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Everything posted by GilTphoto
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We always do full ID's on positive screens. The Technical Manual states that passive anti-D is IgG only, usually weakly reactive at IAT with a titer of less than or equal to 1:4. Using this statement as the reference, our policy is: If only weakly reactive in IAT and history of RhIG, we report passive If the anti-D reacts at any phase other than IAT (IS or 37C), or if strength is greater than 2+, a titer is performed. If the titer is 1:4 or less, and a history of RhIG, we report passive. If greater than 1:4, the supervisor or pathologist makes the decision to consider immune and withhold RhIG. When in doubt, RhIG is given. BTW - We had a baby whose Bilirubin rose to 8.7 from passive RhIG (titer 1:2). Anti-D eluted from baby's cells.
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We report a history check on all samples. Yes, or No histrory. Our computer will generate a QA failure if the history ABO/Rh is not identical to current. The history also shows previous antibody ID, antigen typings, or special instructions, such as issuing a PALL leukoreduction filter or giving phenotype specific on sickle patients.
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Gel vs Tube methods in IRLs
GilTphoto replied to missyg's topic in Immunohematology Reference Laboratories
We only use tube method. About 90% of the anti-M's we see are very strong and don't prewarm away. I have seen a few autoanti M's too. -
I assume you use the Gamma Elu-Kit. That is not the best elution method to detect anti-A or Anti-B. We always do the Gamma Elu-kIt with a 30 minute incubation. If that method is negative and the patient has received blood not type specific, then we do the Lui Freeze/Thaw elution with A1 and B cells. As far as if the patient had a reaction, you will have to use other indicators such as rise in bilirubin, LDH, haptoglobin, drop in H&H (if not blleeding). What were the symptoms? vitals? Elutions all positive or all negative are usually drug induced. What about the pre-transfusion DAT? was that positive? Other possiblities include low incidence antibodies not on your panel.
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Most of the reason for discontinuing the use of Polyspecific has been the high cost and Immucor's policy of forcing you to buy 10 bottles when you would only use 1-2 bottles a year. When they order a DAT on an adult, you test and report both IgG and C3. Anti-C3 can still be bought 1 bottle at a time. Anti-IgG and check cells are QC'd daily. Anti-C3 with Complement check cells are only QC'd as needed. Even if you use Polyspecific, you would only need to QC the anti-C3 and Comp check cells when you have a patient with a pos DAT
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Fill volume daily, spin time calibration yearly.
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We have had a similar problem with shaking off Anti-A. I think it's too long a spin time. Our current spin time is 20 seconds as determined by the centrifuge calibration procedure done once a year. I think it should only be 15 seconds (which is the default for the immunofuge), but what do you do if the calibration procedure tells you otherwise? I told the tech who performs the calibration procedure to find a way to show that 15 seconds works, but the procedure of diluting the antibody used for testing is not real life situations. We have been using patient samples for the anti-A or anti-B, since diluting the monoclonal reagents requires a 512 or 1024 dilution to get that 1+ reaction the calibration procedure wants. She always gets 20 seconds as the ideal spin time!!
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Our hospital has only 1 Blood Bank tech per shift. The first and second shifts average about 15-20 patients per shift. We could never survive only doing one at a time. I usually do 5 at a time (sometimes more). We label all the tubes with patient's initials. Pipet all reagents first into all tubes. Then pipet the patient sample, spin, read, and report, one patient at a time. The antibody screens and XM are all done together after incubation. Last year administration sent a consultant in to evaluate our staffing. Our staff was cut by 10 FTE's for the entire lab, which was more than a 20% cut. They recommended the second shift Blood Banker also do Micro. While administration has been pushing it, our Lab Manager has resisted (thank god).
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Our hospital has also changed to DOB and name, but we have made no changes to the BB policy of name and billing number. For some strange reason, our hospital never used MR# which stays the same. Billing number changes with each admission.
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witness statement and solo draw. This was OK with our last AABB/CAP inspection 2 years ago. Have another inspection coming up in a few months! I think second ABO is necessary if doing Electronic Crossmatch?
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Just saw that in the last CAP Titration Survey instructions. Of course I had already performed the titer using 60 minutes, titration using a 100 ul pipettor and 1 drop of cells. THEN I READ THE DIRECTIONS!!! Repeated using same 100 ul pipettor and a 50 ul pipettor for the cells, incubating 30 minutes The first titer was one tube higher BTW we use w+ to denote microscopic readings only. The last macroscopic reading as 1+.
