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Posts posted by jayinsat
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From my main menu it is: "86: MANAGEMENT REPORTS" and "60: BLOOD TYPE/AB REPORT"
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According to the ARC Transfusion Practice Guidelines, if it the thawed pooled cryo is from a single unit ( which is what we have, the Cryo pool of 5) or units pooled using a sterile docking (FDA approved), it can be transfused within 6 hours of thawing. (Closed system)
Interesting. That seems to be in conflict with the AABB technical manual 16th ed. pg 958: "Prepooled Cryoprecipitated AHF may be prepared by pooling 4 to 10 units at the time of initial preparation.....Pooling can also be performed with the use of a sterile connection device. However, the expiration date cannot be increased when the pooling is performed with the sterile connection device. Prestorage pooled Cryoprecipitated AHF has an expiration time 4 hours once thawed."
I would love to be proven wrong on this. We changed from 6 hours to 4hours based on this manual and critique from inspection.
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We use MEDITECH 5.6.4. I download weekley the BLOOD TYPE/AB report. That gives me a complete blood type and antibody/marker/antigen history, overwriting previous info on the file saved the previous week. I usually put my begin date at 11/11/88 and end date today.
Hope that helps
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Hello to All,
My lab currently uses the ARC pooled cryo of 5. We dispense these products in a closed system so it has a 6hr expiration. What is your policy if the product is returned to the lab greater than 30min but within the 6hrs at room temp?
Curious: being that it is a pooled product, albeit prior to freezing, shouldn't it have a 4hour expiration upon thawing?
In response to your question, our policy would be that the product could be reissued and transfused as long as it was done prior to expiration. That never happens though. We usually end up wasting the product.
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I believe I was told that thumb drives, or any re-writeable drives were not approved for a number of reasons. One of the biggest was the possibility of introducing a virus in the software that could affect patient results and cause great harm.
Don't quote me on that
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Yikes! This IS the internet, isnt it!
Scott
TVC15,
I apologize for the tone and aggresivness of my last post. Emotional responses lend nothing to good academic discussion. I would simply edit or delete the comment but, as you can see, It would still remain under Scott's post. I also apologize for the negative light it puts you in. I'm sure you have a lot to offer to our career field and truly wish you the best. I hope this does not turn you off to this site or great group of people that contribute here. While I stand by my arguments, I am ashamed of the way I've made them.
Peace to you my collegue.
James
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agree to disagree.
I can't convince you that there are times when this practice has proven itself, even though I've seen it in over 25 years of experience. I don't need a study that proves what i've seen in practice. Maybe with a few more years of experience you will gain some wisdom that will give you practical application to your knowledge. I've seen 6mo old babies drawn whose platelet counts read on the analyzer 200,000 and flagged for plt clumps. All indicies were normal. Said sample was vortexed and reran, generating a count of 240,000. Indicies relatively unchanged. Do I restick this child? What benefit would it serve in said childs care? Consider the patient and families point of view. Even dropping the platelet values 100,000 would not affect treatment or diagnosis.
I'm done. Peace Sir. Train on and keep inquisitive. It will take you far, yet be willing to think outside the box.
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http://labmed.ascpjournals.org/content/32/7/361.full.pdf
This is the original study that led to the article you linked earlier. It is written by
Gabriele Mues, MD, Frank H. Wians, Jr, PhD, MT(ASCP), DABCC, FACB, and Steven H. Kroft, MD, FASCP
From the Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.
"1. Vortexing of blood specimens
has been reported to be successful incompletely breaking up platelet clumpsin approximately half of EIPA cases.10Either the entire tube or an aliquot ofblood may be vortexed for 1 to 2 minutesat the highest vortex setting withoutadversely affecting CBCparameters. A postvortex peripheralblood smear should be examined to determinethe efficacy of this procedure
before reporting the platelet count."
the study may have been performed in 2001 but that doesn't mean its outdated. I would venture that these individuals are intelligent and knowlegeable even if i'm not.
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LOL! I would take M.D. Anderson's long history of outstanding experience and accept it more than a M.T. who thinks that vortexing is the correct thing to do. Did you question who taught you to do this or just blindly accept it since everyone else in your lab is doing it? You never raise standards by being just a sheep that follows and never questions.
Additionally what sort of technical judgement are you practicing when vortexing no doubt breakes up RBC's and generatates cellular fragments...then you run this through the analyzer again and assume that the platelet count is actually only platelets that were counted vs. the fragments generated by vortexing?
