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AMcCord

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  1. AMcCord

    Echo vs Provue

    John, you were so right! Now... if I could just get a computer to interface Echo with.
  2. We also would do 2-3 450 mL units a week for new hemochromatosis patients, though our Medical Director didn't like the idea much. The orders had to come from a hematologist, not a family practice doc.
  3. AMcCord

    Echo vs Provue

    We've been live with Echo since Jan this year and love it. I'm the primary operator/trainer/troubleshooter. I have never been of the chemist mind set, so when I tell you that the instrument is easy to work with, I'm not kidding. My techs switched from gel with no problems, learned the software very quickly and like using the instrument. It has little features built in that help save you from making dumb mistakes (putting reagents on in the wrong place or leaving the reagent caps on, for instance) A recent upgrade to allow co-mingling of test batches means that it runs faster than ever. You can put on a test, start that, then keep right on loading and ordering test after test. Then you walk away. When it gets to the right point in it's test process, it will start the next batch, then the next, and so on, not waiting to finish the first batch. Almost random access like a chem analyzer. Our workload means we process in pairs when possible, sometimes singly and it works great for us. Customer support is great.
  4. We had a surgeon here some years ago who could do no wrong (in his mind, anyway). He believed absolutely that all of his patients should get fresh whole blood. He would grudgingly take bank whole blood sometimes. If he had a patient in the OR or post-op in ICU, he would show up in his little green scrubs and stick his arm out, demanding that we draw a unit of blood. This was back in the days of the walking blood bank. We would, grudgingly, draw him and he would then grab the unit out of our hands, take it directly upstairs over our protests that it was not crossmatched and hang it. No tag, no labels, no testing (ever hear of hepatitis, doc?). He at least was O Pos. As to the crossmatch, he would tell us to finish it whenever we wanted, or not - HIS blood was compatible with anyone. Once when he couldn't leave the OR, he had a scrub nurse call his wife and tell her to come in and donate blood. We did get a chance to get an antibody screen and crossmatch done before someone came for the unit. Turns out that the Mrs was O Neg with a strong anti-D. Our patient was Rh Pos. They didn't get that whole blood unit. Even though we told him why his wife could not donate, he sent her in 3 or 4 more times to donate and we had to tell her thanks but no thanks. Very nice lady, just not donor material. Too bad we didn't have a pathologist with you-know-whats to stand up to him!
  5. I am working under a pretty similar workload to yours and the points everyone has been making are absolutely on the mark. The automation tier for reagent pricing made our cost per test less than what we were paying for gel/tube. The point about using fewer supplies like tubes, pipettes, etc is a good one that can narrow the cost difference for you a bit. You may be able to get a deal that locks in or locks down price increases over a period of time - this can save $$$ over the long haul. Worth looking in to. Patient safety was one of my BIG selling points. The Echo instrument functionality prevents a lot of idiot errors (we can all make them on a stressed out day!), which is something the rotators appreciate. It reads barcodes for the patient sample and the donor so those times where you must process multiple patients at the same time, you have a built in safety cushion. Our Blood Bank is not computerized, so using the barcodes has been a big step forward in process improvement. Patients can't be run if reagents are outdated, QC doesn't work, maintenance hasn't been done...that can save you some paperwork reporting errors, not to mention improving quality of product. The instrument is easy to use. Again, this is something the rotators appreciate. Evening/night shift appreciates the fact that they can complete a GroupScreen with immediate spin crossmatch in about 30-40 minutes, with time to walk away in midrun and do other pesky things, like stats from the ER. We improved our turn-around times pretty dramatically on day shift (think 3-5 crossmatches at the same time). This makes your customers happy (and the administration likes happy doctors ). This gets transfusions started sooner, which makes nursing service happy. Need I mention that this is a good thing for the patient as well. Antibody IDs take the same amount of time as a GroupScreen. That is not generally the case with manual methods. Plus, that ID can be running in the workstream with everything else you are doing, not as a separate test process. I know of another Blood Bank about our size that is planning to bring antibody ID in house for the first time in many years because they will have time to do them with Echo running the panels. Tracking reagent lot#s is a breeze. Echo does it for you. QC is documented by the instrument. Maintenance is documented by the instrument. Visual records of the actual patient results are documented by the instrument. Saves me lots of paperwork time (Time = Money). Good Luck! It will be well worth the bureaucratic hassle.
  6. For a list of which antigens are clinically significant (requiring antigen negative cells for transfusion) and which are not, check out the AABB Technical manual. In the 16th edition, chapter 16 covers the pertinent information on pages 493 - 496. John Judd's Methods in Immunohematology, 3rd ed , available through the AABB bookstore, also has a nice section on this topic on pages 304 - 308 (page 308 lists about every antibody problem you could be cursed with).
  7. My latest CAP survey had a specimen that hit this topic - a sample with anti-Cw in it. The results came back with no concensus for that sample - the referees were almost as divided as the rest of us. I think it likely that the folks who found the antibody were doing AHG crossmatches on everybody and picking up the antigen positive donor. The folks who didn't find it were probably doing the AS (which was negative) with an IS crossmatch. It will be interesting to see what the 'discussion' is when the final report comes from CAP.
  8. Well, I really don't think that Ortho is going to share their proprietary recipe for MTS Diluent 2 with their chief (or any other) competition. Yes, it's a pain to have to dilute up cells to use with gel, but we do it, too. We like the results better that way.
  9. We specify a 15 minute return time and take the temp. Over 10C, they have the option of taking it back to the unit, starting the unit as soon as they can and finishing it within 4 hours of the original checkout. Under 10C, we will put it back in stock if not spiked and tag is on it. Our SOP defines time, temp and other conditions. If the temp is over 10C and they know they are not going to be able to start it, we take it back for disposal. We found that 30 minutes meant every unit was warmer than 10C. Some returned in 15 minutes are too warm...depends on which nursing unit it went to and where they laid it (like the heat vent or on the patient's chest).
  10. Good Luck! My best hint is 'Don't second guess!' Answer the question and don't go back to it unless you are certain your answer is wrong. And listen to that little voice in your head...sometimes it knows the correct answer when your conscious self isn't so sure.
  11. We don't take it back unless it's less than 5 minutes after checkout, there is no evidence of tampering with packaging and it is not showing signs of thaw. (We are very, very close to the OR which is a distince advantage.) We also store in an ultra-low freezer.
  12. I've done business with both companies for the last 7-8 years on the same pricing tier. They both have jacked up their prices about the same amount - as much as they thought they could get. First one goes up, then the other 6 months or so later. The increases are not initiated by the same company, either. Sometimes it starts with Ortho. Sometimes it starts with Immucor.
  13. I would ask nursing service for reference/source material as to why the change and the rationale for the change. Could be something very valid. OR Could this be a case of "Well, everybody else is doing it!" like your kid whining to go to the big party and in reality nobody else (or very few) are doing it?
  14. At the urging of SMW, I went back to my supplier (ARC) about the question of outdate on thawed, prepooled Cryo. She went back to the ARC region which supplies the prepools we receive and requested a clarification. The reply she got is as follows: "Our CRYO POOLS were licensed as closed system pools. The reason they must transfuse within 4 hours is because of the thaw to pool and refreeze requirement. All blood centers are required to use the 4 hour transfusion rule." So, 4 hours it is for me. It will be interesting to see what comes from AABB/FDA (thanks, Brenda).
  15. John Judd and John Case had some good exchanges.
  16. AMcCord

