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Brenda Hutson

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Brenda Hutson last won the day on November 1

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About Brenda Hutson

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  • Birthday 09/02/1958
  1. Transfusion reaction protocol

    Our Policy states that it is the responsibility of the Physician to "call" a Transfusion Reaction. Sometimes, they will call us and try to get us to tell them if it is a Transfusion Reaction (i.e. should they initiate a Transfusion Reaction) and I have advised my staff that this is NOT our call.....we do not know the patient, we do not know what their condition was prior to the transfusion, and we are not Physicians. When a Nurse suspects a Transfusion Reaction (and I have assisted Nursing education with the PowerPoint presentation on that for which Nurses must complete the assignment annually), they are advised to notify the Physician and let them make the call (they can also notify us, but we will not tell them whether or not to call a reaction; and they are required to notify us if they have decided to call a Transfusion Reaction). Yes, there are times they call us and based on what they tell us, we may think they should be calling a reaction (but we will not make that decision), and then they end up not calling a reaction (i.e. the Physician decides not to initiate a transfusion reaction). Those times can be disconcerting, but all I can do is continue to educate staff (and even though the symptoms may sound to us like they should initiate a reaction, that is exactly why we do not advise.....it is possible that the patient has been having those symptoms and the Physician knows that....so they are the ones who have the "big picture" of what is going on with the patient, not us). There is a Hospital Procedure which I wrote, which clearly describes various symptoms of transfusion reactions; what to watch for. But they made that call. Brenda Hutson, MT(ASCP)SBB
  2. 2 Mysteries

    Well, not quite sure how it ended up this way in that we spoke to the Medical Director at the ARC twice (he had said to report it as a hemolytic transfusion reaction); I sent them copies of ALL of the work we had performed, as well as a copy of the Transfusion Reaction Form showing the symptoms and work-up; and I attached a letter, summarizing everything that had transpired, and what our additional thoughts were (i.e. Antibody to a different Low Incidence Antibody being just one other thought). I received an e-mail back from the Medical Director a couple of weeks later, and here is what was written: I received this report of a potential TRALI reaction from your hospital, and after investigating the sex of the donor involved in this case--a man--I have decided not to investigate the case. The reason for not investigating the case is that the donor in TRALI cases are previously pregnant women with HLA antibodies, and male donors do not have HLA antibodies. You also had a concern for TACO, but TACO is not associated with any donor or blood component characteristics. I am going to send you formal follow up letter with this decision. So I e-mailed him back, reminding him of our conversations (we never mentioned TRALI or TACO as a possibility for many reasons), and mentioned that I had also attached a letter (which may never have reached him; I can't say.....so I attached it again to my Reply e-mail). I have never heard back from him.....so I guess it is a closed case. We went as far as we could with a work-up.....so if ARC is dropping it at this point, I guess we are also. The patient has subsequently been multiply transfused w/o incident, but we may never know what actually caused this 1 reaction for the patient. Brenda Hutson, MT(ASCP)SBB
  3. 2 Mysteries

    We use Room Temperature Saline and Cold Wash Solution. Brenda
  4. 2 Mysteries

    The patient had just finished chemotherapy. But if for example, he had also just received that drug, it could just be coincidental timing that the drug reacted with his red cells while he was being transfused platelets? Still just guessing. Keep those thoughts and ideas coming and if I hear anything from Red Cross, I will let you all know! I am learning from this one. Thanks, Brenda
  5. 2 Mysteries

    Our Medical Director checked his files and he was not on either of those drugs. The only drug of interest she saw was Promacta, but not sure if that is a drug that acts in this same manner? Thanks, Brenda
  6. 2 Mysteries

    Hmmm....that might fit. I will check into that. Thanks, Brenda
  7. Cord Blood Testing

    We do the same. All group O mothers; all Rh Negative mothers; and if they had some reason to suspect a problem (i.e. a Positive DAT perhaps due to a Low Incidence Antibody that was causing the infant problems). Brenda Hutson
  8. Verbal orders for blood

    We will take a Verbal Order (on an official Verbal Order Form which we keep) for the initial order for Emergent Release (4 uncrossmatched RBCs) or Massive Protocol. Since both of those require a written document of acceptance from a Physician, we attach the Verbal Order Form to that. After the initial order, we do ask that subsequent orders be requested with our official Blood Request form (as well as orders in the computer; but we can work off of an initial order in the computer for a LOT of products so we allow them to complete computer entries when time permits). Our reasoning is that after the initial order, we may be processing a number of different products on the patient. We want to send the "correct product" at the "correct time." I do not feel comfortable just sending blood based on a phone call (especially with OR as they can end up with "too many cooks in the kitchen" sometimes). If they are in a real hurry, we try to compromise (i.e. we will send up the blood product if you turn around and send the Request Form right back; or vice versa; we won't cause a delay over it). We tend to work better together as long as they see we are not trying to hold up their products, and we are willing to work "with them." This is our "policy," but when things get hectic, clearer minds do not always prevail so then we make sure they get what they need and I can follow-up on any issues once things calm down (and we can always document further on verbal order forms; but what we get from the Request Form is that we send the correct product, at the time when they are actually ready for it). That is just our Policy.... Brenda Hutson, MT(ASCP)SBB
  9. 2 Mysteries

