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jalomahe

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jalomahe last won the day on August 11

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About jalomahe

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  • Birthday 02/18/1956

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    LEAD TECHNOLOGIST TRANSFUSION SERVICE
  1. Rosette test quandry

    First, you have a discrepancy between the Mom's Rh type on the pre- vs. post-delivery specimen. That needs to be resolved just as you would need to resolve an ABO discrepancy. I would suggest that a new specimen be collected from the Mom and tested. If the new specimen's Rh type agrees with the pre- specimen, then it would indicate there was a problem with your post specimen either misidentification or contamination. Repeat the rosette test on the newly collected post specimen. If the new specimen's Rh type agrees with the original post- specimen then you have your answer that the rosette test is false positive due to the Mom having a weak expression of D which interferes with rosette testing. You are not detecting Rh + fetal cells, instead you are detecting Rh + (weak) maternal cells which would explain why the rosette test is positive but the KB stain is negative. You would also then need to follow up as to the pre- sample and whether it was misidentified at collection, etc.
  2. IQCP

    Welcome Skye Unfortunately you have posted your question under the Blood Bank section of this site and I'm afraid we will not be of much help with your question. There is a Micro section on this site. If you click on Home at the top of the page and then scroll down you will see it. The lab department sections are in alphabetical order so Micro is down the list a ways. Hope you get the answers you need.
  3. Antibody Titers Gel vs. Tube

    We do our titers in tube. Years back when a lot of places had switched or were getting ready to switch to gel there was a conversation about the difference in titers due to sensitivity of gel. The basic conclusion at least in our geographical patient care area: we didn't want physicians to be getting different titers from different labs solely due to differing methodologies as it could lead to unnecessary concern/procedures for the patient. So we all stick with tube method. In those instances where we detect the antibody by a more sensitive method i.e. gel or Capture but the titer is negative then we report the antibody titer as less than 1 (<1). Jan
  4. Sunquest Billing - Irradiation

    Our irradiation charge is built in the blood component code RAFI is Irradiated Red Cell which includes billing for the red cell plus irradiation plus our processing fee. When the product is issued all is billed. To fix the problem for units going to a patient that does not need irradiation we created two billing codes to back out the irradiated blood charges and re-bill the unit as a non-irradiated unit. CRAFI (credit RAFI) and BRAF (bill RAF). When the unit is issued these codes are used in the pop up charge window. So far it's working for us.
  5. Disinfecting Blood Bank Coolers

    We have a log book that we use to keep track of coolers. We indicate what cooler went where, when so we know when they are approaching 4hr being out of the department and if they go missing we have a way to track it down. When the cooler is returned it is cleaned and that is documented on the form also. COOLER LOG.doc
  6. Return and Reissue of components

    Nursing policy states they are to begin transfusion within 15 minutes of receipt unless the unit was issued in a cooler and if they cannot they are to immediately return the unit to the blood bank. Our nurses are very good at following this policy. That being said, there are times when the unit doesn't make it back to the blood bank in that 30 minutes but it will be back in less than 45-60. Red Cells obviously will not be within temp range so if returned they are discarded. Any other product, if it's within temperature range yes, it will return it to inventory for re-issue. As for Red Cells if they unit can't be returned in <30 minutes and the problem is they blew the IV and they are working on starting a new line started they are told to keep the unit at room temperature and transfuse BUT they MUST complete the transfusion within 4 hours (maximum allowable transfusion time) of when the unit was released from the blood bank. Any time a unit of blood/component is wasted an electronic Safety Report is completed that goes to multiple people to review: patient safety, nursing location manager, transfusion safety officer, laboratory manager, etc. for follow-up.
  7. Return and Reissue of components

    DANSKET I am confused as to why you discard the unit if it passes all other inspections but was out greater than 30 minutes? Are you saying that a Platelet or Cryoprecipitate that has a storage temp 20-24C comes back at 35 minutes with a temp of 24 will be discarded? Ditto with plasma that was issued immediately after thawing so accept range is 1-37C but if it came back at 35 minutes and it's temp was 24C it would be discarded? I understand with the RBCs because chances are that at 30 minutes the temperature would not be within acceptable range. At our facility We dropped the 30 minute rule completely and go completely by appearance and temperature for all products regardless of whether they were issued in a cooler or not.
  8. Rhogam testing

