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jalomahe last won the day on November 11 2018

jalomahe had the most liked content!

About jalomahe

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  • Birthday 02/18/1956

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  1. jalomahe

    Blood Utilization - Peer Review

    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
  2. jalomahe

    Questionable blood types

    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.
  3. 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.
  4. jalomahe

    Blood Utilization - Peer Review

    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.
  5. jalomahe

    Blood Utilization - Peer Review

    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.
  6. jalomahe

    Electronic vs Immediate Spin Crossmatches

    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
  7. jalomahe

    Gold Medal.

    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.
  8. 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.
  9. jalomahe

    AABB 5.14.5

    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.
  10. jalomahe

    Cold auto? Something else? Help!

    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
  11. jalomahe

    Automation Daily QC Documentation

    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
  12. jalomahe

    2 cell vs 3 cell screen

    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.
  13. jalomahe

    Gel and tube discrepancy in antibody screen

    In first scenario, Gel negative but tube ICT positive. Was the ICT positive on all cells or just some cells? Did you repeat both Gel and ICT screens to make sure there were no test performance errors. Did you test with with a different set of reagents to make sure reagents had not been contaminated? In second scenario, basically same questions. However if you have reactions in gel with all cells then it might be an Ortho Enhancement Isoagglutination caused by the preservatives in the reagent cells. You can try repeating the antibody screen in gel using reagent cells that have been washed first to remove the additive.
  14. jalomahe

    Proficiency Testing

    I may go to the extreme but when we receive surveys all of the "patients" are registered in the computer and the appropriate tests ordered. The vials can then be labeled with barcoded patient/test labels and can be scanned. I also enter the "donor unit" into our inventory and print donor unit label for the specimen and place the DIN label on the vial. This way everything is done in the computer just as it is with a real patient. When the tech has completed testing they can print their results from the LIS and if need be I can always go back and look at the results.
  15. jalomahe

    CAP TRM.30450

    When I asked CAP about this they stated that for Blood Bank it only applied to kits that come with their own Pos and Neg QC. So Fetalscreen Kit Yes, Elution Kit No.

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