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jayinsat

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Posts posted by jayinsat

  1. This looks like a typical reaction due to an antibody against a low frequency antigen (like anti-Dia). This is how they are usually found. If you have the ability, I would run a selected cell panel on the pre and post using panel cells that are positive for Dia, co, V, LuA, KpA, etc. If not, send it to your reference lab to identify the antibody against the low frequency antigen. In the meantime, as you have already done, all xm's should be AHG.

  2. On 8/3/2023 at 9:27 AM, AMcCord said:

    Bet they will sooner than later as more antigen typing is automated. I was delighted when the DAT survey for automation came out, even if it is ungraded for now.

    Same. Are you doing both DAT Automation and DAT manual survey's? 

  3. On 7/27/2023 at 7:53 AM, Bet'naSBB said:

    We use Immucor's WBcorQC product....it was actually recommended to us by the service rep that installed / trained us on our VisonMax's .......(on the sly since it's an Immucor product) - but they work great!

    In the IFU it states the Rh phenotypes of each tube....and the types are consistent from lot to lot so you don't have to re-program your QC with every new lot.

    The kit contains 8 tubes (2 each of 4 controls.) good for about a month.

    Wow. Ortho does not produce their own qc material for antigen typing? We use the ECHO Lumena and the WBcorQC make that such a simple process.  I'm surprised Ortho does not make their own.

    Now, if we can just get CAP to produce their RBCAT proficiency testing vials so we can run them on the ECHO's. That would be great!

  4. On 7/10/2023 at 6:13 PM, Tympanista said:

    During a recent CAP inspection, my facility was cited for not having an annual competency assessment performed for the Blood Bank supervisor (me).  Our lab director completes an assessment each year stating that each supervisor is competent to oversee their respective department(s) and listing specific supervisory tasks that are assessed.  Shouldn't this supervisor assessment also be sufficient to verify that I am competent to perform testing in the Blood Bank?  It seems a bit silly to me that I am deemed competent to assess the competency of the rest of my staff, but I'm not competent to perform the same tasks myself.  I must have one of my staff observe me performing critical tasks, only to turn around and complete that person's direct observation myself.   I'm also the one who writes and grades the competency exams each year, but am I also expected to take the test myself?  Please let me know your thoughts on the subject.  Thanks.

    I have had the exact same concern for years now. This is a strange position to be in, especially if you are a manager who regularly works the bench. 

  5. 50 minutes ago, AMcCord said:

    We don't issue cards to patients with antibodies. I've discussed it with several of our medical directors, but none of them have been very enthused. They feel that most of the cards will be lost, forgotten about, or the info won't get passed on to us. Based on our past experience, I can't make a strong case. Our current medical director is a believer in Med Alert bracelets for the scary stuff.

    I've seen only a few cards, under the following scenarios:

    • A few times: nurse is checking out blood and says 'Oh, the patient showed me this card about an antibody or something. Did you need to see it?' YES, before you transfuse!
    • Twice: nurse has started transfusion and calls Blood Bank - 'Mr XYZ showed me a card about an antibody or something today (or yesterday). Do you need to see it?' YES, STOP THE TRANSFUSION!
    • and once, once only - as the patient was being admitted on the floor, the nurse called and said the patient had a card about transfusions - 'Do you want me to fax you a copy?' YES! Gold star for you!

    Sometimes I wish we could put a chip in the scruff of everybody's neck that had all that info loaded on it - allergies, antibodies, med history - wouldn't that be handy.

    I worked at a site that sent cards. Never did any good. For all the work there was no benefit. As for the chip...pass.

  6. 8 minutes ago, John C. Staley said:

    Just curious, do they want the documents sent electronically or hard copy?  Either way, especially since you referred to the request as a "big list" I would probably, respectfully decline.  I would indicate that the listed documents would be readily available upon their arrival.  But that just me and I never had an inspector request anything like this.  I'm sure things have changed since my last CAP inspection.

    :coffeecup:

    I agree. CAP had a HIPPA compliant process for this during COVID and it was a PITA (see if you can figure out that acronym ;)). Outside of that, I would inform them that all those records would be available upon their arrival.

  7. 21 hours ago, AMcCord said:

    Exactly what we do.

    There is one danger in this process, and I have seen it happen. Miscommunication between shifts opens the possibility of an expired unit being successfully issued because the expiration date in the LIS is different then what is manually written on the unit. If you are not changing the expiration in the LIS, you will need some sort of system in place (in policy and practice) that shows you mitigate this possibility. 

  8. 17 hours ago, RRay said:

    In the post-partum workup that has the fetal screen in it...  I've never seen the battery NOT include at least a screen as well.  I can't find any requirements for what it does or doesn't have to include.  Do you include a screen as well, or just the fetal bleed screen?  Am I missing some sort of accreditation checklist item?

    I am not sure I understand your question. 

    If the mother had an admission type and screen and was rh negative, then all that would be required post-delivery is the fetal bleed screen. Why would you want to repeat and antibody screen post delivery?

