Barb Thompson

Hi, I’m back. Can you send me your email and I can send you what I have. Just be aware that they are at least 10 years old. Barbara

It was a ransomeware attack. All the data was electronically backed up daily. Just imagine backing up on a flash drive (for those of you who do) then having no computer to plug it into! We thought we had all bases covered, then this happens. Do you back up your backup? And the backed up backup? To go back to paper files would require a whole room to hold everything. be warned! If it happened to us, it can happen to you! we had no access to any pc’s or LIS or HIS. this was a nightmare, but also a learning experience.

The data is backed up, but we are not allowed to use flash drives and can’t access any computers! The paper filing cabinets took up too much space, so everything went electronic. Nothing is accessible. Not the LIS, not the pc’s, nothing!

Ok, so my facility is in the middle of a massive computer downtime. No electronic records can be accessed, not even the patient backup/history file. ABO confirmations are still required, I imagine, but in this type of situation, would we just require a second specimen on everyone? (I think I already know the answer). Has anyone else been in this situation and how did you handle it?

I have a study guide from the 2006 AABB annual meeting. PM me your email if you would like a copy.

I can send you some old study guides from AABB if you message me your email. Barbara

Hi, I have study guides from the 2006 AABB meeting if you would like. I know they’re old, but better than nothing. If you’re interested, message me your email.

I am the blood bank supervisor in a 233 bed acute care facility. I am a working supervisor. We are not a trauma center. Most days, I am the only blood banker on the shift, so there is no one to call. If I am lucky, the chemistry tech might be available to help. I can also get the manager to issue blood, but that's all. We rarely have MTPs - a ruptured AAA or OB bleed, but they are few and far between.

I have an AABB study guide from 2006 if you want to message me your email.

copies sent

I did an online program while working 3 jobs. Its a lot of work. Check aabb.org; they have a listing of programs out there. Some are on site, some on line. For the most part, it's a 12 month program, so there is light at the end of the tunnel. If you really want it, you'll find a way to do it.

We don't retest because we do not have the antisera. So far we have not had any issues. We only stock Rh, K, FyA and JkA.

I believe there is a Rapid Start section in Bridge? We do have a paper downtime form, and if cerner is not down, we reprint the unit issue tag (ours is a label) and stick it on the form. We rarely have to use these, as the nurses have been told they must use bridge. Or iView if they can't get into Bridge. We also have an emergency release form that the physician has to sign and return to the blood bank before we give them anything. It helps that we are right next to the ED. We do have issues where I can't find any documentation in PowerChart except maybe in the Notes section (not appropriate), and when I see this, I notify a clinical systems analyst in IT to retrain the nurses. Not sure if this answers your question.

I just sent you copies from the 2007 AABB meeting.

AABB has a study guide with questions. I found it quite useful.

The reference lab updated the report and now calls it a warm auto with little c specificity. They also say that c negative blood is not necessary and transfused cells should survive as long as his own. his hgb is down to 10.7. He is still in house. Still no hematologist on the case. Barbara

We use gel for the antibody screen and ID. The DAT was done in tube. The reference lab uses PeG.

The patient had his hernia surgery on Wed May 11. His post-op Hgb was 16. He does not appear to be experiencing a hemolytic process, although no testing was performed (no LDH, haptoglobin, retic, etc). His TBil was slightly elevated at 1.8. It does not look like a hem/onc has been consulted. Reference did not give any recommendations as to what type of blood to give, should he need a transfusion. We are still waiting for the results of the molecular typing. Anesthesia was funny (funny-sad) - I was trying to explain that we would not have compatible O negs for the patient, and she replied that she would just take trauma blood, then. As if that would solve all the problems. Thankfully, he did not need a transfusion. My theory (and it's just a theory) is that this is a warm auto, caused by a yet-to-be-diagnosed malignancy. Possibly his colon cancer has returned. Did I mention he is 82? Barbara

The patient is rr. Reference reported it as "unidentified antibody with anti-c specificity".

