, but others have decided that it puts the patient at higher risk. The theory is, you remove a unit or two of blood in the surgical suite and replace it with a crystalloid volume expander, and when they bleed X amount, their oxygen carrying capacity is lowered at a slower rate than if they lost undiluted whole blood. When the patient approaches hemodynamic instability, you infuse their own blood that was withdrawn earlier. There are practice guidelines for hemodilution. Hopefully your gasman is following such. We do not assist with the hemodilution program here- the perfusionists do that duty. More power to them! This is an area I avoid like Denge Hemorrhagic Fever (it's coming to a city near you).
BC
-
Linda,
I test for 4 hours, then make the validation 2 hours to give that margin of error that comes from opening the cooler to check the blood. I stop at 4 hours because the regulations require that you take the temperature of the blood every 4 hours if the blood is not being continuously monitored. That is the storage requirement, not the shipping requirement. However, unless the blood is being toted round and round the nurses station, you would have a hard time showing that the blood is in transport if it is inside your facility. Rather, the storage rules (and thus the 4-hour limit) would apply.
BC
-
Something I learned in law school: If you give an adult patient blood knowing that it is against their wishes, you can be charged with criminal battery, even if they are unconscious and you deem it necessary to save their life, and you can certainly be "sued for everything you've got", as the saying goes. This does not apply to minors. However, it is prudent to get a court order if you are going to go above parental wishes and give blood. It puts the onus on the court rather than you. I have never seen the court rule in favor of a patient in this regard.
The gray area involves the case where you know your patient is a Jehovah's Witness, but do not know their specific wishes. It is gray because the refusal of blood is personal to each Jehovah's Witness. One may say yeah, give me all you've got. Another will say only autologous blood. Another will limit it to derivatives such as albumin and specific clotting factors. Another only allows blood salvage with immediate reinfusion after washing. We have perhaps the largest per capita population of Jehovah's Witnesses in the world in my service area. They have an annual convention here that draws close to 225,000 people for a week. I have seen the full gamut of patients. We work with them to meet their wishes. Legally, that is your only alternative to prevent serious lawsuits.
BC
-
The practice of having blood bank separate from the rest of the lab may have come from the labeling requirements, which require labeling operations to be separated physically or spatially from other operations "in a manner adequate to prevent mixups." See 21 CFR 606.120(a).
Maybe some of the really old techs on this site can help with this (that's a joke- I say- that's a joke, son!).
BC
-
Addressing John's comments: Establishing "trauma pack" criteria is going to have to be a cooperative effort. If you ask the physicians what they want, you will never be able to fill their request. But, if you tell them what you can reasonably provide in a short period of time, then you can come to an understanding. Until then, you will just have to borrow a line from "Treasure of the Sierra Madre":
"Trauma packs? We ain't got no trauma packs. We don't need no trauma packs! I don't have to show you any stinkin' trauma packs!"
BC
-
We use Safe-T-Vues. There is no guarantee they won't take the blood out of the cooler without such an irreversible temperature checking device.
BC
-
-
See what they think about a simple keep-ahead policy. They take 2 units of whatever, you set up 2 more. You can save a lot of time and trouble that way, and keep from wasting a lot of FFP.
As far as the O negs, make the protocol O pos for adult males. We keep about 100 O negs on the shelf, and that is how we do it. Granted, we use a lot- there were 6 level 1 traumas between midnight last night and 800 this morning, with 1 massive transfusion protocol activation. We transfused 2 O neg and around 40 other units, 25 of which were A pos, the type of the MTP activation patient. I am about to go in this morning and do the review. We use downtime protocols for massive transfusions. No computer can keep up.
BC
-
There is a subset of B cells that can be stimulated to make antibody without having antigen presented to it by an antigen presenting cell. However, the antibody produced is often of poor affinity. This is the same set of B cells that can make autoantibody.
BC
-
Ah- you gave me away! I just said on another BBT thread that I didn't know AABB had forums. I did cross my fingers when I said it, though.
BC
-
What?! AABB has forums? I didn't know that!
(fingers crossed)
BC
-
Monica,
We have two sets of 6 O neg and one set of 6 O pos set aside for trauma massive transfusion activations. Our massive transfusion protocol is basically a keep-ahead order. We will send 6 units of RBCs, and have one unit of SDP ready to go, and 4 units of AB FFP thawed. If ER asked for x number of RBCs, we set up the same amount to fill the keep ahead order ready. We don't do anything else- just keep it ready. That has worked better than any other formula I have worked with at the other trauma centers where I have worked.
BC
-
Congratulations! SBB has been a goal of mine for 15 years, but I never had the time to do it before now. Yes, Clare is great. I have known her for years due to participating in the GRIPS program. She certainly makes you work hard, and loves sending samples with esoteric antibodies (anti-K and anti-KN in one sample!). I begin to worry if can't find at least 2 antibodies in our unknowns. When I went to Houston for the first week of classes, I was right at home, having worked out of Houston for 30+ years (20 for Missouri Pacific RR driving high speed freight and passenger trains between Houston and New Orleans, 10 for Memorial Hermann).
BC
-
If you use an Igloo Elite with 2 quarts of wet ice on top of 2 units of blood, it is usually good for 2+ hours. I had one come back the other day at 9 C after 2 hours 30 minutes. The OR people said they didn't open the cooler (which cuts back on the time it will remain at 1-6C). We put a fluorescent "Return by" sticker on the outside of our coolers.
BC
-
By the way- yank the back off one of those 2991s and look at the "solid state electronics" used to run the thing ;-) Reminds me of the old 3-story high computer I ran when I was in engineering school back in the 1960s.
BC
-
Same colorimeter we use. I bet they sold/gave away thousands of those things. Our platelet apheresis nurses use one on all our SDP components. We also have an analyzer in our chemistry department (I still need my GPS to find the place) that measures plasma free hemoglobin.
BC
-
Back before our last cell washer kicked the bucket, we did a protein dipstick and used a hemoglobin colorimeter scale to do our deglyced and washed QC. We are now in the market for a new machine. Any recommendations?
BC
-
The story I was told was that the 3-day rule came from a desire to not have to perform repeat compatibility testing over the weekend, and is thus completely arbitrary, to allow a specimen collected on Friday to be good until Monday.
BC
Donor Notification of Testing and Arm Prep
in Donor Services and Donor Recruitment
Posted
I am the quality assurance officer for our donor center, processing lab, testing lab, and transfusion service. Here are my views:
1. You may choose to notify donors in the donor consent that testing may not be performed. Our wording addressing this issue: "I understand that there may be unexpected circumstances where infectious disease tests cannot be performed." This meets all tests, including the FDA regs. You may choose to state that no disease testing will be performed unless a full unit is obtained from a qualified donor.
2. Pressing down on the gauze is bad practice. The gauze should simply be placed over the site without any pressure being applied. It is better to use the gauze than to not use it, as bacteria and fungi are ubiquitous in the air, and the uncovered site will just be recontaminated if there is a delay in venipuncture. If, however, you are ready to immediately insert the needle, then no gauze is needed until the needle has been inserted and anchored.
BC