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Joanne P. Scannell

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Posts posted by Joanne P. Scannell

  1. All Blood Products: We require a current BB sample, tested, etc.

    Plasma, Platelets, Cryo: No time limitation as long as the patient is still wearing the matching BB Band. 

    Plasma: If there is no current sample tested, it is given 'Uncrossmatched'.  If I'm interpreting the 'rules' correctly, that's what we have to do for plasma.

    Platelets: We stock Group A Platelets so that is what they get.  We obtain Group compatible if we have to order platelets for a specific patient or a neonate.  Shortest outdate is used first.

    Cryo:  There is no consideration for ABO Group ... shortest outdate is used first.  

  2. We change all batteries annually while we are doing the QA on them so it's not likely that a battery will fail during the year.  However, things do happen and I agree with exlimely, if you do have to change or replace (say it fell out for some reason) a battery, then a 'calibration' would be prudent.

    Also, we are not talking high precision here, i.e. wider acceptability range than a pipette would be, i.e. testing is done in ranges of time, not exact seconds.  This 'calibration' is just a simple check up to make sure the timer isn't totally out of range.  Most of the time, the error is the readout gets 'broken', not the accuracy of the timer.

  3. On 9/11/2020 at 11:46 AM, bowerj1 said:

    A question that also comes to mind as we are writing our SOP for thawed plasma, is it necessary to have the provider sign an Emergency Release form when A plasma is given to someone with no blood type on record. Does anyone do that? Or is the policy stating when to use the A plasma sufficient?

    There are actually 2 scenarios in this string:  1. Issuing plasma that you know is incompatible with a patient (i.e. ABO is verified) and 2. Issuing plasma when you haven't verified the patient's ABO with a current sample.

    For #1: If you are in the US, the CDC/FDA wants us to treat all incompatible plasma as if it were 'Emergency Release' so use your Emergency Release Protocol.

    For #2: If your patient's ABO Group has not been verified (e.g. sample tested using your protocol for verification), use your Emergency Release Protocol.

  4. I hear there is some chatter/literature about immunizing Rh-Neg Females under 50 is, today, probably 'much ado about nothing'.  Well, not nothing, but the argument is, with today's techniques (in utero transfusions, more sensitive monitoring, etc.), the risk of HDN is less likely than it was 'all those years ago'.  Does anyone have any articles or insight about this 'new turn' to share?

  5. Without some sort of 'vending machine' device to control and document the in/out/in/out/transfused to whom information, just leaving O Neg RBCs in a refrigerator somewhere for nursing to take/return at will is not a good idea.  I'm not even sure if regulatory agencies will support that.

    Not only that, giving O Neg to 'everyone' is not good management of resources.  We (and most hospitals in our area at) restrict the use of O Neg to Females <50yrs old.  (And even that is coming up for debate in some arenas.)

    There are 'vending machines' out there that will interface with some Blood Bank Software.  Maybe someone who is using such a machine can comment on that.

  6. On ‎6‎/‎22‎/‎2020 at 3:00 PM, DH41785 said:

    Hello Blood Bank World,

    I am having a tough time figuring out the requirements to be able to use expired panel cells as part of a workup. I started as supervisor at my current place of work less than a year ago and I cannot find any mention of or documentation that expired panel cells are appropriate or what steps to take in any procedure. Currently, the techs are using expired panel cells. They are antigen typing the cell for Fya antigen to prove the cell is reactive with an antigen that is known to be less stable with length of storage.

    Where I worked before, we had to antigen type the out of date cell for the antigen that we were using the cell to rule out. EX: Using cell to rule out M in the presence of Anti-S, type the cell for M antigen to prove that the specific antigen is still reactive on the expired cell. This option makes more sense to me.

    Does anyone know which way is correct? I'm currently updating the procedure to write it in officially. Also, I've seen mention of a validation needing to be performed, does anyone know what kind of validation, if any, is necessary? I have no record of validation being performed either.

    HELP!

    As you see from the posts here, there are various opinions of what to do. 

    Correct =The regulatory agencies do state to run some sort of controls, etc. 

    You are in charge, therefore you do what you believe is best within the guidelines when there are gray areas like this.  If you believe you should change the protocol to 'QC for the Antigen', then do that.

    Validation?  You have criteria, I'm sure, for the cells passing inspection for use.  I venture to say that most hospitals don't keep reagent RBCs more than a month or two past their outdate.  It would be interesting to hear about that.  If you are running QC for the tested antigen 'Day of Use', that's your validation that the cell is still working for your purpose.  (I maintain that 'validation' is needed for situations where QC is not going to be run, e.g. You validate the time a box will hold a temperature so you don't have to take the temperature every time.)