    If the patient had a pre-delivery Type & Screen performed then we only do the fetal screen post delivery.
  9. Automation that uses Window 7

    The IT department should not be able to NIX instrumentation selection for the lab. If the ECHO is the best fit for your lab then that's what you should go with. I suggest having Immucor Sales Rep get the Immucor IT folks to talk to the hospital IT folks so they can speak the same language and understand what the issues and whether or not they can deal with it until the new W7 version is available.
  10. Automation that uses Window 7

    I'm not sure what IT has to do with it. They usually balk at versions for PCs that are used for normal PC use. That's because they are required to support those PCs when there are issues. Since the ECHO PC is only used to interface with the ECHO and the IT is not who has to provide technical support for the PC they shouldn't even be involved other than providing access for an interface and to an internet connection for the cisco box. Any problems with the ECHO PC will be handled by Immucor, not IT. I think they've overstepped their bounds on PC requirements.
  11. Rhophylac - safety device

    If you switch to RhoPhylac talk with the Rep, they will be happy to send in training staff free of charge to help train nursing in any location that will be administering the product. The nurse educators at our facilities really appreciated the help and it allowed all of the staff to get all of their questions answered.
  12. Gel Titer on Ortho Vision endpoint

    Question. How likely are you to be doing titers on maternity patients that might have titers performed at another location? Since the sensitivity of Gel is higher than tube methods might you give the pt's caregiver confusing information if your titer is elevated due to method vs true rise in titer? I only ask since this was a question in our region where there are multiple hospitals that do prenatal testing and sometimes patients/physicians don't stick to one lab. The consensus was that for prenatal titers the standard of care within the area hospitals is to perform the testing by the Uniform Tube method so that there weren't variations in titer strength based solely on methodology.
  13. FFP thawing with no hot water

    So I'm guessing you are a really small lab without many resources? What is your plasma usage? How likely are you to need plasma during the outage? ----You could thaw one or two prior to the outage to have on hand in case they are needed. You'd have up to 5 days to use them. That would give you more time to thaw using cold water if you needed more. ----Ask supplier for liquid plasma for use during outage? ----Is there a water bath anywhere in the lab that you could use? ----Microwave water and keep it in a large thermos would work and then mix with cold water to get temp you need. To late now but for future..... if you are not a high volume blood bank, Helmer makes a really nice plasma thawer that does 2 units at a time. It's not terribly expensive and has a small footprint. Would be a lot better/safer than a bucket with running water.
  14. ECHO equivocal results

    It's really an experience thing. The more experience they have with ? results the more comfortable they will get. We've had Echo for 3 years, before that we had Galileo. I would say that techs who are in the department on a regular basis and are comfortable doing blood bank as a whole (good understanding of theory and process) get comfortable with it within a year. Techs who do not like or are not comfortable in blood bank may never be completely comfortable with ? results. We train with and use the example reactions that Immucor provides. The cards are kept at the bench for quick reference. Also as the techs come across ? results they can get a more experienced tech to review the result with them and explain why they graded it the way that they did. We also teach the techs that if they are unsure and have no one to ask then they should treat it as positive and follow the workup SOP/flow sheets. Better for them to result out a "Clinically Significants Ruled Out" and do coombs crossmatches than to miss something important. HOWEVER, having said that, when the tech is new you may see a slight up tic in the number of panels being performed. Hopefully not too much unless you are having problems with a lot of unexpected ? on your results in which case you need to do some troubleshooting on your Echo.
  15. ECHO D typing Discrepancy

    Without seeing the well images and/or the reaction strengths the Echo uses for grading reactions I can't say. Did the "0" result look at all grainy? Since the reaction strength for a "0" (Neg) is 0-2 and for a "?" is 3-9 perhaps your patient might have fallen at the upper end of "0" and the lower end of "?". I like reproducibility in instrumentation also but you will get variation at the low/high ends of cut-off ranges in all instruments. Would you have been as concerned if the difference was between a 1+ and 2+ reaction? Also remember that Immucor recommends reviewing all reactions prior to reporting your results just to make sure that it's not reporting a very weak reaction as negative. I'm not saying that happened in your case but it has been reported to happen. And remember, if the instruments were perfect all of the time they wouldn't need the techs LOL!
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