AMcCord

Our oncology patients seem to get a 20-30,000 bounce. Other patients may get a bounce up to 50,000. So, that's what we tell the docs who ask - "In our experience............" - and we leave it at that.

And (correct me if I'm wrong on the time frame) the child can sue (or someone can sue on their behalf, if a minor) until they are 21 years old for 'damage' suffered as a result of something that can be connected somehow with mom's pregnancy or delivery. So, if mom has an anti-D that "should" have been prevented and baby suffers for it, the doctor is on the hook for it for a long time and potentially for many, many dollars.

We had a patient like this, though she also had an anti-Di(a) to go with her anti-c. She came in bleeding out 5-6 times over the course of a year. We were also forced to give uncrossmatched blood and some c positive blood. Fortunately, the patient did not have an acute or delayed reaction in any of these visits. We kept a close eye on her Hgb and renal function until dismissalt each time. We always dreaded a return visit from her.

Speaking of doctors lacking education (and common sense), we have an anesthesiologist who will draw blood bank specimens (and hemo, chem and coag specimens) directly above an IV. He's done it multiple times, we/ve explained multiple times why that's a really bad idea and the next time he has a patient going south fast - he does it again. We generally catch it cause the patient seems to have a 2.3 Hbg. Education isn't working well here. I'm thinking a big thump on his noggin might get us equally good results.

Giving RhoGAM to weak D positive patients is not an uncommon practice in the US. It's a very conservative approach. (I understand that we also give larger doses of RhoGAM.) Don't forget one very big difference between your medical system and ours - many, many medical malpractice lawsuits. Medicine is practiced here in an increasingly defensive mode - sad, but true.

Long ago and far away (in another galaxy), there used to be a little vial of RhoGAM intended for crossmatching with your patient in the box with the syringes of RhoGAM. That was discontinued many years ago. Our workup includes Rh type, antibody screen (which I would like to drop), fetal screen and Kleihauer-Betke if the fetal screen is positive.

Eoin... Nice worksheets!

We do a DAT.

I (reluctantly) decided to call them critical materials. We capture the lot # of the infusion set on the transfusion record - used to be on paper, now electronic. Compliance is good and I don't get any grumbling from staff. The checklist explanation states that anything that directly affects patient safety qualifies and there have been some recalls due to sterilization failures of infusion sets. That's how I sold it to Nursing administration. They had no problem with it.

We handed our therapeutic phlebotomies over to the Outpatient Infusion Clinic several years ago - at their request - so, that it makes it a nursing function. (Can you see me smiling?) When we did them, it was a tech that drew the patient. We are a smaller facility, so I trained all of the rotators who worked regularly in Blood Bank on day shift. If Blood Bank was too busy (2 techs) to cope with the phlebotomy on any given day, we always had 1-4 other techs we could recruit from the main lab to perform the phlebotomy.

I agree with Linda 100%. We also are small volume and will be running anything on our Echo that it will do. It's a tremendous help to evening/night shifts and it gives us more time for paperwork, etc, etc on the day shift.

I've had the FFP in the microwave reply, too. Told them Over My Dead Body! The doc stomped off to rant at the BB Medical Director and I never heard another word about it. Never got that request again, either.

The Durascale is also what we use. Works very well.

We might, under some circumstances, do it for an internal investigation. It is just a 'quick and dirty' type. It never goes on the patient record, it never goes on Blood Bank's records, it is never a redraw specifically for a type. It would be done on a specimen or specimens in hand whose results are discrepant, usually wildly discrepant. It is never ever used for firing someone or as 'proof' for disciplinary action. It is simply used to solve a mystery. (And it usually doesn't help much since most folks are going to be O Pos or A Pos anyway. My lab manager is a chemist so take that into consideration.)

See AABB Technical Manual, 16th ed, page 404 'Concomitant Rh Antibodies'. This may be what your supervisor was talking about. The same material is on p 327-328 in the 15th ed.

Do you suppose that it is because the FDA is all over their business - new quality program, etc?

Congratulations! Doesn't it feel great...

Great Job! When you get that passing score, it's huge personal satisfaction.

We use a little blade (not sharp) that is about 2-3 inches long and has an edge like a file. Kind a like a tiny hack saw blade. I have no idea in the world what it is or where it came from but you could look over the right section in the hardware store and I'll bet you'd find something similar.

We've put a few on ankles at patient request - very hard to see their names in that location! We will replace the ankle band with an armband upon admission to make it easier for staff to find it.

I talked to someone at Shamrock labels who knew all about FDA requirements for labels, very helpful. 800-323-0249.

We have asked the pathologist to call the nurse and order her to stop the transfusion. This is a rare occurence thankfully.

The Echo is Stat friendlier. Samples can be added, tests ordered and the 'begin' button pressed at any time without halting testing or waiting for the analyzer to be ready for you to add samples or program tests. The new software upgrade allows the test to be started at the earliest opportunity comingled with other tests already in process. The Provue must have approx 25" behind it for service access. The Echo needs about 12 -14" minimum. The Provue has a lid that opens upward, so if you have overhead cabinets, be aware of height. The Provue is also much heavier, if that matters to you.

I Agree!

I have seen some references which say that ideally you should wait 24-48 hours (see Mollison - Blood Transfusion in Clinical Medicine), but that's not very real world. We try for 1/2 hour after the end of the transfusion if we receive an order that specifies a draw 'after the 2nd unit' (or 1st or whatever). However, if you are talking about a patient who is actively bleeding, the Hgb is a moving target, so an immediate (5 min) draw can be useful to the physician - is he keeping up with the bleed or losing ground. The amount of fluid pushed into your patient will also have an impact on the Hgb level - the Hgb level at 24 hours might be 10% higher than the level you got at 15 - 60 minutes due to fluid dynamics. So, in some cases, our draws are when the doc specifies. The time most commonly specified by our docs is 30 minutes. 5 minutes is common in surgical bleeds, 15 min for active GI bleeds. Many of our post-transfusion draws are simply ordered for next AM. You might find this article helpful: Equilibration of Hemoglobin Concentration After Transfusion In Medical Inpatients Not Actively Bleeding, Wiesen et al found in the Annals of Internal Medicine 15 august 1994, volume 121, Issue 4, Pages 278-280. Wiesen and company did a small study of their own with patients >18yrs and no recent active bleeding. They determined that Hgb levels measured in this type of patient at 15 minutes, 1 hr, 2 hrs, and 24 hrs were statistically equivalent. (They note small studies done in pediatric patients and neonates which give equivical results or agree with their findings in adults.) They also cite 19 sources, so you might find a study that is more relevant to your patient population.