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Joanne P. Scannell

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Everything posted by Joanne P. Scannell

  1. How are you handling crossmatching when a patient's plasma contains 'Anti-D due to Rh-Immune Globulin'? This is a passively acquired, low titer Anti-D, we are issuing Rh-negative RBCs and the guidelines (AABB) are too broad ('clinically significant antibodies = extended crossmatch') so they don't seem to address this common situation. Are you performing an Extended Crossmatch or just Immediate Spin for these cases?
  2. So, what about all the antibodies that react ONLY with homozygous cells? Very scary that you are ruling out with heterozygous cells ...
  3. No Clinically Significant Allo-Antibodies = No Extended Crossmatch (what are you expecting up there other than the same insignificant mess, e.g. DARA, WARM AUTO?). In Sunquest, we enter the code %CINS for the Antibody Screen (%AS). This was 'invented' (by Sunquest) for this situation ... so electronic crossmatches are possible. We enter %POS for %AS only if we find 'Clinically Significant Allo-Antibodies' ... and then we do Extended Crossmatches.
  4. I agree: If the manufacturer must state that this is a valid Fetal Cell Screen OR there must be literature/studies out there validating that a FMH greater than 30mL will always be detected in gel (ABO and Rh Typing). Has anyone out there seen such literature? Yes, annoying when facts are twisted and general statements are made that don't reflect the truth of the matter. There are lots of them out there. Grrr, too.
  5. We built a 'test' in Sunquest that is simply 'allocate (using barcode reader), press 'OK', sign-out, tag the unit, hand it over'. The advantages are computer assisted QA only when appropriate (e.g. trying to allocate A POS to an untyped patient), no handwriting and accurate recordkeeping.
  6. We used to use the >10oC limit but we got cited for that by the FDA a few years ago. As I stated earlier, they consider the blood on the floors 'in storage'. So now, we have to use the 6oC limit. Grrr.
  7. We are using AlbaQ-Check and it states in the IFU (aka Package Insert) "Once opened, vials can be used for 7 days." IF there is such a restriction on the corQC, it would state it in the IFU. If not, then it should be good until the original expiration date. If it doesn't last that long, then that's a problem with the product and the manufacturer should address it.
  8. Ditto! I took the exam in 1981 and it was essentially 'Trivia Pursuit' for Immunohematology ... and yes, it included a set of unknowns that were sent if the written portion was passed. Those were wild, crazy as well. For some reason, the requirements for 'passing the SBB Exam' have drastically changed. I've seen people study 'a book of questions' and pass the exam ... Just sayin' ...
  9. Since all antibodies have a specificity, we don't use the old term 'non-specific'. If we don't know 'its name', we report one of the following as applies to the workup: Cold Antibody: Undetermined Specificity Cold Auto-Antibody: Undetermined Specificity Warm Auto-Antibody: Undetermined Specificity Antibody Detected: Too Weak to Identify at this Time Possible HLA/HTLA Antibodies Antibody Detected: No Identification at this Time
  10. In the US, we use metrics in the lab - Celsius, grams, milliliters, centimeters, etc. The 'outside world' uses Fahrenheit, pounds, cups, feet, etc. ... even nurses and MDs! It would be nice to go metric 'out there', too!
  11. Here in the US, according to the FDA CFR640.2c3, we cannot issue a unit that has not been maintained at required temperatures ... we can take it back, but we cannot issue it. Therefore, I believe it is a violation of this requirement to hold the unit in the BB and reissue it, even if it is for the same patient, even if it is within that 4 hour window. BTW: The 4 hour limit is for the completion of the transfusion, not the start of it. In addition, the FDA has told us during our most recent inspection that the CDC determined that once issued blood is delivered to the location, it is conside
  12. I agree ... this is extenuating circumstances and actually more efficient at getting blood products 'out the door' when 'multiple unknown recipients' are involved. I believe they used this approach during the Boston Marathon bombing but instead of 'just anyone' distributing the blood, they used a BB/Lab tech who knew the importance of keeping track of the units/recipients.
