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AMcCord

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Posts posted by AMcCord

  1. 9 minutes ago, Kim D said:

    Do you have policy in place to cover "deviation" from O negative to O positive males and females outside of childbearing age?  Do you notify attending physician?

    Below is our policy for switching Rh negative patients to Rh positive red cells for non-emergent cases. We would document that decision and any pathologist instructions in the patient's profile. 

    For emergency release/MTP we follow policy and do not notify the provider unless it is a patient under 19 years or a female of child bearing potential. 

    image.png.940865e7643554f993815d744390e875.png

  2. On 9/1/2023 at 8:43 AM, jshepherd said:

    The response I got from ARC is that it is up to our medical director. There is no FDA exception needed, as the FDA doesn't have a regulation on shipping duration or transit time. They only care about temp, and since the temps are in range, there is nothing to seek a variance from. 

    I heard from people who use other blood suppliers, and the general consensus is that if the packing is correct, ice is still present and the units are in temp range, they are acceptable, as long as there is documentation of this deviation from the hospital's normal policy. 

    I ended up adding this tidbit to my SOP as an allowed deviation by our medical director, just need to fill out the deviation documentation form and have him sign, but this way, we can accept the units in immediately and not delay having them be available. Especially important for platelets! :)

    Good info - may have to update our SOP.

  3. 19 hours ago, snance said:

    Some references related to the Platelet Glycoprotein, GPIV

    B. R. Curtis, J. G. McFarland. Human platelet antigens – 2013. Vox Sang 2013;106:93-102

    Curtis BR, Ali S, Glazier AM, et al.: Isoimmunization against CD36 (glycoprotein IV): description of four cases of neonatal isoimmune thrombocytopenia and brief review of the literature. Transfusion 2002; 42: 1173–1179

    Ikeda H, Mitani T, Ohnuma M, et al.: A new platelet-specific antigen, Naka, involved in the refractoriness of HLA-matched platelet transfusion. Vox Sang 1989; 57: 213–217

    Curtis B, McFarland J: Detection and identification of platelet antibodies and antigens in the clinical laboratory. Immunohematol 2009; 25: 125–135

    Thank you!

  4. I didn't find much either, but from what I did find it looks like it could be another interesting blood banker's problem since CD36 is definitely found on RBCs. And it sure looks like it may be utilized with immunotherapy for multiple kinds of cancer treatment to make it more effective. Or for FNAIT.

    https://pubmed.ncbi.nlm.nih.gov/1382721/

    The link below is interesting - not sure how it would relate. 

    https://pubmed.ncbi.nlm.nih.gov/8623134/

    And then there are these tidbits:

    https://pubmed.ncbi.nlm.nih.gov/34041523/

    https://www.ahajournals.org/doi/full/10.1161/01.atv.16.7.883

    If patients with African descent are more likely to develop anti-CD36 due to CD36 deficiency, are their red cell ABO types (or other antigen types) going to be affected by that antibody (which would be an autoantibody)??? 

    I'm with Mabel - anyone out there know anything about using anti-CD36 for cancer treatment or FNAIT treatment?

  5. 23 hours ago, jayinsat said:

    Same. Are you doing both DAT Automation and DAT manual survey's? 

    We are doing both. We use automation at this time only for cord blood specimens, but having a survey will save us from the alternative testing issue on the All Common CAP checklist.

  6. Ours print on a 4" x 4" label from a Zebra type printer. We stick them on a slightly larger tag made from card stock with an eyelet at the top for a rubber band. The back of the card stock tag is printed with a list of transfusion reaction symptoms and a brief description of response expected. Below that are blood handling instructions/education. All nursing documentation is in Epic.

  7. On 7/31/2023 at 8:49 AM, jayinsat said:

    Now, if we can just get CAP to produce their RBCAT proficiency testing vials so we can run them on the ECHO's. That would be great!

    Bet they will sooner than later as more antigen typing is automated. I was delighted when the DAT survey for automation came out, even if it is ungraded for now.

  8. The ARC told us to put the chilly platelets in the incubator and let them rock for a couple of hours, then recheck for swirl. If they look good at that point and our pathologist is OK with that (which they usually are), we put them into inventory. We will use the unit(s), if we need to, until we restock. If the patient can wait for the next shipment, we hold off. Fortunately we only see this problem once or twice every winter.

  9. 18 hours ago, DebbieL said:

    This is Method Comparability, not Test Result Comparability. Does CAP have to have a quota of standard changes they have to meet? I'm on a soap box and I am sorry to rant but this seems unnecessary and extra work for the same AB screen results across the different methods. 

    Job security??? My comment about several of the All Common checklist items is "we ain't chemistry!". Not that it gets me anywhere.

