John C. Staley
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Posts posted by John C. Staley
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14 hours ago, SbbPerson said:
Not sure why is this very hard, maybe I am missing something. The patient is informed about the transfusion and all the risks involved and then they give or not give their consent. It is very hard in Ohio for the provider to get a consent form signed?
My guess is the very hard part is getting the provider (I very much dislike that term) to document the informed consent with a patient's signature. How accessible is the form when the physician is actually with the patient? If someone isn't there to hand the form to them they won't go looking for it. On a side note, whose responsibility is it to make sure the form is signed and in the chart? I certainly hope it's not the transfusion service's.
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Thanks Cliff. Just noticed I didn't have to sign in. To be honest, I was surprised I even remembered my password!!
- Cliff and Malcolm Needs
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20 hours ago, jack323 said:
Im guessing since uk has a national database that this happens alot less. The usa should have something similar.
Is there statistics on anamnestic response? How often have you delt with it?
The USA is considerably larger, we do not have a national healthcare system (which I personally hope we never have), and there is not a central data base that is accessible to all. I'm afraid the cost / benefit analysis of establishing such would not favor attempting one. Just my opinion.
- Malcolm Needs and MAGNUM
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Just curious, do they want the documents sent electronically or hard copy? Either way, especially since you referred to the request as a "big list" I would probably, respectfully decline. I would indicate that the listed documents would be readily available upon their arrival. But that just me and I never had an inspector request anything like this. I'm sure things have changed since my last CAP inspection.
- jayinsat, MAGNUM and Kelly Guenthner
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20 hours ago, Malcolm Needs said:
Have you thought of thumb screws????????!!!!!!!!!!!!!!!!!!!!
Most blood bankers I know have a pain tolerance only slightly less than their resistance to change!!
- Malcolm Needs, Ensis01, AMcCord and 1 other
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Malcolm, my questions were directed specifically to applejw and the several examples mentioned. I was assuming they were fairly recent, at least in the last couple of decades and that info might be available. In 1967 I was in Jr. High and did not even know there was such a thing as blood banks!
- Malcolm Needs and exlimey
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8 hours ago, applejw said:
At this facility, we do not have the readily available option of washing units that contain plasma antibodies. The policy has been to only transfuse these units to patients that already have the identical antibody (anti-D in patient and unit). Even though Adsol units contain less plasma, I have seen several examples of passively acquired antibody in post-transfusion samples from recipients of units containing antibodies.
Just curious but how long did those passively acquired antibodies remain detectable? We're they ever responsible for a transfusion reaction? Did they ever cause anything more serious than an inconvenience for the staff? I really am just curious what the ramifications were, if any.
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I've been thinking about this question and I don't remember if our SOP specified what type of cell to use (I've slept a couple of times since last performing a titer). What I do remember was that we wanted to use the same type with every repeat during the pregnancy. In other words if the initial titer was done using an R1R1 cell for anti-D then every subsequent titer was performed with an R1R1 cell. At the time, the change in titer was considered the most important finding. Also, again I'm trying to awaken long dormant memories, we used a tube/saline or tube/albumin technique ( can't remember which) because that was how the original studies were done for anti-D and how the values utilized by the OB docs were derived. I know this is ancient history for many of you but thought I would throw it out there.
I seem to remember that titers were going out of vogue about the time I retired and there were much more accurate methods of determining the effect on the fetus from maternal antibodies coming into use.
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8 hours ago, SbbPerson said:
I am sorry, but I think that is a poor excuse. "I am sorry, your son died because we are under staffed." If a service is not available, do not offer it. Personally I think if a facility is not equipped to take care of a bleeding patient, they should not accept that patient in the first place. Especially for an ED that can't wait 20 minutes for blood. They do more harm than good. This just has lawsuit written all over it. I don't mean to offend anyone, this is just my opinion. Thank you
You may not "mean to offend" but that does not make it any less offensive. If you have nothing helpful to contribute it's best not to.
I have worked in level 2 trauma centers with 24 / 7 coverage in the blood bank. I have also worked in a rural clinic in a Wyoming county the size of most states east of the Mississippi and there was not hospital in the county. The closest hospital was 2 hours by ground and if we needed a trauma center it was at least 3 hours to get a helicopter or airplane in and out. You do the best you can with what you have. The people of the county realized that one of the prices they had to pay for living in one of the most beautiful areas in the world was limited access to health care. They understood, accepted it and were actually grateful for the level we could provide! They neither wanted nor needed .......... I best stop now.
