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cswickard last won the day on May 17

cswickard had the most liked content!

About cswickard

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    Seasoned poster
  • Birthday 04/17/1953

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  • Location
    Las Cruces,NM
  • Occupation
    Transfusion Service Supervisor

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  1. cswickard

    RHoGAM work up post partum Weak D

    It is a good reminder to generalists who can forget over the years that a strongly positive fetal screen with a negative Fetal stain is not a weird result (?!?) - it is probably just a weak D. Without doing weak Ds regularly, it is easy to forget that as the years pass. Doing the weak Ds as part of the RhIg workup is a different idea. We just do them once on any Rh Neg and put it in the computer history. I am trying to catch the young females and send them out for genotyping - nice to have a definitive answer that gives assurance of the right choices for individual pts. So far, we have sent our genotyping to the UBS Reference Lab - which sends them on the Grifols Lab. We get them back in about 2 weeks, so it goes in computer history for the next time we see the pt. Has anyone been using Immucor's Lab for RH genotyping? How long do they take and how much do they charge? (if anyone knows)
  2. We start with O neg (2u - no more than 4u) and hope we have a specimen before the 2u are in. We then switch to type specific and hope it is not O neg. We are under pressure to switch to O pos by one of the ER docs - may have to go that way in the next year or so as they gear up here to be a Level 4 trauma unit. So far, most of the emergency releases stop transfusing with 2 units.
  3. cswickard

    Direct antiglobulin test

    Quote: Again if agglutination cannot be seen with the naked eye, a hand lens, a convex mirror, or the type of microscope in which the contents of the tube are viewed while still inside the tube by placing the tube itself on the microscope slide, IT IS NOT THERE. Were it not for special tests, such as those in which mixed-field reactions may have occurred or when a small percentage of fetal cells might be present in a maternal sample, the microscope should be banned from the blood bank. Is this section clearly referring to rolling a tube on a microscope under a 10X lens?? - As opposed to pouring it out on a slide and using a higher power??? If so, does this quote condone the use of a microscope under certain restrictions and/or for certain tests (notably the Fetal Screen - which it must be used for) - or is it truly interpretable as "a scope should not be used at all"? Just checking ------ And for the start of the thread - Yes - we check our DATs under the scope - tube rolling only; we use Immucor reagents and use CAP and API for various Proficiencies (API for the DATs). I don't know of a Joint Standard that requires microscopic reading, but the inspectors always check that a full DAT investigation includes both IgG and Complement reagents (Polyspecific or the individual monospecific reagents (and you have to have complement dependent check cells too)).
  4. cswickard

    FDA Question

    Don't forget that if you make reconstituted units for neonate transfusions - that counts and requires an FDA registration. We irradiate, so already had them coming, but had to add that product after an inspection, so now, may never get rid of them!
  5. cswickard

    Consent for Blood Transfusion

    Our consent forms are good for the length of stay for our in-patients, but only for each encounter for our out-patients. We require a copy of the consent form each time a unit of blood is picked up (barring emergency and a massive bleed). This has helped us reach (AND MAINTAIN) a 100% 'signed consent form on the chart' standard, but it can be a pain for the RNs and has occasionally lead to loss of the form (Xerox monster) but we can frequently give them back a copy from prior transfusion pickups. Interesting that 2 of you said consent forms for out-patients can last so long. How do you keep track of them and where do they have them stored? How does the RN know the form exists, has been signed and is still good?
  6. cswickard

    Upgrading BB software

    Sorry I don't know - but it might depend on what the upgrades were about. Any patient/system safety issues would be high priority. Other stuff, not so much probably.
  7. cswickard

    Addition of sterile saline when pooling cryo

    We get pooled cryo now too, but we did have a procedure where we added a little saline (10 mL) to the first bag and then over time, for the subsequent bags, only added a little of the pool back (10 ml or so) to help with recovery from the subsequent units (instead of a lot of the diluted unit or transferring the whole volume to each new unit, if that is what you are saying). That could save you some time. One does worry about whether either procedure is worth it. Ask you distributor if they have pooled units - marvelous product!!
  8. cswickard

    TAT for STATs

    Love the idea of setting a timer - it is so easy to get distracted and miss the finish of a STAT specimen. The ECHO does not have a loud (obnoxious) alarm when finished and many of our techs are out in the Main Lab anyway when the instrument is running (perpetual staff shortages).
  9. cswickard

    Hettich EBA 21 Serofuge

    We have had the Hettich EBA 21 centrifuges for years - have never had any problems with them. Speed 3000 rpm, ramp up 9, ramp down 5, for all times (20, 45 and 60 secs). We wash our titers in the Helmer Ultra CW, but spin them in 1 of 2 Hettich EBA 21s. Within reason (and training), we do OK with titers (Cap proficiency is midrange on the bell-curve.)
  10. While it shouldn't be affecting your in-house panel, watch for shipping damage (out of temp) also on the commercial panels. Might cause the damage. We just had one CAP survey for automated Blood Bank that we had to replace 1 out of 6 tubes that was dark (and hemolysed?). Rest were ok.
  11. cswickard

    Suspected Transfusion Reactions

    Fantastic list - now all they need is TACO (Transfusion Related Circulatory Overload) and it's differential diagnosis from TRALI and they are set to go with current recommendations. Seems like there is an increased interest in TACO with regulatory agencies lately.
  12. Interesting idea to try to get the form electronically. We have fought for years to try and get the Admissions folks to get the patient into the computer in a timely manner so the whole hospital has access to pt. information and computer ordering. As we try and transition to a Level 4 trauma center (yes - I know - why bother? We already stabilize and ship), there have been improvements. But we just discovered we still - even if the pt. is in the computer - have problems getting the name in the Lab if we are not receiving orders. We currently have a handwritten Emergency release form - it might help us to have that changed to an electronic form so we get the order, the pt. name and the ordering Dr. - all at the same time. All Blood Bank orders could be entered there to keep the encounter together. For our MTP - the Blood Bank is doing all of the ordering, but an electronic order to start it might help us there too. We are currently counting on a verbal order, followed by the handwritten Emergency release form. We are currently starting our MTPs with 2 units O Neg, uncrossmatched RBCs and have had 2 encounters decline additional units after receiving only those 2 units. (Not complaining - just noting a trend!) Given the problems we are having getting the ER Drs to order Blood Bank correctly - I really don't know if adding even more orders for them to think about will help though. Thanks for the information.
  13. cswickard

    DTT for DARA - help!! :)

    DTT SOP.pdf This procedure is based on the HemoBioscience SOP and the AABB SOP. Works for us. Prior threads on this topic have indicated that the DTT treated cells will not last long, so we do this only at need.
  14. cswickard

    Gold Medal.

    You should be excited - a well deserved honor. Congratulations and well wishes from across the pond.
  15. Try the Blood Type setting for Emergency Issue Units prompts. It says you can define products, etc. We don't have ours set up that way, but will need to consider it for MTP/ Trauma.

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