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AMcCord

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AMcCord last won the day on July 11

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About AMcCord

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  • Birthday May 8

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  • Location
    Nebraska
  • Occupation
    Blood Bank Section Supervisor

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  1. AMcCord

    Platelets acceptable return temperature

    Unfortunately, we have weather extremes that sometimes affect deliveries of platelets. We don't have any issues when Plts are delivered by the blood service, but in the extreme temps of summer and winter when they are delivered by a contract carrier, we can have temps outside of the 20-24 C range when we receive them. It's all about how the boxes are handled. If someone with the carrier doesn't do what they have been instructed to do (keep the blood boxes out of the unheated/un-airconditioned warehouse), then we have the potential for temp variances. Doesn't happen often, but often enough that checking temps is a must. When you make your decision on whether or not to temp your Plts when received, consider the delivery method and your environmental factors. If you live somewhere without extreme temps, you are probably not going to have a problem.
  2. AMcCord

    Positive Antibody Screen due to Rhig

    I would definitely rule out other significant alloantibodies in some way. Assuming that the antibody present is 'only' RhIG is asking for trouble. 99% of the time, it probably will be, but the time it isn't could bite you in the tookus.
  3. AMcCord

    Platelets acceptable return temperature

    We do take temps on Plts when received. We expect them to arrive between 20 and 24 C. Plts that are over 24 C are not accepted because of increased risk for bacterial growth. Plts that come in cold - depends on how cold and how badly we need them. If the temp is between 18 and 20 C, we do a shimmer test when we unpack them, then repeat the shimmer test after they've been on the rotator for a couple of hours warming up and getting happy. If they don't shimmer, we don't use them. If they do shimmer and we have a patient that can't wait for a new delivery, we let our Medical Director make the decision whether to transfuse or not. He will make that decision after consulting with the ordering provider. This is not something we do very often and only when we really have to. We are 150 miles from our supplier and bad winter weather can really have an impact on product delivery at times. If we transfuse a cold unit, we fill out a Deviation from SOP report to document the decision process. There is some really interesting new work getting published right now about cold storage platelets, so this isn't that crazy. We also take temps on blood product returns. I would expect Plts to be returned between 20 and 24C. If they are outside that temp, see above for what we would do. But please, don't ask me about temps for FFP returns, that is still a work in progress. The Plt temp policy was developed with the input of our blood supplier and their Medical Director. If you haven't contacted your supplier, I would recommend that.
  4. I would agree with David. It is too much to expect to get the same kind of documentation during a MTP protocol that you get during a 'normal' transfusion. One thing that nursing staff does at my facility is to designate the resource coordinator to sure as the recorder for everything that goes on during a MTP or Code. If he/she isn't available, someone else will fill that role. That person can document provider orders, med administration, blood products, etc.
  5. AMcCord

    Complement QC with Poly IgG

    TRM.40200 DAT Controls Phase II When performing an antiglobulin test with anti-IgG or polyspecific antiglobulin reagents, IgG-coated red blood cells are used as a control in all negative antiglobulin tests. NOTE: IgG-coated red blood cells must be used to confirm all negative antiglobulin test results when the antiglobulin reagent used for testing has anti-IgG reactivity. Tests found negative by tube methodology must be verified by obtaining a positive test result after adding IgGcoated (control) red blood cells. If a licensed blood typing system is used that does not require verification of negative test results using IgG-coated red blood cells, an appropriate quality control procedure must be followed, as recommended by the manufacturer. Evidence of Compliance: ✓ Records of testing that include control results confirming negative antiglobulin tests TRM.40210 DAT Phase II When performing an antiglobulin test with anti-C3 antiglobulin reagents, C3-coated red blood cells are used as a control in all negative antiglobulin tests. NOTE: Complement-coated red blood cells must be used to confirm all negative antiglobulin test results when the antiglobulin reagent used for testing has anti-C3 reactivity. Tests found negative by tube methodology must be verified by obtaining a positive test result after adding C3- coated (control) red blood cells. If a licensed blood typing system is used that does not require verification of negative test results using C3-coated red blood cells, an appropriate quality control procedure must be followed, as recommended by the manufacturer. If a polyspecific antiglobulin reagent is used, refer to checklist item TRM.40200. Evidence of Compliance: ✓ Records of testing that include control results confirming negative antiglobulin tests ********************************************************************************************************************************************** I was cited for this years ago. I called CAP and was told that because poly AHG has anti-C3 reactivity as well as anti-IgG reactivity, both had to be confirmed. In addition to this std, she also referred me to the all common checklist which requires that we perform QC on reagents every day of use. So unless the manufacturer of our reagent had some other recommended QC procedure for C3 reactivity, we were required to use the complement coated cells. I put a standing order in for C3 coated cells that day, sent the confirmation email to CAP and my citation was considered corrected on site. I would assume that AABB would view this in a similar way, not to mention CLIA. When we do a DAT, we are looking for both anti-IgG and anti-C3 activity. If the DAT is positive with poly and anti-IgG, that doesn't preclude anti-C3 activity. If you aren't doing QC for the anti-C3 activity of your poly AHG, how can you demonstrate that your reagent is reacting properly? If you send all DATs out to check for C3 activity, then you would only have to QC the anti-IgG activity and your reference lab would be responsible for the C3 activity. Having said all that.....have I ever seen a failure with the C3 activity? Nope and I don't expect to. I've given students anti-C3b, -C3d reagent that's outdated by years and it still works just fine. But that's irrelevant and not how the game is played. We don't do very many DATs, but that's also irrelevant. So, I stock the C3 coated cells. Cost of doing business. I find ways to save in other areas.
  6. AMcCord

    ARC Packing Slips? Keep? Trash? HELP!

