[Lipoclear replacement]

I guess I better find one as we got rid of ours years ago. 

[Blue top shortage]

We have been working closely with our vendor and have been able to stay stocked up.  We have stopped collecting extra blue tops but we haven't had to restrict testing yet.

[Been gone for a while]

I joined this page 13 years ago but haven't really looked at it in at least 5 years. Through moves and promotions, I haven't been as involved in blood banking as I used to be.  I was surprised to see my password worked (luckily I had it written down).  I was happy to see many of the members from so long ago.  I see we still need to grow the non-blood bank forums. I suggest this site to every medical laboratory scientist and student I know as it has helped me greatly in the past.  I am glad to be back. 

Carrie 

[Lipoclear replacement]

Now that Lipoclear has been discontinued, I am struggling to find a suitable substitute for our lipemic specimens.  We are trying Cleanascite but are not having much luck with it.  What are other laboratories trying?

[Bit of a rant....]

This just made me feel better because i thought it was just our laboratory with these problems.

[Mass Transfusion Protocol for Pregnant Patients]

My hospital helped develop an Massive Obstetrical Hemmorhage Protocol that has garnered recognition for our multidisciplinary team.  This is an email that I sent out to my staff to help understand what is going on. 

 

 

There are risk levels and stage levels. 

 

A risk level is “how likely is the woman to have a hemorrhage”. Therefore, we draw and test initially based on a risk level.

Low Risk = Band and Hold

Medium Risk = Type and Screen

High Risk = Type and Cross 2 units

 

Stage levels coincide with “how is the patient doing”

                Stage 0 = Routine delivery

                Stage 1 = Increased bleeding but still watch and see

                Stage 2 = Increasing bleeding. Maternal Hemorrhage called. DIC panels every 30 minutes initiated.  Products are NOT ordered at this stage.

Stage 3 = Blood loss is >1500mL. DIC panels every 30 minutes.  Need MOH Pack (3 RBC, 2 Plasma, 1 PLP, 1 cryo), additional packs as needed.

                Stage 4 = Modified post-partum care based  on what stage 2 or 3 hemorrhage.

 

Patients may go through the levels quickly but remember that the physicians are trying all options to stop the hemorrhaging. Therefore patients may never go to stage 3 but stop at stage 2. And not need any blood products.

 

We have found over the last 3 years that they will typically transfuse everything but the cryo so we have changed the policy to not give the cryo until specifically requested (which is usually with fibrinogen <200)

[Use of an anti-A,B test result]

It was 2009 or 2010. We were using Immucor monoclonals.

[Use of an anti-A,B test result]

I worked in a lab where we discovered a weak subgroup of A using Immucor Anti-A,B to retype a unit, I believe it turned out to be an A_x. Typing with Anti-A and Anti-B yielded negative results. The Anti-A,B gave weak reactions but were defintiely visible. This unit was promptly returned to the blood supplier for retyping.

[Stain down the sink]

We have our collection bottle stored in another container with a lid to help with the fumes.

[Help: sample validation plan of blood bank procedures]

^{This is what I used at my last hospital. It's a very comprehensive plan. I left it filled in as the validation plan for Titer because it is much easier to understand it fully completed.  Not sure when it was developed or by whom. Titer Uniform Procedure Validation.doc}

[History Upload from Meditech 6.0 to Cerner Millenium]

Has anybody actually accomplished this? Are there any 3rd party vendors that can do this? 

 

It isn't in the scope of our contract with Cerner but I am trying to push for funding sp that we have everything in one place and I don't have to worry about typos when entering data in manually to Millenium. Nor do I have to maintain 2 systems.

 

Thanks

Carrie

[Moving to CO...Need help!]

Belle Bonfils is a good choice in Denver for an SBB. I believe they have a reference laboratory. I would think there would be quite a few hospitals to work in depending on how far you want to travel. denver is pretty spread out.

 

I know the hospital I worked at in Colorado Springs had a lot of SBBs and most of the day shift were dedicted blood bankers. Evenings and nights had generalists.  But much has changed there since I left in 2006.

[Grading reactions]

Thanks to both of you. I have been looking for elecronic versions to attach to my procedures.

[New Supplier for Rhogam]

At my last hospital, we stocked enough Rhophylac to be the 1st dose in a patient with ITP. Pharmacy was expiring the IGG they used and we never expired Rhophylac. I miss Rhophylac. I suggested it here and was told "we tried that and the nurses hated it". May re-assess soon.

[Blood bank supervisors - Who does YOUR competency assessment?]

Anyone who is qualifies under CLIA as a supervisor can do the competency for the BB supervisor.

[Transfusion Reaction - hypotension or hypertension]

According to the Technical Manual, a sign of a transfusion reaction may include hypertension or hypotension. Does anyone have these defined? Our nursing form just states a "drop in blood pressure" with no clear guideline whereas for temperature we state an increase of 1C. I have looked through a few books and nothing gives a clear guideline.

[Bench and Microscope Disinfection]

Trying to remember from my CAP inspection days (current lab TJC only). At my last facility, we documented bench cleaning each shift. I thought it was based on the CAP general checklist but can't remember exactly. It was mandated by our Laboratory Safety Officer. As for microscope disinfection, I know we didn't have a policy in the Transfusion Services but I do not know if Hematology or Urinalysis did.

[2 blood types]

We are in the process of setting this up. We will require 2 blood types for all blood/blood product transfusions. At my last facility we tried dropping the requirement for plasma but the medical directors said NO. They felt (and I agree) that having a single standard for all products was less confusing for the cross-trained generalists.

[SBB project ideas 2013]

I did my paper on the differing protocols used in transfusing patients with sickle cell disease.

[Urinalysis QC]

We run QC on the "dipstick" part of our analyzer (Clinitek Atlas) once per day but on the Microscopic (UF100) 3 times per day as it is a laser and cell counter just like a hematology analyzer. Actually since we had problems hitting the 8 hours + 15 minutes, we went to running 4 times per day. So we QC our analyzers (including Abbott Architect electrolytes, recommended every 8 hours) at 0300, 0900, 1500, and 2100.

[Thawer pockets]

I was so happy when ours died and I was able to get a Helmer DH4. Had I known the pockets were so expensive I would have saved them and "auctioned" them off.

[SBB Exam]

I really recommend Last Chance Review. I did the Florida Blood Service online SBB course and then also went to Last Chance Review. The concise presentation of the material gave a really nice study guide to augment my 12 3" binders from the SBB course. Plus there is a review on how to take the test that was nice. And it's always great to meet new people and network.

[D neg to D pos]

One thing to consider also is the technique used by the technologists performing the tests. My first thought was that it is an Immucor/Orhto reagent problem. But if the same reagents are used and one technologist let the tube sit at room temperature for an extended length of time, that may change a negative reaction to a positive reaction. I have seen this with some weak Ds although going beyond 1+ is unusual.

[Trying to find British comedy sketch on blood transfusion errors]

Googling how to save this to my computer and rip to a CD......

[SoftBank versus Cerner]

GilTPhoto, I feel your pain. We switched to Meditech 6.0 which in my opinion is far inferior to Cerner, but I can't tell if it is the programming or the stupid standards committee at the corporate level. I know a lot of your pain is the standards committee because we didn't run into your problems when I helped build Cerner two jobs ago.