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Everything posted by Antrita
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We have the Genesis TCD-B40. We got it earlier this year. It works great and it was around $8,000. Antrita
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We are not training every tech that works in the Blood Bank the exchange transfusion procedure. Is it acceptable to add on my exchange transfusion procedure to call the lab manager of the blood bank supervisor when one has been ordered? Should I list the technologists that have passed competencies on this procedure?
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Thanks, that makes me feel much better. I have enough going on right now I don't need FDA fear lurking over my shoulder.
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I was hoping they might leave me alone since the exchange transfusion is the only thing we do that requires FDA registration. I see this is wishful thinking on my part.
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what is the importance of ruling out little "c" antigen?
Antrita replied to trisram's topic in Transfusion Services
My old pathologist use to ask me about Anti-c when I had an Anti-E antibody. I finally realized that he was just getting them backwards. It can be hard to R/O Anti-E when a patient has an Anti-c. Maybe this is the problem. Antrita -
Our patient population is such that is not unusual for us to get patient's with no prenatal care. I must say though that I've never seen a Rh baby like this. The neonatalogist said she was dating herself because as soon as she saw the baby she knew exactly what was going on and what we had to do. I'm glad we did one, it makes a straight NICU transfusion seem extremely easy. Antrita
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Our patient was on her 11th pregnancy with only 1 live birth (the first). She went to her OB at the beginning of her pregnancy and then nothing until 37 weeks. At this point they did a emergency c-section. The baby had a 5 hgb and a very high bilirubin. We registered with the FDA because I have no idea how many exchange transfusions we will have as we are just started up our NICU. The fact that our first transfusion was an exchange transfusion may not be a good sign. I'm not sure why registering with them should be avoided at all costs as some have told me. Do they inspect every one that is registered?
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We are in the middle of adding a NICU to our hospital. I contacted the FDA and we had to register with them because our blood supplier does not reconstitute blood for us. The easy part is the registration. We had to do an exchange transfusion 2 weeks after we got our registration and before we even did a simple transfusion. We have only 1 CLS on nights and 2 on pm shift so we have decided when exchange transfusion is ordered on these shifts either myself or the lab manager will come in and help. Hopefully we will only have 2 in 8 years. It is very labor intensive to make up the reconstituted units.
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We use AS-1 as that is the only additive our supplier draws. We haven't had any trouble so far. Our NICU is just starting up. Right now we only have 5 beds but the hospital is adding a new wing and we will eventually have 32 beds. The first patient we transfused was a double exchange transfusion and of course it was in the middle of the night. Since the AS-1 has a lower hematocrit we needed to pc units and they had to monitor the glucose. We do the sickle screen testing here as our supplier doesn't and they provide us with CMV negative irradiated. We also have a sterile docket so the expiration date stays the same. If you are just starting up I highly recommend getting a sterile docket especially if you have BB techs that have never worked with babies it is a lot less stressful knowing you have a closed system. antrita
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Thank you everyone, This will give my pathologist his pick of how he wants to address this problem. With all the changes that have been going on in my department, I don't know what I would do without all of your help. Antrita
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We have a new maternal hemorrhage protocol. Included in this protocol is a type and screen on any patient with a previous c-section. Of course we are now finding Anti-D on everyone that had Rhogam during their pregnancy. This is not making us very happy. Our policy is to automatically set-up 2 units of blood. Also, once a patient has a positive antibody screen, there history is marked and we always do an AHG crossmatch on their units even if the antibody screen is now negative. I have 2 questions, 1. We use gel and there is a modified antibody ID for patients you know have an anti-D. Does anyone use this? 2. We would like to remove this antibody from their history if they return with a negative antibody screen. does anyone do this? Thanks Antrita
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I did forget to mention with the red shield coolers the cooling element needs to sit out on a counter for about 20 minutes. This is not a problem for our outpatient transfusions. We did decide not to use them for OR trauma packs as this 20 minute wait was not acceptable. Antrita
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We use the Red Shield coolers with a validator. It takes temps every 2 minutes. They are from International Wizards. We have small satellite hospital where we do outpatient transfusions. These coolers are heavy (on wheels though), but work really good. Sometimes I don't get them back for 48 hours and the temperature is still good. Antrita
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Thank you everyone. We are going to do the sickle screen. I have talked to other hospitals in my area and the 2 larger ones do screen for Hgb S. Some seem to ignore the whole thing. I can't ignore something I know about so, Hgb S screening it shall be.