    6.2.9 std 5.1.6.5 ?
  7. AMcCord

    TRM.30700

    I have marked that one N/A for years - we don't prepare (manufacture) blood products. Just get them ready for transfusion, which is crossmatching, thawing, pooling (if you do that), etc. No inspection problems.
  8. AMcCord

    MTP with EPIC

    How do we survive without a BBIS? Well, it takes a boatload of paperwork and even more time to deal with the paperwork. We've never had a BBIS, so we don't truly know what we're missing (though I have a vivid imagination, did work with a BBIS validation years ago, and I am soooo looking forward to getting SafeTrace Tx up and going - I have been the squeaky wheel for years pushing for a system and they finally said YES ). We've given as many as a thousand units of red cells a year with paper records, though we are currently down to 700ish with patient blood management taking effect. I track products with an Access data base and we had a DOS data base before that . We use report forms built into our LIS - the LIS we are using now and what we were previously using. These are strictly reports, nothing more. All other documentation of testing, etc. is on paper. Prior to that (and not so many years ago) we typed our reports on a typewriter - I kid you not! Our entries in the LIS are made manually from drop down boxes, a minimal number of free text boxes and using barcode scanners for DINs and product codes. We have rules in the LIS to remind staff about required testing. All entries are verified by a second tech and are further reviewed at a later point by myself or a designee. Old school, but it works. The pertinent information passes from our LIS to EPIC, so BPAM works. I wish we were going to use the SafeTrace blood admin module, but that decision was made for us. I stress to every nurse that I talk with about patient ID that the information that BPAM is checking is a manual entry, so is not a guarantee of anything. If something doesn't look right, they are instructed to stop instantly and contact us. The 2 person bedside check of armband and unit tag/bag information that we were doing prior to BPAM is still critical. And our medical director and I meet every new nursing hire for a pep talk in Blood Bank about patient ID, transfusion safety and MTP/emergency release. We pass Joint Commission, CLIA and CAP inspections w/o issue and transfuse our patients safely because I am a well known, absolute DRAGON about following procedures and doing things right! (Did I mention that I can't wait to get SafeTrace up and running ??? )
  9. AMcCord

    MTP with EPIC

    There is an emergency transfusion option in Epic. We are not using it yet, but I've seen a demo - our mother ship for Epic is still playing with that. It is pretty slick. It allows the patient and the unit to be scanned, then quick notes for the infusion. These entries can be added to very easily as the transfusion is continued and finished. Info can be added later if something is missed or there isn't time when it's happening. It looked like it would be just as fast or faster than hand written notes when the trauma coordinator was showing it to me. The sticking point right now is that we don't have a blood bank information system, so chances are good that some or all of the units that are emergency released are not going to be in Epic. When we get caught up, if we get caught up, the units will be there. That takes time as everything is a manual entry at this point. Nursing staff just doesn't get that. Once we bring up SafeTrace Tx, hopefully by the end of the year, we'll have emergency release through the system and everything will be in Epic. I hope we can implement that piece in Epic.
  10. AMcCord

    ARC Packing Slips? Keep? Trash? HELP!

    Our packing slips have unit info, time packed and documentation about time and condition when received. Saved for 10 years.
  11. AMcCord

    BB Exam

    This would be a big help for you.
  12. AMcCord

    BB Exam

    It's been years since I took my SBB exam but...... Read AABB Technical Manual cover to cover Read AABB Standards cover to cover - twice Make sure you can do the math: RhoGAM dose calculation, FFP and Cryo dose calculation, etc etc - anything you come across in the Tech Manual that includes calculations, make sure you can do them. Be very familiar with donor standards. ABO discrepancies Antibody ID - what is clinically significant, what is not and you may have a question or two or three asking you to ID an antibody from a workup they provide for you. Maternal/Neonate - which antibodies can cause HDNF, exchange transfusion (unit selection, testing, etc), RhoGAM Coag - coag cascade and treatment with FFP, Cryo, Factors Modern Blood Banking and Transfusion Practices - Denise Harmening --- this is an excellent book, I would recommend reading it cover to cover as well. Good Luck!
  13. AMcCord

    Transport or Storage?

    Agree. I have also heard this straight from the FDA at a question and answer session at AABB. The answer was quite explicit - storage.
  14. AMcCord

    Blood Bank staff

    I agree. We are a clinical site for a university program. Our students spent 7 weeks in blood bank, but only 3-4 hours a day on the bench, max. The rest of their day will probably be spent on topics other than blood bank. Hands on seems to be the best way to solidfy what they read in books (if they bother to read - many won't) and lectures, but they get such a small amount of hands on time.
  15. AMcCord

    IgG vs AHG

    You can avoid some annoying clinically insignificant cold reactive antibodies by using anti-IgG.
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