Mabel Adams
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Everything posted by Mabel Adams
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Since this case was originally posted last July--maybe it's time to test the kid again! Of course most moms aren't excited to have their babies' blood drawn so it might be a tough sell.
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Could this be another subgroup of "A"?
Mabel Adams replied to lmeduran's topic in Transfusion Services
When was the platelet transfusion and was the donor type O? Do I understand correctly that the eluate did not react with any O reagent cells, but did react with A1 cells? if your sample was drawn soon after the transfusion of an O pheresis platelet, you may be finding passive anti-A in the eluate. It would be pretty much all stuck to the patient's A cells so it is not interfering with the back type. Was the crossmatch by an antiglobulin method or immediate spin? An antiglobulin method might be able to pick up a small amount of anti-A in the patient's plasma, but one would expect an IS xm to behave like the back type. Did you test the patient with anti-A1 lectin? ...Or is this what you meant by Anti-A1 positive? Then the question becomes, "Did you test the eluate against A cells?" -
Why is it coming out now that the FDA wants a variance when people have been using a 24 hr outdate for 10 years?
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blood storage refrigerator in operating room
Mabel Adams replied to ccmd's topic in Transfusion Services
JCAHO came out with a recommendation a few years back but it wasn't actually a regulation as far as I know. -
Spin Immediate Direct Antiglobulin Test??? Does that fit the context at all? Sounds like someone's computer acronym to me, but maybe I am out of this loop.
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Of course, the boss doesn't want us doing any work we don't get paid for. Charging for unordered work is fraud, I think. I appreciate your clarification. Thanks.
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I am confused. Why would the FDA require anything for outdating FFP in 6 hours instead of 24? I know there is a move to go to 5 days. Are we maybe not all talking about the same thing here?
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I'm guessing you are already automated, but, if not, be sure to plan space and work flow for that (and any other changes on the 5 year horizon). When we remodeled 10 years ago, we had a stand on wheels built for our plt incubator. It has file drawers underneath and a "bread board" that pulls out. It has often been near the plasma freezer and we greatly appreciated extra space on the bread board when logging in plasma etc. I am all for moveable furniture for future flexibility.
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My boss says we aren't supposed to do any tests that aren't ordered (although we don't offer the Rh alone) because it is fraud or something. It also has to do with being legally liable for having info about a patient that we need to provide to the doc. I am sure you could clarify some of this for us, Bob.
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If you strongly suspect a new antibody formed due to recent transfusion that might be mostly IgM (c3) but possibly starting to make IgG which would all be stuck to the transfused cells in circulation, then it might be worth doing an eluate, but otherwise, we wouldn't.
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For awhile CAP made it sound like they wanted us to keep it if we use a tube system to issue, but they reworded the standard so now it is covered by the nurse doing an ID check when hanging the unit. I haven't gone back to tossing mine again yet, but probably will.
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We don't offer Rh types alone. We have had no compliance issues.
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We will be going live with Meditech in the next few weeks. It took some building but we got it so it will warn when we crossmatch or issue Rh pos to a neg pt. Our old system, Hemocare, did this automatically. We aren't required to enter a reason. Hmm. Wonder if I could make it do that?
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Remember 9/11 when all shipping stopped? Anything could have been rare then.
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Ditto
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How expensive are these "buttons"?
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And Babs, some 40+% of your new patients will be O anyway so no need to recheck them. So how many patients would 60% of your new (no previous record) patients be? Maybe the oncologists would be willing to submit a sample for a blood type when they begin chemo or something and the patient is being drawn for some other testing anyway.
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Patient Specimens During Continous Dialysis
Mabel Adams replied to Mary's topic in Transfusion Services
Dialysis doesn't remove immunoglobulins, does it? What other choice do you have? -
If you are only going to give it to a B or AB patient, it shouldn't matter if the B antigen is "weird." Now if you plan to give it to an O or A patient you may have a problem. The only reason to question the unit is if it suggests a mistake was made. What mistake are you thinking of that might be present here?
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And what do you all do regarding the blood bank reference books' recommendation that the cultures from units be incubated at various temperatures when your microbiologists look at you like you're nuts because they know all the bugs (even Yersinia) will grow in their usual blood culture system? Or have they updated the BB books since I last checked?
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My transfusion committee is asking for better guidelines relating to blood usage review. If a trauma patient gets 6 units of blood in one day, is it justified for the doc to give plts and 2 units of plasma? This doesn't fit my view of a massive transfusion, but the doc may have ordered the products early on when he thought it was going to be worse. How do we make blood utilization criteria jive with the newer thinking on traumas? We are a level 2 trauma center that probably gives uncrossmatched blood about 4 times per year, so it doesn't make sense for us to keep thawed FFP hanging around and our docs may get overly excited when they do get a badly bleeding patient. Any suggestion on where I can get current blood utilization guidelines including for trauma patients would be appreciated.
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Would a larger-than-usual difference between top and bottom temps in a fridge clue in the more oblivious among us (like me) that the fan has stopped working in the fridge?
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We don't do cardiac surgery or livers so we only give cryo for DIC. We have a calculation in our SOP for when the doc orders 2 units on an adult or something, but otherwise we do what the doc orders--often comes out to 6 units.
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For the historical record: They used to always order plts and FFP after 8-10 units of red cells. Then that went out of fashion and they were supposed to only order components based on coag and plt count results. More recently (there was a really interesting teleconference on it last year) they are saying the worst trauma patients can't wait for the test results to get back and they need to start the FFP and plts earlier. Coagulopathy of trauma including the effects of hypothermia etc, I think.
