L106

I don't have a "procedure". We just make a dilution, then do the test. If the reaction is too strong, we dilute it some more & recheck (or add more antibody if it's too weak, etc.) and just repeat the adjusting and testing until we are satisfied with a 1+ reaction.
Donna

I don't have a "procedure". We just make a dilution, then do the test. If the reaction is too strong, we dilute it some more & recheck (or add more antibody if it's too weak, etc.) and just repeat the adjusting and testing until we are satisfied with a 1+ reaction.
Donna

Dang!  I should have slipped in  "probably is an A1 individual".  (You are very alert for a Monday morning!)
 
 
Donna

Dang!  I should have slipped in  "probably is an A1 individual".  (You are very alert for a Monday morning!)
 
 
Donna

Megan - Since CAP does not offer an automated DAT survey (as far as I know), my suggestion would be a variation of the #2 option in your list:
 
1.  Perform your regular manual proficiency testing on the CAP-DAT Survey samples (and report your results to CAP.)
 
2.  Then perform the DAT testing on the CAP-DAT Survey samples on your Echo instrument.
 
3.  Don't submit your Echo results to CAP.  Rather, keep the results in a file.  When you get the results report from CAP, compare the report with your Echo results, document whether your Echo results were satisfactory, and have your Pathologist Medical Director sign and date this (and return it to your file.)
 
Donna

Hi everyone,
I would really encourage you to take a moment to read a blog article I wrote regarding a lab scientist's connection to their patients from "behind the scenes".  This subject is very near and dear to my heart and I hope others find that it resonates with them as well.  Please feel free to share any thoughts below the article in the comments section. Thank you for taking the time to click!  And as always, thank you for being an integral part of our healthcare system.
https://www.staffready.com/patient-behind-scenes/

John -
I have never heard this topic explained so concisely and so clearly! Those two simple sentences sum it up perfectly! Thanks!
Donna

Megan - Since CAP does not offer an automated DAT survey (as far as I know), my suggestion would be a variation of the #2 option in your list:
 
1.  Perform your regular manual proficiency testing on the CAP-DAT Survey samples (and report your results to CAP.)
 
2.  Then perform the DAT testing on the CAP-DAT Survey samples on your Echo instrument.
 
3.  Don't submit your Echo results to CAP.  Rather, keep the results in a file.  When you get the results report from CAP, compare the report with your Echo results, document whether your Echo results were satisfactory, and have your Pathologist Medical Director sign and date this (and return it to your file.)
 
Donna

Time Out........
Yes, our computer automatically checks all current ABO/Rh results against pts' ABO/Rh previous results and alerts us if the results do not match. (Our computer records go back almost 20 years.) So that is not a problem for those of us who have a computer system.
Am I the only one that thinks the CAP checklist item refers to checking for ABO/Rh testing for each pregnant patient (not just the pregnant patients that have current Blood Bank testing ordered)? In other words, we (in our Blood Bank) don't always know if a patient is pregnant, we often don't have access to their prenatal testing (done by a reference lab), we don't handle Rh-Immune Globulin (it is issued by our Pharmancy Dept.), etc. So our Blood Bank Dept is not in a good position to oversee this important patient care issue.
I think this checklist item dictates that your institution must have some policy/procedure in place that guarantees that the OB (and Emergency Dept) personnel check the ABO/Rh results (and administers Rh-Immune Globulin appropriately) if a patient is pregnant. (Am I a "Lone Ranger" with this interpretation of CAP's intent?)

Megan - Since CAP does not offer an automated DAT survey (as far as I know), my suggestion would be a variation of the #2 option in your list:
 
1.  Perform your regular manual proficiency testing on the CAP-DAT Survey samples (and report your results to CAP.)
 
2.  Then perform the DAT testing on the CAP-DAT Survey samples on your Echo instrument.
 
3.  Don't submit your Echo results to CAP.  Rather, keep the results in a file.  When you get the results report from CAP, compare the report with your Echo results, document whether your Echo results were satisfactory, and have your Pathologist Medical Director sign and date this (and return it to your file.)
 