    We do validate that a new panel is ok by running QC Antisera with them when they arrive.  I've had inspectors tell me I must do this and I've had inspectors tell me to stop.  Hmmm … I do what I am comfortable with, i.e. err on the side of caution.

    We don't use outdated panels … too many issues. 

  7. 'Liquid Plasma' is never frozen so there's no need to thaw it therefore the outdate is not changed.

    'Thawed Plasma' is the 5 Day product which results from Thawing Frozen Plasma (in all it's various forms, FFP, FP24, etc.).

    Note: When Frozen Plasma is thawed, it is assigned a 24hr outdate.  You can extend that outdate to 5 Days IF you label it 'Thawed Plasma'.

    e.g. Frozen FFP is thawed to Fresh Frozen Plasma (24h outdate).  You can leave it that way or change it to 'Thawed Plasma' (no FFP designation) and assign a 5 Day outdate to it.  Most hospitals, if they go that route, just label it 'Thawed Plasma' with a 5 Day outdate immediately after it's thawed.  (One Step vs Two Steps)

    Note:  I'm using USA FDA rules, I don't know what they do in other countries.

  8. 19 hours ago, John C. Staley said:

    My only thought is, "What is the motivation for such a change?"  The retesting will still have to be done and you will pay for it one way or another so what, exactly are you hoping to accomplish??  A little convenience for the transfusion staff?  

    I think that is the point = remove the requirement for the hospitals to perform the Retyping.  Motivation? I agree that it is a waste of time and resources. 

    The labeling facility has already tested the unit and rechecked it how many times?  How many discrepancies have you found in your career?  In over 40 years of mine, I have never seen a discrepancy.  That's not of the units I have personally rechecked, it's of the 100s of thousands of units I have overseen. 

    And, please correct me if I'm wrong, I don't think they do this recheck in the hospitals in the UK, maybe all of Europe?  Help me out here with that.  What is their kill rate because of mislabeled units?

  9. 23 hours ago, Malcolm Needs said:

    True Joanne, it is very fast, but one of my points about this is that, when a baby is found to have a Weak or Partial D (such as Partial DVI), it would be good practice to test the mother for Weak or Partial D expression, if this has not already been done, because she may be the source of the mutant gene leading to the baby's Weak or Partial D type.  If she is the source, then it is a moot point, to say the least, as to whether she should or should not be exposed to a human-derived blood product that may, for all we know, be harbouring novel virus that may be transfusion-transmitted.  AT the very least, she should have the risk, albeit very low, explained to her before she is given the anti-D immunoglobulin.

    Good point ... but most MDs give the RhIg when Weak/Partial D is reported because they don't understand the situation even if we try to explain it to them.

  10. On ‎6‎/‎12‎/‎2020 at 1:11 PM, Malcolm Needs said:

    It is not the gel test that does not detect Partial DVI, it is the monoclonal anti-D blend in the gel that you use that does not detect those four Partial DVI types.

    We use gel, and as other are doing, if Rh Neg with Gel, we test for Weak D. 

    I must add this caution: Be mindful of what your Anti-D is capable of detecting.  Some purposely do not detect DVI.  You want to detect DVI on these newborns to determine the possibly of immunizing an Rh-Neg mother, i.e. Is she a candidate for Rh-Immune Globulin. 

    n.b. Currently, we are using an Anti-D reagent that detects DVI (as well as other Weak D)  at Immediate Spin, so the 'Weak D typing' is very quick and simple.

  11. We keep them for a month or two.   Once I do my 'turn around, vendor assessment audit', I toss them.

    Why?

    1. These aren't handwritten papers anymore, we have other records bearing the exact same data generated by the exact same actions: All units scanned as shipped appear on the 'packing slip' and on our account, i.e. A unit is not going to be listed on a packing slip that does not appear on our account and vice versa.  

    2. The techs correlate the packing slip with the actual units at the time of receipt so we know the numbers are right.  Discrepancies are remedied at that time.

    3. The units are entered into the lab computer system where the record is kept 'indefinitely', not just 30 years (that rule reasoning goes back, again, to keeping those old handwritten log books) ... who decided 30 years was a good 'throw them out now' point, by the way?  With computerization, we are keeping these records 'forever'.  Maybe the rule will change to something past the max human lifetime, like 'keep electronically for at least 110 years'.

