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Everything posted by cswickard

  1. We do an eluate only if the Dr orders one, and we haven't had that in years. We only do the cord bloods of O and all Rh neg moms anyway. An O mom with a B baby can frequently be seen to have a more aggressive HDN - but usually treated just with Bili lights and hydration, occasionally they also don't let the mom breastfeed. Any ABO HDN eluate workup really doesn't yield anymore useful information than you already know - Mom's are usually O and the babys are A or B - DAT mystery solved. On the rare clinically significant antibody - try to find whatever it is mom has and phenotype the baby (if possible) if the DAT is positive - might be worth sending out if you can't do any of that. Do you have to send out AB Titers if they are monitoring the pregnancies? Do you usually know in advance, the moms with positive antibody screens or do you get little prenatal work? That might effect what you need to do. On the very rare(!): Dad has a rare antigen and mom has the corresponding antibody - good luck even remembering that if shows up. The only real way to work one of those up is to have specimens for Mom and Dad and crossmatch Mom with Dad's cells. If Mom had a negative antibody screen (frequently) but is incompatible with Dad and the baby - send that out for information to use on the next pregnancy - if there will be one. Otherwise - the current infant will have to be dealt with as well as possible - Bili lights, hydration, maybe exchange transfusion with units compatible with Mom's specimen. That is what we would do.
  2. mostly 72 hours, but if we can get some history - will extend until midnight of 3rd day.
  3. A - to find out the specifics of the problem - personnel may not talk in front of supervisor, so this needs to be done 1st. B - to get the other side of the story - if there is one. Don't spring a meeting on the supervisor with other personnel present without discussing problem 1st. 3 - to work things out - if possible.
  4. There has been the occasional OR RN who has had to crawl under the table and access the wristband under the drapes! The Cardiac OR team has learned to get their BB pick-up cards ready in advance.
  5. It might be that today's philosophy could be stated as: "I have to give one unit - but I don't need to give two." We are seeing some REALLY low hemoglobins around here, but the Docs have adjust nicely to giving fewer units.
  6. That's usually true Malcolm. But in the world we live in with these pesky patients doing their "own" thing you just never can say never. We had a anti-Lea the other day that we didn't even see with solid phase (almost never do/ detects IgG dependent Abs)) and didn't see it with immediate spin XMs either (should have picked up IgM), and then the pt HATED a unit - nasty transfusion reaction. Went looking for a low frequency antibody, but found the anti-Lea and it was reacting 4+ only with AHG tubes - so was it IgM (no I.S,. reaction) or IgG (no solid phase reaction)???. Go figure. That one sent us back to the textbooks. Immucor had just put out a Self-Check with an anti-Lea. The discussion paperwork gave us a good idea of what the patient had been doing - but it makes absolutes seem like a distant memory in this field sometimes. Happy 4th to all of you that are in the states! Everyone else - have a nice day.
  7. Are you computerized? If so - build a Cord Blood panel that includes what you want - ABORh and DAT, say. Then the Dr only has to order that for whichever mother/baby pairs you ordinarily do that work for. If your orders are on paper - see if you can get a Cord Panel added to the order form - same result. We just do the Cord panel (ABORh /DAT) on the OPos and all Rh neg mom's babies. We don't have to evaluate "DAT yes/no" based on prior work or digging up the Mom's types. It is DR/Nursing responsibility to get the Cord workup ordered. All Cords are kept in the Blood Bank (part of our "Abducted Baby security SOP) so we do get all of them sent to us so we can see if they missed a CORD order on one. Labeling for babies is as AMcCord above (Mom's and Baby's labels on tube) - except the mothers are using so many 1st and last names now - we had to flip the baby name convention to Last name, Male/female Mom's 1st name (Smith, Female Sissie) - otherwise we ran out of label space before we got to the baby's sex.
