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Everything posted by mhc
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Our facility interprets the UNOS rule as 2 separate samples drawn at 2 different times . The transplant team insists on a hard copy report as well.
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We are planning to move into a new laboratory in the near future and will need to move 7 large LN2 (vapor) freezers that are full of HPC products. It's in a different building, but the move can be accomplished through underground pedestrian tunnels- about a 7 minute walk. We would like to move the freezers without emptying them of the products since we do not have adequate swing space to move the products to. Has anyone done this and can you suggest a way to secure the products so that they dont get jostled during the move? Any advice would be appreciated.
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I agree that would be a rare event, but I'm sure you get the point of that study. You need to simulate the "extremes", or limits of detection, when you validate a procedure. That's what gives you the evidence to conclude that your method is as good as, better than or worse than your "gold standard".
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I found this manuscript that might help with your validation protocol. as you can see, no method is perfect at detecting all ABO incompatibilities, but you should be cautious about using O plasma vs A1 cells and "proving" that the gel method is suitable for detecting ABO incompatibilities. We still require an IS in addition to the IgG gel when doing an AHG XM. abo_geltestjudd.doc
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Well look how many of us use the ARC as our blood supplier and we all know what kind of hot water they have been in with FDA! My point here is that this issue with Immucor does not mean that we should run out and find another vendor even if we had a plentiful choice. They are too big for FDA to pull the plug as was stated before. There are plenty of facilities that operate under a consent agreement and still produce quality products.
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I did not see any changes to that particular CPT code in the 2009 updates. And while the FI's may have the last word on reimbursement, in my experience they rarely are less restrictive than the AMA CPT guide. Usually, they are just unprepared to handle the changes in the time frame that CMS wants. But by all means, check with them.
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I copy below from the Reimbursement FAQ on the AABB website: Billing for Antigen Testing Question: Is the blood bank able to bill for antigen testing on all the units tested or for just the antigen negative units? Answer: The CPT description for code 86903 Blood typing; antigen screening for compatable blood units using reagent serum, per unit screened instructs to bill for each unit screened. Therefore, the facility can bill for all units tested to find the antigen negative units. However, if a single unit is tested for multiple antigens, 86903 may be billed only once. Reference: AMA 2007 CPT
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The other hospitals have it correct. You charge CPT 86903 (if using reagent antisera) times the number of units screened, regardless of the number of antigens screened for. So if your patient has anti- C, E, K and you screen 10 units for the 3 antigens, you charge 10, not 30.
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While I agree with the "however you define it in your policy" concept, I think that you also need to strive for good laboratory practices, even if they are not specific standards or regulations. So in this case, the practice of documenting the date that something was done as "month/year" may not violate a particular standard and may even be what's defined in your policies, it doesnt strike me as a particularly good laboratory practice.
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My frustration with this requirement is that because it was not required "pre-hire", I'm having to cajole, remind, harass, etc. my staff to get this done. I even had an officer on site for several fingerprinting sessions and I still have outstanding staff, including a few who have to have theirs re-done because the FBI found them to be illegible. All this for what?
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Another solution might be to get pre-storage leukoreduced units from your blood supplier. They are QC'd for WBC content and you can be assured that a patient who needs LR blood is actually getting it.
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The ABC (America's Blood Centers) Newsletter has a help wanted section.
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I suppose that is what CAP is requiring, although I've always looked at coombs control cells as an assurance that the AHG reagent was actually added to the test, not as a "positive control". Tell me, do/would you set up all tests that use poly AHG in duplicate (panels, screens etc.)?
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Phew! I was trying to figure out how to use both the IgG and C3 coated cells for one poly DAT test!
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IgA deficient patient needing rbc transfusions
mhc replied to dcharland's topic in Transfusion Services
"IgA content of washed red blood cell concentrates" (Vox Sang 1998 74:13-14) might be a start. -
I agree with John. We have been manual gel users for over 10 years and have had ProVue for about 5, but we are now moving to the Galileo and the Echo, mostly because of the increased throughput and flexibility that those 2 machines offer. Plus, there's a little bit of a cost savings. I know it will take some time for my staff to get used to the new platform, but I think that it will work out better for us in the long run.
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IgA deficient patient needing rbc transfusions
mhc replied to dcharland's topic in Transfusion Services
Another strategy might be to provide products from IgA deficient donors. Usually we get plasma or platelets that are IgA deficient, but I dont see why your blood center couldnt find RBC donors as well, especially using the great apheresis technology that is available. You could freeze and stockpile them if your patient is a chronic user. With a high titer anti-IgA like that, I would want to make sure that the washing process removes as much IgA from the unit as possible, if washing is the method of choice. You should validate your process before you transfuse that patient with washed RBCs. -
That is correct. Unless it is fatal, that error would not be considered a BPD by FDA. It would however, make a whole lot of other accreditation agencies nervous!
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Reference Laboratory Contract?
mhc replied to JMunden's topic in Immunohematology Reference Laboratories
I think that the intent of the AABB Standard 4.0 is that you have P/P/P to evaluate the ability of the reference lab to meet your specifications. You dont necessarily need a contract, but you should have it spelled out somewhere how you came to choose XYZ lab as opposed to another one. That's what I look for when I do assessments/ inspections. -
Moving from Cesium 137 Blood Irradiators to X-ray Blood Irradiators
mhc replied to conwaysbb's topic in All other topics
I did too, although I wish that there had been other vendors there besides Nordion, just for comparison. I think that in terms of the way we irradiate products at our hospital facility ~ 1000/ month, that the cesium is a more efficient choice. But since we may not have the choice for much longer, the Xray will have to do. Thanks for your input. -
We are also Hemocare going to HCLL but will need to go up with ISBT on Hemocare. I have the ISBT product conversion file maintenance done and I can scan in what ISBT label samples I have so far. The next hurdle is to set up a label printer for the in-house labels we will need. Since Hemocare wont support ISBT label generation, I have a stand-alone PC running digitrax software but havent tested anything out yet. Any other Hemocare users out there with advice?
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Moving from Cesium 137 Blood Irradiators to X-ray Blood Irradiators
mhc replied to conwaysbb's topic in All other topics
We are also looking to replace our iradiator with an X-ray type, hopefully to coincide with a move to a new laboratory at the end of 2009. I fear we may be compelled to do it sooner, though, judging from the press. Besides Nordion, does anyone know of any other vendors? Nordion is great, but Canada is a long way from here and the PM/service calls are expensive, even if infrequent.
