AMcCord

I assign ours like adiecast and have for years. Never any problems with inspectors.

......

OK...I found the other thread...started by me! - forgot that part of the discussion. The title is 'Infrared Thermometer Validation', dated 7/30/2008. Someone on that post said that the emissivity for blood in a clear plastic bag should be 0.85. (Our new gun came pre-set with an E value of 0.95, which is supposed to cover 90% of anything you want to use it for, though not apparently blood bags.) Whether or not that value should change for the bags that are less than clear, I don't know. There was no reference given, so my next mission will be to track that down.

My boss handed me one last week that is Cardinal catalogue # T2971-11. One of the advantages of this model is that you can adjust the emissivity to obtain truer readings. There was another thread somewhere on this site, maybe a year ago, that discussed infared thermometers and the emissivity of blood, if only I can find it. There was a really informative discussion about the whole subject. I've just been playing with our new one today and I can get readings on red cell units that vary by less than 1 degree from the refrigerator temp. Ditto for platelet single donor units. We had been experimenting with a different model that ate batteries at an alarming rate and gave up on it for that reason - sorry, I don't remember what it's model # was but it was not gun-shaped like this one is. We did discover with that one that you do indeed need to be very careful about how far from the bag you are pointing it. I think your procedure would have to specify a distance at which it must be used when taking temps. If the temp is close to a temp range limit (say 9 degrees for shipped blood), we will require that our regular temp probe be the final word on acceptability. We are planning on using the gun as a quick temp screener. Dr Pepper - the temp problem you had with the 10% glycerol bottle may have been because of the color of what you were trying to read (or maybe I should say, lack of color). The previous infrared thermometer we played with warned that temps of clear glass or plastic or liquids were not going to read as accurately as something with some color. I'm remembering that this maybe had something to do with the emissivity of the object being pointed at ??? I think that was something that was also discussed in the previous thread. (I wish I had been more attentive in physics classes!) If I can find the thread, I will post the name of it here.

When we set up for gel (9 years ago), we were told that 0.8% cells should not be converted to 3% suspensions for tube testing. If you want the ability to go both ways, you could buy 3% cells and convert to 0.8%. We made a batch of 0.8% cells routinely every morning, QC'd them and then used them for 24 hours. The upside was that we stopped seeing most of the funky reactions like you are sending off to the reference lab that turn out to be nothing. Money saver!

I've also been a walking blood bank in the past. I got called in one day on my day off years ago because there was a bad trauma case and they needed more hands. Once I got there, I was asked my blood type and the medical director decided they needed my blood worse than they needed my hands! One of our local state troopers and the hosptial CEO were O neg. They got a lot of calls and were always very willing donors. The craziest situation was that one of our surgeons always wanted 'fresh, whole blood' and he would march over from surgery once his patient was on the way to the recovery room, demand that we draw a unit of his blood, grab the unit out of our hands immediately after we pulled the needle from his arm and take it straight to the patient and hang it. (We scrambled to do the quickest crossmatch we could once he stomped out the door, blood in hand.) Crossmatch? He didn't need no stinking crossmatch!!! His blood was perfect. Our medical director lacked the fortitude to stop him. Those were the days..........and I'm glad they are dead and gone!

That's how we work it.

Some years ago we were cited by CAP for this very item. It is indeed a nursing competency. I collaborate with nursing education for a yearly review/quiz done on a computer. One thing we've done, which seems to open a lot of eyes, is to give them an overall review of symptoms and the procedure to follow with a suspected reaction in conjunction with a case study for a specific type of reaction. Each year it's a different type of reaction. I can tell over the course of the following year that the information hits home with nursing staff based on the questions I get about specific patients.

We actually see slightly fewer non-specific problems with Echo than we were seeing with gel. And we are identifying antibdodies with Echo that we would not have been able to ID with gel or PeG (and not all of them are RhoGAM ;>). For us, that trade off makes it less of a burden.

Thanks Dawn. I sent my fax via personal message.

Would you be willing to share a copy of your form?

I swear we see more of these kinds of nasties in the winter time. Maybe it's just me

You're welcome, Jane. I'll see if I can find that article. One thing we weigh against all those funky results is the number of antibodies we detect with solid phase that are not detected by tube methods or are weak enough that they are difficult to ID or can't be ID'd with tube. It makes the aggravating ones a little more bearable.

