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We used to do eluates but with the infrequency of need and competency challenges we decided to send to our reference lab. We request eluates on patients who need a transfusion (or investigating a TRRX) and are DAT + and who have been transfused within the past 14 days to rule out newly forming antibodies that could be completely absorbed onto the donor RBCs and may not be found in the plasma. Our reference lab has recently changed from 14 to 21 days post transfusion for eluate testing but we have not yet changed our rule. I believe the thought process behind this is that after 14 (or 21) days the newly formed antibody has had sufficient time to spill over into the plasma and can be identified in the ABSC/ABID. On patients that are transfused frequently we sometimes opt to give phenotypically similar blood for transfusion instead of sending out for an eluate with each transfusion event as this is time consuming and expensive.
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All in fun!! I do appreciate the feedback as I need to address this at some point, like yesterday.
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Thank you for the clarification Malcolm. By the way this came right out of the current CAP standards. Maybe they need to be schooled too COMPUTER CROSSMATCHES A computer crossmatch is an electronic method that is used to confirm that the unit is appropriate for transfusion to the intended recipient through the use of validated software logic to determine compatibility, rather than serologic techniques. For laboratories that employ computer crossmatching, serologic crossmatch techniques must be employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum reactivity, apparent change in blood type post hematopoietic stem cell transplant).
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For laboratories that employ electronic crossmatching, serological crossmatch techniques must be employed when ABO typing discrepancies are present (e.g. mixed filed reactivity, missing serum reactivity, apparent change in blood type post hematopoietic stem cell transplant.) Does a discrepancy still exist if you have figured it out? (As in extra reverse reactions: rouleaux, cold autoagglutinins? Mixed field that you can explain: a B person who received O blood, an A sub group with Anti-A1 ; system set to transfuse type O blood) How are you satisfying this standard? By procedure only? With Immediate spin crossmatching? Is there any way in Cerner to block electroninic crossmatches for these instances? Thank you for your input.
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We currently check the BB Alarms by using iced water to bring the containers holding the probes to a temp down below 1.5 and warmer water to bring above 5.5. Our Helmer refrigerators have automatic alarm checks- press a button and POOF - done. Is the automatic check sufficient for all or part of the required checks? This is a question I ask myself every 3 months.
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Thank you for the information. I have a demo cooler on the way
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Do you have a catalog number or website for the MAXQ cooler you are referring to ? Is it a one time use? How did you get a demo to look at? Thanks for your help. We use the ARC boxes for occasional storage in ER and OR but would like to get something else.
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Thanks for the quick reply. Somehow I knew that would be to good to be true.
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I am not familiar with the Immucor AHG that does not detect IgG4. When using Immucor's AHG for testing patients after Dara treatment do you still see pan-agglutination? We are currently sending patients treated with Daratumumab to ARC reference lab for DDT treatment and transfusing K- blood if no antibodies are identified. After a molecular phenotype has been done we consider transfusing phenotypically similar blood without an antibody workup which requires a signed deviation form per patient. Both options are time consuming and expensive.
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Does anyone have a good method for determining if units packed to send with the patient/transport team are transfused to the patient, accepted into Inventory by the receiving hospital, or discarded?
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Did anyone listen to the Sept 20 CAP webinar that was mentioned below for standard changes? Was any clarification given? Do you know if it was recorded and can be accessed through the cap WEBSITE?
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I asked this question at a Cleveland ARC seminar. It was explained to me by Dr Gerold Holtche who at the time was with CAP that the fetal stain is considered a special stain and did not fall under the BB QC guidelines but under Histology standards. The QC slide that had both adult and fetal cells was sufficient to show the stain worked. This was several years ago so you might want to check directly with CAP.
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We just purchased 2.5 gal of buffered saline for the fetal screen test. It is 0.85% Isotonic Solution. The inserts for all our BB testing require 0.85 - 0.90% Isotonic Saline. We will probably just substitute the Buffered saline for all BB testing. Has anyone else done this? What sort of validation is needed if any?
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Don't you think it's about time for ORTHO to start putting their reagent in bottles that protect the reagent from light if they think that is the culprit?
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We do not although the lot# is recorded on our QC log. The bottle is labeled Saline Solution, Change Daily. In our QC SOP it states saline is replaced daily prior to running QC. We have never been cited for this by CAP or FDA. ?
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We are looking for a different method to quantitate fetal hemaglobin. Our obstetric department orders KB stains STAT to determine if a Mom has a fetal bleed during pregnancy. Based on our KB results additional procedures may be done on the Mom. The test is very inacurate, time consuming, and difficult for some techs to read. Does anyone know of an instrument that has Fetal Hgb testing available? Please send manufacturer or contact information, thank you so much.
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I would also like a copy of your check list. Thanks
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We type verify on a second sample if no history. All our lab samples must have 2 identifiers on the label so we feel it meets BB requirements to use a previously drawn CBC sample if available. We also do not require O patients to be verified with a repeat type. Did you challange your deficiency with CAP? I am interested in their response as I do not feel you should have been cited.
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The fetal screen kit has Anti-D in it, it reacts with the baby's Rh pos cells yielding a pos result. If the Mom is Du pos, the fetal screen will be a false pos because it is reacting with Mom's cells. The fetal stain looks for fetal cells not Rh pos cells, so if should be accurate. I would present findings to our Pathologist and let the final decision as to the number of vials up to him, filling out a deviation report.
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We have had 2 Isotemp Plus under counter Plasma Freezers. They are very dependable but are very noisy.
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We ask for a midterm RHIG history on OB patients that develop Anti-D. If RHIG is administered in past 2 months we suggest that the Anti-D may be passive. If the patient later returns for a crossmatch we would be required to do the AHG Xmatch vs the Immediate spin due to the anitibody history even if the screen is currently neg. As time goes on we will have allot of these patients who will eventually come back for surgies/anemias. How can I present this to my pathologist so we can go back to Immediate Spin crossmatches on these patients? Wouldn't the Anti-D still be there if it was a true Anti-D? Does the titer of Anti-D ever drop below detection if it was antigen stimulated? We would give Rh neg blood to them anyway based on their blood type except for extreme circumstances.
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Do you use any cut offs for weak D when testing a cordblood sample to determine if Mom is RHIG candidate? Weak DAT's carry over to the D type/control making invalid. Do you consider baby RH Pos/Neg if reaction is less than 2+?