    Since we are in our inspection window, I made emergency changes to my SOP/form for that and we will scramble for suitable specimens. :rage:  Our problem is finding enough suitable antibodies with sufficient sample volume to do all this extra testing. As part of our Patient Blood Management program we draw minimal patient specimens - just enough to do the ABS and an antibody ID if it isn't a warm auto workup. We can squeak extra antibody screens out if the patients Hgb is low enough, but not multiple ID panels. My only solution to that is to do abbreviated panels using 3 Ag positive cells and 3 Ag negative cells, then state that the results are consistent with the antibody IDed with solid phase. If that's not good enough - (bad words). 

  10. On 7/21/2023 at 1:43 PM, applejw said:

    So, CAP is pushing back on my challenge to the argument that an antibody detection and identification use the same method and for which we ARE performing comparability studies using the different testing method platforms.  I'm still arguing but I'm not hopeful.  Has anyone else run across this with recent CAP/AABB inspections?

    We are in our inspection window now, so I'll let you know how we come out on that one. 

  11. If the model is discontinued and no parts are available for repairs, I'd say it has reached its 'end of life' - however I'll bet it will still work a long time after that before a part needs replaced (especially older, quality scopes). I can see 'end of life' for more complex or expensive equipment, but a microscope for blood bank is more of a minor equipment purchase. My 'new' scopes are student scopes that cost less than $500 and they work just fine for our purposes. 

  12. 16 hours ago, Mabel Adams said:

    Does anyone remember the humorous/terrifying thread on here more than a decade ago of all of the insane things we had heard of?  "I can't hang this plasma on my patient, it's liquid and the doctor ordered FROZEN plasma".  Or, "I don't care if the plasma isn't thawed yet, I need to hang it stat! Send it up now!" "I ordered that blood culture stat and it's been 2 hours.  Why don't I have a result yet?!"

    Oh yeah! That was fun (sort of).....

  13. 18 hours ago, Ensis01 said:

    I have never encountered a patient that says they have antibodies unless they have a card. 

    We don't issue cards to patients with antibodies. I've discussed it with several of our medical directors, but none of them have been very enthused. They feel that most of the cards will be lost, forgotten about, or the info won't get passed on to us. Based on our past experience, I can't make a strong case. Our current medical director is a believer in Med Alert bracelets for the scary stuff.

    I've seen only a few cards, under the following scenarios:

    • A few times: nurse is checking out blood and says 'Oh, the patient showed me this card about an antibody or something. Did you need to see it?' YES, before you transfuse!
    • Twice: nurse has started transfusion and calls Blood Bank - 'Mr XYZ showed me a card about an antibody or something today (or yesterday). Do you need to see it?' YES, STOP THE TRANSFUSION!
    • and once, once only - as the patient was being admitted on the floor, the nurse called and said the patient had a card about transfusions - 'Do you want me to fax you a copy?' YES! Gold star for you!

    Sometimes I wish we could put a chip in the scruff of everybody's neck that had all that info loaded on it - allergies, antibodies, med history - wouldn't that be handy.

  14. On 6/2/2023 at 11:37 AM, Malcolm Needs said:

    I realise that this is a very vague explanation, and that there are many other causes of anti-D immunoglobulin being less than effective (such as giving it to the father, or even to the ambulance staff (SHOULD be unbelievable, but is actually true), but it does show just how complicated such a simple thing as this can be.

    Nothing is ever simple, is it? Especially when you get other folks involved.

    I stopped a dose of RhoGAM from being given to the baby. I've had nurses squirt some out of the syringe because "it's an early miscarriage, they don't need the full dose". I asked how they were calculating that dose and how did they know how much they squirted out...no answer :faq:

  15. 18 hours ago, Mabel Adams said:

    Anyone else remember when the RhIG used to come with some of it in a separate vial which we had to test against the patient's cells? I guess to prove that they really were Rh negative.  We definitely had to do an antibody screen with that.  That was before 28-week RhIG or Fetal Screen/rosette tests.

    Oh yeah.... that dates us. :D

    And I remember doing antibody screens post RhoGAM, prior to patient discharge, to 'see if the RhoGAM dose was adequate'. No anti-D detected = give more RhoGAM. Something the OB folks thought seemed like a grand idea before the fetal bleed screen was available. Fortunately fetal screens came out about then. We were able to convince the docs to stop with the ABS orders by running parallel tests with the fetal bleed screen for several months to demonstrate how meaningless the antibody screen idea was.. 

  16. 2 hours ago, jayinsat said:

    There is one danger in this process, and I have seen it happen. Miscommunication between shifts opens the possibility of an expired unit being successfully issued because the expiration date in the LIS is different then what is manually written on the unit. If you are not changing the expiration in the LIS, you will need some sort of system in place (in policy and practice) that shows you mitigate this possibility. 

    Would agree with that. Our software automatically 'thaws' and updates the unit outdate when we product select. Our potential failure point is that the tech who thaws and tags the product fails to change the outdate on the unit face label. 

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