  8. Does your system allow you to "GROUP" all of the individual products(codes) under single headings (RBC, FFP, CRYO, PLTPH, etc)? If so - then that is probably how you then build the Ordering screens to limit the Drs to the seeing the Groups only. Anything special they have to put in comments - or your system may allow some questions and answers in the Order screens. That is how Meditech does it and I think that is how Safe-Trace did it too. You see all the product codes in Blood Bank - but the Order screens don't - that would be complete chaos!! The system on your side also has to recognize the Groups so you don't have to line up each special product to a special order - also chaos!
  9. This is such a complex question - I don't even know where to start. Meditech is a basic system (DOS based) that ties the unit to the patient after ordering and resulting. The system then "issues" the unit that has been crossmatched in an ISSUE screen that lists the patient, the unit, the date/time (and who crossmatched the unit) of the crossmatch, the date/time and people involved in the issue process and then transfers the unit to transfused status in the system - all tied to the patient. So I guess the basics of what you need would be: Patient - full ID (name, DOB, system IDs (medical record #, etc.); Pt's group and type - ideally, the system should also list any pt. antibodies on the tag also. Blood Bank ID band numbers (if you use one of those systems) and/or any other required identifier for your hospital Unit number and Group and type - the system should be built to help you restrict units to type specific/compatible units only Ideally the system should be able to list any antigen testing on the units. Who did the crossmatch and when (so you can keep track of expiring crossmatches) When the unit is issued- by who and to who Our Meditech Issue/Transfusion tag is also built to print out a blank form (this is the bottom half of the tag) for Nursing to list; Transfusionists (transfusing RN and secondary ID check RN), the times and vitals for pre, 15 min, 1 hour and End for the transfusion - but if you do this some other way - say in the computer itself - you may not need that. Does that help? In any computer system, this data has to be linked to so many different areas in a Blood Bank system that getting that data to a new form is where the challenge comes it. Best of luck.
  10. Been there - done that - still can't make any headway with the neonatologists! Not even when we brought our Blood Distributor"s Medical Director with all the facts and figures. They still want CMV neg. On the plus side - everyone else is OK with leukoreduced cells as CMV safe now.. I think leukoreduction is the best production step that has ever been added to blood - especially the pre-storage leukoreduction we get now. Now - if we could just get some more donors....
  11. How many of you are giving Hgb S neg (tested) blood to your neonates services? Any problems with not doing it? I know it is an AABB recommendation for neonates and we have been doing it, but are getting very mixed responses in the region on continuing it. Also, our regional supplier is noting anecdotal evidence that Hbg S positive units (for trait) will not generally flow though a leukoreduction filter - they fail the filtration step. Any feelings on this either way? We get one pediatric unit every 2-3 weeks and we must be able to use it for either small volume transfusions or the rare exchange transfusion. Malcolm - good post - I always wondered about babies and Rh Pos units. It is so difficult to get a CMV negative, Rh neg unit in this region (US southwest) that we have often thought about having an O Pos unit for pedi stock - never been brave enough to try it though.
  12. I don't think the posters in this thread were talking about "repeating" panels - they were talking about "running" a panel with the same method when you get equivocal results on your primary method. If using solid phase - run a solid phase panel. If running gel - run a gel panel, etc. Don't just step down to tubes (or a weaker method) without giving the primary method (and usually more sensitive method) a chance to show you what it is trying to show you. For your next question - working with the specimen might have some validity if you have centrifuge problems or are running clots (red tops) for screens instead of EDTA (purple tops) specimens. Make sure your spin speeds and times will clear the white cells in a EDTA tube. Make sure you follow Immucor instructions on degrees of lipemia and hemolysis that are allowed. Otherwise - if you are running the same lot # of strips on 2 different ECHOs - I would be surprised if they give different answers. Does that help?
