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Everything posted by rcurrie
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Best of luck, Liz! I am in the wrong part of the lab. I got to work at 7:00 AM, and my wife called me at 7:30 PM to come home to supper. Flow works 9:00 AM to 5:00 PM, they take 1.5 hour lunch breaks, and no one works weekends or takes call. Bob Currie
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We do not typically test the purported father. We give RhIG based on mother's blood type. If she is D negative, she will get RhIG at 28 weeks, and if the baby is D positive, then another vial within 72 hours of birth (more if there is a documented fetal-maternal bleed greater than 30 mL). Sometimes the purported father is not the real father. Our motto is "if in doubt, give it out." This means the mother will get RhIG in most cases if she is Rh negative. BC
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Liz, 7AAD is just another way of viability testing, and can be used on a flow cytometer rather than using a microscope. If your flow people are already doing viability testing, why are you doing it also? I would send all my viability testing to Flow. But, if you want to have a backup test, the trypan blue is okay, but you can also use 7AAD if you want. It is just another dye exclusion method. We use trypan blue dye exclusion, but have thought about using flow since they do our counts for us. BC BD-Via Probe.pdf
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I am not sure what you mean by "missing some autoantibodies", as PEG is merely an enhancement to the autoantibody uptake on the autologous cells. The idea is to remove the autoantibody (usually of Rh specificity) and then test the absorbed plasma for underlying allos. You use 4 drops of the absorbed plasma (half plasma and half PEG), with no additional PEG (it's in there already!). You can go to 6 drops if you suspect a weak antibody. All this is spelled out in the tech manual. I like it! You can also do a second adsorption if there is still remaining autoantibody in the plasma, as indicated by all cells reacting on the panel after the first adsorption. BC
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As far as the background colors of a field, you set that by going to Format then Conditional Formating. I make two columns- one is the date of the last review. The column next to it is the due date for the next review, which is a formula such as =B12+365 where B12 is the field with the date of the last review. I then go to Conditional Formating and select the condition "Less than" and put "=TODAY()", then format the background to be pink if the statement is true (in other words, the review date has passed); I add another condition "Greater than" and "=TODAY()" and format the background to be green if the statement is true (in other words, you still haven't passed the review date yet). I have attached an Excel sheet with an example of the formatting (click on New Sheet attachment). I hope this helps. BC New Sheet.xls
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No. I set the hyperlink to go to the SOP. For instance, if you look at the Table of Contents and scroll down to the SOP for, say, ABO/Rh Testing, all you have to do is click on the name of the SOP and the hyperlink will take you directly to the electronic SOP. You do this by going to the Insert dropdown menu and selecting "Hyperlink" (bottom of the dropdown menu). You then browse your files to the location of the file, then link it to the highlighted text (Word) or the field (Excel). BC
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We do a post transfusion DAT and look for hemolysis if we transfuse ABO incompatible platelets or cryo. You never know when you are going to have a Super O who makes a potent high-titer anti-A,B. If there is fever, we will culture the bag. If we suspect that we have transfused based on a blood sample from the wrong patient, we will ask for a redraw and retype the patient. We never issue blood components based on an historical blood type. I have been burned by that too many times. BC
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Making ABO discrepancies for teaching
rcurrie replied to jbeauvais's topic in Immunohematology Reference Laboratories
Anna, I agree that you can't "make" a weak D. Luckily for me I now have a regular weak D donor, and he allows me to collect an extra tube for my students. Until that happened, I would make two "weak D" patients. For one I would use 2 drops R2R2 plus 18 drops rr, and for the other I would use 2 drops CCC plus 18-24 drops rr. The purpose of my weak D exercise was for the student to tell me which specimen was a possible weak D and which specimen was probably not weak D due to the positive DAT. I would explain that this isn't what a true weak D looks like but that the point was to do a DAT, and if it was positive, then probably not weak D. Now I have that weak D donor source. I also have a donor who is A2 making anti-A1. I have about a gallon of his plasma frozen in single tube aliquots. Bring on the students! BC -
It's convenient, isn't it Bev? When the FDA asked to see such and such SOP, I had it in their hands in less than 5 minutes. No seaching through heavy binders. BC
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Liz, Let CAP know about this. They can arrange for their subcontractor to package the survey in a manner that it will get to you intact. I take it you don't have flow cytometry? Are you using the trypan blue exclusion viabilty test? How about 7-aminoactinomycin D staining? We use flow cytometry with trypan blue exclusion as a backup. BC
