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jalomahe last won the day on January 30

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About jalomahe

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  1. I read this requirement as referring back to TRM.40720 and that if the patient has special requirements that blood bank has to provide that nursing checks that the unit fulfills that requirement. So if the patient requires Irradiated blood that the unit is truly irradiated or if the patient needs HgbS negative units that the unit is in fact HgbS negative.
  2. We do up to 30 days prior as long as patient has not been pregnant or transfused in previous 3 months. The 30 days was put into place <20 yrs ago to help our Pre-Surgical Services manage appointments for patients more easily. We do perform EXM at our facility. Patient comes in PSS and is asked if pregnant or transfused in past 3 months. Specimen is collected and sent to the BB with the information and the date of surgery documented by nursing on the order request. Blood bank performs a history check on patient. In the computer (Sunquest) we go under patient's order and if no pregnancy or transfusion we change the Expiration Date of the TYSC specimen to 3 days post the scheduled surgery date. If the patient answers 'Yes' to either question then the Expiration Date remains 3 days from collection. TYSC is performed: If the patient answered 'No' to the questions and if no antibodies (historical or currently id'd) the specimen gets placed in a rack according to the date of surgery (we have multiple surgery date racks that can normally handle 3 surgery dates per rack). If the patient has antibody(ies) an aliquot of plasma is frozen for use in xm'ing ag negative units on day of surgery. We also keep a log book with all of the patient information logged on a spreadsheet each surgery date has it's own sheet. If the patient answered 'Yes' to either of the questions then the specimen is placed in the regular racks (we keep our regular racks for 10 days). We review surgery schedules a day ahead. If we have a patient with only one blood type on file we put them on a list that is sent to the Pre-op center and the nurses order/draw an ABORh when the patient presents on the day of surgery. The nurses also re-ask the transfused/pregnant in previous 3 month questions at that time and it is documented in the patient chart. Once the ABORh is completed and if the patient has not history of antibody(ies) the patient is eligible for EXM. Patient's who have antibody(ies) have units IAT crossmatched on the day of surgery using the frozen plasma aliquot. At the end of the day all of the surgery specimens are placed in the regular racks so that they are saved for 10 days post day of surgery. Works for us :-)
  3. Our SOP states that if there is no blood type available on the neonate then you go straight to the Kleihauer-Betke. There is no point in performing a test (Fetal Screen) that may give a false negative result and thereby possibly doing irreparable harm if the mother develops anti-D because she did not receive an adequate dose of RhIg.
  4. Here's a easy read version of the Transfusion Safety Officer job description at our facility. Hope it gives you an idea of what might be possible at other facilities. TSO JOB DESCRIP.doc
  5. Our site would do the same as Malcolm suggested. We would enter an internal note on the patient record about the weak reaction so techs would be aware when any future workups were ordered.
  6. We have a Special Care Nursery, but not a NICU and transfuse a neonate maybe 1x a year. We keep an O Neg Irradiated <7 days old with satellite bags (6) attached ( sterile coupling) by our blood supplier. The unit is replaced weekly as part of our regular inventory. If it does not get used for a neonate transfusion we just cross it over to our regular inventory and use if for an adult patient. We have a large enough oncology program that we have no problems using up an O Neg, Irradiated unit.
  7. The people you mentioned are RNs and MD (Heme/Onc specialty) and do not have a Transfusion Service background although the are very good at asking questions of the Transfusion Service. They are currently working on getting AABB Certification for the Blood Management program so they have LOTS of questions. The Transfusion Service Medical Director, Supervisor and the Lead Technologist are all part of the Blood Management Committee. All policies and procedures that involve ordering, handling, and transfusion of blood/blood components are reviewed by the Transfusion Service. We also give input and review RN and MD training materials. We provide statistical information and are also involved in recommending/reviewing/testing of updates/upgrades for the HIS (Epic) which utilizes BPAM for transfusion documentation. And of course we attend all of the Blood Management meetings and they attend all of our Transfusion Service meetings so everyone stays on the same page. All in all it is a great collaboration between our 2 groups. We just had our CAP inspection in September and our inspector was very complimentary with our program.
