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Mabel Adams

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Everything posted by Mabel Adams

  1. I think they made it so you can run fewer than 11 or 12 dilutions on the Vision now but initially, I didn't want to use up that many reagent cells for every titer because most are less than 8. We would have to notify a perinatologist in another city who consults on all of our antibody patients so we have not switched to gel. Maybe someday. Tube titrations are time-consuming and require technical skills that are getting weaker as fewer of our people have spent years doing tube testing.
  2. The BBIS records should meet US regulations. Our BBIS could print a report of all antibodies if we closed and needed to give that to lawyers. We always do data conversions when we change BBIS vendors. Reviewing old panels and testing records is sometimes informative so we keep them and try to weed out those who have died. Familysearch.org has a records search function that may help. You have to create an account I think, but it is free. They also have a family tree search and usually won't publish a record on someone still living. The people in that tree will have records attached to them, that are probably even correct! They connect with Find-a-Grave and BillionGraves records too.
  3. We supply blood to a helicopter service with a contract with our hospital system. We put Safe-T-Vue indicators on all of their units. They provide us a copy of their in-flight chart when they transfuse anyone not coming to our hospitals. If the patient doesn't come to us but has an account in our HIS, we create a bogus registration in our BBIS using a defined format account number. If they don't exist in our HIS, we create a complete registration manually in our BBIS using a defined format for MR# etc. Then we emergency issue the product in our BBIS and handle it just as we would those patients who expire before a specimen is drawn etc. We charge the helicopter service for the products which they include in their flat fee to the patient. We maintain the final disposition records for any lookbacks etc. If we got a market withdrawal or lookback, we would notify the helicopter company to follow up with the recipient. That duty is at least vaguely covered in our agreement with them, I believe. We tell the helicopter crew to return any unused products to us and not to leave them at the receiving hospital but this isn't perfect. We sometimes transfer products on paper to the receiving site if we can document handling sufficiently. It doesn't work easily if the receiving hospital doesn't use the same blood supplier.
  4. https://www.youtube.com/watch?v=OGeHG_DbCdE&feature=youtu.be&fbclid=IwAR0I-pK1bARk0rtSsti-2axaWveg1efHGpOQxQDejfFgaJqXozTyOfYxRks I hope it is okay to share the link to this video here because I think it helps explain some of the complexity of blood types to patients who may come here with questions.
  5. I once had a patient who did not show the same blood type as his historical record. We had to redraw him and repeat all testing which matched what we had on the sample from earlier that day. As Scott said, we could at least safely transfuse him but later we learned that he was registered under the record of a prior patient with the same name (different DOB) so then we had to separate all of the testing records from the prior patient and clean up the records. Much better than a mistransfusion but still not optimum. Nowadays the habit of asking the patient to verify ID verbally should have caught that before he even got his blood drawn but this was eons ago.
  6. As Malcolm said, it is unfortunate that you were frightened. Because your anti-Coa will react with most of our test cells, you could be subject to panicky medical providers in the future too. (Sorry I implied above that being negative for the Coa antigen is common; Malcolm has stated that much more accurately.) If you are in the US, I would suggest that you contact the lab at any hospital you would likely use and ask to speak with the blood bank section. Provide them with information about your antibodies and ask them to formulate a plan for managing your anti-Coa should you need a transfusion, especially in an emergency. This will save time when they have to repeat your antibody identification workup. If they formulate a plan in advance they can probably keep it in your record in the blood bank so that it will be available when needed. If they are a small hospital, they should be able to discuss the plan with their reference lab or the medical director of their blood supplier to come up with something that works in your locale. These things always work best when blood bankers speak to blood bankers because, frankly, no other medical practitioner is taught all of this information in the detail that we are. My goal for you would be that a plan be created that provides you with the safest transfusion possible when transfusion is life-saving but that you avoid transfusion if possible to prevent you from making any more antibodies to other antigens that you lack. You are welcome to answer this post or message me on this group if you need help with talking to your local blood bankers or understanding what I am suggesting. Best plan of all will be to be too health to ever need a blood transfusion!
  7. If by this you mean that you are negative for the antigens Kpa and Coa then that is of no more importance than if you have blue eyes. Antigens are structures that antibodies recognize and attach to. They could be on the flu virus in a vaccine or on a strep bacteria or on red blood cells. We in blood banking deal with those on red blood cells. Being negative for Kpa and Coa is just a genetic difference in your red blood cells and a very common one at that. If you have made antibodies to these antigens which you lack then that could cause some potential problems with your pregnancies or transfusions but they are manageable. Your children will not have any special risks in their pregnancies because of this.
  8. In your case, all scanning would be correct so the technology won't save you. Thank heavens for phlebs also asking patient to verify ID. I've seen several registration errors that could have had negative downstream effects.
  9. So the same logic applies as for E & c--avoid stimulating anti-V/VS during more routine transfusions to save yourself the option to have a compatible crossmatch during a crisis when you may be giving V/VS+ blood to save a life. If the patient has already made anti-V/VS you can still choose to ignore it and give incompatible units because it is a lesser evil but we would mostly feel better if we could avoid giving crossmatch-incompatible blood because it would be hard in the moment to prove that there wasn't an additional antibody directed against a different low incidence antigen. That's why we do AHG crossmatches I'd say. Same argument against it of using a precious resource before the patient has made the antibody.
  10. If Type and Screen not yet done, will it do the emergency release function in the BBIS? Is your BBIS STTX or HCLL or?
  11. But I bet they make the V/VS positive unit crossmatch incompatible so you can't use it, right? And that from a very limited pool of units.