  13. Years ago, when we had a case of a 3rd B baby to an O mommy with high titer IgG anti-B - the OBs would not let her breastfeed her 3rd child because they knew it would contribute to the baby's problem. With fore knowledge of the problem, Bilirubin light therapy, heavy hydration (I don't know how they did that) and no breast feeding - the 3rd baby did not have to have an exchange transfusion as the 2nd baby had to have. Interesting case. I do wonder how the IgG gets from the baby's gut to the RBCs in the baby's circulation though? Is that a normal process anyway? Any articles on that?
  14. sorry - fighting a cold - at least I got it right once!!!!
  15. What are you referring to with "95% of recipients of AB plasma have antibody to the soluble antigen present"? Even with low titer O Pos WB units aren't you going to see just as much formation of antigen-antibody complexes as you do with a non-type specific platelet pheresis? The volume of plasma will be about the same and will contain anti-A, anti-B and anti-A,B, correct? What about the Trauma centers that are using A plasma - is that any better?
  16. You should probably get used to the DTT procedure. Hemo-BioScience offers the reagent in small aliquots that can be used easily without bothering with trying to manufacture the stuff. There are several threads on this already on this site. Do a search and see the discussions. I had posted our procedure in one - let me know if it is not accessible now and I can send it to you. The cord panel method would be nice if you are doing a lot of pts, and at least the cells will last a while. DDT treated cells will not last long at all.
  17. Does the O.R ever tell you that the Pt's armband is "inaccessible" because it is "under the patient and contained within the sterile field"? We use an armband system for our BB patients and we get told that occasionally when we need to transfuse in O.R. and they didn't get the armband number before they covered up the pt. The RN usually winds up crawling under the pt's table. What does your O.R do in that case? Especially since they are having to do a barcode read of that band? We use coolers for our O.R. deliveries (one pt per room) and I never want to even discuss the introduction of an O.R. refrigerator. Anything giving in the O.R. is documented in the anesthesiologist"s records, which are also part of the electronic record.
  18. What is the rational for Whole blood vs. FFP and RBCs, especially with the blood mixers used at trauma bedside? Are there no problems with the decreased Coag factor levels with the older plasma in the WB units? I know some trauma centers are using liquid plasma so there is no delay in response - is WB even better than that? In what way? What about platelets? Do you still have to add them into the mix?
  19. We have two forms I could send you if you want to message me your email address. Most of ours is now in the computer also, but the forms have more instructions, both for Nursing and the techs. Good start.
  20. Since we use CP2D units for both our exchange transfusions (reconstituted with FFP) and small volume transfusions, we do not spin the unit down. We just measure the Hct and provide to the Drs.
  21. Malcolm - would you be able to share what happened to "improve" the titers? What changes were made in the procedure/ cell choices, etc that made them more reliable? Was it something specific or just more practice? CAP has introduced a "Universal titer procedure" - but peer results are still all over the place.
  22. Amen! Our nurses take vitals before, at 15 mins, at 1 hour, and at end (<4hrs). Don't know where it came from but that is our policy.
  23. We use the Helmer D4 and have had it for years - it doesn't have speck of rust anywhere. We only fill it with distilled water and use the Helmer CleanBath Would the dry heat thawers work well for Plasma exchange transfusions? The 4 well waterbath we have is not going to get through 16 units very fast.
  24. We have an irradiator on site, so irradiate 1 aliquot at a time. For the infants, we will not use an older irradiated unit. I can't give you any data on how fast the K+ builds up, but I wouldn't stretch it to 10 day for neonates. Since no one else answered - you might have to do an internal study to see how fast the K+ rises (and it DOES rise). Good luck. The other hospital in town does not have an on-site irradiator and I think they are now ordering at need - a tough job in this neighborhood.
  25. 1 per year or 1 every other year. Nightmare to maintain competency and training on! We get the little ones transferred here now - about a 200 bed hospital with maybe 10 neonate beds. (and to think we have a Children's hospital and a second huge pedi/neonate service 50 miles to the south of us - it is all a prestige thing, I swear).
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