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Antrita

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  1. Antrita
    We have had enough "gelbodies, I really like this term", that I take Immucor screening cells, wash them with MTS diluent and them dilute them to 0.8%. Most of our "weird" ones are negative with these screening cells. Our only other option is to go to tubes and I'm afraid that any negative reactions are due to using a weaker screening technology. We run daily QC on these Immucor gel diluted cells. Does anyone see a problem with this? Antrita
  2. Antrita
    We have just had our 2nd Rh positive patient with an Anti-D. The scary part was the night tech thought this was impossible and decided the man had an nonspecific warm autoantibody and was going to let them transfuse Rh positive blood if they needed it. The antibody Id panel was a perfect 3+ anti-D. Luckily he has not been transfused. I am sending his specimen to our reference lab for further work-up. Has anyone had similar experience and what did you do? Antrita
  3. Antrita
    We are a much smaller hospital (140 beds). I didn't have any trouble with the medical staff. ER and OR were very unhappy with the 30 minute delay due to thawing a jumbo plasma when requested. I thought I would see an immediate end to wasted plasma but this wasn't so. I started out with having 1 AB thawed. Since our supplier didn't want me to go thru all their AB plasma I wasn't using it until the 4th day it was thawed if I didn't have a stat. If course, right after we started with the thawed plasma our census dropped. So, I was still wasting plasma. It is better now, but I have to keep a close eye on it, our census and what kind of patient's are in the hosptal. I also went to 3 days on the AB thawed. I also found out that I needed to re-educate some of the techs on what blood type can use what FFP type. It was really discouraging to come to work and find out that the evening before a O pos patient wasn't given the A FFP that was going to expire the next day. Antrita
  4. Antrita
    Has anyone seen an red cell antibody reaction that was only hemolyzed the red cells? I was working with a specimen that was "pink" not "cherry syrup" on a patient that was a hard draw and was thinking about the fact that I have never seen an antibody that only hemolyzed the red cells. It is important for transfusion reaction work-up that you don't start out with "cherry syrup" but where do you draw the hemolytic line on the initial antibody screen? Antrita
  5. Antrita
    We have had the same situation as Malcolm, trying to explain that the "universal donor" isn't really universal is not so easy.
  6. Antrita
    Our policy is to provide type compatible, which overrides what the doctor orders. This came after a death in the OR many many years ago. We use to have to ask the ordering MDs permission to change from type specific to type compatible blood (very stupid policy, I don't recommend it). The patient was A positive. When we ran out of A positive and A negative the tech wanted to switch to O positive. The anesthesiologist said no. Of course it was in the middle of the night. The tech had the pathologist over the phone talk to him but he would not change his mind. The patient died in the OR. Our policy very quickly changed. Antrita
  7. Antrita
    Sounds good. My procedure would read the modified antibody Id can be used if there is documentation the patient had Rhogam. Without documentation, do a full work-up. Thanks Antrita
  8. Antrita
    I wanted to ask this question again because I am trying to decide if help or make things more confusing. I asked about using the Gel modified antibody Id panel when a patient has had Rhogam. My problem is this is not always documented at the time of the order. When I review the antibody panels and I see a Labor room patient with an Anti-D I do investigate and see if she had Rhogam. It is not always there and so I have to make phone calls. Do those of you that do the modified antibody Id panel have the patient's Rhogam injection history readily available? I'm wondering if the evening and night shift techs will spend more time checking the patient's history then they would just doing the complete antibody Id panel. Do some of you assume the patient had Rhogam if they are Rh negative and the screening cells look like an anti-D? Thanks Antrita
  9. Antrita
    We are adding a new patient wing to our hospital and will have a 32 bed NICU. Right now we have only 4 beds designated as NICU. Our patient population is such that we have a lot of women having a lot of babies and we see a lot of antibodies. One of my part-time techs works in a hospital in a college town 30 miles north. She says she wants to work here because we get antibodies she has never seen before. I think we get more zebras than most.
  10. Antrita
    We recently had an O positive baby with a B positive mom. They wanted to transfuse the baby. The baby had a 4+ direct coombs. The mom had an Anti-c. We transfused c-negative O positive units. We usually transfuse O just so we don't have to worry about the Anti-A or Anti-B from the mom. We have always had specimems from the mom. I am not looking forward to a time when we have a baby with a 4+ direct coombs and no maternal specimen. Antrita
  11. Antrita
    When I was reading other hospitals policies for Massive Transfusion I fould a few large trauma centers would take units that were sent with patiients if they could document the units were stored properly. This doesn't happen very often, but when it does, I do the following: 1. I use shipment boxes from my supplier that have been temp checked. 2. I pack with wet ice. 3 I put HemoTemp labels on the backs of the units. and 4. I have an Issue/ transfer form signed by the ER doctor stating the units are to be transfused during transport. My thought was to let the receiving hospital decide if they want to use any remaining units. I wouldn't use them but we aren't a trauma center and it is very rare that we are short of packed cells. I guess I also feel bad sending units to a trash can at the next hospital. Antrita
  12. Antrita
    I agree, and our as it turns out our blood warmers are ok for FFP. The waterbath would be better than the blankets if you can't use a blood warmer. One of our sister hospitals is using blankets, so I was going to suggest the waterbath to them. I have stayed out of the loop when it comes to blood warmer technology since we no longer monitor them. It was a good wake-up call. Even though I don't monitor them doesn't mean I can ignore them. Antrita
  13. Antrita
    That does sound like a good idea. It would be more controled than a blanket. I don't think they are lacking in blood warmers. We no longer have anything to do with them, they are monitored by bio-med. Were we still monitoring them we would have found out about how they were using them. I guess out of sight out of mind. Antrita
  14. Antrita
    Adiescast is right. A trauma patient that is hypothermic, acidodic and has abnormal coag results has a 50% decrease in surviving the trauma. The company manufacturing our blood warmers says they have FDA approval for running plasma. These patients have multiple lines so they don't need to run the platelets and cryo thru the same lines that are being used for the packed cells. I heard from one hospital that doesn't use blood warmers for their FFP they wrap them in warmed blankets before transfusing them in a trauma. Does anyone do this? Antrita
  15. Antrita
    My problem was I never considered the fact that during a trauma they might be using a blood warmer for all blood products. My lab manager found out at a trauma meeting and freaked out. Hopefully we have convinced them of the error of their ways. Though, since they have adopted a policy of using "packs" of products during a massive transfusion and only half of the staff know about it I doubt if this is they last we will hear the about the misuse of blood warmers.