    4. I can access the bills online which bear every unit of blood in every transaction and I can review every unit in our database if there is a question on a bill.  Note that discrepancies are picked up when they are received, not weeks, months or years later.  I don't know how it's been going in other BBs, but our discrepancies that I detect during my 'audit' are about the billing from the Reference Lab or other services such as 'STAT Fees' that should not have been applied, not about which units of blood did or did not arrive.

  12. On 4/30/2020 at 11:31 AM, diplomatic_scarf said:

    Thank you very much.  This have been very helpful. I am sorry, I just have another question. You said you have seen so many of them.  What was the cause for majority of those cases you encountered?  What was the typical/common reason? 

    We, too, encounter Anti-M often using Gel.  Apparently, Gel is just acidic enough to enhance this pest.  

    Because the enhancement is more about pH than temperature, whenever we suspect Anti-M, we revert to other methods to help determine it's 'etiology'.  Prewarming Gel does not change the pH issue so we don't do that. We can't trust that negative results in prewarmed Gel are truly due to a cold Anti-M or that the positive results aren't due solely to the acidity.  (Besides, if testing is done using a Blood Analyzer (e.g. Vision, Eflexis), the cards are pre-warmed anyway.)

    So, we test the plasma using Prewarmed Tube Testing (e.g. PEG which has similar sensitivity for most antibodies sans the low pH).  If positive with that, it's a Warm Anti-M. 

    We also test at Room Temperature using Pooled Screening Cells.  If positive, then it's a cold Anti-M. 

    If negative with both Prewarmed Tube and RT Pooled O Cells, it's 'Anti-M (Detected using Gel Only)' ... just due to the pH drop, no clinical significance. 

    Likewise, positive with both, it's an Anti-M with a broad thermal amplitude.

    Do what you like with the results.

    PS.  Testing positive with Anti-M reagent does not mean the patient can't make Anti-M (Patient may be Mg Pos).  Someone please correct/confirm that or am I working on old reagent data?  (Like we don't see Anti-T or Aquired-B anymore because the reagents are 'purer'.)

  13. Ok, I'll ask the other question that needs to be asked:  Are you SURE that the cells put into the vial for Unit #1 are from Unit#1? 

    Serologically, those discrepant results don't make sense (which is why you are inquiring) so I'm looking at the mechanical issues.  Is it possible that during the heat of the moment (STAT, Uncrossmatched), the tech who retrieved the segments from the 2 units actually pulled both segments from Unit #2?  When the crossmatches were repeated manually, was a new segment taken from the unit and that's why you saw the expected incompatibility?

  14. 21 hours ago, slsmith said:

    The in house irradiated product label doesn't say "irradiating in house" but it does in the lower right corner of the label have the hospital name and the FDA registration number. Probably the same thing? Anyway my hospital is inspected by FDA, AABB, CAP and ISO; never have we had a issue with this process.

    Ditto (except for the AABB inspection).  When we thaw, aliquot, and/or irradiate, the default message is 'Further processed by ...' followed by our Facility Name (exactly as our license states), address and FDA License #.  Never been a problem this way.

  15. Yes, I got one of those emails 'from you' and almost answered it until I saw the grammar and thought, 'No, he wouldn't write that badly!'.  So, I decided to check with you in here to see if you did send it.  Guess you didn't!

    Hoping you are well!  I haven't done much in here because it's been ridiculously busy!  And we are 'this far' away from being able to order/transfuse COVID Convalescent Plasma.  A new product ... lots of fun.

  16. We issue Group A Plasma (or whatever is shortest outdate as long as it is not Group O)  until we have a BB Specimen and the ABO/Rh is verified.  Then we switch to ABO compatible/specific.

    The expiration date of the specimen does not apply to non RBC containing blood products, so as long as the patient is wearing the corresponding BB Band, we will issue Plasma, Platelets and/or Cryo.

    I agree, the non-ABO match allogenic stem cell transplant recipients are a challenge, but as someone pointed out in an earlier post, these patients become obvious and we can deal with their 'new' blood type 'in the moment' according to our current protocol.

  17. We purchased bins from VWR International.  They are manufactured by AKRO MILS if you want to check their website: https://akro-mils.com/

    They are inexpensive and come in various colors: Red, Blue, Clear, White and many sizes.

    We got Item# 75854-808 ... a case of 12 clear, 4" tall x 11.625" deep x 6.625" wide.  6 fill one of our drawers (3 in front, 3 behind them) very nicely.  If you message me, I'll tell you the price (very reasonable).

    They sell dividers for them, too ... again, in the same colors.

    We also use them for our reagents.

    We stole the idea from Chemistry, by the way, so I can't take all the credit for this idea.

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