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JPSCANNELL f. CROKE last won the day on November 26

JPSCANNELL f. CROKE had the most liked content!


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  • Birthday 10/10/1952

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    Blood Bank Manager

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  1. Ditto. We haven't 'split' a unit for a non-neonate for over 20 years! I agree with the above ... we'll just state what we do if we ever do get an MD who requests a split unit. I'd only add that the usual approach is for the MD to instruct the infusionist to 'Transfuse over 4 hrs.' vs the usual transfusion rate of 1.5 - 2 hrs. Eventually, hopefully, the CAP Checklist Team get the message that splitting the unit is not the only answer and shouldn't be unless it's done often enough to maintain competency, etc.
  2. Devil's Advocate Asks: If we establish that the reason for the reactions in the backtype are due to cold agglutinin(s), why are we pre-warming ABO tests? Pre-warm = 37C reacting antibodies. If this is a valid alternative to RT/I.S. Crossmatch, then shouldn't we be performing an Extended Crossmatch (37C to AHG) to look for the IGG versions of the ABO Antibodies? Simple Answer: Immediate Spin Crossmatch: If due to cold agglutinin (other than ABO) = Compatible by Blood Type.
  3. Postpartum: Type and Screen (Pretransfusion specimen) upon admission to the Delivery/Labor Room. We do not repeat the Rh Type or Antibody Screen if an RhIG injection is needed but a KB is done (post-partum specimen) to determine the dose. Antenatal (28 week gestation dose): Rh Type + Antibody Screen Miscarriage/Abortion: Rh Type Emergency or Other Indications (Pregnancy): Rh Type + Antibody Screen, but we will issue RhIG if needed asap with only the Rh Type done. AS can wait. We still do the Antibody Screen because it is good documentation that will likely answer questions later, like 'Is this patient producing Anti-D or is this the RHIG injection she got a month ago?' As far as the MD is concerned, they rarely care about the AS result, e.g. we've reported an Active (as opposed to Passive) Anti-D and they still want to give the RHIG, so it's good documentation for that, too.
  4. 2+ is the only result possible as you have a mixed cell population in the tube now (patient/donor + check cells). The definition of a 3+ and 4+ is a clear background = not mixed field. And 1+ is just too weak, something is wrong.
  5. We take the temperature of the unit when it is returned no matter how it was sent. This has become an issue here in the US and the FDA considers these units 'in storage' if they are not moving so the restriction is 1-6oC.
  6. We use Sunquest as well. Our MTP does not drawn anything. All it does is print the order in Blood Bank. The BB Staff orders what is needed (Prepare Orders, etc.) and informs the provider IF a BB Sample is needed (often times we already have a sample). I suggest you get the order for TS out of your MTP order. We, too, put MTP on 'Downtime' protocol. Our Unit Tags are 3 parts: White Top copy, Yellow middle copy and card stock back copy. When issuing blood 'routine', the white top copy is discarded, yellow copy is kept in BB and card copy stays on the unit. For 'Downtime', the white copy stays on the Unit Tag and they use this for their dual checks, etc. Message me if you'd like more information.
  7. No, because, unlike tube testing, you cannot spin a gel test twice. Part of the calibration of the gel test, aside from the pipetting 'exact' amounts, is 'this is how far the cells migrate through the gel beads at this speed for this period of time', i.e. second spins cannot 'count' because to do so, you have violated the requirements of the test.
  8. Under routine circumstances, we do not prepare an eluate from positive DAT cells from a neonate because identity of the antibody can be determined from the mother's sample. Of course, if a neonate with a Positive DAT arrived without a mother, no maternal sample, or from a Group AB mother with a Negative Antibody Screen, we would likely prepare and test an eluate to aid the pediatrician with his/her care plan. (For the latter case we would request a sample from the father to determine if the mother is producing an antibody to a low incidence (aka private) antigen passed on to the infant by the father.) But, that's a whole 'nother conversation!
  9. Given that the BB/BB Medical Director has the knowledge and background to determine transfusion safety and is responsible for blood transfusions that the MD's order, we simply wrote our policy. Yes, sometimes we get questions from the infusionists, but the BB Staff can easily answer them.
  10. We haven't used "Post-Storage Leukoreduction" (aka Bedside Leukoreduction Filters) for many years. Search the literature and you will find that they are essentially useless. Leukoreduction is accomplished by adhesion, not size so effective reduction is dependent upon the activity of the leukocytes. Once they 'die' and breakdown during storage (a few days), they won't adhere to the filter no matter how old the unit is. In addition, the by-products of their breakdown, which cause reactions, are now released into the plasma and there are now leukocyte fragments floating in the plasma which could result in reactions caused by pulmonary filtration of these particulates or sensitization to their HLA Antigens. Bottom Line: Leukocyte reduction is effective when performed shortly after donation while the leukocytes are still viable and will adhere to the filter.
  11. We use them and do not plan to discontinue. Too many reasons why!
  12. WOW! CONGRATULATIONS! It's a well deserved honor!
  13. True, David. FDA in action: We got cited during an inspection a few years ago and had to switch our Auxiliary Blood Box (aka Cooler) temperature limits from 1-10C to 1-6C. Someday, they will straighten this out (why the two limits?), but until then, we are stuck with it ... here in the US, anyway. What is the rest of the world doing?
  14. If I remember correctly, D-neg RBCs are also LW Positive and with a strong Anti-LW, you may not see any difference. More so that this is transient.
  15. Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) : Select Product in this order ... Indated product using shortest outdate first. (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.) ABO Group: ABO compatible are preferred but not essential. (And then there's a chart because it is a procedure and that has to have everything in it.) Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist. Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period. Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated. (And then instructions about how this is done and documented.)
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