  16. Antrita
    I found out Friday that OR has not been informed of all the changes ER has made to the MTP. This information might have been helpful. The powers above wanted to know why we did not release the blood in packs. OR said no to packs, as it turned out, they knew nothing about packs. Antrita
  17. Antrita
    They are putting everything thru a blood warmer. I do understand the FFP going thru the warmer but the platelets and cryo arn't cold. The manufacturer of the blood warmer says not to put platelets and cryo thru but doesn't say anything about FFP. We just want to make sure that the coag factors are not destroyed by the 40 C blood warmer.
  18. Antrita
    I found out that during traumas they are using blood warmers on all blood products. I told the surgery supervisor that they can't give platelets and cryo through a warmer. What I have found on FFP seems to be a little iffy. The blood warmers go to 40 C. I understand why they don't want to give these patients cold blood products. What do all of you do? Antrita
  19. Antrita
    I am questioning the validity of the warm autoantibodies we are seeing in the Gel. When you get 2+ reactions in the screening cells and no reactions or reactions where everything is eliminated in the antibody Id panel over and over, I think there is something wrong with the Ortho screening cells. I have one tech that goes immediately to a tube crossmatch when she gets anything in gel, which pretty much defeats using gel at all. This problem use to be in an occasional lot but know it seems to be the oposite, an occasional lot doesn't have problems. Antrita
  20. Antrita
    We have always used the unique single product codes in Meditech for ISBT labels. Our hospital chain is working on a new update which will link many hospitals together. We want to stay with the single product codes but the update has been started with the product groups. Does anyone have any more information on this? Does the FDA prefer one way over another? My blood bank IT tech is about ready to quit, so any help would be apreciated. Antrita
  21. Antrita
    We also have been getting more warm autoantibody results in gel. We have started looking at automation and I'm leaning towards the ECHO. I never thought I would want to quit gel but I am really tired of working up nothing. I have immucor tube screening cells. When I have weird reactions in gel I make gel dilutions of the immcur screening cells first. If the antibody screen is negative on these (which is about 70%) I leave it at that. Antrita
  22. Antrita
    Part of our problem is we are not a trauma center but we are the only hospital with a population of 90,000. We get cases that we probably shouldn't and we may go months without any major traumas. It seems like after we have one I usually only find out what doesn't work. I like the idea of a wallchart though hopefully it would be read. I have placed tables with what type FFP is compatible with the patient's blood type in 5 places in the blood bank. In this last trauma the patient was O positve the CLS was OK with giving the patient AB plasma but not B, but this is a whole other issue. Thank you Malcolm for the train story, a laugh always helps.
  23. Antrita
    What bothers me is so much time is spent on writing procedures and policies on what is in a pack, how many packs make it a massive transfusion, how often do we do coag tests, etc and then we get a trauma. The traumas are at night of course and the OR wants blood and plasma, not packs. The people that some how never got the training are always the ones in the OR and our protocol falls apart. We have improved though, we are getting them to use more plasma, platelets and cryo but it is just not working right. There has to be a way of getting the right ratio of products without it being so cumbersome that when trauma hits the protocol is the first thing to be tossed aside. Antrita
  24. Antrita
    Does anyone have a massive transfusion policy that actually works? Ours keeps changing mainly because it doesn't allow for different situations. Right now we are going with "packs" A pack is 3 pack cells, 1 jumbo FFP, and 1 platelet. If they order 2 packs it is considered a massive transfusion and we are to supply additional packs until they say it's over. Every other pack we are suppose to provide pooled cryo and also run DIC panels. 8 hours ago CCU ordered a "probable massive transfusion" They think this patient will hemorrage at any time and they want everything ready to go. I have had FFP and platelets tied up on this patient all day. I feel like I need different types of massive transfusion procedures, or better yet I think just ordering the packs as needed Antrita
  25. Antrita
    We also have it on 24/7. It's kind of odd they would say to turn if off when not it use as the main selling point is to have the hemotemp strips ready at all times. Antrita
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