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Joanne P. Scannell

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Everything posted by Joanne P. Scannell

  1. Precisely! Read, read, read the package insert and make your policies based on the facts. Not all Anti-D reagents are the same ... some detect weak D at IS, some after 37oC incubation, some require AHG Phase. Furthermore, some are designed to NOT detect DVI (e.g. MTS). 1. Does anyone know where the 'magic' number (grade 1+) came from? Do patients with less than 2+ reaction make Anti-D even though they have the D antigen on their cells? I suspect, like some of our 'old rules', there is nothing to support the statement ... especially knowing what we know now about making reagents and the D
  2. We also use BB Bands so we do not require a second specimen. We do require a second tech perform a recheck if there are no previous BB Banded specimen ABO/Rh on record. (Prenatal, hearsay, etc. doesn't count.). And ditto: No BB Band = No Transfusion. (Take it 'Uncrossmatched' until a valid specimen is drawn and all required testing is done.) Just because 2 specimens are the same blood type doesn't mean they came from the same patient. You still don't know if the first one was right ... or the second one. Well, that's what we tell Hemo when they come in asking us to type two specimens be
  3. Ditto. Perhaps the logical solution to the problem of 'not wanting to redraw a neonate' is to restrict neonates to Group O. That follows the policy actually ... 'Give Group O until a second sample ... blah, blah, blah.' Love the 'Bombay' comment, btw ...
  4. No diluting for Tube Testing. BUT we do have to dilute the Confidence Antisera for manual MTS testing otherwise the result is 4+ which is useless. At this time, we add 1mL Confidence Antisera to 9mL 6% Albumin (I prefer that to saline, but perhaps saline would work). This dilution produces a 2-3+ result in MTS. I must add that I am in the process of decreasing this so that we get 1+ results in response to a lot of chatter out there about 'testing vs a weak antibody' (CAP)... I don't see 2-3+ as 'weak'. So, this dilution will be changing. But it's a start ...
  5. We have one of these collecting dust on the shelf. How did you get yours to validate?
  6. I agree with John and Malcom. Future transfusions? Non-ABO antibodies are mostly 'extravascular' hemolysis and, as I've said before, 'Exanguination is a lot harder to treat than a delayed hemolytic transfusion reaction' so all those IgG antibodies tend to get 'ignored' during a massive transfusion situation. We actually try to hold the 'totally compatible' RBCs until the bleeding is in control/stopped. Plus, yes, there's the dilutional and immunomodulation effects of massive blood transfusion. Check the 'Instructions for Use' on your Rh-Ig product. Rh-Ig prophylaxis is usually recommende
  7. In my opinion you are absolutely, sanely right on this! But unfortunately, 'here in the states' we have a different set of rules to follow mandated by the FDA. I always say 'Europe is ahead of us' on these things ... which is why I enjoy hearing your responses.
  8. Where is the regulation stating that the blood can be out of temperature for 30 minutes? Since coolers can never really be validated (like someone said, cannot control opening/closing and temperature of the room/car will affect the temperature flux ... plus there's no guarantee the units are actually staying inside the cooler the whole time), and since those little temperature check labels are difficult to validate and expensive (and timely to remember to put them on during an emergency), we take the temperature of the unit of blood at the time it is returned. FDA made it very clear to us
  9. You got it, Dr. Pepper! I was cited for this (COM 30450) during my CAP Inspection last fall! We are now performing this "QA" on all incoming RBC panels by testing them with dilute antisera (originally the ALBA-QC antisera, I may change that after reading this and another set of discussions), recording on a perpetual worksheet so it's easy to compare 'old lot to new lot'. This passed CAP approval. We don't use outdated panels so no "QA" on that end. (Yes, the quotes are there on purpose.) I better shut up now.