  9. You are in a tough situation. Either your facility will need to invest in a digitrax printer to print ISBT labels or you should not modify the component in the LIS, only manually change the expiration date on the face label and document the new expiration after issue and transfusion (or by comment). I do not like the former option. I would insist on obtaining an ISBT label printer if I were in your position. That is the cost of having a blood bank.

  10. 12 hours ago, Cliff said:

    Just be aware that dry ice turns into a gas.  I presume your freezer is not fully airtight, but it could open rather violently depending on how tight it is sealed, and how long since the last time it was opened.

    We have to open it to get freezer packs for coolers and thaw FFP so the gas gets dissipated a few times/day. Thanks for the warning though. I'll put that in my freezer downtime policy.

  11. All, I am about to blow your mind....

    Our plasma freezer is down and so is our backup. The freezer will not get colder than -18 C. I was preparing to move all the products into boxes with dry ice until I had a conversation with my 87 year old dad, a retired blood banker from University of Chicago. He said to me, do not take the plasma out of the freezer and put it in boxes, PUT THE DRY ICE IN THE FREEZER, IT IS THE BEST STORAGE BOX YOU HAVE!!!!:eyepopping:

    MIND=BLOWN!!!!

    I did that. Our freezer is currently reading -25.1C and getting colder. Furthermore, the probes in the freezer continually monitor the temp in the freezer so you don't have to record temps every 4 hours, the chart is doing that for you!!!

    Isn't that cool? That perfectly illustrates the difference between wisdom and knowledge there. I wish we could hire my dad.

    I just had to share this here.

    PS. Freezer is now at -26.4C.

     

  12. 5 hours ago, jojo808 said:

    2 units O positive trauma blood were requested and sent to the ER. After back from ER, found that the patient had a historical Anti-E while doing the history check. The ER MD was notified and after he found out that the workup would take 45min to an hour he said to continue with the trauma blood (Hgb 5.3, not sure of clinical condition). Hindsight, I could have said about 15 min to screen for E neg units but I didn't know if the patient had made new antibodies and was just thinking about the panels and identification. Anyway, 1 out of the 2 units was E pos (incompatible). The MD and pathologist were notified. Going forward, how long would it take for a delayed transfusion reaction (DSTR or DHTR?) to occur? What would you do for the follow-up for this situation? What should be done? Thank you in advance!!

     

    You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.

    Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

  13. On 4/10/2023 at 1:45 PM, JJSPLAYHOUSE said:

    @jayinsat, how is EMISS set up in Meditech? Do you have the dictionary parameters for the physician signature process? I would love to move our facilities to this.

    It is an orderable test. When it is ordered with the source "Emergent/Triage," it triggers the physician electronic signature requirement. With HCA, we have LIS coordinators that build these things. I do not know how to set up the parameters. Sorry.

  14. I think the only real option in this case is to place 2 units of O neg in a monitored fridge or validated cooler for emergency use only. We have MAX Q blood bank coolers which we validated and hold temp between 2-6 C for 24 hours. They could rotate the blood and cooler daily until they get a blood bank fridge to put in the ER. You will need to come up with a process for them to manually document the transfusion and provide notification to the lab when someone is on duty. 

    We have freestanding ER's (FSER) in our area that are not staffed with labs at all. All testing is POC performed by nurses. There is a blood fridge located there with 2 units O neg that we rotate regularly. That was our solution. Not perfect but it works.

  15. 20 hours ago, AMcCord said:

    We are using CH5214-18 from Cardinal - plastic, 2 mL, consistent drop size for Blood Bank. Had some trouble getting them for a while about a year or so ago, but not recently (knock on wood and rub my lucky rabbit foot!).

    Agree with AMcCord. We use Cardinal CH5214-18. 

    Question: why are you looking for glass pipettes? We were forced to stop using glass pipettes years ago by our infection control team (glass breakage/employee injury risk). We were able to keep the glass tubes because of the potential effect on antibody detection. I do not believe using plastic pipettes pose any risk though.

  16. Same as @AMcCord. We use MEDITECH and cold antibodies are listed as clinically insignificant in our rules table for determining if EXM will be allowed. For those who are panicking, note:

    1. EXM will be rejected if the CURRENT antibody screen is positive
    2. EXM will be allowed only if the CURRENT antibody screen is negative and THE ONLY antibody listed in the patient's history is a cold antibody.
    3. EXM will be rejected if any other clinically significant antibody is present, regardless of the current antibody sreen.

    That's how we handle it.

  17. CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.

    The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

  18. On 3/10/2023 at 4:43 PM, BankerGirl said:

    We are in the process of remodeling our Lab to accommodate an automation line and need to replace our decades-old lab benches and storage.  Has anyone done this recently that can give me recommendations on suppliers?  I should mention that we are in the US.

    Have you asked the vendor who is providing the automation line for a Six Sigma or Lean evaluation of your lab? They may be able to provide recommendations for furniture and storage.

  19. We order and perform ABORH confirmations as needed. 

    In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.

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