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I have hit my next roadblock in blood bank procedures for our upcoming NICU. Screening for Hemoglobin S for exchange transfusions. My blood supplier doesn't do this test. We have a very low sickle cell population. I have asked other blood bank supervisors (in my organization), and have had mixed opinions, such as; 1. Sickle cells won't go through a leukocyte filter. 2. make a slide and look for sickled cells and then follow up with Hgb S test. 3. Do a Hgb S screen here. I would really like to go with #1 but I think this might be wishful thinking. I have never worked with a NICU and I want to be sure I am doing everything correctly. Thanks Antrita
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We have been having a lot of probelms in the past 6 months with weak looking reactions, especially with Cell 2. We are looking into automation this year and the Immucor Echo is looking better and better. Antrita
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An emergency RN asked me the infusion rate for pooled cryo. Since I only issue to them and don't transfuse, I don't know the answer. Does anyone know? Thanks, antrita
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We did a parallel study when we first started using gel, as a training tool. We did 100 patients and did not see any difference other than some fibrin on some of the serum specimens. Antrita
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The patient in question is getting Rhogam. With the ok of my pathologist I am changing blood type to Rh negative with a long explaination in her history. We don't want her to miss any further Rhogam and I don't want to drive another CLS crazy. What would you do, change her type or leave her a Rh positive? Antrita
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We do our blood typing in tubes and antibody screens in gel. We only do Du testing on Rh negative babies of Rh negative moms to make sure we don't miss a Rhogam. So if the patient had not been born here we would not have done a Du this time. We would have typed her as Rh negative and stopped there. There was one other time when we got an autologous unit from our blood supplier that was O postive. When we typed the patient we got O negative. We did a Du on her and it was positive. This was quite a long time ago and the whole Du thing had not started to bug me. This may seem like a really stupid question but why is there no little d? Antrita
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I doublechecked with the CLS. She said they don't draw serum for Blood Bank tests, only the pink EDTA tubes. She is very unconfortable adding units to anyone because she is forced to use the pour-off tube. She is hoping that with response to this question here she will be able to get them to change their ways.
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I guess what bothers me is I've only had 2 "Du" positive patients since we quit doing them on anyone other than Rh negative babies with Rh negative moms and each time they either were E or C positive. So, I guess I can't make a case out of 2 patients but it does bother me. Also, having a pregnant 13 year old doesn't help. Antrita
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If it had not been for the previous history we would never had tested the patient for "Du" and she would get Rhogam. So, it makes me uncomfortable to not give it to her now.
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A part-time CLS asked me about a policy at another hospital where she works. All the serum must be removed from the clot within 2 hours from when it was drawn. If this is not done the patient has to be redrawn. This makes her very unconfortable, as she does not want to use serum that someone else has removed and labeled. I agree with her, we only remove the amount of serum/plasma that we need so the next person adding units is able to take from the original specimen. I know the Technical Manual does't say to remove all the serum. Wasn't there something about doing this a long time ago? Antrita
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We only test for a "Du" (weak D) on Rh negative babies of Rh negative moms. This is so we don't miss giving a needed Rhogam. We use to do any females of child bearing age or younger. We had a 13 year old come in yesterday with a Type and Screen order. She had a history of being B positive. This was done when she was born. The CLS yesterday got a B negative blood type. Since her history was B positive he did a Du. The Du was positive. I did here phenotype and she was r'r ( positive for C,c,e and negative E). Since almost all Rh negatives are rr( positive c,e and negative C,E) could the positve Du be a carry-over of the C being positive? Wouldn't it be safer to give her Rhogam? Antrita:confused: