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Everything posted by BBK710
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We do send blood to the OR in coolers although it is not done too often. We require that they return any unused blood in the cooler to us immediately after the procedure. Under no circumstances is it to be sent with the patient. We usually don't have any problem with this policy.
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We do the KB in the Blood Bank but only on day shift. I agree BSIPHERD that it is not necessarily an easy test to master. It is also difficult to maintain competnecy for a procedure that is not performed frequently. That is why we do the test on day shift only and have only a few techs that are proficient in this procedure. Some of the OB/GYNs are not happy that we don't do the test STAT but fortunately it is not the only diagnostic tool that they have in the event of trauma to a pregnant patient.
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Does anyone have a policy for handling cases where patients are transferred to another facility when the transfusion of blood or components has been started but not completed? How do you handle the medical record for the completion of transfusion, adverse reactions etc?
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Sorry, I have never been good at sharing. I like BLOOD BANK TALK just the way it is.
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ER and Surgery Issue of Rh Immune Globulin
BBK710 replied to ffriesen's topic in Transfusion Services
We do the same. -
Reference lab workups
BBK710 replied to keisterkid's topic in Immunohematology Reference Laboratories
I agree completely. As a client it is extremely frustrating when we send a sample for identification to our reference lab and they tell us that it is negative when we had positive reactions in gel. Then they will test in gel for an additonal charge and only when one of their "gel techs" are available. Doesn't help the patient who is waiting for a safe transfusion. -
So you are charging for each panel that you run even if you run each panel using the same technique? What CPT codes are you using? CPT code 86870 is described as "Antibody identification, RBC antibodies, each panel for each serum technique." I can't decide if that means you can charge a quantity of 2 for running two panels in gel, or if it means that you can only charge 2 if you run two panels using 2 different techniques.
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We do the same. I have never seen the QC fail. I think if it did it would probably be due to contamination which would be proved by repeating and/or opening a new bottle of reagent. I don't think that this is testing it into compliance but determining what the problem is with the QC and resolving the problelm to assure accurate patient testing.
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If the mom is type O and the baby is A or B we do an antibody screen (on the mother) if it is negative we report that the DAT is positive and probably due to ABO incompatibility. If the mom's antibody screen is positive we don't add the comment and it is up to the physician to order addtional testing.
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Bio Rad is the US supplier for Biotest reagents. I have evaluated them and they seem to work as well as Immucor and Ortho. The pricing is about half the price of the others. However the drops are larger and consequently you don't necessarily get the same number of tests per bottle but it is still a cost savings. We are seriously considering switching.
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Factor Concentrates: Pharmacy or Blood Bank?
BBK710 replied to DFields's topic in Transfusion Services
Pharmacy handles all factors and albumin. We handle Rh Immune globulin. -
I couldn't agree more. Don't know what I was thinking. I try very hard not to ever say NEVER.
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We do the same.
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If the baby is A or B with a postive DAT and the mom is O with a negative antibody screen we report "presumtive evidence of ABO incompatibility. We have never been asked to do an elution and we have been doing it this way for over 10 years.
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Adiescast thanks for this reply. I had never given much thought to this issue. Now I have added to our procedure that the thawed/pooled cryo should be placed into the platelet incubator until issued. Don't know why I never thought of this before.
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Our maternity unit has a standard order set that requires an order for a blood type on each patient admitted in labor. We document all Rh negative patients on a paper log. We then check for the receipt of a cord blood and an order for Rh Immune globulin. If we don't receive either we call the floor and ask for orders. Is this perfect? Of course not, it assumes that we receive an order for a blood type for all patients admitted. We know that we don't because occassionally we receive a cord blood and when we check the mom's blood type we find that we never got an order for one. However, it's better than nothing and we have had no problem with CAP inspectors.
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We run an auto control and a DAT with each antibody identification. We use gel for antibody screens and antibody panels.
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We are evaluating the Biotest reagents so I was very interested in this post. I just compared Biotest antisera to Ortho antisera. Twenty drops of Ortho antisera was 1.1 ml. and twenty drops of Biotest was 1.4 ml. Granted this was not done to strict standards but it seems pretty obvious that you will get fewer tests per vial from Biotest which probably off sets their lower prices. I am going to mention this to my rep and see what she has to say.
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I just got my CAP checkist with the new TRM.31450. I understand why you would need to do a correlation if you are automated and use something else for backup if it's down or for stats etc. We are not automated, use gel for antibody screen, antibody identification and AHG crossmatches. We use tubes for ABO/Rh. If we do antibody screens or panels in tubes it is not instead of gel, it is to aid in identification/interpretation of the results in gel. So I planning to check with CAP for some clarification on this reg. Comparing gel and tube methodology is really comparing apples to oranges and seems to me to be a waste of time and money.
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Brenda, Are you putting the Safe-T-Vue 6 on the blood bag at least an hour prior to packing the cooler? If not is it working ok? Most of the time we don't know an hour in advance when the OR would like blood sent in the cooler.
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We did an in house comparison and got the opposite results. Immucor's positive control was much stronger. Ortho's procedure states to centrifuge for 15-45 seconds. We found that if you centrifuged for only 15 seconds the postive control was negative. We had to centrifuge for 45 seconds and then it was a weak positive. We also did the CAP PT with both Ortho and Immucor and got the same results with both but Ortho's had to be centrifuged for 45 seconds. My techs prefer Immucor so we will stick with it.
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What kind of quality control do you perform on heating blocks or incubators used for tube testing other that daily temps? We have a procedure to determine incubation time by checking how long it takes for the reagents and cells in the tubes to heat to 37 degrees and then adding that time to the incubation time stated in the manufacturer's inserts for each procedure. Does anyone do this? I don't know where we got the procedure because it isn't in the current technical manual.
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We do the same except that we put it in a bag marked with the expiration date so that we know when we can discard the bag - 7 days after the expiration of the units. We rarely have to go back to find a segment though.
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I haven't seen a new checklist. Could you tell us what TRM41025 states?
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"Does the transfuison service laboratory have an effective mechanism for evaluating and selecting suppliers of crical materials and monitoring suppliers' ability to meet the laboratory's needs?" I take this to be very similar to what aabb requires as part of their quality progam. You need to have a defined process to evaluate suppliers qualifications and an ongoing audit of their ability to meet your needs. We work with our procurement department to assess vendor qualifications etc. For example I know that Immucor can provide a vendor qualification packet. We monitor and report to Transfusion Committee the number of days that our blood supplier can not bring our inventory up to the desired level. These are just a few examples but I think the key is to have it defined and documented.