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May 2024 Challenge

John C. Staley

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Everything posted by John C. Staley

  1. John C. Staley
    Unless I'm mistaken, there are two types of patients you are saving the Rh neg units for. They are those young females in child bearing age and those patients with a demonstrable anti - D. In the case you describe of a female trauma patient of child bearing age we would most likely not switch her to Rh pos units until we ran out of Rh neg and then switch her back as soon as possible. She's the one you are saving the Rh neg for, why would you switch her to Rh pos while still leaving Rh neg blood on the shelf?
  2. John C. Staley
    You have a positive fetal screen, you do a weak D test and it is positive. Are both positive because mom is weak D positive or has there been a significant fetal bleed or, heaven forbid, both? This is the question you need to ask your self. I would think the the only reliable way to determine the difference would be a test for fetal Hgb, either flow cytometry or the oft maligned K-B stain.
  3. John C. Staley
    I'm curious, if your alarm is functioning properly and would notify you if the storage device went out of temp and you have someone who would hear the alarm 24/7, why do we need to record the temp every 4 hours? Logically it dosen't make a lot of sense. We're not looking at the chart every 4 hours to see if it's working or if the temperature is being maintained. We depend on the alarm to tell us that. We document the temp seperately every morning and if the alarm dosen't sound then the temp range has been maintained. Oh, yeah, we do it too, we record the temp every four hours if the chart isn't working. Logic seldom overcomes inertia.
  4. John C. Staley
    Thanks everyone. Your response have been a great help.
  5. John C. Staley
    Can anyone who "converts" their thawed FFP to Thawed Plasma with a 5 day out date tell me how they label the product? Our QA group have so far been unable to find a commercial label or a standard name for the product. Thanks
  6. John C. Staley
    Actually most of our antibody screens are 4 cell screens performed on the ABS2000 but our manual screens are 3 cell.
  7. John C. Staley
    For those of you who convert your thawed FFP to thawed plasma with a 5 day outdate I have a question. We are currently getting a great deal of the "Frozen in 24 hours" plasma from our supplier. If you use this product and convert it to thawed plasma do you give it a 5 day outdate from thawing or a 4 day outdate from thawing because it has already lost a day? Thanks John
  8. John C. Staley
    We have been using the Immucor ABS2000 since 1999 and have never seen a need to routinely repeat Rh types. We are still required to perform weak D testing so those are done manually but if the instrument says it's positive that's good enough for us.
  9. John C. Staley
    Our current SOP indicates that a drop of 15 mm in systolic &/or diastolic pressure is considered significant and should be brought to the medical director's attention.
  10. John C. Staley
    We also stopped providing the mini doses years ago. Most docs didn't like being put on the spot telling us just how far along the patient was. It was much easier for everyone to just provide full dose RhIG.
  11. John C. Staley
    One way to remove the microscope from routine use is to replace it with an automated testing instrument. It sure worked for us. since we strted using the ABS2000 in 1999 our microscopes collect dust between KBs and the rare need to check a tube from a panel or DAT.
  12. John C. Staley
    Janet, that was exactly our stance. It is ancient history when we used to issue 1 FFP for every 6 RBCs and such nonsense. Some how that has not made it to some of these groups. I know a number of facilities have such protocols but I suspect they are more to pacify an inspector than anything else. When we were preparing for our inspection I did a fair amount of research in the literature and found quite a diverse number of protocols and most had vey little in common and even fewer had any supporting documentation.
  13. John C. Staley
    Who will designate your facility as a level II trauma center? That will dictate some of the expectations. If it is the state they may have a set of expectations specific to you. On the other hand if it is the Academy of Surgeons then their expectations will be a little different. I would work closely with your facility Trauma Coordinator. They should have all of the information you will need. We just completed our inspection by the Academy of Surgeons and it was pretty painless. The biggest issue we had was that we don't have a massive transfusion protocol as such but we were able to convince the inspection team that what we did have was sufficient.
  14. John C. Staley
    I can't help but I do have a question. Why are you pooling FFP? That's a new one for me.
  15. John C. Staley
    2 units or 4 hours per set is the protocol our nurses are supposed to follow.
  16. John C. Staley
    I see no value in retyping the same sample and even less value if it is done by the same tech using the same reagents. In my opinion (for what it's worth) if you are going to do something then it should be on a different sample collected at a different time. This will cover more of the variables including patient identification. Even then I'm not an advocate of second typing new patients, I'm convinced it causes far more problems than it solves and has the potential of delaying much needed transfusions. If you're really concerned just give type O until there is a second type on record.
  17. John C. Staley
    I keep our old panel sheets for 5 years from the last time we worked up the patient. This was from the direction of out QA group.
  18. John C. Staley
    That is one of the reasons we would not give type specific but I will argue long and hard that by giving type O you are just adding fuel to the fire by adding more Anti-A, Anti-B and Anti-A,B especially if you are not using ADSOL units. I can't believe I'm saying this but simpler is not always better.
  19. John C. Staley
    On the other hand we always go with type specific unless there is a reason not to.
  20. John C. Staley
    We outdate about 20% annually. We have an active heart program and are required to have plts available at all times. We also have an oncology program but it's not really active enough to count on using short dating plts. As a general rule we have 1 A and 1 O plt apheresis on the rotator along with an AB irradiated for our NICU. We are about 2-3 hours from the blood supplier, depending on traffic.
  21. John C. Staley
    I'm curious, does anyone know what kind of clinical decisions a physician will make base on the titer of an anti-M or most any other antibody excluding anit-D? Considering, to my knowledge, anti-D is the only antibody to have been studied and clinical outcomes reflected by titer values established.
  22. John C. Staley
    We require a current type and screen, current is defined as this hospital stay. The FFP or Plts can be issued prior to the completion of the antibody screen. I thought that one of the AABB standards indicates that you can not issue blood products based on a historical type. Don't have a copy at my desk to quote from but that's what our SOP is based on. But then if you are not AABB accredited, no worries.
  23. John C. Staley
    Im curious, just what "regulation" requires this QC? "The regulation says that you have to have a policy for using expired panels and must run QC when used."
  24. John C. Staley
    Cliff, I need to update my e-mail address and I can't figure out how to do it. I'm sure it's easy but can you give me a hint on where to start? Thanks John
  25. John C. Staley
    We have a very active NICU but have not had an exchange transfusion in more than 3 years. The neonatologists have told me that if they feel they have failed if they have to resort to an exchange. Our most serious cases result in intrauterine transfusions and none of them have resulted in an exchange transfusion after delivery and very few have required supportive transfusions. Anti-D is still the most common problem we see. Just a note, the worst case of HDN I have ever been involved with was due to anti-c. Just because an antibody is not anti-D don't dake it lightly even if the doc does.
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