webersl

Hi, I'm a Blood Banker - I need some chemistry help on a personal note. Does anyone know about, or have they observed, that people with hemolytic anemias have lowered serum cholesterol? My husband was recently diagnosed with Warm Autoimmune Hemolytic Anemia. Right before it started, his fasting Total Cholesterol was 198mg/dL (we eat vegan - no dietary cholesterol). Right after he was diagnosed, it was 111. Once he was receiving treatment (prednisone) and his hemoglobin began to return to normal, his cholesterol was 146. In a Facebook support group for those with AIHA, there is another person who said their cholesterol decreased significantly post diagnosis. Some brief research led me to believe that hemolysis does NOT interfere with cholesterol tests. I couldn't find anything discussing whether hemolysis could actually lower serum cholesterol in vivo. Has anyone read or seen this before?

Another way to explain to RN's: Bateria proliferate best at warmer temperatures. With certain bacteria, counts can double every 30 minutes. Because a unit may be issued and returned several times before a patient actually gets the unit, we limit the return times so that they are not likely up to >4 hours, which is the benchmark for acceptable time outside of refrigeration. [Of course, the 30 min rule is going away. It is now a timeframe which you have validated.]

If you are served by Community Blood Center of Kansas City, they have a database for types and antibodies to which many area hospitals contribute. (They serve 70 hospitals, I don't know if all of them contribute.) I know this is not exactly what you are looking for, but we have found it to be very useful. They wrote and article on it in "Transfusion".

Jen makes an interesting point - at my hospital too, the old guard has almost all retired and the new staff have very little experience. In the last 4 years, 14 of my 16-18 member staff (mature, experienced) have been replaced with younger staff with 0-3 yrs experience. I get a lot more off-hour calls now, but it is a lot more "fun" in the lab with the shiny, happy people. and they also help point out redundancies and non-value added busy work. My fear is that they may point at a seemingly unnecessary step and ask if it can be removed, and that I will have forgotten over the years why it is that we have always done that, and maybe it was really important, but I can't remember now, and maybe I'll agree to remove it - and find out the hard way why it was there in the first place....

Maybe the inspector was trying to get them to do a "utilization review" and used poor language to describe it. I am not aware of any regulation that insists that you determine the efficacy of transfusion. Isn't that what the FDA (supposedly) and peer reviewed papers are for? Here's what we do for "utilization review" of RBC's. It is retrospective (after the transfusion). We choose a statistically significant number of transfusions to review, and we look at the pre-transfusion hgb. If it was 7 or lower, we are done. We conclude that the utilization of blood was probably appropriate. If it was above 7, we review the chart for any reasons the transfusion may have been deemed appropriate - like the patient was still bleeding. We have a list of reasons that >7 hgb might have warranted a transfusion. If we can't find a good reason, then the Transfusion Committee writes a letter to the ordering physician asking for clarification - and we give a little education on why the transfusion may not have been in the pt's best interest. With the other blood products, we do a concurrent review and do not issue the product if the pt doesn't meet certain criteria. If they still want it, they have to have a discussion with the Medical Director of Transfusion Services - to that is a PROspective review.

We always get Helmer

labgirl153, What is your intended purpose of the cold panel in your context, please? When I began to think about your question, I realized that I haven't done one since school. I wondered if that is because we use gel and don't see as many colds [though you can-and they have a weird look to them, but if we get one of those, we switch to tube PeG and it goes away], or because on the occassion that we do a tube antibody screen (always w/PeG) we no longer do an immediate spin, avoiding colds in the first place, or if it's because we give up on potential colds because we DON'T do a cold panel, and so we send them to a reference lab. So, in your context - you lab - what is the value of the mini cold screen to you? What prompts you to use it?