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We got our recall letter from Immucor for the Fetal Screen kit on July 2nd, for a lot number that expires on July 3rd, that way Immucor doesn't have to issue replacement kits. Immucor is currently THE ONLY supplier of a Fetal Screen kit. Ortho pulled their kit off the market as they were never able to resolve their problems with it. Their rep claims they are working on getting a kit to market again. I also don't like the fact that Immucor ships red cell products without ice. I work in FL. Those cells are sitting on trucks where the temperature must exceed 100F before being delivered.
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Most of our doctors specify how fast they want it infused (transfuse over 3-4 hours for RBC). We recommend 2-3 hours, but there must be a lot of CHF patients as we also see (follow with Lasix). Many doctors are also premedicating with tylenol and Benadryl to aviod febrile and allergic reactions. For FFP we recommend 15-30 minutes. PLT's 30-60 depending on the volume. You should definately specify that NO blood product should infuse longer than 4 hours, due to the risk of bacterial contamination.
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Don't you mean 1-6C and alarm at 1.5C and 5.5C?
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FFP and Cryo must be stored at less than -18C. Most plasma freezers maintain -30C to -40C. If blood or plasma has to be moved to a refrigerator or freezer that is not monitored by an alarm system, the temperature must be checked at least every 4 hours.
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We use a 3 day limit. Transfusion histories are not always accurate, the patient may be out of it and not be able to give you accurate answers, exposure to fetal antigens, etc. It's too time consuming to investigate the transfusion history. Faster just to get a new sample (and safer). BTW, samples in the US must be stored 10 days (7 days past transfusion) and we always separate plasma from cells.
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We require ALL BB draws to be witnessed. We have a form that must be signed by both the phlebotomist and a witness. Occasionally, a nurse will send down a specimen where only the witness section is signed (I'm a nurse, not a phlebotomist!). Those specimens are rejected. The blood didn't draw itself! This policy was put in effect to satisfy the requirement to have a plan to reduce misidentification.
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I can't believe there was no mention of problems with the false positive Fetal Screens. That problem has not been corrected. The past 2 CAP surveys had samples with false positives (the latest survey results aren't back yet, but I predict an ungraded sample on that survey, as on the previous survey)
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Routine cord blood testing (ABO, Rh, DAT)
GilTphoto replied to phouck's topic in Transfusion Services
We do all cords. Part of the reason is for detecting low incidence antibodies. If the mother is ABO compatible with the baby, and her antibody screen is negative, but the baby has a positive DAT, a low incidence antigen from the father should be suspected. True, they could just watch for icterus, but sometimes it takes a few days for the bilirubin to build up, and they would rather know earlier. -
The first problem I see, is why did the tech get antigen positive for M and Jk(a)?. There was no mention as to whether the patient was recently transfused or DAT positive. They will both invalidate antigen typings. What antisera was used for M? Ortho's anti-M procedure requires NO SPINNING after RT incubation, while Immucor's does require spinning. I have no experience with Gel, but do understand tube testing is STILL the Gold standard. Most anti-M's I've seen are very strong and many are still reactive at IAT. Was the Jk(a) identifed with M negative cells? We do our XM and Antibody screens using Immucor N-Hance, but require
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I think that since we're a small hospital that doesn't handle trama, it hasn't come up. Most cases are just episodes of bleeding with or without abdominal pain, some ectopic or misscarriage Trama patient's are taken to Jackson Memorial Hospital in Miami. At what point of pregnancy is the blood volume of the fetus large enough for a FMH to be detected? If a woman is only 4-6 weeks pregnant is the fetus developed enough to even have a vascular system with blood? At what week gestation has cellualr division specialized to form all the different systems?
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What manufacturer do you use for fetal screen?
GilTphoto replied to LaraT23's topic in Transfusion Services
Immucor is the only supplier at the moment. BTW, Immucor has been subpoenaed in a U.S. Justice Department antitrust investigation, http://www.bloomberg.com/apps/news?pid=20601103&sid=ai7EcSt_VRyU -
We get a 16 cell panel every 2 weeks, so we have 2-3 in date panels at a time. We're not too quick to throw out the expired panels either, so we usually have 6 panels. Last month we had a patient with an anti-E, c, K, and Jkb. It took cells from all 6 panels to rule out others and rule in these 4 antibodies. Whatever was detected with expired cells, we will retest as new panels come in with appropriate cells. Does anyone freeze rare cells from panels? I see Medion is selling some products for freezing and thawing aliquots. Does anyone have experience using it?
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Same here
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Does anyone have a reference for the need for doing them ante-partum? For a significant FMH, needing more than 1 vial of RhIG, the bleed must be greater than 30 mLs. At what point during pregnancy is the fetus large enough to have a blood volume capable of a FMH. How many weeks gestation? For those doing KB's for trauma, do you also do a Fetal Screen first to determine who needs a KB, or do you go directly to KB?