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We use W.A.R.M., but I have been experimenting with PEG autoadsortions and they work perty derned good. It only takes 15 minutes to do a PEG adsorption. The last one I did went from a 3+ to negative, but you can do a second adsorption if the plasma is still reactive with all cells. BC
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Yes, we follow that regulation. We have a training document for each SOP and an evaluation schedule for each employee. We do direct observations for almost everything. A direct observation doesn't have to be overt. You can simply swing through the lab while the tech is performing it and then document on their training document what and when you observed. I prefer to do it that way. But some things you simply have to schedule ("Hey Patty, let me know the next time you have a KB"). BC
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I use Word, but I password protect the files. I have an archive folder for ones removed from use. I also have an Excel spreadsheet that I use as a link to the current SOPs. No need to seach through a bunch of folders on the shared drive. Just go to to the Excel Table of Contents, and the name of the SOP is hyperlinked to the actual current SOP. I also have a review trigger on the same sheet that tells me when the last review was and tells me visually by color that review is coming up (yellow highlight) or overdo (pink highlight). I have a WIP (work in progress) folder for SOPs I am modifying. BC
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We don't unless ordered. We occasionally find a positive DAT due to an antibody the mom has. We had one today. BC
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I have a Nikon Coolpix L3 that is tiny, takes great pics at 5.1 Megapixels, and takes video with voice of quality that is darned close to my $1200 digital movie camera. It cost right at $250. It has a feature that cuts out redeye, and it has "Face-priority autofocus". BC
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We respect the specificity and give E-negative units, crossmatch-compatible with adsorbed plasma. BC
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I never have any trouble explaining the discrepancy. I have donors who are also patients, so it happens enough for me to be quite good at it. I simply say, "Mr. Smith, as a donor you are Rh positive because you make at least a portion of the D antigen, which is called the Rh antigen. Your blood could cause a recipient to make the anti-D antibody. But, as a patient you are Rh negative because you could make anti-D should you receive Rh positive blood. You could possibly make this red-cell destructive antibody even though you make a portion of the D antigen." I have never had this explanation questioned. I only run into this problem with one in 10,000 donations. However, if I were to tell all donors their weak D status, I would be on the phone continuously explaining this. So, no, we don't explain weak D up front when giving donors or patients their blood types. BC
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We do pretty much the same thing. The idea is to detect that brand new underlying allo that patients with autos tend to make. I am in favor of doing all this on a less frequent basis (say once a week) in patients being transfused. Not my call, though. BC
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The number one goal is to protect the patient. So, you can never go wrong calling a patient Rh negative with that goal in mind. However, if you call a patient with less than optimal reactivity with anti-D Rh positive, you could invoke sensitization to the D antigen if you transfuse Rh positive blood. So, to protect your patients, give all patient Rh typings to the tech with the hardest shakedown. ;-) Just be glad if you don't do donor testing also! If you do, my advice is simple: donor testing techs are donor testing techs; transfusion services techs are transfusion services techs; never the twain shall meet. BC
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And they do it so proudly, don't they? BC
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That's nothing, Karen: My OR has a monitored refrigerator for platelets! BC
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Mabel, pun intended. If I ever have a bypass, I am asking for an artery for an artery. No leg veins. BC
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I have so few requests from the cath lab that I don't even know where it is. I have since found out it wasn't an artery. This patient was a CABG with stenosis of a venous graft. Venous grafts just aren't that hearty, and the angioplasty didn't work. So, they set him up for emergency bypass. No blood was needed in the cath lab. BC
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Different reagents, different methods, different results. Your Rh pos is correct if you followed your procedures. Their Rh negative is still Rh negative if they followed their procedures. It isn't always clear cut. I personally think anything less than 3+ on Rh should be called Rh negative for transfusion purposes. We have a donor whose results alternate between positive and negative by PK method. We just have to reconcile the current results with the historical and invalidate the Rh negative results. BC
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Plasma Frozen within 24 hrs.
rcurrie replied to Mary's topic in Donor Services and Donor Recruitment
We will use 4 quadrant label with unit # cut-out feature. That way the original unit number is not covered up. BC
