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Posts posted by AMcCord
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3 hours ago, Joanne P. Scannell said:
We switched to Rhophylac here in the hospital because 'everyone' likes having the option of giving the dose IM or IV.
The MD's are still using RhoGam (no IV option) for their office injections (IM Only), e.g. Antenatal/Antepartum dose.
Ditto for us. It was actually nurse driven for patient satisfaction. The providers didn't care one way or the other except they weren't going to sign off on it if it cost more than RhoGAM. The only kicker is that the IVs are not discontinued as soon as they were when IM RhoGAM was administered. If the patient wants the IV out NOW, then they get the Rhophylac IM - their choice. We've had no issues.
- Baby Banker and David Saikin
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Get a current version of Harmening and the Lomas and Reid Antigen Fact Book. The Technical Manual and Standards are a must. The AABB review notes will be a big help. Don't forget to study Coag.
I did my SBB as a self study 20+ years out of school by studying over a year. Go for it!
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22 hours ago, mrmic said:
What? No one questioned NISS? I am impressed. Long Live NISS!
OK, I'll admit it - have never used or seen NISS. Maybe I'm too young?
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We use PeG as our routine backup for solid phase testing. However, there is a place for LISS in our tool kit. If we have an antibody consistent with a warm auto and the patient has never been transfused, we use LISS to decrease sensitivity to get under the warm auto. If the LISS screen is negative and AHG crossmatch is compatible, we transfuse those units. We also see panreactivity in some OB and Onc patients both with solid phase and PeG. We run a solid phase panel - if panreactive, we switch to LISS following the same process we use for the warm auto.
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20 minutes ago, Baby Banker said:
The Lui Freeze Thaw method is good for demonstrating anti-A, anti-B, and anti-A,B from small samples. We used it to confirm that an infant had ABO HDN. I'm not sure if we still have a procedure for it. I work primarily with the Blood Bank Computer system now.
We don't do elutions to confirm ABO HDN, which is why I don't think I've ever used the Lui for a patient test. If Mom is type O with a negative antibody screen and baby is A or B with positive DAT, it's presumptive for ABO HDN. If there was evidence indicating that something else was going on (significant anemia, elevated bili that seems atypical for ABO HDN, etc.) we would investigate further. It is possible to use Elu-Kit II on a small sample, though we usually have cord blood to work with, so that is the method we would use for that extended investigation to make sure that we aren't dealing with a non-ABO antibody.
My students have mixed success with the Lui, but we do it anyway. Hands on with methods like that seems to really help them understand the written material they are given.
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7 hours ago, MAGNUM said:
All the albumin that I buy is 22% not 30%.
30% albumin hasn't been available for years - I think we saw it last in the early 90s.
I don't think I've ever used the Lui Freeze Thaw on a patient. I keep a copy of the ancient procedure around for students.
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I've got an OLD OLD procedure that adds 3 drops of 30% albumin to 0.5 mL packed red cells prior to freezing. The reference is the 10th edition of the Technical Manual.
The procedure is so old and so bare bones that there isn't any other information included - just the step by step. Looks really odd compared to current procedures.
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Whatever you choose to do, just make sure that it is written explicitly in an SOP, either for using the ID panel or for QC. Then be able to demonstrate that your policy is followed.
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20 hours ago, David Saikin said:
I heartily agree. Fortunately these are few and far between. Ortho Gel tends to make these pop out. I find few that are reactive at 37C.
That was also our experience when we used gel. Solid phase seems to pick up very few of them and they are more much more likely to be reactive at 37C - not that I mind that missing out on those extra workups!
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19 hours ago, Malcolm Needs said:
Anti-M that reacts at STRICTLY 37oC can most certainly be clinically significant.
Antibodies directed against, for example, antigens to the Chido/Rodgers Blood Group System, the JMH Blood Group System and the Knops Blood Group System, however, are NEVER clinically significant, although those within the Chido/Rodgers Blood Group System can, on very rare occasions, cause an anaphylaxis type reaction.
Yep, we had a patient with one of those nasty Chido antibodies. No fun for her or us. She had serious anaphylactic reaction to platelets unless they were washed. We didn't do the workup - beyond our capabilities by a long ways, but we transfused her regularly. We washed platelets for her (manually) 2-3 times a week for almost 18 months and crossmatched the occasional red cell unit. Her case was published in Transfusion 1992; 32:576 Westhoff CM, Sipherd BD, Wylie DE, et al. You never know what odd ball antibody is going to show up in your Blood Bank.
Trivial pursuit - couldn't resist
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If you are using SafeTrace Tx you can link with HaemoBank. I think Soft does as well.
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On 6/19/2020 at 3:49 PM, Clarest said:
Hi Kathyang,
When you use either ImmuAdd or Gamma N-Hance, do you do the microscopic check for the negative reaction at AHG phase?
A magnification aid is optional for N-Hance. It could be an agglutination viewer, rather than a microscope.