If we get a positive antibody screen on Echo and an ID that is non-specific/indeterminate we run another screen with PeG/tube. If that screen is negative with a negative auto or negative tube DAT we report the antibody screen as Positive with 'solid phase reactive antibodyof undetermined specificity'. If we have a positive DAT on Echo or with tube with the scenario above, and all screen cells are positive on Echo, we would call it a warm auto. If a crossmatch is ordered in a case like this, we would do an IS and tube AHG/PeG crossmatch. If the IS and AHG/PeG crossmatches are compatible, we would release the blood for transfusion with the comment that the unit is compatible in AHG with PeG. If the IS crossmatch is incompatible, then we would look for rouleaux or cold reactive antibody to explain the IS results. If the problem is a cold (P1, M, N, etc) that is not clinically significant (and is AHG compatible) we would not screen for antigen negative units. (Please note that we do not do cardiac surgery here.) If the PeG screen is positive, then we are going to do more of a workup, such as an ID panel with PeG, a repeat screen with LISS, elution if indicated by patient history, etc. We may still end up calling it a warm auto or antibody of undetermined specificity, but we've worked it up more fully before we do that. If we are still not satisfied with what we are seeing, especially if the patient has a warm auto that we can't minimize with PeG or LISS, then we send it out to our reference lab. We used gel for almost 9 years and we had similar looking antibody situations with that and that's where this approach came from. We have never had a physician question or even ask about the reports on these patients. If we feel that the antibody is significant (warm auto), the physician decides whether or not he/she wants to continue with the transfusion. I've had discussions with the reference techs about these kinds of reactions and their feeling, based on experience and discussions with other reference labs, is that we are probably picking up autoantibodies that are more enhanced by solid phase than our tube methods, HLA antibodies, drug related antibodies (which we don't see if the patient doesn't have that drug in question in their system) or antibodies directed against preservatives or other chemicals in our test system. These types of antibodies are a pain in the posterior for us but probably not significant in terms of transfusing the patient, though I'm not going to report that. The patients we see with these problems are usually Onc, cardiology, and frequent flyers with multiple serious health issues. They've been multiply transfused, multiply drugged and their immune systems are not like yours or mine, so it's hardly surprising that they cause us problems. Bottom line - if we're not comfortable with the what we see with repeat screens or IDs in tube, we send it out. But we don't have to do it too often.

We 'fetch' the cord bloods from OB as soon as we are notified of their presence (that unit if FAR FAR busier than any other unit in the hospital - in their opinion - so we fetch all their samples) and that is usually within 15-20 minutes on days and evenings. On nites it may be 2 hours. The cord bloods are tested as quickly as possible. We then draw our RhoGAM workups - the urgency is less for testing them - and most of our patients received their RhoGAM in less than 12 hours post delivey. Most nite time deliveries get their RhoGAM the next morning. Our policy states that Mom will be drawn 1 hour post delivery or as close to one hour as possible. Most of the time we are between 1 and 2 hours. It was that way when I came here many many many years ago and it still works for us. Everybody is used to it, I suppose. Though we did have one nurse practioner who works here with a Family Practice group who insisted on being redrawn for her fetal screen. She insisted on exactly one hour post delivery and she felt that we had drawn her 7 (yes, 7) minutes too early. We obliged.........the customer is always right (in her mind).

We're with Alabama with some of the lowest Medicare reimburesment in the nation. Two of our same size (large-ish) neighbors laid off across the board a year ago. We've seen a bunch of bad revenue months but our bottom line was in pretty good shape going into this mess, so we survived last year without anything drastic - watching overtime, no new hires, postpone major purchases, watch supply inventories, etc. Time will tell how things go this year. We had just gotten good and started with a major remodel/expansion project hospitalwide when this hit, talk about good timing! We've had no 'real' raises for over ten years, just tiny so-called cost of living raises. My stats for last year actually show an increase in blood useage - why? I have no idea. Our jobless rate is lower than the national average, so we are hoping to survive another year without anything drastic. Time will tell.

Malcolm...we like to decorate for Halloween! wink wink

The photo and signature included on a blood card is a great idea.

We do type for the c antigen when possible, however in cases where the patient has been recently transfused or is pregnant, then we transfuse c negative red cells in the presence of anti-E. If we get the chance to type them for c antigen down the road, we do it so we can stop providing unneccesary c neg units. It seems like most of our anti-E patients are frequent flyers.

Well put!

We do what gshickman does. The Technical Manual (16th ed) says: "Some Rh antibodies are often found together. For example, a DCe/DCe (R1R1) patient with anti-E most certainly has been exposed to the c antigen as well. Anti-c may be present in addition to anti-E but may be weak and undetectable at the time of testing. Transfusion of seemingly compatible E-negative blood will most likely be c-positive and may elicit an immediate or a delayed transfusion reaction; therefore, some advocate the avoidance of c-positive blood in this situation." That's the rationale for those of us who do it this way.

When I talked to Immucor's technical people about my Fetalscreen issues, I was told that Immucor uses the pHix buffered saline for everything they do. We are still using NERL buffered saline for our manual testing and pHix buffered saline for the Echo. My rationale for this is... I've been too lazy to do any validation studies to switch saline. Since I have 2 cubes of saline open all the time anyway, it hasn't been an urgent thing. I would say, do whatever works best for you.

Our order is for RhoGAM. Blood Bank is responsible for determining what tests are required/appropriate for each patient.

Until we discontinued the test, KB was done in Blood Bank.

Would you be willing to share a procedure for this? I have the freezer and the glycerol.