  10. I totally agree! It seems they have the 'same' technical training while maybe the MTs have more of the background/academics like Biochemistry. I have found that MLTs function the same on the bench as MTs except when running into problem cases. After a few years, this can even out depending upon how much experience the MLT has had and how willing he/she is to learn the background. There are MTs that don't 'measure up' ... and, as David stated, there are SBBs that fall way short of expectations. So, even though MLT/MT/SBB don't start off 'equal', the individual proves him/herself after a wh
  11. There's not much I can add to what has already been stated ... a learning experience, talk about it so you can be better prepared next time, etc. Except ... 1. Your supervisor dropped the ball here. As 'Quality Guy' quoted CLIA (and it should be a 'rule' regardless of who requires it), your supervisor should have a 'call me anytime and if you can't get me, call ____' with the phone numbers perpetually posted at every BB phone.As far as the policy about 'the patient has not been transfused so you do not need to repeat the workup' - yes, it may be a rational thing to do, but unless this ex
  12. At the time of thaw, we assign the 5 day outdate (expires at 23:59, which is very nice!) and use the 'THAWED PLASMA' versions of the Product Codes (NOT the 'Thawed NNNN' version!) I didn't see the sense of putting extra steps in the process (i.e. relabel after 24hrs). Here are the ISBT128 Codes that we use (we are 100% FP24). We used Hematrax for labeling ... I don't know where you'd get all these labels if you needed them. We also have the policy that during an emergency (or MD can't wait), we issue whatever is already thawed according to outdate, not ABO Group. Exception: We do not is
  13. We did a 'validation' and found it took about an hour for 'just thawed' plasma to cool to below 6oC in the refrigerator. Given that, if we issue Thawed Plasma within the hour from thaw time, we put a notation 'Issued Prior to Cooling'. If it comes back, it is not expected to be less than 6oC, obviously, so here's our criteria for returning the product to inventory: (Rationale: Room Temperature stored products, e.g. Cryo, are 'good' for 6hrs after thaw.) Thawed Plasma: ‘Issued prior to Cooling’ and it is less than 6 hours from THAW time.Issued after cooling to 1-6oC and meets the same criter
  14. Ditto. There are just too many reasons for the ? to create a single instruction.
  15. To add to the above (and yes, there are many versions of the 'Extensions') ... Our 'extension' is 5 days, that works for us. If a patient is being drawn earlier than 5 days or refuses to wear the BB Band, Antibody Screen is ordered and a notation is made in the chart to draw a Pretransfusion sample the morning of surgery. The result of the Antibody Screen gives us the information we need to be ready for the surgical date. BTW: We locate our specimens by the date drawn ... placed in dated racks. The computer displays the draw date so they are easy to find when needed.
  16. EXACTLY! We shouldn't be talking 'least incompatible' anymore and we need to teach our MDs to stop talking that way, too. BTW: Since it is under the BB MD license to choose blood for patients, we do not put this burden on the ordering MD who is likely not well versed in all these BB variables. We have written protocol regarding how to deal with warm/cold panagglutinins which I won't go into on this string. But, I will say if we have to give out RBCs that are truly incompatible, it is because we are not given the time to find antigen-negative RBCs or to complete our investigative testi
  17. DITTO! We do the workup/tests ONLY if clinically indicated, i.e. no 'routine orders', must be ordered by the pediatrician for a reason. We do perform 'Rh-Only' on the cord blood of Rh-neg mothers because we need that test result to determine if she needs Rh-Immune Globulin.
  18. If the DAT is positive (we use gel, but if we happen to use tube testing then yes, everything counts) AND the patient has been transfused recently (still debating the definition of 'recently'), we prepare and test an eluate. Keeping in mind that even if the entire unit were transfused, only approximately 10% of the circulating RBCs in the patient will be donor cells ... now remove those donor cells that are being destroyed ... so, ummm, why do we expect a strong positive DAT then? (We actually had a mistransfusion (nurses not doing the ID of the patient because 'they know who they are worki
  19. We do everything except require a Post-Transfusion specimen (hence, no post-transfusion specimen DAT, ABO/Rh Recheck, Antibody Screen repeat). 'Everything Else' = Clerical Checks, Inspection of the unit/IV tubing/IV Fluid, Documentation and Pathologist Evaluation. Yes, as some of you have stated, it is important to consider 'all those other things' that can cause adverse reactions ... it's not all about RBC Incompatibility.
  20. Ok, so perhaps once out of temp for an hour does 'no harm', how about twice, three times, four times, etc. And I disagree with the unit staying within temperature for up to 60 minutes (were these in the days of 'whole blood'?). We take the temperature of returned units and I have yet to see one last longer than 15 minutes 'out there in the unlimited unknown environments'. Nevertheless, the very bottom line is: So what do you tell the FDA (or AABB or CAP) Inspector when they cite the 'store at 1-6oC, transport at 1-10oC' regulation?
  21. Ditto re the reasoning. However, we don't issue RBCs until we have completed the following: If we cannot circumvent the auto antibody using other methods (which is more often than not) then we send samples to our local Red Cross Reference Lab for differential absorptions to determine if there are any underlying allo-antibodies. If negative, then there is no 'clinically signficant antibody' and we crossmatch/issue RBCs Imm Spin. If positive, we honor the identifiedantibody by selecting antigen negative RBCs but we still skip the extended crossmatch because we all know it's going to be posi
  22. Ditto except the FDA forced us change the criteria to 1-6oC because the unit is considerd 'stored' not 'transported' once it has stopped moving from one place to another. (Someday they will fix this unsubstantiated dual temperature requirement.)
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