  13. Whenever this subject comes up, I respond with 'Would you rather have the BB Techs running around the hallways or in the Blood Bank working on the case?' We do not deliver. Period. There are lots of people in this hospital who are trained to do that (like every ward has a handful, transportation department, etc.). If requested, we say 'call the nursing supervisor, he/she will make the necessary assignments.' PS. We do have a DumbWaiter that we use for the ORs (one floor above us).
  14. Anything over 3 cells is a panel = bill for a panel.
  15. Translate/Calculate them to 'panels' and bill 'per panel'.
  16. Note that we are all ruling out with only 1 cell every time we interpret AS = Negative. If we had to use the 3+3 rule for that, Antibody Screens would have to contain a lot more cells. I see the 3+3 rule as applying to Antibody Identification, e.g. Don't call it an Anti-Cw unless you have 3 positives. Don't call it an Anti-Jsb unless you have 3 negatives. (Ruling out others, of course.)
  17. Where can we get these red insulated pouches with the gel packs? I like this idea considering that we, too, have experienced 'over the temperature limit' units that have been issued in a ziplock bag then returned 10 minutes later. And I agree with some of these posts that ... a) The safest route is to take the temperature of the unit when it returns to determine acceptability regardless of how long it has been 'out'. Since there are regulations (at least here in the US) that state that if blood products are not under continuous temperature monitoring, the temperature needs to be recor
  18. Cold Antibody: Anti-M? (Gel is notorious for picking up Anti-M due to it's acidy ... so don't expect duplication with tube.) And Anti-M is so persnickity ... reacts with homozygous-only sometimes, reactive cold-only sometimes, reactive warm sometimes ... and sometimes the screening cells are all M Positive ... temperature of the plasma/gel card/room at time of testing ... etc. We find 'a lot' of Anti-M's on our prenatals ... just a thought to chase down.
  19. We DO use cord blood for pretransfusion testing but prefer a direct sample from the baby ... which is not what they want to do when a child actually needs a transfusion. All Cord Blood is specifically labeled according to our current pretransfusion sample criteria. It is a special blue top, non-vacutainer tube ... no confusion possible with maternal sample. We use gel testing. In gel, you can easily see dual populations ... as opposed to tube testing where 'mixed field' is difficult to detect. N.b. We were all taught many years ago that newborn ABO Typing is weaker than in adults. There's an
  20. I've seen them at 'The Container Store' ... USA.
  21. I am, I imagine like you all, tired of the thousands of words written about this topic ... and we never come to a consensus, never a conclusion, and no one is changing the rules out there. Just putting this thought into the mix ... We are not supposed to use outdated blood products for transfusion for various reasons ... and we don't dispute that. So, if we need the extension, we freeze blood products (when applicable) to extend the shelf life ... 1 year for plasma/cryo, 10 years for frozen RBCs (correct me if I'm wrong about that). We are not supposed to use outdated reagents for another
  22. It's just a worksheet that has columns for the 11 or 16 cells (depending on the panel) for rows and rows and rows ... this way, it's easy to see the results from the previous panel(s) for comparison. (ie. we are not recording the QC onto the antigrams supplied by the manufacturer).
  23. This is precisely why instructions to check/test the father's RBCs is part of our Unicorn Tracking Protocol.
  24. Ditto, ditto, ditto here. The reality is that the Rh is the only test result we NEED if Mom is Rh-neg. Of note, the Neonatologist at our hospital put in place a 'screening system' for determining which babies were jaundice. As you all know, babies come in many colors so visual determination is highly 'unscientific' so a bilirubin is performed after so many hours and if over a threshold, another is ordered for another so many hours. If this happens, they order the tests they need to help determine the cause of the elevated bilirubin (e.g. ABO/Rh/DAT). PS We perform ABO/Rh/DAT on all babies b
  25. Interesting, thanks! Somewhere there's an article that states that DVI is the 'weak D' that makes Anti-D, the other 'weak D' types don't.
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