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Posts posted by Hi-Freq
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Our doctors in specific units (ICU and Burn) have an order to Keep Ahead X units for 72 hours. We match the 72 hours to the expiration date of the type and screen. It works very well for us. We have not had any problems with any of our inspectors. We can stay on top of our patients needs easier when they are in surgery or having a large bleed if we are the ones ordering as we know when the last unit walks out our door and don't have to wait on anyone else to realize that nothing else is ready. Even with this procedure in place, we maintain an average C:T ratio of 1.3:1.
This is very similiar to experiences I have had in hospitals with busy transfusion services. All of them had "keep ahead" orders, whether it was from the trauma center or from surgery or ICU. I agree that it worked well with the blood bank monitoring when the last unit went out and when it was time to have a new sample drawn again. It sure cuts down of the "panic" and super-stat orders. Also creates a cooperative atmosphere within the "transfusion team".
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I read recently where H1N1 is expected to become more virulent as it makes it's 3rd cycle through humans, estimated to be sometime this winter. Donald Rumsfeld's connection with Tamiflu leaves me wondering...........
Not necessarily being an alarmist, but I'd rather think through all the possibilities rather than simply discount them because the "authorities" say so. So, will any of you take the vaccine, or not? I'm personally leaning towards not taking it.
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Sounds easy to me.
ONLY JOKING RASHMI! DON'T KILL ME THE NEXT TIME WE MEET!!!!!!!!!!!!
Maybe Rashmi will trade you their analyzers for your negative antibody screens!
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I can definitely see why you are getting fed up. That's way too much work. Can't see any time/cost savings there. Which analyzers are you using? Six validations in 16 months in outrageous - I'd be seriously complaining to the manufacturer/ sales rep for some sort of assistance.
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How about discussing it with them directly- report it as a complaint to be logged in their deviation system .....it may be their chief doesn't know?
Anyway- this is distracting from my Poll !!...would you test discrepancies on each of your analysers occassionally as a consistancy check ? i'm only mentioning this because I am still having these problems, one analyser detects the -K , -E etc.. , the other one doesn't. ...occassionally. Washer changed, camera changed, PBS stored correctly etc....aaargh!!!!
Do you experience the problems (missing reactions) on the same analyzer? If so, it sounds like a problem with one of your instruments. Possibly an internal centrifuge error, or temperature error? If one instrument is missing a -K or -E, I would definitely consult the manufacturer by placing a service call immediately.
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Hi There Hi-Freq,
I agree with you entirely, and without reservation, that there are blood bankers and non-blood bankers, and that even some very experienced people within the blood bank can, in fact, be non-blood bankers when it comes to samples with antibodies present. Having said that, however, we ask them to ask the doctors/phlebotomists to take sufficient samples so that tests can be performed at the Hospital prior to submission, and to hold some back from this sample, so that they can cross-match when we supply them with antigen negative blood.
I realise that the fact that we ask them to ask the doctor/phlebotomist to do this does not mean that they will recieve such samples, but there are times when we receive three samples on the same patient, find that the DAT is now negative, or that the antibody is still an "easy" monospecific, and we then telephone them with the results, only to find that they have sent us all the samples and they have none left with which to cross-match.
I wouldn't mind, but some of these occasions have occurred in hospitals (during the day) where the chief in blood bank is ex-Reference staff themselves.
I DO TRY TO HAVE MERCY ON THEM, BUT I NEED A RANT SOMETIMES TO RELIEVE THE PRESSURE!!! CONTRARY TO WHAT MY FRIENDS AND COLLEAGUES FREQUENTLY SAY - I'M HUMAN.
Well, this is a good place to rant and let off steam! I feel your pain! I know all too well how frustrating it can be. Makes you wonder how some of them made it through Med Tech school. (some, not all). Let me ask, when it's an easy monospecific, and they've sent you all the sample, do you then have to do the crossmatch for the hospitals and send compatible blood over? If so, it's still sounding like fear - like maybe they are sending the whole sample over on purpose, so they don't even have to mess with it at all. And if their Cheif Tech is there, maybe she/he's telling them to do that????
Read the Serenity Prayer sometimes. It may not help, but it can't hurt!
Hey, if nothing else, think of it as job security for Reference Techs! :cool:
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I agree with clmergen (and L106's assessment of clmergen's answer).
