John C. Staley

David, how come you never came to my facility as an assessor?? I would have truly enjoyed one with your attitude toward the assessment. Most of mine were of the attitude that their way was the only way and there was no room fro discussion. I've actually refused a couple when they were assigned a second time. :disbelief

About a 1000 years ago on the soap General Hospital, Rick turned out the be the father of Monica's baby and it was proven because the baby had the Bombay blood type. I never did quite get over that one!!!

You can add me to the list of old timers who have never even heard of such practice. :eyepoppin

I would have my medical director chat with the patient's physician and explain that you are potentially causing this patient more harm than good. If this patient is not critical and you can get B platelets shipped in within 24 hours that would be your best option especially if the transfusions are prophalytic and not to try to stop active bleeding. As noted above there are other possibilities but my philosophy has always been to try to rule out the most likely first and then go hunting for unicorns.

We ID the anti-D and ask the patient/Dr./Nurse if the patient has had RhIG recently. If the answer is yes we result it as Anti-D Possibly Due to RhIg and add a comment that the patient had received antenatal RhIG. If the answer is no we result it as an allo anti-D and treat it as the real deal from then on. If we can not get an answer we, well we've never not received an answer one way or the other but if we did we would probably result it as an allo anti-D and treat it as the real deal from then on.

Couple of questions: First, how difficult would it be to get B plts? Second, which has a direct bearing on the first question, how much notice do you get prior to the plt transfusion? It always amazes me how giving incompatible FFP is virtually taboo but we don't seem to hesitate at all giving the same volume of incompatible plasma if it is associated with plts.

Play the odds and stick with >50 as your cut off. I think you'll be fine. We have no plans of changing here.

:bye::bye::bye: Well folks it's time for me to follow in the foot steps of the famous Bob Currie and move on to the next phase of my life. On December 10th I will be ending my career in Blood Banking. I am semi-retiring to a small town in Wyoming to work in a clinic that does moderately complex and waived testing only. I will be trying to remember things I have not even thought of in 25+ years. I will continue to haunt these page occasionally in the future but my imput will be based on historical information and not current real time. Cliff, thanks for putting together such a terrific site for blood bankers to get together and learn from each other. I finally exceeded your number of posts so it's time to move on. Cheers John :wave:

I can not even begin to imagine what anyone would use to base any problem with storing those reagents in your refrigerator. Many of our small rural facilities have only one refrigerator and it is a blood bank refrigerator that does double and triple duty for the entire lab. I think you can find something elses to worry about.

lauried01, please don't limit your Echo to just routines. If you do that you might as well tie one hand behind your back. It's fast, very fast. We use it for everything, STATS, routines, prenatals, dosen't matter. It's hard for even your best tech to beat 22 minutes test time for 4 group and screens.

:confuse:I'm not sure but I think a few places may still draw a limited amount in heparin for special reasons that I can't seem to remember at the moment.

Cliff, that's exactly how we issue blood to the OR. It would be very difficult (to them impossible) for OR to follow our normal protocol. When they need blood they call, provide the patient's full name and MR number from the armband. We write that on the request form everyone else sends to us and then follow through our process. So far so good and we've been doing this for over 6 years.

I'm still fighting the battle to bring the use of 5 day plasma to my facility to reduce the waste of a valuable resource and I need some help. First if anyone has a journal reference or two concerning the factor levels in 5 day plasma and or the efficacy of 5 day plasma I would appreciate knowing where I could find them. Also, I have been asked to provide a list of facilities currently utilizing 5 day plasma, especially level I and level II trauma centers. Any help will be greatly appreciated. Thanks John

As a transfusion service, my annual direct obersvation is to watch a Type and Screen with at least one unit crossmatch from specimen arrival to issue. That covers virtually every technique we employee on a regular basis. Everything else if monitored by record review and error documentation. Keep it simple and manageable.

Tell you what, you come up with the solution and I will certainly consider it. There are too many variables in the real world for us to account for every one of them. There comes a time when you need to forget the perfect world and do the best you can under the circumstances. We are working within biological systems in which everyone is a little different and "always" and "never" should not even be in our vocabulary. Some problems simply do not have reasonable solutions under certain circumstances. I have came to realize this many years ago and the stress levels dropped considerably. :surrender

Once again real world clashes with perfect world. We get our RhIG draws the next morning as well.

Interesting that you consider something missed by Gel and picked up by the Echo as false positive yet something missed by the Echo and found by Gel as worrisome. No system is 100% sensitive or 100% specific. Over the years I have seen every system pick up something missed by another system and heard similar reports yet all of those systems are still being used. We do the best we can with the tools available. Having said that, we have been testing with the ABS2000 since 1999 and the Echo since 2007. I have not seen anything that made me want to abandon the technology for something else. Until some one comes up with the perfect, never miss system we will have to learn to live with the occasional misses no matter what we are using. I'll be concerned we we start seeing problems with the ABO testing.

Cliff, you should have told the inspector that if the grenade was rolled in during an inspection you would throw the inspector on it.

Our STAT TAT is 60 minutes as well. Usually they are done much faster but you can not control all of the variables. Best to keep a little fudge factor in the equation.

I would imagine that depends on your state laws regarding such things.

If you are using the instrument they won't be "reading" the capture, that's the instruments job. When we first went to the ABS2000 we kept PEG as our back up method, now that we've gone to the Echo we're doing the same. The difference is that now we get to look at the reactions on the Echo where we never saw them on the ABS2000. Within a couple of months the staff have become very adept at looking at the photos and understanding what the instrument is seeing. No Problems there. I think you can focus your concerns elsewhere.

I want to echo Bevs post. When will the nonsense ever stop.

My experience is that with dialysis patients you will be lucky to see one with a H&H of 8/24. Most of the docs I've worked with will set the H&H they try to maintain for their patients and write it in the orders. Ususally something like: transfuse 2 units if H&H falls below XX. I am not aware of any standards for these patients. Years ago we had one doc who tried to keep his patients at an active / normal level so he was transfusing 2 - 3 times as much as any other and the units were all washed. When medicare noticed they informed him that keeping the patients alive was enough, they would not pay to keep them active and enjoying a normal life.

Try this one. Probably the best you can hope for is to explain all of the potential dangers such as the coolers getting switched and ending up in the wrong room and hopefully some one will see the light. At the very least I would try to get a blood bank refrigerator installed and monitored by a blood bank emplyee who would be responsible for dispensing the products as needed.

It is truly amazing how often incompatible blood to atypical antibodies is transfused with no ill effects to the patients. The biggest concern is ABO, get that compatible and most of the time everything else works out OK! :raincloud