Hi, we just had a patient who is O neg, is c-positive, and has a perfect Anti-c in his plasma. He claims to have never had a blood transfusion. His current diagnosis is "Incarcerated Ventral Hernia", but had been treated for colon cancer 17 years ago. The surgeon won't take him to OR unless we have blood available. His DAT is 3+, Anti-c eluted from his red cells. No unusual meds. I'm thinking Warm auto mimicking anti-c. Reference is sending out for molecular genotyping because they are thinking he may have a little c variant and this is an alloantibody (he is white, and has never been transfused). Any thoughts on this?

Does anyone know how long after treatment has started before the interference shows up? Are all patients on darzalex affected? I had a patient come in the day after her first dose. Her screen was positive in gel. I sent it to reference and they called it a cold and suggested doing a prewarmed screen and crossmatch. Any thoughts on this? thanks, Barbara

For patients with hyper hemolytic syndrome, do you require the physician to sign an emergency transfusion release prior to issuing units?

Well, I had a mislabel that was caught, so there was no bad outcome, just an angry nurse. (this was > 10 years ago) Nurse A claims to have drawn Bed 8 in ICU and uses BBID band. Tube types as A Pos. Luckily, we had a history on the patient, which was O Pos. I called Nurse A, who claims she drew the right patient and refuses to redraw. I offer to send up a phleb, which she also refuses. Turns out she drew Bed 7, banded Bed 7, then a CNA saw the wrong band on Bed 7, removed it, and placed it on patient Bed 8 without Nurse A knowing about it. Her refusal to redraw Bed 8 was overruled, and a lab phleb was sent to do the redraw. In this case, history saved the patient. 2nd incident at another hospital: phleb draws and bands the patient. We have no history. This was before the push for 2nd draws. Patient types as A Pos. I get the blood ready and issue it. The nurse immediately calls down and says she can't find the BBID band on the patient. I ask the phleb to go back to the patient and show the nurse where she put the band. Instead, the nurse comes back with the blood, and the phleb brings me a new sample and new BBID #'s for the patient. This new sample types O Pos. The phleb refuses to admit that she initially drew the wrong patient. In this case, lack of a BBID band saved the patient. (yes, the phleb was soon terminated). Nursing follows the policy, and the patient lives. I have also had a few cases where the type and screen specimen was one type and the confirmation specimen was another.

Does anyone have decent templates for letters? Mine are old and need updating. Thanks in advance.

Every system is set up differently. This is how we do it. If the patient is eligible for the Computer XM, you can see it in PPI (Patient Product Inquiry). When we get an order to transfuse from Order Entry, we first go to PPI to see if the patient has a current specimen, what day it was collected (so we know where to find the BBID #), and CXM eligibility. If eligible, we go to DOE, add the XM test to the accn using the Accession Add On application, then go to Result Entry, scan the BBID (we use BB armbands), then scan the blood unit number of the unit that we take from the fridge. If the patient is not eligible because there is no 2nd ABO/Rh on file, we go to ORV and see if we can find a lavender drawn at a different time by a different phleb. If so, we go to DOE and order an ABO Confirm using the Order Entry application and mark it as collected based on the container details from the tube that we found (usually in hemo). We perform the ABO/Rh and voila - the patient is now CXM eligible. Then we do the steps above. If we know the patient is getting transfused, we get it ready at the time we receive the order. But, there are times when blood is ordered "On Hold", and we do not set these up. We will make sure these patients are CXM eligible if possible. Theses are usually OR patients. If OR then needs to transfuse, they must reorder the product with a transfuse priority of "Now", call us (to make sure someone is home) and come over to pick it up. At this time, we can go directly to Dispense and Assign, select the 4th icon from the left (may be different for other facilities) which is Computer Crossmatch Dispense and do the dispense and XM all at the same time. The unit tag will print after clicking OK. The only thing I don't like about this is that it throws a XM test on to your pending list, but it will fall off after the TS expires. I have found cerner to be quite convoluted, but it is better than what we had before, which was paper. You can't do the computer XM dispense using the regular dispense routine (2nd icon from the left) because you will have to override, even if you can see that the patient is eligible.