As a reference Service, we do a panel on each sample as a "first line of defence", as the presence of an antibody is why the sample has been sent to us in the first place. Some of these, of course, are DAT+ with free auto-antibody in the plasma.
However, what REALLY annoys us is when we receive a second or subsequent sample from the same hospital, when the patient was DAT+ with free auto-antibody in the plasma, and on this occasion the DAT is negative or positive, but there is no longer free auto-antibody (or alloantibody) in the plasma. Very often this is because they have put on to their computer, "Send to the Reference Laboratory" and have not tested the current sample themselves at all before referral.
Excuse the pun, but this makes my blood boil.
I know what you mean, MN, but try to not let it get to you. The hospital techs who are sending you those samples are more than likely frightened to death of "Reference Lab" samples, and antibodies. You know there are blood bankers and non-blood bankers, and no in-betweens. If on the other hand, this patient was a known Reference Sample, and the hospital techs wasted some of the precious sample by performing an ABO/Rh and Antibody Screen, only to have it turn out positive yet again before they sent it to you - and this time this patient had developed an additional allo, or two, you'd be wishing you had some extra serum!
Just have a little mercy on them, they mean well, they're just scared! -
Also, if the actions taken actually work--reduce the spread--the public concludes there was not much risk to begin with when maybe it is just that the actions worked. I am not saying some didn't overreact this time, although early word of it's mortality made it seem justified at first. Mostly I am making an observation of human nature that if the case didn't stay dramatic, they think it must not have been real, rather than the knowledge of scientists actually helped us recognize or avert a crisis.
I agree, I think the possibility of a real crisis might have been avoided this time. Our schools also opened early than originally planned. I don't think there was anything "normal" about this flu at all.
Just curious - how many of you are going to take the H1N1 Vaccine when it becomes available? Isn't Tamiflu marketing that vaccine?
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We had one person test positive for HINI SO-IV in our area. Today it was announced that 3 local schools are closed for the week in our city because an 11 year old has symptoms, and has a relative who is confirmed positive. Cleaning teams are going in to disinfect the schools, desks, surfaces, etc. This seems a bit extreme to me if this is "only a flu-like illness". We don't even close schools for a week for extreme weather conditions. I recall that HAZMAT teams went in and cleaned/sanitized buildings after the Antrax scares a few years back, when suspicious packages were mailed. Local daycares are also beginning to close. We are currently unsure how this is going to impact our company since many of our employees have either small children or school-age children.
Does this not strike anyone else as a bit odd, that 3 schools would close for a week, cleaning teams would go in to disinfect/sanitize, just because one child "has symptoms" and is a relative of someone who has the flu? Why would such measures be taken?
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The article I posted above is from the www.cdc.gov website. On their website there is a link to World Health Organization, or WHO. I "copied and pasted" directly from the WHO website.
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Influenza-like illness in the United States and Mexico
24 April 2009 -- The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.
The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.
Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.
The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.
Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.
The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.
From what I'm reading, this is not the usual "Swine Flu". This virus, according to WHO, that they are describing as causing Influenza Like Illness, or ILI, has not previously been detected in pigs or humans. This lends at least some credibility that the virus may have been manipulated, or genetically engineered in some way (based on some of the things I have read). Just a thought. I think it's not outside the reaml of reason to at least consider that a biological weapon may have gotten out.
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I work in a reference lab and had a patient that had a positive antibody screen (1+) so it was sent for an antibody ID. This came back as anti-D too weak to titer. The doctor waited 4 weeks and did another antibody Id but this time it was negative. We dont have any patient info except age and sex. What would cause the ID to be negative???
Thanks
RhoGam is your most logical answer, but you would need verification from her physician's office. I work in a very large reference lab and we see this a few times a week. We always call the physician's office to confirm the date of RhoGam injection, and attempt to explain that when ordering the prenatal work-up, they can save a lot of unnecessary time (and money) by directing the patient to have her blood drawn for the antibody screen first, then giving her the RHIG injection afterwards. Often they do not do that because they want to give the patient the RhoGam before they get out of the office (for fear they will not come back) - but it's worth a try.
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A "new" strain of virus, relatively uncommon passed from human to human - until now - capable of morphing. Blood bankers are wondering aloud "Should we be screening the blood supply for this new virus, can it be transmitted through the blood supply from asymptomatic, infected donors?" Does this sound like circa 1980 to anyone else?