  8. We have a Transfusion Safety Officer as part of our Blood Utilization/Management program. They are responsible for monitoring and addressing utilization, wastage and training of all staff involved blood transfusions. Any Safety Event reports that are related to blood or blood components are automatically routed to her (we have an electronic reporting system). There is a weekly meeting of the Transfusion Safety Officer, Blood Utilization Manager and Blood Utilization Medical Director to review outliers and Safety Events and if necessary letters are sent to physicians where there may have been straying from the transfusion guidelines. The utilization team is also setting up a new endeavor to make a dashboard on the hospital intranet blood usage and wastage available to all clinical staff showing usage/wastage by medical department i.e. surgery, heme/onc, obstetrics etc. That way they can see info for themselves and how their department as a whole is doing.
  9. No previous history on patient then do immediate spin crossmatch with type "O" blood until type is confirmed on 2nd specimen drawn at a different time form the original BB specimen. Once type is confirmed then electronic crossmatch with type specific units
  10. CONGRATULATIONS! It is well deserved. You are always such a great resource for everyone with questions no matter where we are located, what our backgrounds and knowledge level.
  11. Do you take temperature of platelets when received from outside blood supplier? Do you take temperature of platelets if they were issued for transfusion but then returned because order cancelled or IV problems or....? What is your acceptable temperature ranges? Current AABB states "Storage 20-24C" and "Transport As close as possible to 20-24C". The "as close as possible" seems a bit ambiguous and confusing as to setting a policy that the techs can follow. Thanks for your input.
  12. We try not to stick the patient a second time if at all possible. If the patient has a historical type performed by one of our facilities we use that. If no historical but the patient had another specimen that is suitable for ABRH testing i.e. a CBC, HH and was drawn at a different time than the current TYSC specimen we will obtain that tube and perform the testing on it. If there is no suitable specimen we can put our hands on and the patient is highly likely to require transfusion then we will request another specimen be collected. Until there is a second ABRH on file the patient receives group O RBCs.
  13. You could still be looking at an additive/preservative issue. You state that Gel testing performed by your site was Grifols and the Reference Lab was Ortho Gel with Immucor reagent red cells. Immucor does not make reagent red cells for use in gel systems so the Reference lab would have had resuspend the 3% cells to 0.8% for use in gel. If I remember correctly that involves taking an aliquot of the red cells, adding saline to make them easier to decant to a "dry" button and then adding MTS Diluent. So you are essentially washing away the additive/preservative in the reagent cells and thereby removing that as a potential problem. The fact that the crossmatch performed in Grifols gel was negative also points to the reagent cells as being the issue. I would suggest that you try rerunning the specimen in Grifols with "washed" reagent red cells to remove the additive/preservatives and resuspend them in the same diluent you use for the donor cells and see what you get. As to the C3d being positive. Have you checked patient's meds list? Some meds cause the DAT to be Complement Positive e.g. antihistamines containing brompheniramine, phyenyltoloxamine
  14. For those of you using automation and especially Galileo Echo users: How do you document daily QC? Do you printout the WBcorQC results, sign off on them daily, and file them for ___ period of time? Do you just have it as a check off item on the Maintenance Log and document review there knowing that 1) the Echo won't let you run the test if QC is not performed and passes 2) the actual QC runs are on the archive disks? Or do you have another method? Currently we print the QC daily but that's a lot of paper and storage space so I'm looking for another way of handling it. Thanks for your help
  15. Way back in 2003, the AABB published "Guidelines for Implementing an Electronic Crossmatch". In the section REQUIREMENTS on page 4 "Additional criteria suggested, but not universally accepted, include: ... The antibody screen should include a three- or four-cell sample." No further explanation was given but presumably it was for the reasons stated above that you are likely to have more cells with a homozygous antigen expression in a 3-cell panel than you are in a 2-cell panel. Most manufacturers of 3-cell panels make sure to include cells that are homozygous for Duffy and Kidd to avoid missing those. So long story short....that's why we use a 3-cell panel as part of our due-diligence of providing blood by computer assisted crossmatch.
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