  12. We also send small pink top tubes for 2nd types to help prevent the extra tube in the pocket. Because we don't do it for group O patients, our number of redraws is pretty small which I think might help reduce the likelihood of holding back a second tube to send later. We haven't been parafilming the tubes but we did pretty thorough education when we went live with this. I hope that gets passed down to new hires.
  13. I think how rural you are also plays into this. We are the only lab that does antibody IDs in a region of rural Oregon the geographic size of a small Scandinavian country. Our blood supplier is 3.5 hours away over a mountain pass and it snows here. I am not 100% convinced that we should do this but the logic behind our policy to avoid causing production of anti-c is because 5 small hospitals with no ABID capabilities would preserve the ability to select Rh negative blood in an emergency and have very good odds of it being compatible in a patient with a known anti-E, but once they have anti-c that option is gone. We can screen for the c antigen here but if we need to find 6 units our odds get ugly and we would rather get them from the supplier--but they are not exactly across town.
  14. For those of you with blood vending machines who allow emergency issue of O blood from them, does the nurse have to enter a patient ID to get the blood or can they take units out without any patient ID?
  15. This is what we have done for well over 10 years and have not seen any problems from it. For those repeat Rh negative trauma patients, even Rh incompatible blood carries oxygen and transfusion reactions are seldom intravascular so are usually survivable. Also, patients often have hemorrhaged out a lot of antibody as well as blood. You can fill them back up with Rh neg after you ID the antibody. We had to knowingly give e+ blood to a trauma once and she did fine other than having a positive DAT. We only gave a few e+ units and got in some e negative to fill her back up with. I think she got 2 units of each.
  16. I agree with David. We don't do an antibody screen for RhIG workup anymore because it doesn't change what the patient gets. If it is positive they get RhIG and if it is negative they get RhIG. In the rare situation that there is some other antibody that is significant it could be found after the baby is jaundiced just like it would be for your A pos moms. Our current policy is T&S on all OB admits so the latter doesn't apply to us. We identify about 5-6 cells as a selected panel to run for moms with positive screens and suspected RhIG exposure. One caveat: both of the D+ cells on the screen need to be positive or else the selected panel needs to include another D+ cell similar to the screen cell that didn't react (usually the R1R1 cell). Otherwise, you could call a weak Anti-E showing dosage passive anti-D by mistake. Statistically, as long as you have at least 5 negative reactions (D- cells) and reactions with at least 2 D+ cells, you can call it anti-D (passive or otherwise).
  17. I'm feeling more urgency to have a basic plan in place for a mass shooting. Most of these events have occurred in large population centers where they are close to their blood suppliers and have many hospitals to spread the patients among so our odds seem lower but I think we need at least a very basic plan. We are 3.5 hours' drive from our blood supplier (state police can do it in 2 hours). We have 4 hospitals within our region, 2 critical access and one 40ish bed that we supply with blood products as a depot for our supplier and our 170ish bed level 2 trauma center. Although we have MTPs called every week or so, we truly massively transfuse (10-20+ red cells) a patient only every few months so we aren't in practice like a big trauma center. Does anyone have any wisdom on how to predict the number and severity of hemorrhaging patients we might get based on the initial information from a mass shooting? I know it will be highly variable. I need to know whether to have the blood center pack 40 red cells or 100 at the first inkling so it may arrive in time. I can't take all of the blood from our supplier because that city is where we would send stabilized victims that exceed our capacity. I suspect that the worst injured don't make it to the hospital. Mari, how many massively transfused patients did you get and how many rounds did they take? Did you ship them all out? Did you get to type-specific on any? How many RBCs and plasma were actually transfused? How fast did you get replacement blood in? How much blood did you get in? Did you actually feel like you "ran out" of blood? Did you end up with a huge excess of blood products after the fact? Roughly how many hours elapsed from when the first patient arrived until the last emergency issued unit went out? If anyone else has info to share on this, I would much appreciate it.
  18. We don't. It doesn't change the patient's treatment so why expend the resources? If the screen is positive with anti-D we give RhIG. If the screen is negative, we give anti-D. If the baby has HDFN then we would be looking at the strength of the mom's anti-D. That would be our evidence of sensitization that I think a standard still refers to.
  19. Looks like it can be credited to Dr. Robert Beal per Google and a 2008 article in Blood.
  20. Some great resources here. Thanks. Can anyone register for the eLearnings and is there a fee?
  21. Thanks for this. I love the marriage quote. Any idea who it should attributed to? You?
  22. Has anyone had any experience with the SIWA anti-Fya monoclonal immediate spin reagent yet?
  23. When we went live with a better electronic ID patient ID system, I considered giving up a separate BB band. We didn't because of OP transfusions and pre-ops who aren't wearing a scannable ID band when their specimen is drawn. It also matters a lot how compliant everyone is with proper scanning of patient before drawing/labeling specimens on those patients who are wearing ID bands. If there are a lot of workarounds, then the system may not be too safe. Read up on the Baylor-St Luke's transfusion fatality and figure out if anything like that could happen at your sites.
  24. We use a process where the BB armband is verified before the patient is draped and the BB band number plus patient ID sticker are placed on 2 identical cards. One of these cards is used by a runner to come pick up blood products and the other stays in the OR to serve as a proxy for the BB band while it is under the drapes. The cards are discarded at the end of the case and not used outside of OR. I am sure the process is not always followed perfectly but it is better than us having policies that OR finds impossible so they just totally ignore them and don't check blood at all. We installed Epic not too long ago so blood is checked by the scanning process too. Of course, in OR, the anesthesiologist can just click the "Uncrossmatched" button and hang anything without Epic raising any flag. I assume they are doing manual ID checks in those cases (crosses fingers).
  25. The antibodies didn't read our books???
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