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Hi everyone,
Weak D testing on prenatals and Rh negative females of child bearing age is not required. Weak D testing is only required on red cells of donors and infants when determining if mother is RhIG candidate. The current Technical Manual has a nice little explanation about D typing of donors and patients and why D typing on all patients is not required.
JB
You are correct, and that is our policy. However I end up on the phone at least 3 times a week explaining to physicians why we typed the mother as "negative" but when she delivered, the hospital (who still performs Weak D testing) typed her as Rh positive. And they do not understand when I say "both results are correct".
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Not a problem. I understand somethings just get lost in translation. Hopefully I can help with forms and such. As someone above mentioned, the AABB Technical Manual and Standards would be the place to start. You're doing a great thing for your country.
Fred :cool:
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Dear Hi - Fred!
Thank you so much for your support! Here, we are working for the national hospital, so we can not give the dicision to make you our assistant. Please forgive me, it depends on many things. But I think that we can learn from your experiences at work.
My very best wish to you.
Hieu.
No, I didn't mean that I wanted to be the assistant,
just that I would like to help via email. -
Dear Hieu:
How very exciting! What a wonderful and exciting venture you have undertaken. I often reviewed ads for "volunteer vacations" and thought many times about visiting Vietnam to work for a while. I have my SBB certification in addition to an MBA, and have worked many years in the blood services/collection industry, many of which were in the American Red Cross and some in private blood centers. I did my thesis on "The Stability of Factor VIII in Thawed Cryoprecipitate: Room Temperature versus 4 -8 degrees Centigrade".
I would love to be of assistance to you in any way that I can. I've spent many years writing policies and procedures, training phlebotomists in the donor room, preparing for FDA inspections (maybe something you would want to design your collection/processing/storage around, but hopefully you won't have to deal with the equivalent of the FDA!) as well as training medical technologists on the infectious disease testing of blood and blood products. I would love to be of any assistance to you. I will give you my personal email if you would like and we can correspond. Just let me know. Wishing you all the best, Hi-Feq
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Do you have any A2 cells on hand you could test her with? Just curious.
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I've looked at some BB automation systems in the 90s so I'm out of date. I'd like to hear from an experienced BB-er if they think that agglutination testing, panel interpretation or other BB functions can -ever- be automated.
I don't think it's impossible, but so much is a matter of interpretation and I don't know if all the truth-tables and algorithms we use to handle the 'difficult patient' can be automated easily enough to serve as a day-in-day-out system, replacing the Bench Tech, and still be economically feasible.
In fact, I still don't know of a robust algorithm (which has to be coded by humans) which can take the place of an experienced reference lab tech. For one thing, how do you get a machine to do the battery of tests a human can do from variations on serology, incubation, enzyme enhancement and just 'seat-of-the-pants' or gut-instinct on what to do next, including transfusing antibody positive blood for the first 10 units for massive transfusions (> 1.5x blood volume) and oddities like that.
Now, it may be I'm trying to be too all-inclusive, but the automated systems I saw required one or two full-time techs to go over the results and didn't result in any appreciable money or time savings.
I am an experienced blood banker (SBB) 28+ years in the field. I agree with your summation, that an instrument cannot do the battery of tests a human can perform. In other words, the automated instrument is not capable of abstract thinking.
The other problem with automated instruments is listed in Section 9 - 7 of the users manual which states the "limitations" (of the Galileo). The Galileo does not detect reactions that are 1+ or less, nor mixed field reactions. Enough said? Why bother to attempt a panel on an automated instrument with these limitations?
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One of our clinical affiliates uses the Galileo, and they have encountered the same situation: Rh negative on the Galileo and 4+ Rh positive in tube testing.
Immunohematology published an article in 2005 about FDA approved anti-D antisera and partial D cells. The citation is:
Judd WJ, Moulds M and Schlanser G. Reactivitily of FDA-approved anti-D reagents with partial D red blood cells.Immunohematology Journal of Blood Group Serology and Education. Vol 21, 2005
It appears from their results that partial D patients could expalin the variability of reactions with different antisera, but these situations occur fairly frequently in our laboratory, perhaps too frequently to be explained by partial D.
If these situations DO represent partial D patients, wouldn't typing them as Rh negative make sense?
