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May 2024 Challenge

Mabel Adams

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Everything posted by Mabel Adams

  1. Mabel Adams
    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).
  2. Mabel Adams
    The antibodies didn't read our books???
  3. Mabel Adams
    Ortho gel is known for picking up weaker D antigens than some tube reagents. I know that Quotient/Alba anti-D blend reacts more like the Ortho gel but the Immucor Gammaclone doesn't pick up those (mostly) weak D types 1 & 2 at IS. They will show up positive at AHG phase with Immucor. John Judd published a paper, which many follow, of considering anything 2+ or weaker in gel as Rh negative. I assume if you take the tube testing through AHG you will get a positive. Doing that will help troubleshoot the situation. None of this probably has much to do with the transfusion reactions. Rh typing of weak and atypical D antigens is a complicated mess both serologically and the terminology. If these are young females, we try to send them for molecular D typing.
  4. Mabel Adams
    Does anyone have a good, current information sheet for patients regarding risks/benefits of transfusion that they could share?
  5. Mabel Adams
    We have sent out a test for the antibody plus ARC wanted us to do a high sensitivity test for the antigen so we are doing that. One of the providers wondered if she should wear a medical alert bracelet. I was a bit ambivalent because I wouldn't want anyone to be afraid to transfuse her if she really needed it. I said the wording should be to avoid transfusion unless life-threatening emergency and prepare for possible anaphylactic reaction if transfusion needed. Of course, this is only if she has the antibody and maybe then it is excessive. Thanks for your input. I welcome additional information.
  6. Mabel Adams
    I felt that the section on segments surely applied only to RBCs. Do you think that means the whole standard does? To me it implied that the other parts applied to non-RBC containing products but I'll be happy to assume it is for RBCs only.
  7. Mabel Adams
    We have just learned that we have a 32 week pregnant IgA deficient mom admitting tomorrow for observation for the next 2 weeks with plans to deliver at about 34 weeks by C-section because of placenta previa and vasa previa. There is no record of anti-IgA testing that we can see. This is not her first pregnancy--G3P2. She is about 30 years old and was identified as IgA deficient 5 years ago. She is donating 2 autologous RBC and FFP units. I assume there is no extra risk for the baby. We are 3.5 hours' drive from our blood supplier. Any advice appreciated as we create a plan for dealing with possible hemorrhage.
  8. Mabel Adams
    I moved them to Hem at my prior workplace but not at the current one. Hoping the Hem analyzer someday has flow cytometry method for it so then it will go. The more adult cells you count, the more accurate your result should be but otherwise the math is proportional as mentioned above. We use a Miller disk (like for manual retic counts).
  9. Mabel Adams
    Epic/Beaker/SafeTrace Tx. There are some quirks of moving specimens between our facilities and outpatient orders that Epic and STTX sort of fight over. We had to make some special settings in our interfaces to make them play well together. We are using BPAM and scanning blood is working pretty well. We are still working the bugs out of scanning for MTPs--mostly user error. It works well in OR but the humans have trouble getting it all right in the ED and ICU sometimes. Also, some MTPs are so fast they can't keep up with the documentation in real time. Lastly, BPAM in an MTP pretty much requires 2 nurses to manage transfusions and not every place has that many people to use for just the transfusions.
  10. Mabel Adams
    This makes me look at Std 5.11.4 "Retention of Blood Samples: Patient samples . . . shall be stored at refrigerated temperatures for at least 7 days after transfusion." Do you still have the specimen drawn on day 1 of admission 7 days after platelets were transfused on day 15 of admission? We keep our specimens 17 days after last use due to our pre-op policies but I have never looked at their storage with FFP or platelets in mind. I doubt that we think we are "using" the specimen when we issue platelets so we don't move it forward to the current day's rack so it gets saved for 7 more days. Besides regulatory nit-picking, what is the risk to the patient if we no longer have the specimen (that we collected and typed early in the admission) 7 days after the platelet or plasma transfusion?
  11. Mabel Adams
    "Establishments must be registered and products listed within 5 days of beginning operation, and annually between October 1 and December 31. Blood product listings must be updated every June and December." is from https://www.fda.gov/vaccines-blood-biologics/biologics-establishment-registration/blood-establishment-registration-and-product-listing. Does anyone know what we were required to do in June? If nothing changed in our product listing was I supposed to have done something on the CBER site in June?
  12. Mabel Adams
    Our supplier won't rotate WB. We would have to schedule our shipments for probably every 2 weeks which means the units have only a few days before expiration by the time we get replacements (after accounting for testing days before they can be distributed plus transport time). Trying to use these up as packed RBCs with only a few days left will likely mean they are given to any blood type. If we stock them on our helicopter they won't be settled when we want to pack them. I have seen some smaller refrigerated centrifuges that look like they will spin blood units. Has anyone used a Rotina 420R from Helmer for blood units?