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It's never safe to assume that everyone, or for that matter, anyone knows what you are talking about when providing one short sentence. Especially us old, retired guys. Both Malcolm and I thought you were looking for some philosophical discussion. Hope you find the key you are looking for.
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I have to agree with Malcolm. In the 35+ years I spent in blood banks and transfusions services I saw and trained many Clinical Laboratory Scientists. I have to say that there were a noticeable few who just did not have the talent for it. No matter how knowledgeable they were in the science they just could not see it. I might even argue with Malcolm's 75% science. I'm leaning more to a 60-40 ratio.
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20 minutes ago, Neil Blumberg said:
Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement. There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement. Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood. Rant off :).
As I've said many times, "Inertia is the most powerful force in the universe and blood bankers prove it everyday!" Sadly, "that's how we have always done it!" is often our mantra and no amount of data or lack of it can change many minds.
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Malcolm, I meant that statement not as a criticism of them but just a recognition of reality. Frankly I was excited to get the forms back most of the time and fully understood the pressure they were under. When I was in school I worked in the emergency room on night shift so I was very familiar with trauma situations and fully understood the, "do it now and worry about the paperwork later" mentality.
Cheers
- AMcCord, Malcolm Needs and Ensis01
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What I noticed over the years was that many times when faced with signing for uncrossmatched blood the physician would take a second to reevaluate the situation. Often they would then respond with something like, I want it crossmatched so hurry. Not always but it was not uncommon or rare. When they did sign the form it was most often when the crisis had resolved and the dust settled.
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It's not uncommon for inspectors/assessors etc to come up with their own interpretations. Before I would bother making any changes I would certainly do as Neil suggested and go up the food chain for clarification. Actually, my first inclination would be to ignore this on the chance you never see that inspection person/team again. If you do need to respond in some manner then "we're looking into it" should buy some time for confirmation. Best of luck.
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Mollymotos, sorry I don't remember! That was 16 years, 2 jobs and retirement since 2015 ago. If I were to guess we probably would have reported as positive or negative for fetal cells or possibly as no fetal cells seen or fetal cells seen. We were really into waffle words when making such determinations.
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2 hours ago, Malcolm Needs said:
The Donath-Landsteiner Test for the Donath-Landsteiner antibody (IgG auto-anti-P that binds complement) that causes PCH (see the PowerPoint I attached above).
I hate to admit it but I don't remember ever hearing about that test in my 35* years in Blood Banking! I guess you are never too old to learn something new, but remembering it is another story. Thanks Malcolm.
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I would make the argument that the blood was inspected when it was issued to the remote storage unit. At that point the transfusion service had completed it's obligation. I am assuming (and we all know how that goes!) that the remoted storage unit has been exhaustively validated and monitored with documentation to confirm my assumption. As well as any training required for those accessing the remote storage unit. I'm always more worried about the blood going to the wrong patient in these situations than I am for the quality of the unit.
Personally I always enjoyed challenging such citations.
- David Saikin, jayinsat and exlimey
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On 12/29/2022 at 7:35 AM, Andrea Pointer said:
I came here to ask about traumas/emergencies/MTPs and how often THOSE vitals should be taken.
My experience, though it was a while ago, was that during those events the vitals are being monitored constantly whether transfusion is occurring or not. The documentation may or may not reflect that but it is being monitored. Personally I think the blood bank/transfusion service should start being in the loop concerning vitals when the crisis is over and transfusions are slowing down or stopping. Then the vitals will be come relevant. Just my 2 cents worth.
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15 hours ago, Ensis01 said:
Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.
I know that tech! She left a day blood bank position for a graveyard generalist position so she would not have to use the new automated instrument because if she didn't do the testing it was probably wrong.
- AMcCord and Malcolm Needs
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Dr Peter D Issitt.
in All other topics
Posted
One of the highlights of my career was getting to meet with and talk to Peter. I am saddened to learn of the passing of another great in the world of blood banking. Please share my condolences with Marilyn.
Malcolm, thanks for for keeping us informed.