In my opinion, No. Why would you want to call them Rh Negative when in fact they are not? By doing so, you are subjecting the patient to potentially unnecessary procedures - administration of RhoGam. I don't need to go into the potential (though small) risks associated with RhoGam, but there is also the cost associated with it. I do not believe it is ethical to change the basic principles of blood banking to fit the limitations of an automated instrument. The Galileo does not detect 1+ or mixed field reactions. (Section 9 -7 of the Users Manual)
Typing everyone who reacts less than 1 or 2+ on immediate spin (as one paper has suggested) as D negative, seems to be a "work around". It would make just as much (and save money) to simply do away with D testing and call everyone D Negative. Except in donor centers, of course.
Anyone who has been in blood banking for a while knows that old soldiers from WWII are all "O Negative". That's what their dog tags said. That too, was a work around. Just err on the safe side and call them all O Negative. It seems we are digressing in bloodbanking. I can't believe I'm seeing the day where educated professionals are calling macroscopic reactions, 1 to 2+ upon immediate spin, "negative". You have an antigen-antibody reaction taking place in that tube - what does that tell you? What if you took that anti-D tube that tested 1+ at immediate spin all the way through AHG and got a 3+ or 4+? Then would you call it a partial or weak D, or would you call it D Positive?
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hello
I am from Germany and here in the University of Erlangen they have made a direct comparison between Galileo and Tango optimo. If you want to have these datas I can give it to you
I would also be interested to see the comparison data.
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A lot of the above mentioned information is very good. I also attended a 1 year SBB program, and passed the exam. However, in addition to studying the AABB Tech Manual, and Standards (which actually I like), and of course Issitt, I had just happened to be in a job where I was doing ELISA method viral testing, and thus had read many package inserts on HIV1/2, HIV antigen, HCV, Core, HBsAg, HTLV, and there were questions on every one of the viral markers on the SBB exam!!! My exam also had quite a bit of Probability and Statistics. And all of them have you to calculate the platelet count in a patient whose plt count was X and after receiving 10 units of pooled platets, by how much did his platelet count rise, or something to that effect. There's questions about temepratures galore! The storage of thawed FFP and cryo - for how long and at what temp - room temp or refrig? And how many gm/dl does 1 unit of packed rbs raise the hemoglobin? Of course reading the panels and ruling out was a breeze, I thought. But the exam (IMO) would have been quite difficult to pass had I not been through the exhaustive and intense SBB program first.
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I think I would rather call a weak or questionable result "Rh negative" and give them Rh negative blood and RhIG than call them positive and have a partial D that gets sensitized. We follow John Judd's recommendation and anything less than 2+ with anti-D in tube is called Rh negative. He recommened less than 3+ when testing using gel. (I am not talking about donor testing, just patient).
Not all reagents are the same, and they react with different D variants differently. You should see some variations in reactions with different reagents and methods.
There have been multiple articles about this, and most recommend dropping the weak-D test.
Linda Frederick
In this case, the patient sample was clearly positive in the tube method. Immucor Series 4 Anti-D she was 1+, and with the gamma clone Anti-D she was 3+, both at immediate spin. On the Galileo, she resulted D negative. Therefore, she is not, in fact, Weak D, (or Du) positive, she is D positive.
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I heard from Immucor just now. If you check your user manual under "Limitations", Section 9 - 7, it states, "Warning: The Galileo cannot reliably detect hemagglutination reactions that are graded as 1+ or less in test tube methodology. The Galileo does not differentiate mixed-field reactions." So any of our patients who are 1+ or less are going to show up as Rh Negative on the Galileo. I'm not quite sure how we're going to handle this, as we test several hundred samples per day.
Not necessarily being an alarmist, but I'd rather think through all the possibilities rather than simply discount them because the "authorities" say so. 
Anyone who has been in blood banking for a while knows that old soldiers from WWII are all "O Negative". That's what their dog tags said. That too, was a work around. Just err on the safe side and call them all O Negative.
D Pos then D Neg
in Immunohematology Reference Laboratories
Posted
If it wasn't a mix-up in patient's/tubes, then I would bet it's the different reagents. I deal with this same issue every single week, having to explain to the doctor's why we get Rh Negtatives and the mom delivers and is typed at the hospital as Rh Positive. We use Immucor series 4 and 5, but one of the main hospitals uses the Gamma Clone. Drastic difference it the reagents.