  13. Mabel Adams
    Can you keep a thermometer on it to make sure proper temperature is maintained? Or validate that it is in range? Those old serology/RPR rockers used to have a motor that got hot in the middle so we had to put a rack on it to keep the platelets away from the motor (this was probably 30+ years ago).
  14. Mabel Adams
    That's what we do with age 50 for women. A bit of confusion now with extended gender choices in Epic but we haven't got a way to identify MTF trans patients adequately. We don't change to type specific (other than matching Rh) until we have crossmatched blood but that is because of the fear that they will think uncrossmatched is always universal donor so don't think they need to check ID when they hang it. I keep hearing people express that thought. "What, you need patient ID for me to pick up blood in a massive transfusion?!?" "Yes, this is crossmatched blood." This is on a day when we had multiple MTPs underway. KISS principle here. Some exceptions include a young female A neg when we have used all of the O neg units.
  15. Mabel Adams
    We don't worry about Hgb S in neonates except for exchange transfusions for which we request it. I've heard the same about the LR filters but don't have true evidence.
  16. Mabel Adams
    I'm reactivating this topic because it has come up again. The AABB Guidelines quoted above are over 15 years old and the only reference in them that says not to use for platelets is to a specific blood warmer's operation manual. Does anyone know of any studies with modern rapid infusers like Belmont RI-2 and Level 1 regarding infusion of platelets and cryo? It seems like they should be safe and it really helps with the workflow to use them but we need evidence.
  17. Mabel Adams
    Some of the success of WB may be due to the reduction in crystalloid rather than the whole blood itself. I look forward to more good studies being published.
  18. Mabel Adams
    We are on Epic and that is one of the reasons that we have continued to use a separate blood bank banding system. Outpatient transfusions cause the same problems. Beyond that it matters greatly whether you have good institutional compliance with the electronic Epic ID scanning for inpatients. We also draw a second blood type confirmation tube on new patients. For small children we may just give them group O blood the first time but that is a quite rare event for us which would be quite common for you.
  19. Mabel Adams
    We test any sample that meets the manufacturer's specimen requirements and ours are more than 24 hours. We even validated citrate tubes so we could use them for blood types. I'm comfortable with getting a second draw on only non-O patients because we also have a BB banding system and an electronic patient ID system. The problem is the rogue humans who decide to make end runs around the systems but with belts and suspenders and duct tape, I feel pretty confident. We are also lucky in that we do the prenatal testing for most of our OB patients. That's a point to consider in making the determination of how many specimens you will have to collect.
  20. Mabel Adams
    And Admissions sometimes selects the wrong patient's record to admit--usually someone with the same name. You would hope that we have enough checks to catch this pretty quickly these days, but strange things happen.
  21. Mabel Adams
    We have a pancreatic cancer patient who swears he has never been transfused and doesn't appear to have had major surgeries that require transfusion but who has an anti-Fyb. No evidence of a source of passive antibodies. Negative antibody screen elsewhere in recent months. Are there reports of naturally occurring anti-Fyb?
  22. Mabel Adams
    Remember that the impact can be affected by A and B substance present in patients and donors. Of course, that also means more immune complexes formed.
  23. Mabel Adams
    So you could pull off an aliquot of "packed cells" from it?
  24. Mabel Adams
    We are doing pre-treatment antibody screens and sending out for full molecular typing. We started this before we were doing DTT treatment in house. We serologically K type them if we need to give blood before the molecular typing results are back. Now I am not so sure that the full typing is justified. It seems to us that those who need transfusion whilst on the drug often don't stay on the drug long-term. As mentioned above the majority of patients on it don't require transfusion. I'm not going to change policies right away but am interested in others' experience.
  25. Mabel Adams
    I am revising our procedure for HLA-Matched platelets and reviewing literature so we can have an evidence-based policy. If you are a hospital without its own HLA lab, what approach do you take? Do you start with HLA antibody testing and give units compatible with the antibodies found and only HLA type the patient if they have a high percent reactive (PRA) or do you always start with HLA typing the patient? When do you order HPA antibody testing? Do you know of evidence to support your approach? It might also be helpful to know if you are across town from your HLA Lab and blood supplier or more remote. Thanks for any input.
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