John C. Staley
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Posts posted by John C. Staley
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Wow!! I find this incredible. Personally I consider this an incredibly over the top response! I hope it isn't wide spread among all blood suppliers.
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Just for sake of argument, why is this a big deal??? You don't find a patient in a more controlled environment than an OR suite. If the original sample is drawn in the OR and is delivered directly to the blood bank where is the opportunity for mixing up the sample if it was labeled correctly in the OR? What, exactly are you trying to accomplish here? At some point is any process involving humans you will have to have a little faith that the others in the process are doing their part as it should be done. In emergency situations you need to make allowances. Which is the higher risk, running out of type O and not having it available for those who can have nothing else or the off chance of a patient getting the wrong type in this situation for any of the many reasons you can imagine? Just a little food for thought.
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15 hours ago, KRIS said:
Sir John , in my case I am working in a small hospital and its my first time to work in Blood bank, most of my antibody screening are all negative. I rarely or never got an antibody positive patient in a month. In this case what will be my sample for validation studies?
David answered your question exactly they way I would have. Validation does not require patient samples, only positive and negative samples in your testing procedures. Follow David's suggestions and you will be fine. The manufacturer has done all the heavy lifting to get it to market. You just need to show it works for you.
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Yes, but the validation does not have to be exhaustive and unreasonable. All you need to do is prove that it works as advertised in your lab.
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My best guess and it is nothing more than a guess, is that if these patient's require any support from the transfusion service it will be due to a preexisting condition and not the direct result of the corona virus. I don't recall in all my years, of any patients with pneumonia requiring a transfusion due to having pneumonia and I understand that pneumonia is the primary reason for hospitalization here. Now I may be way out there on this but only time and experience will tell.
- Kellimq, David Saikin and jojo808
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Thanks for the info. That actually makes sense for a change.
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I'm curious, why was blood requested for a patient with covid19/flu like symptoms??
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I have to admit that when I first responded I was not looking at the big picture! I guess I've been away from the trenches long enough to have lost some of my perspective. I have to say that my priorities would still be staffing first and blood supply a very close second. Since my last facility did not have donor capabilities and depended on ARC for our blood supply I'm not sure how much I would have been able to do concerning the blood supply beyond encouraging folks that were well to donate.
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I'm just curious but are you referring to the possible staffing issues due to staff getting sick and having the good sense to not go to work or are you concerned about any possible impact on the patient load? Or both? From what little I have read of the symptoms I can't imagine any patients hospitalized needing much blood bank support. I would think the biggest issues will be staffing.
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If I remember correctly, back in ancient times, we did not include any control with the initial titer. (Probably because no one thought of it!) For any subsequent titers we would use a frozen sample from the previous titer.
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If I read David's original post correctly the titre started at 2 then went to 4 and then to 8. That's why I asked how quickly it went from 2 to 8. If that's a relatively short time span then I would consider it significant and the RhIG dose would be a confounding factor on subsequent titrations.
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Malcolm, her titre was already rising so I don't see the need to continue. There are better ways to monitor the fetal status during the third trimester when you know the titre is rising. At this point, it's just numbers and academic.
David, you indicate there were 3 titres performed, how far apart were they? In other words, how quickly was it rising?
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My first thought was, why on earth did they give the RHiG!!!! I'm with Malcolm on that. You great minds do think alike!!
I really would like to hear the rational if there is any.
To answer your question, I see absolutely no value in additional titers, at least not until the next pregnancy.
- David Saikin and BldBnker
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20 hours ago, Oniononorion said:
A bit off topic, but traditionally MLS schools teach immunohematology as one, one-semester course with lab plus clinical rotation. While the clinical rotation solidifies the theory a lot more than the class, I believe our graduates would benefit from a second “Immunohematology II” class covering practical basics such as the types of things similar to OP’s question and things related to more in-depth troubleshooting and discrepancy resolution, and in addition, advanced theory for selection of appropriate components for transfusion for problematic patient needs and emergency situations. Sorry for the slightly untimely ramble....but chemistry, hematology and microbiology get the dual-course treatment, BB should too.
Things must have changed dramatically as they so often do over the past 42 years but I recall that immunoheamtology received no less emphasis or time than the other disciplines when I was studying in a MT program. Maybe the program I was in was the exception at the time but I hope not. Having already completed a BS in Microbiology when I entered the MT program I assumed that would be my area of expertise but after one year after graduation working as a Generalist, I found myself as a full time Blood Banker and never looked back. While the bulk of my knowledge in Blood Banking was attained "on the job" I always felt the foundational information I received in class certainly prepared me for my future.
Wow, we sure hijacked this discussion!!
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Just curious and an obvious tangent but why is the blood bank doing any testing for a broken wrist???
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21 hours ago, Sonya Martinez said:
Hi John, No we did not do every antigen. Hemo Bioscience makes a validation kit that contains 8 positives and 2 negative specimens plus they make MedTEK kits that contain vials with a single antibody in them including D, C, c, E, K, Fya and S. I'm using both to validated our new Bio Rad IH manual gel this quarter
Personally, I would consider this extensive QC and not validation. There really is a difference. There truly are things that can not be reasonably or realistically validated in the clinical setting, antibody panels and antibody screens are just 2 of them and for the same reasons.
I think I'll stop there.
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20 hours ago, TreeMoss said:
We cross-check our panels on receipt with the panel currently in use. This gives us the cross-check of the new panel and the "intermediate" check of the current panel.
We do not do any QC testing on a panel on other days of use.
What do you mean by "cross-check"?
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On 12/27/2019 at 8:20 AM, Sonya Martinez said:
When I changed from Immucor to BioRad for our tube panels I did performance validation covering avidity (strength of reaction), accuracy and precision (predictability). The FDA liked it and that's my plan now that I'm changing over to BioRad's gel reagents as well.
I have to ask, did you do this for every antigen listed on the panel?
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If I remember correctly, we QC'd new panels on the day we received them and then each day of use (daily for us). I started doing that 9 years before David and never had an issue with any inspecting/accrediting agency.
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We always sent our out with a filter set because that's what we had. As far as being required, I don't know.
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And to all of you who will be working the next couple of days, THANK YOU FOR BEING THERE! You truly are the special ones. Over the years I worked my share of night shifts Christmas Eve so my heart is with you.
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First off, what is MFM and FOB? I don't think you want me guessing!
Secondly, the guidelines coming from someone who has little knowledge is not just foolish it's potentially dangerous. It is not uncommon for the husband, mate, partner or most recent paramour to NOT be the biological father and to assume so has the potential of severe consequences. There is no need to make an issue of it with the mother, just do the testing in the background if the physician is smart enough to understand this.
- Marilyn Plett and AMcCord
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I must respectfully disagree with Malcolm (a rare occurrence). In my transfusion service we documented the time of issue as the time the blood product left the blood bank and became the responsibility of the nursing service. Maybe this is one of those things where we have 2 countries separated by a common language.
From Merriam-Webster
Definition of issue (Entry 2 of 2)
1a: to put forth or distribute usually officiallygovernment issued a new airmail stampissue ordersb: to send out for sale or circulation : PUBLISHcBritish : PROVIDE sense 1a, SUPPLY- Malcolm Needs, jalomahe and AMcCord
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Uncertainty of Measurement in Transfusion Services
in Transfusion Services
Posted
I'm not sure I want to admit this, and I have been out of the business for a while but, what on earth is "Uncertainty of Measurement"??? Can anyone tell be in 50 words or less? I think it's one more reason I'm glad I retired when I did.