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I work in a small-to-medium sized hospital with a Blood Bank supervisor that has only worked in the same hospital her entire career. Nearly everyone else agrees that she gets worked up about many things that other experienced techs would not think twice about. For instance, she claims that about 25% of our patient population has "cold autoantibodies" which require extra time to work up and patients ultimately "require" blood warmers because of this. We use the gel system as a primary method of performing antibody screen and crossmatch (yes, gel crossmatch even in patients without antibodies). With the smallest speck of an rbc not completely forming a button, she wants a DAT, antibody panel, and "mini-cold panel" performed. She claims that all of these are cold-autos after nothing else proves significant. Then you are forced to do a strict pre-warm tube every single time due to a "history of cold auto." Many times it is rouleaux showing up in the gel... and it WILL go away with strict pre-warm tube testing, have a negative panel, negative DAT....but this is not the solution to the problem. A simle tube test, without the extras, would demonstrate compatability/negativity. The funny thing is this: I had a nurse manager call from another hospital because they were trying to transfuse one of our regular patients. The patient refused to receive blood without a blood warmer. The patient told them that she required a blood warmer at our hospital, and was of course scared what would happen if she didn't use one there. They had no issues with her screen/xm. They did not have a blood warmer on site to use, therefore they called me to ask about her history and reason for blood warmer. This caused all sorts of confusion. The patient has no significant auto and did not need a warmer. It was somewhat difficult to explain to that hospital why we say that she must have a blood warmer, but indeed she does not. This is only the beginning..... But it all seems like a waste of money, tech time, and leads to patient confusion. Any ideas on how to solve this problem? i.e., how to approach the issue?

I should add that Coulter suggests to correct the RBC by subtracting the WBC result from the original RBC. Determine correct hgb, hct, mcv, mch, mchc by either using manual hgb-hct methods (calculate other parameters with corrected rbc) OR by method of plasma replacement (remove as much of buffy coat as possible) and all rbc parameters may be reported.

I'm new here, and late to respond, but I'll still add my experience. I work in a smaller hospital (70 inpatient beds+many clinics). We store, on average, 60 RBCs and 60 units FFP. A few years ago we were to undergo a "brief" period on our backup generator power in order to switch over to some new power system. After a few minutes of being on generator power, the generator caught fire, and the entire hospital was without power. The lab was without any power whatsoever for around 3 hours (middle of summer with 90+ degree temps). Of course it was the weekend, with only 3 techs working the entire lab. We do not keep coolers on-site. Luckily, our blood supplier is only about 10 miles away. They were able to bring some storage containers to store the RBCs before the fridge temp began to rise. We placed the FFP in our dry ice bin and checked temps regularly. Thankfully, we did not have any emergency blood bank patients during this period, as emergency release would have been the only option. Lesson learned. We now have an emergency plan for this kind of situation (backup storage!)

Hi Carol, I found this article that may be interesting for you to read. http://static.cjp.com/gems/labhem/7.4.Fernandez.PDF We use a LH 780, and I'm not sure of the minor differences with the 750. It appears from the above article that WBC is linear up to 400,000....so I would think the max dilution you'd want to do is a 1:4. We rarely have to dilute for WBC, and if so, I can't imagine we'd ever need to do more than a 1:2. I have questioned the same thing about the parameters being affected, hgb in particular. It seems like when the WBC gets around 100,000 that the RBC parameters will all have "R" codes. I came across this situation not too long ago while working alone on my shift. Since the patient was transfusion dependent, it seemed obvious to want to take the (more accurate) hgb value from the diluted run.... however I was told the following day that we can't do this because it's not in our procedure AND that since we rarely have this problem, that we will continue to only report the (false!) undiluted hgb. Ugh! So, I'm interested to find out what you learn about this! Probably wasn't much help to you

I'm new here-- hi everyone I have used albumin, on occasion, to preserve cells when doing a manual diff if I believe it will make a huge difference in the counts. I have found it helps when the white count is very high (~100,000) and a lot of the early cells become distorted when making the slide...more in AML/ALL, not for a simple CLL. Do I think it makes any difference in the diagnosis? Probably not! But it makes me feel better. I work in a hospital where this might be useful once a month, so it's not a big deal. It is not required, and our procedure solely suggests using this technique at the technologist's discretion.