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On 6/19/2020 at 3:41 PM, Clarest said:
Hi, our lab has the same situation as yours. I am wondering if you do the microscopic check for the negative reaction at AHG phase when using LISS enhancement.
On the ImmAdd package insert, it doesn't mention the use of an optical aid, but the N-HANCE one does.
Thank you in advance for your response.
We've used N-Hance for many years as an alternate enhancement method, mainly for warm autos. David is correct - it was a Gamma product which became Immucor's baby when they bought Gamma. We were educated in the use of N-Hance by a Gamma tech specialist (long ago). The optical aid mentioned in the package insert is optional for that product - 'may be used' - and could certainly be an agglutination viewer/mirror as Marilyn suggests. Microscopic exam is not necessary.
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We run old control and new cells plus new control (even if it's the same lot#) and old cells. Results should be as expected.
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Our order is set up as Convalescent COVID-19 Plasma in Epic but is mapped to FFP in SafeTrace. The order set in Epic is only available to our pathologists and to a select few physicians who are caring for these patients, so it isn't ordered inappropriately. It is up to the tech to select the correct product for issue. We receive an order print out in Blood Bank from EPIC and the requested product is very obviously spelled out on that document. The product description in SafeTrace reflects what it is and of course that prints on the product tag. We have not given this product to a large number of patients so we (one of the pathologists and myself) actively micromanage each of these transfusion events.
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Yes, you should perform the weak D test. The fact that you haven't seen a positive yet doesn't mean you won't see one tomorrow. If mother is truly D negative, she has been exposed to D antigen and needs to receive RhIG. As Monique pointed out, it changes how you determine RhIG dosage as well. We see 1 to 3 babies each year that have positive weak D tests out of the 150 or so tests we do, so they are out there. Actually...it's kind of fun to find them in a total geek way.
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On 6/7/2020 at 12:37 AM, Oniononorion said:
That’s a really good point Ward_X.
Emergent events documented in the EMR should be enough to justify our actions in the case of unXM’d blood. I have never thought of the possibility that that would suffice as documentation for this purpose but requiring docs to sign papers really does seem a little archaic after thinking of it in terms of all the information that is available to us in the EMR to prove who requested it, but we in the blood bank are so used to having >complete documentation of everything. But this also can never be assumed as not everyone is so meticulous....
I think there is a good point made here regarding the assumption that the request for uncrossmatched blood has been documented in the EMR by the provider who requested it. In my experience with chart reviews for patients who've received emergency release and/or uncrossmatched blood products, I've seen multiple examples of notes by nurses regarding emergency release w/o a corresponding note by the provider. We do not have a specific order set for uncrossmatched blood products in the HIS (though I wish we did). All our orders are received verbally and the products are released from our BB LIS using the emergency release functionality, which pushes the information over to the HIS. If we don't get the signed document, it's quite possible that we would have no documentation that the provider requested the release. If you have an order set specific for uncrossmatched products that the provider enters into the HIS, I would think that that's a different story. The order has captured an electronic signature. I would think that a brief statement could be added to the 'uncrossmatched' or 'emergency release' order set (thinking in terms of Epic here) that states that the provider is aware of the risk, etc. etc. I would think that would cover what needs to be covered...BUT then I'm not a lawyer.
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We require a signature on an Emergency Release document, but we don't require that signature prior to the release of product, just a verbal. If the ED provider requested the release he/she is usually available to sign once the patient has been turned over to the surgeon/transferred/admitted. In some cases the form may get mailed to the surgeon's office the next day for signature or wait a few days until the ED provider is on duty again.
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When we issue platelets for transfusion, they go out the door in a FinalCheck ziplock bag. The infusion must start within 15 minutes so we don't use a cooler. When we issue them to our cancer center, which is a short walk across campus, we issue them in a FinalCheck ziplock bag in a Credo cooler at 22 C.
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18 hours ago, B Postive said:
Dear AmCord, What HCPCS code are you applying if the units are given as eIND?
We have not transfused a patient under an eIND - patient got better thankfully. When we started that process there wasn't a specific HCPCS code yet. I think there is one now, but I can't tell you what it is. We are now enrolled with May Clinic for the EAD so won't need the code for now. Maybe someone else in the group has it.
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My facility strictly limits who comes through the door. Our weekly restock driver makes it through - he has a letter stating that he is an essential service provider and that his temp is taken every day at work by someone qualified to take his temp and before he heads out on his route to us. The driver who transfers products between us and other facilities and rotates our platelet stock doesn't make it through the door - not sure why - so we go to them. There hasn't been anything said about paying for boxes. That would get expensive in a hurry!
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On 4/10/2020 at 12:19 PM, David Saikin said:
My lab is going to try and go with all pathogen reduced plts.
That's our plan.
IV vs IM Rho (D) Immune Globulin
in Transfusion Services
Posted
When we made the switch to Rhophylac, I made sure that there was a clear understanding that we would not be doing the workups STAT. They've been good about it. Once in a while they call and ask for a time estimate because a patient is getting anxious about the IV, but it's just for info, not pushing.