Here is a shorter version of the answers. These are geared more toward a patient who may not be a native speaker of English, and less toward a learning scientist: Questions: 1)Does ANTI-Mia means any problem with my blood? No problem for your blood or your health. But, your doctor(s) and the laboratory/transfusion service need to be told about the Anti-Mia if you need a transfusion in the future, or if you get pregnant, because they will need to be ready to take special precautions. 2) what does the transfusion recommendation refers to? AHG means? This comment is directed to the laboratory, blood bank, or transfusion service. It tells them that if they want to give you a blood transfusion, special testing is required in order to find a transfusion that is right for you (compatible). Most people can accept any unit of blood that matches their ABO type. But for you, they will need to do more testing to make sure that the blood also matches your Anti-Mia. AHG is the name of the special test. 3) what is haemolytic transfusion reactions? like if tranfusion i might have reactions to certain blood even though it may be compatible like O+ blood receive O+ blood but may reject? Yes. That is why it is important for your doctor and the transfusion service or blood bank to know about your anti-Mia. They will be able to select blood that will NOT cause a haemolytic transfusion reaction. 5) what is haemolytic diesease of newborn? does it mean that there are some complications if i was to intend to have babies? Yes, it is possible, but not certain. Remember, the report said that it is RARE. It is possible that your antibody may begin to destroy the baby's blood while the baby is still growing inside you. Your pregnancy doctor needs be told about your antibody (Anti-Mia). If he knows about it, then he will carefully watch the baby for any sign of problems and then he can take action to prevent harm to the baby. If the doctor sees anything starting to become a problem, as Malcom said, he can do some things to prevent the harm: deliver the baby early or give a transfusion to the baby while the baby is still inside you. As the report said, this is most common among Asian populations. So, if you are traveling or living in a non-Asian country, the doctors and transfusion services (the part of the lab that supplies the blood that will be transfused to you) may be less familiar with this antibody. It will be even more important that you make SURE you have repeatedly told your doctor and the transfusion service the name of this antibody - Anti-Mi(a).

Darn. I always respond without realizing there is another page of comments to read. Sorry if this seemed out of place.

I agree with all the posters here who ask you to return to SOP until you have convinced your superiors and they have changed the SOP. Here is how I switched from a 10 minute spin to a 2 minute spin (I am a supervisor): For each of 20 specimens (10 w a pos antibody screen, 10 with a negative antibody screen) I spun according to the SOP (10 min) and on a worksheet I commented as to the visual appearance, including clarity, hemolysis, and the sharpness of the interface between cells and plasma. Then I tested the specimens according to SOP and reported. Then, I completely resuspended the specimens on a tube rocker and respun them at the new setting (StatSpin3) for 2 min. After the spin I again recorded the visual apearance and then repeated all the testing and recorded the results on a worksheet (did not report). I then compared the apearance and results. There was no difference in any of the visuals or results, so I considered the new process to be valid. I wrote up the mini-study and sent it to my Medical Director for approval to change the SOP accordingly. Once approved, I began making the SOP changes. Then, staff read the new SOP, were trained on the new centrifuge settings, demonstrated competency. Then I announced to all staff that we would 'go live' with the new settings on a certain date. I realize your lab did not perform a comparison of any kind when they got their new centrifuge, but they should have. If you cannot find a way to convince them, I am sorry for you, but you MUST continue to follow SOP as written, or speak with your Medical Director (physician in charge of the lab) about your scientific concerns so that a proper change may occur. Best of luck.

We give CMV "reduced risk" - aka leukoreduced - to all patients. No special consideration is given to pregnant women. If CMV neg is ordered, there is a discussion with the pathologist and the ordering physician to decide if CMV neg is really needed before we order it special from the supplier.

Truman Medical Centers in Kansas City, Missouri is a smallish hospital (350 beds) but we get about 30-40 traumas per month which makes us "hoppin". Techs are generalists and rotate between Chem, Hemo, BB, and Micro (set-up). We currently have openings. Go to trumed.org and click careers. Let me know if you apply so I can make sure the ball doesn't get dropped in HR.

Ooops. I answered too hastily. Of course, if they couldn't aquire the unit, my techs would be forced to "request permission to deviate from SOP", and then it would be evaluated on a case by case basis to determine the best course of action. Sure - there are exceptions to ALWAYS and ALL, but they are not listed in my SOP, which is geared toward rotating generalists at a hospital that rarely dispenses units to infants. :surrender

Dear , OK, yes, there is a comment in the footnote of the SOP on how to handle it if you can't give O for some reason. "Giving non-group-O RBC’s to neonates requires special testing and would require written permission from the Transfusion Service Medical Director for an exception to this SOP." Special testing is [from my head - this is not in SOP]: If mom and infant's types don't match, check for mom's non-matching antibody (anti-A or anti- in baby's sample by AHG (use cord, or if too old/not available, use infant periferal draw). Make sure donor type is of a compatible type with any antibodies (anti-A or anti- detected by AHG. :tongue:

We only see babies who are born here, and only during the neonatal phase, so we always have both mom and cord to work with. Once a baby is discharged, they do not come back - they would be refered to the nearby children's hospital. We only transfuse about one newborn a month. ABORh and DAT are done on the cord and not repeated for 4 months. We ALWAYS give O neg to ALL babies; that allows us to never stick the baby (for blood bank) and reduces the on-hand inventory. For transfusions, we use the mom's antibody screen result (within 3 days of birth). If mom has an antibody, we give antigen negative units. We do not perform a crossmatch.