    I have to admit that I am not familiar with the abbreviations of ALG or ATG (unless that is referring to a type of antihuman globulin)? We did not ask for the patient's medication list but a comment I just noticed that our Medical Director wrote on paperwork we are sending to Red Cross (we decided to send all of this to them in case they could find something we could not), was that other possible explanations were Dyspnea secondary to COPD or Drug Reaction. But there is still just that darned confusing DAT (I suppose could have been non-specific drug binding with the "coincidental" Anti-Lua eluted). Anyway, will definitely update you all if I hear anything different from ARC. Thanks again for your input; always invaluable. Brenda Hutson
  10. Blood Bank staff

    Currently I do not work in such a Facility so have Generalists that rotate, but most of the Hospitals I have worked at in my career, were large Medical Centers that fit your description and they always used Blood Bank dedicated staff. I think you need that specialization to be performing high level testing. Also, it would be a lot to ask of Generalists who have to rotate between all depts. that they would be that specialized in the Blood Bank, but also be able to be knowledgeable and competent in the other areas as well. You need a certain depth of Blood Bank knowledge to be training interns; to do high complexity serology; to know how to handle difficult trauma situations. Just my thoughts.... Brenda Hutson
  11. 2 Mysteries

    Thank you all for your input. With regard to the comment that the post was long....I tend to like to explain things thoroughly so readers have all of the information I have, and know what my thoughts are up to that point. Sorry, just my style. ABsub did also occur to me, but in all honesty, I have only rarely seen this in my 30+ years (just lots of AsubB). Also not sure if it was just weak due to age so would not want to "label" them as ABsub if 6 months from now, they typed 4+ with Anti-B. So was a little nervous about coming to that "official" conclusion. So we did make the recommendation that if they really wanted to know, they could try submitting a new specimen in about 6 months. I agree that there could be a different Low Incidence Antibody that caused the transfusion reaction (we only tested what we could get from our panels). We are sending pre and post specimen plus leftover platelets to the Red Cross to see what they come up with. They may or may not elect to run a panel of some Low Incidence Antigens from their frozen inventory; but of course they can't test every Low Incidence Antigen so it would just be a "hit or miss." But I guess what is still just odd to me is that the DAT was negative before the transfusion (just that morning; was just sent because the patient was being seen by their Oncologist and has been using blood products steadily, so they wanted us to have a specimen available should they need to transfuse more RBCs in next few days); then clearly positive right after the transfusion; and there was definitely an Anti-Lua coating the cells (but also a mystery as to why the strength of the DAT would so obviously weaken in just a few hours, if no evidence of hemolysis). Also, with regard to the comment from BankerGirl about why we were calling it a hemolytic transfusion reaction. We had called the Red Cross Medical Director right after we discovered the Positive DAT and he instructed us to do that; however, our Medical Director did not state that on the Transfusion Reaction Report; but in fact, stated that the reaction may not have even been related to the transfusion; could have been coincidental timing (but that still doesn't explain a Negative DAT becoming Positive from Pre to Post). So is the suggestion then that while we eluted the Lua.....that had we performed an eluate on the negative DAT cells from the morning, we may also have eluted it then but it is just that it is not present on enough cells to have resulted in the Positive DAT (i.e. as an explanation as to why the DAT changed but no Anti-Lua was identified in the platelet plasma)? I am still trying to make sense of that part; that if it was not the cause of the reaction and was not in the platelets, the assumption would have to be that it was already present and coating the cells prior to the transfusion; just not enough to cause a positive DAT; but enough to come off in a concentrated eluate? The patient had received numerous red cell transfusions over a long period of time; so there certainly could have been a small population of transfused cells that were Lua POS to which the patient's Anti-Lua attached? Also, Antibody Screen Negative, so no "free" Anti-Lua (unless low titer). If Red Cross comes up with anything more concrete, I will pass that along; but I really appreciate your input on this mystery! Brenda Hutson
  12. 2 Mysteries

