John C. Staley
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Everything posted by John C. Staley
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frequency of antibody identifications
John C. Staley replied to suhu's topic in Transfusion Services
Bob, I think that's the shortest response you've ever given. If we get "who-knows-what" antibodies we will try to identify everytime we get a positive screen with this patient. It is not unusual for an antibody early in it's develpment to not really know what it's going to be when it grows up so the next time you test the patient the antibody may have had time to mature into it's recognizable state. -
We just ID the antibody. Usually, if there is a problem, we'll contact the nurse and let them know why it's taking longer than usual but that's about it.
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Sterile tube welder
John C. Staley replied to spavlis's topic in Donor Services and Donor Recruitment
We only use the weld integrity kit because it's available. If it were not a vailable we would do like everyone else, give the line a little squeeze and see if it leaks and look to make sure both sides of the weld are lined up. Not much more you can do. -
Does any one other than me find this interesting since the ony antibody I know of that has any published clinical correlations is anti-D? What do the OBs do with the info and what do they base their actions on? It was a slow week, I had time to think of stuff like this.
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The following is a question making the rounds amoung the transfusion supervisors of our corporation. I was just wondering how others would respond to the question. Thanks John :pcproblem Are you automatically reflexing a titer for any IgG antibody found during prenatal testing in a pregnant woman or are there some you just report out the ID and wait for the physician to order a titer if they want one? If you are reflexing a titer for all IgG antibodies, why?
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Wow Linda, just about when I start thinking I've heard of everything some one surprizes me. I've never heard of this. From your description I can't even think of how it could be done. I would be interested in any references anyone come up with. Purely acedemic curiosity, I sure don't want to get involved. :surrender
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Plastic tubes for serologic testing
John C. Staley replied to JClausen's topic in Transfusion Services
For years, in a previous life, we used the MLA system for batch typing. I won't go into detail describing the system but simply put, the tubes used were plastic and they worked great until we switched from glass pasteur pipettes to plastic pipettes. Then static electricity became a major issue. We ended up grounding the workstation, putting a grounded mat on the floor for the staff to either stand on or have their chair on and we still experience problems. What would happen is you would have a drop about half formed at the end of the pipette and it would suddenly go zinging (real word!!) off the end of the pipetted and stick to the wall of the tube about half way down. Not sure if they have re-formulated the plastic tube to avoid this problem but you might want to watch for it. -
Ellis, It really dosen't matter what we think a trauma pack is. Ask the physicians asking for it what they expect when they order it. Once they tell you their expectations then you have a base line to work from. When ever I have tried to guess what they have wanted I have never quite got it right. I have found that physicians are like everyone else. The way things happended where they were before is the only way to do things even if they have gone from a 1500 bed level I trauma center to a 15 bed rual hospital. Some times they have to be told, "sorry we just can not do that" by your medical director. That's assuming your medical director is will to do that.
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I'm fairly active on both forums and see a few others who are as well but I find the diversity of BBT to be refreshing. Too much on the AABB forums is AABB says this and AABB says that. While AABB standards are the gold standard we are all held to I don't think they have all the answers and that's why I visit both on a daily basis.
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I'm not really sure where the old "blood bank must be separate" came from but it does seem to be the norm. Maybe we like the mystique of being special, I don't know. What I do know is when we designed the lab in the new hospital (we moved in, in 2002) the Transfusion service became part of the general lab. We do have modular furniture and there is some frame work between departments but you could never call them walls. We are actually considered part of the lab and have gotten to know others in the lab much better than before. I'm all for taking down the walls. If you can't focus with a little outside distraction coming from the rest of the lab you will probably have problems focusing in a closet all by your self.
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On the website I posted above for Bob there are two buttons at the bottom right of the home page. One says Italian. The other says English. If you push the English button it will translate for you.
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Bob, check out www.angelantoni.it They have a system that I thought was remarkable (but then I'm a self confessed technophile) :pcproblem They are computer controlled blood bank refrigerators. I would love to have them in my transfusion service but I can see how they could reduce the heartburn with having them in OR, ER or any place else that wants the blood stored next to the patients.
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We never get anything back on any transfusion (unless there is a problem but that's whole different story). So from that standpoint, it dosen't matter if the patient stays here for the entire transfusion or gets it enroute. The next day the blood is posted in the computer as transfused and we are done with it. If we shipped patients with blood hanging a lot, and we don't, I would probably figure out how to do the occsional audit just to confirm the life flight guys are as good as they claim but I would not fret over every unit. I have plenty of other things to fret over.
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Our Auto and Directed units are treated just like any other unit. They are received in the computer and processed just like all the rest. The only thing we do different is print a list of Auto and Directed units with the patients they are for as a quick and easy reminder that they are here. The list is posted in our sample receipt area. I see no reason to do anything special like you describe. Just a question, have you ever had to refer to the log for any thing that could not be found in the computer? If not I think the log is of little or no value.
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I don't remember. It's too long ago!!!
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The physician would need to order the RhIG. If the patient is <13 weeks gestation we would not do a K-B. The testing we would do is an Rh and if there was no record of a negative antibody screen during this pregnancy we would do an antibody screen as well.
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The past couple of weeks I went on three site visits to check out blood bank computers. One of the things that really surprised me was that 2 of the 3 facilities DID NOT POOL ANYTHING!!! If the Doc ordered a 6 pack of platelets or 10 cryo that's exactly what they received. No more questions on why did you send me 1 when I ordered 6. That would certainly address your mixed pool issues.
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I thinks it is pretty global. Utah has a big problem with this. People don't realize how dangerous it could be for them.
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I'm with Bob and Cliff. If the unit gets spiked and hung, no matter how long, it is considered transfused and charged.
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You can add my facility to the Pharmacy list as well. Bev, looks like you are out numbered on this one.
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Sounds to me like you are working up a justification to move to electronic crossmatching then sample volume would not be an issue. If I run out of sample I get more, completely retest and move along. I don't see the problem. You test a new sample and the 3 day clock gets restarted. Considering all this patient is going through another 4 - 7 ml tube of blood should not be an issue.
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Mabel, there is always the possibility of physical harm anytime you inject anything into anyone. The Docs can do anything they want in their offices but when they come to my house they must play by my rules. Actually they are not "MY" rules but that's a subject for another discussion. The only time we don't repeat the antibody screen is at delivery and we have a record of a negative screen during that pregnancy. Since they started shipping all of our prenatals out we seldom have any record of the preganacy and even before that a lot of the miscarriages we saw occurred prior to any prenatal care so we didn't have a record of any previous testing. The only miscarriages we know about come through our ER and more often than not it's the first time we've seen them.
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The other possibility we have seen is the patient is sharing their medical card with friends and family. You may never know who is the real patient this time.
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Mabel, ARUP does the testing 7 days/week. I guess the issue would be getting the sample to them in a timely manner on a week end. Not sure how you could work that one out. Maybe UPS or FedEx overnight or something like that.
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I guess I should have mentioned. We always issue the initial RhIG and not wait for the results of the flow from the reference lab. About one per year we have to get a second dose to the patient.
