L106

Same as others here......record the temperature once a day, label "for specimens or reagents only", no alarm, no temperature recordered.

Our current protocol states that if there are clinical symptoms or laboratory testing results that indicate that a hemolytic transfusion reaction may have occurred a pathologist must be notified immediately. He or she will consult with the patient's physician and decide on treatment and any further action that is warranted. In the situation involving a suspected Ebola patient, I am sure the decision would also involve the infection specialist physician. I would also expect that "where do we go from here?" would depend a lot on the patient's medical condition, etc. Donna

Oh, goodness!! Good question, but with Ebola (hemorrhagic fever), how in the world would you tell he/she is having a transfusion reaction? (It seems like the disease itself pretty much looks like a hemolytic transfusion reaction!)

We will give uncrossmatched O Negative Packed Red Cells, Group AB Frozen Plasma, and Plateletphereses of any ABO/Rh.

I'm sure she meant that the organization is inspected by the Joint Commission. What you said is true.....we never used to see the JC inspector come to the Lab. (I always suspected that if the Transfusion Service was CAP and/or AABB accredited, JC felt comfortable and didn't want to waste time there.) However, now the JC inspectors take more of an inspection approach of selecting a patient case and following it all the way through from admisstion to discharge. So if the case happened to involve transfusions, you are now more likely to have the JC inspector come down to the Transfusion Service and ask questions, etc. Regardless of whether the JC inspector comes to the Transfusion Service, if your instituation is JC accredited, you are obligated to abide by their standards that pertain to the Transusion Service. Donna

I'm sure she meant that the organization is inspected by the Joint Commission. What you said is true.....we never used to see the JC inspector come to the Lab. (I always suspected that if the Transfusion Service was CAP and/or AABB accredited, JC felt comfortable and didn't want to waste time there.) However, now the JC inspectors take more of an inspection approach of selecting a patient case and following it all the way through from admisstion to discharge. So if the case happened to involve transfusions, you are now more likely to have the JC inspector come down to the Transfusion Service and ask questions, etc. Regardless of whether the JC inspector comes to the Transfusion Service, if your instituation is JC accredited, you are obligated to abide by their standards that pertain to the Transusion Service. Donna

This is what we do, too. Donna

As the younger generation would say: "OMG!" (I don't think I want to hear any more of the horror stories!) As several others have said, I respect and congratulate you on your professional ethics. I'm sure that was not a pleasant decision to tackle, but I bet you never regret it. Glad that you already have a couple leads on a new job. Good luck! Donna

This morning we also adopted the policy of no Blood Bank testing. Suspected Ebola patients will receive uncrossmatched O Negative packed red cells. Donna

Heather, I also saw the article in AABB News. WAY TO GO!!! Congratulations, Heather! Donna

I also highly recommend the Helmer brand. (We have had both their platelet agitator and environmental chamber for many years and problems have been very rare.) I suggest you go to their website and request price quotes for your budget. It is very quick and easy to do, they will email you a quote within a couple days They might send you a follow-up email to make sure you received the quotes, but I don't remember any salesperson ever calling or pestering me. (They know that we have to submit quotes for budgets, even though the budget items are often subsequently not approved for purchase.) Donna

So do I! Donna

This is what we do also. Donna

"teaching my grandmother to suck eggs" ???????

TAR = Thrombocytopenia-absent radius syndrome The child has lacking the radius bone in each forearm and they have a low platelet count. TAR Syndrome is also often associated with other skeletal, hearth & kidney malformations. Our patient took numerous platelet transfusions (and occasional red cell transfusions) during her 5 years of life before she passed away from an infection not directly related to her TARS. Donna

We had such a patient and never had any problems with her ABO reverse grouping. Donna

My response on how we would have handled the situation is the same as Mabel's response. Donna

May I ask, John, why did you decide to take this action and put your sanity at risk??? Donna

Glad to have you with us, rerun!

Glad to have you with us, rerun!

Yes, the 12-18 months to feel comfortable/confident. My first position was on the evening shift in Blood Bank. I learned so much from my rather eccentric, but very knowledgable and enthusiastic coworker who willingly shared her 20 years of experience. Also, the small staff and the fact that no "boss" was present on our evening shift made you learn to work independently, solve your own problems, and make decisions (good ones, hopefully) pretty darn fast. It was a wonderful environment to start my career.

I understand some of your confusion. When dealing with non-immunocompromised patients, the main thing to think about is: "Is the donor of the blood product an unusually close HLA-match to the patient?" When we are transfusing random Packed Red Cells or Platelets to the patients, it is very unlikely that they are a close HLA-match. (Think about how difficult it is for most transplant candidates to find a close HLA-matched organ donor.) If we are giving HLA-matched platelets to the patient there is an increased risk of Transfusion Associated Graft Versus Host (as JEMarti explained) because they are HLA similar. If we are giving Packed Red Cells or Platelets from a close relative (ie: a "first degree relative"), it is also likely that they may be HLA similar to the patient (at least significantly similar to the patient than donor blood that comes from a random stranger.) Now, if we are dealing with very young or immunocompromised patients, their weak immune systems increase the risk that transfused T-cells in the donor blood might engraft and result in TAGVHD, so those patient might need all donor Packed Red Cells and Platelets to be irradiated before transfusion.

Oh, my gosh.......After a moment of thought, yes, I do remember those little steel beads. I had completely forgotten that's how we used to start the blood collection flowing. We had a day back then when we thought we were going to need to call a plumber, too. There was this awful smell coming from the cabinet under the sink. Didn't need a plumber after all........We used to pack our donor whole blood units into Packed Cells, then throw the bag of plasma into a box under the sink (and later sell the plasma to a fractionating company.) Turns out that one of the plasma bags (several weeks old) had a leak and we had quite a disgusting population of maggots. (None of us felt like eating lunch that day.) Donna

I remember all of those things too, tricore. (Gosh.....hadn't thought about the "buffy-coat-poor" leuko-reduced cells by inverted spin for many, many years.) Donna

We do only the FMH Screening Test. (No Antibody Screening.) If the FMH Test is Positive, we do an Rh typing (and Weak D Test, if necessary) on the mother's specimen. If the D and the Weak D tests are Negative, we do a Direct Antiglobulin Test on the mother's red cells (to make sure that a Pos DAT is not causing a false positive FMH test.) Donna