    Immucor

    I hadn't looked at their stock list for a while - but after looking today, I only see 10 L and 20 L saline buffered. (I swear they used to carry buffered in the 4L size as well!) Fisher is the same story. Sorry the 4L size doesn't pan out. Have you thought about getting a 4L unbuffered saline and adding the appropriate amount of pHix to get pH 7? Downside is validation and the hassle of adding the buffer and checking pH, plus buying the pHix. Might be cheaper to just buy the 10L size and dump some.
  17. AMcCord

    Immucor

    Cardinal has buffered saline in smaller volumes - 4 and 10 L boxes. You might check with Fischer. If Cardinal has it, they probably do, too.
  18. I use corQC for tube also and my directions are tube only, though I do use the undiluted serum for a strong positive control with gel. too.
  19. I was also intrigued by this conversation, so I contacted my supplier (ARC) and asked the director of manufacturing and hospital services what the straight scoop was on pooled cryo. My ARC region does not manufacture cryo, so she contacted the region who supplies us. Their reply was that the outdate for thawed prepooled cryo was 6 hours, though they would recommend transfusing as quickly as possible. Their (ARC's) pooling system is a closed system. This is a question to the folks who refrigerate cryo up to 24 hrs for fibrinogen.......once you get the cryo down to 6C, doesn't all the good stuff turn to goobers again? Are there problems clogging infusion sets when it's given?
  20. Extra fun patients always show up at my hospital on holidays so we have to figure out some way to get the sample to the reference lab in the first place before we can even think about bugging the folks on call. Good luck and my sympathies!
  21. We've transfused 2 scary ones, hemolyzing their cells and the transfused cells faster than you could say Warm Autoimmune Hemolytic Anemia. Neither had alloantibodies that we or the reference lab could find. Neither had any underlying medical problems that could explain what was happening other than their immune systems just felt like going crazy. Both were worked up extensively for infection, malignancy, etc. Neither were on any medication. No treatment worked. They just stopped hemolyzing as suddenly as they started and both survived, but barely. We transfused another one with 3 alloantibodies identified before the auto problem started. The first time we saw her, the auto was fairly weak, so we and the reference lab got a full phenotype on her (and we agreed, too!) and found no additional antibodies and managed to get a clean crossmatch with LISS. The next time we saw her, her auto was 4+++++++. Sent that one straight out to reference, who tried 3 absorptions for the book and 2 more for fun and her antibody screen was still all reactive 4++++++++. We gave her phenotypically similar red cells. 3rd time we saw her, same story. 4th time, reference lab begged us to persuade her to move out of state - we assured them that we had already tried that to no avail. Anyway, we transfused her 4 times uneventfully over about 3 months. Saw her 6 months later and her DAT was only weakly positive and haven't seen her since. Go figure! There have been many more who have received multiple transfusions here with no apparent reactions. Problem is, there is no good way to tell which one will hemolyze and which one won't. Thankfully, most will do OK. It's always nice when these patients are referred for a consult with the hematologist or an oncologist. Those folks generally do a good job of discouraging transfusion. cassiepenn, the medical director of your blood center (or ARC reference lab - if they are not the same) could be helpful to you. They will talk to your medical director or to the patient's physician about your patient's case and offer some good advice.
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