Donna

Megan - Since CAP does not offer an automated DAT survey (as far as I know), my suggestion would be a variation of the #2 option in your list:
 
1.  Perform your regular manual proficiency testing on the CAP-DAT Survey samples (and report your results to CAP.)
 
2.  Then perform the DAT testing on the CAP-DAT Survey samples on your Echo instrument.
 
3.  Don't submit your Echo results to CAP.  Rather, keep the results in a file.  When you get the results report from CAP, compare the report with your Echo results, document whether your Echo results were satisfactory, and have your Pathologist Medical Director sign and date this (and return it to your file.)
 
Donna

We are a little larger than your facility, WFMB.  We've had an Immucor Echo for 7 years and have been satisfied.  It's just right for our size.
 
Donna

SMW and shelleyk482 gave presented accurate information. We used to perform the compatibility testing for a non-affiliated dialysis center, pack the donor units (with ice) in an approved Red Cross box, and a dialysis nurse would come picked up the donor units and transfuse them during dialysis. However, several years ago Medicare stopped reimbursing for transfusions in that setting (so the dialysis center no longer transfuses and blood.)
(Those of you in a hospital setting: Don't you wish you could just stop doing things that are not reimbursed??)

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

We are like you, pbaker..... not a high risk OB facility.  We did so few Kleihauer-Betke Stains that we discontinued doing them and started sending them out to a nearby hospital  around 3 or 4 years ago.  I don't have statistics on how many we send out, but I have noticed that there has been a significant increase during the last couple years.  Apparently our Maternal Fetal Medicine Physician now orders a battery of tests on OB patients who have experienced a fetal demise, and a KB Stain is one of those tests.
 
Donna

Oh, I'm all for what David and pbaker do.  The reason we routine do a full panel on every new specimen that demonstrates a Positive antibody screen is because our laboratory staff rotate working the various lab departments.  Some of the generalists would have a little difficulty picking out the right selected cells, so it is just easier and quicker for them to throw in the entire panel (and they are more comfortable with that, so it's fine with me.)
 
Donna

I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.

Believe it or not we actually had an "SOP for SOPs".  When we were initially reviewing it I suggested that they increase the font size from 10 to at least 14 or 15 to accommodate the aging laboratory staff.  The Pathologist initially thought my suggestion was funny until I explained that I was quite serious and had been doing it for years, much to the appreciation of my staff.  He was then quite upset that anyone found any fault in his beautiful masterpiece.  As you can guess the font stayed 10. 
 
The SOP was quite helpful in both standardizing the corporate lab SOPs, which was the primary goal, and making reviewing and accepting them a fairly painless operation.  Hopefully your facility has something similar to help guide you through the process.   

Thanks for your kind words, Malcolm.  Like John above, I'll continue to "troll" and try to stay current with the field.  I've had a wonderful career (and I'm convinved that there have been guardian angels preventing me and my staff from making serious mistakes through these many years!)
 
Donna

I am "retiring" on 11/11/15 (but will probably continue to work a couple/few days a month.)  (We'll see how that goes.)
 
Donna

Thanks for your kind words, Malcolm.  Like John above, I'll continue to "troll" and try to stay current with the field.  I've had a wonderful career (and I'm convinved that there have been guardian angels preventing me and my staff from making serious mistakes through these many years!)
 
Donna

Congratulations Donna, BUT, as I, for one (of, I am certain, many) have always respected your views on this site, PLEASE do not "retire" from "PathLabTalk" for many years yet!

Malcolm, I'm sure I will continue to be the troll under the bridge for this site for quite sometime.  I find the discussions interesting and enlightening.  I've noticed that my expertise in some areas is already waning and outdated since I stopped being a dedicated bloodbanker a few years ago but I hope that some of my management insights are still useful and my mistakes of the past can be a learning experience for others.  There you go, more of my philosophical drivel.

We do a panel on every new specimen (if the Antibody Screen is Positive.)
 
Donna

Thanks for your responses.
 
As Molly indicated above, The Mayo Clinic did a nice job of validating the use of A FFP in emergent situations.  They have video explaining the process and reasoning here if anyone is interested:
 
http://www.mayomedicallaboratories.com/articles/hot-topic/2014/03-15-group-a-thawed-plasma/
 
Scott