    Ok, so this is even more confusing. The repeat of the Lua+ cell was definitely Positive (tested with eluate), however, we then decided to test the plasma from the platelets against the same cell, and it was non-reactive. If there was truly an Anti-Lua in that Platelet, I would have expected it to also react against that cell. Yet there must be some significance in eluting an Anti-Lua; and in a Negative Direct Coombs before transfusion and 3+ Positive after transfusion?? I feel like we are missing something but I don't know what it is. It is possible that the patient's reaction had to do with chemo drugs he had been given....maybe even possible that the positive DAT was due to some drug interaction. But how to explain the eluted Anti-Lua?? Thanks again, Brenda
  13. 2 Mysteries

    So we have had 2 patient mysteries in the past week. One of them probably has a simple solution....but is just not something I have ever seen in over 30 years. The other one is more of a mystery. 1st case: We received a Cord Specimen on the baby from an A NEG mom to evaluate for Rhogam. The baby typed 4+ with Anti-A, but 1+ with Anti-B. We did wash the cells many times. We also obtained a heelstick but obtained the same results. I am used to seeing weak A typing on newborns; but not used to seeing it with Anti-B (but then statistically, I have seen many more A's over the years than B's); especially when it was so strong with the Anti-A. Have any of you seen that weak of typing with Anti-B on newborns, or are there any other thoughts on what is occurring here? 2nd case: 62 year old male with diagnosis of COPD, Dyspnea, GI Bleed, Chemo (as recently as yesterday). So ongoing problems. He has had MANY transfusions of RBCs and Platelets over the past year; including past 3 months. The patient is A POS. Yesterday, he was transfused with an O POS Platelet (we only keep 2-3 in-house at any given time so just have to give what we have, and do so by outdate). Anyway, after receiving only 151 cc's of Platelets, he had Chest Pain, Respiratory Distress and Vomiting. He was transferred by ambulance the 1 block to the Hospital ER. All of our clerical check was fine. Our Policy for giving Platelets is that we just have to have a historical type on the patient; it does not have to be a current type. However, the Cancer Center had drawn a HOLD specimen that morning so as it turned out, we did have a pre-transfusion specimen (just had not been tested yet). Upon testing both the pre- and post- specimens, the only issue we came across was that the pre-transfusion IgG DAT was Negative, but the post-transfusion IgG DAT was 3+. When we spoke to the Medical Director of our Donor Facility, he said to report it as a hemolytic transfusion reaction. Problems with that are: After whatever treatment they gave patient in ER, he was sitting up and feeling just fine. Also, no indications of it being TRALI. So we became concerned that perhaps we had a platelet with a high-titer Anti-A,B. We performed an Eluate on the post specimen and tested it against screening cells plus A1 and B cells. All testing was NEG. Now we were really stumped. We had the patient re-drawn and now, several hours later, the IgG DAT had dropped to 1+. Not a dramatic drop in Hgb.....from 7.4 before transfusion, to 7.1 after transfusion, to 6.9 this morning. So my last "guess" was that perhaps he was just really unlucky and the donor of the platelets had an Antibody to a Low Incidence Antigen, and the patient just happened to be Positive for that Low Antigen?? So we are testing just the Lows that are on our panels (Cw, Kpa, Jsa and Lua). Of course there are a lot more Low Incidence Antigens that it "could" be if that is what caused this. But that decrease in strength of the DAT, in light of not really seeing evidence of hemolysis, is very confusing. And if it is an Antibody to a Low Incidence, due to his many transfusions of RBCs, is the Antibody attaching to his own cells, or to donor cells he previously received which may have been Positive for a Low Incidence Antigen? Any thoughts/ suggestions. Also, as I am completing this, my Tech. just brought me a gel card with the results from 2 of the Low Incidence Antigens. It looks like the card spun at an angle so I want it repeated, but it appears that the eluate is reacting with the Lua+ panel cell. But I wouldn't expect an Anti-Lua to cause a severe reaction in a patient like that. Anyway, will keep you posted on our serological results.....but if you have any other ideas/ thoughts, would love to hear them. Thanks in advance for your input, Brenda Hutson, MT(ASCP)SBB
  14. Grifols Erytra

    Yes, we do sometimes see specks. But what has been more problematic for us is seeing a lot of haze (and when you are working with a new analyzer, you are not sure how to interpret "heavy haze.") We also get a number of false-positive reactions. So we end up doing a lot of work-ups. Grifols has found an issue with their reagents from this and we hope to see an improvement soon. Brenda
  15. Grifols Erytra

    Note: Undetected volume turned out to be a problem with analyzer; not our handling of the cards (they are now going to install a new version next week to fix the volume issues). But we did have a crash not longer after going to double-layer racks so we are back to single-layer. We don't need the volume the double-layer provides and it just isn't worth having the gripper crash into a card where a corner is slightly sticking up.....but that was just our personal decision. Brenda
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