Please show a link to the standards that support such a practice.
BTW M.D. Anderson did not say that they despsied it...they just could not make one ounce of logic as to why anyone would do such a thing.
Did you read the CAP article? "Based on these data, it seems reasonable to attempt to vortex samples as a first-line attempt to resolve platelet clumping." This is from CAP. I'm pretty sure that the people working at M.D. Anderson are M.T.'s. Theirs is just an opinion. The article, produced by CAP (I believe they are still reputable) says that in 50% of the cases it works. Here, i'll link it again:
http://www.cap.org/apps/cap.portal?_...geLabel=cntvwr
Again, we have to agree to disagree. I don't believe any harm is being done to the patient. I would argue that, at least 50% of the time, we are saving a patient from an un-necessary recollect.
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Excellent power point Mabel. I was trying to put something like this together. You saved me a lot of work!
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Thanks. I just realized that the version of Internet Explorer on our work computers are so old that there are a bunch of tabs that don't show up on this website. I pulled out my iPad and, there it is!
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can someone link it for me. I can't seem to find the "Library" forum and there is so many posts in Education that I can't find it there.
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Hi Mabel,
This was the only article I could find when I googled http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2Fq_and_a%2Fqa_0401.html&_state=maximized&_pageLabel=cntvwr
This seems to be a very outdated practice. M.D. Anderson Cancer Center is the most outstanding Cancer Center on the planet...if they were shocked as much as I was and others I have mentioned it to...then it can't be all that common today. Logically it just does not make sense to me especially when there are other means to resolving this.
You guys that vortex...did you ever consider that vortexing will break up RBC's and other cells and the bits that are broken off might be counted as platelets? Therefore you get a falsely elevated platelet count.
Typically, you vortex after you've run the CBC initially and found the platelet count to be suspiciously low. You simply compare the pre-vortex results to the post-vortex result and make a technical judgement as to whether or not the results are valid. This is another one of those scenarios where each individual lab, and tech, has to do what's comfortable practice for themselves. Just because M.D. Anderson despises it doesn't make it wrong.
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where is it?
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I have vortexed. It works
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Don't know how many in all of the 40 years that we have prevented an HTR (haven't been here all those years!), but I can say for the last 20 years or so.....I can think of 5 or 6 times we discovered that the patient in the bed was a different type than the blood set up. Mislabled samples are usually the culprit.
Each one of those incidents would have been FDA reportable errors since the wrong blood was sent out of the department to the bedside. How did FDA respond to these errors?
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We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.
Wow! Honestly, I feel this is overkill. As a patient (presumably, without a line) I would NOT want my finger stuck 4 times if I were getting 4 units of blood and the nurse was too slow to hang the subsequent units before the prior was taken down. This is especially irritating when you consider all the other times the patient is stuck for other lab tests. I could see doing this before the 1st unit is hung and that be the only time for that admission, but every time? Too much!
I would much rather use a band system or something to prevent abo htr's than this. I have worked in the blood bank for 25 years and have never experienced an abo htr either. Not one hospital has ever gone that far. The cost of the extra staff, in my opinion, outweighs the benefit. I'm not sure what size hospital you're in but in a major medical center, this will never work.
Just my opinion.
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The original idea of this thread needs every sample from every patient to always get a 'reverse group' (i.e. the first and every subsequent sample of any patent), is this the case? Also, where do group AB patients 'stand'?
From a practical stand point, you have to weigh cost/time vs. risk. Like John said, how would you know if an AB patient was immunosuppressed? Do you do further testing on every AB patient? The way antibodies against low frequency antigens (Cw, V, JsA) are detected usually is via a reaction. Should we crossmatch every negative antibody screen through AHG so as to completely avoid this?
Because the risk is so low in all these cases, consensus says proceed as if there is no significan alloantibodies.
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I'm glad I'm not the only one who thought those questions were poorly worded.
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I am an ECHO user and have seen a significant number of what I like to call "anti-ECHO antibodies". We have maintained gel as a backup for the ECHO. When we see these panagglutinins on ECHO, we repeat them on the GEL. If it is negative on GEL, we call the screen negative and carry on. The ECHO seems to have more false positives than GEL.
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That's right--TRALI is no big deal.........
TRALI? Isn't that what you ride in San Francisco?
:confused: Maybe you can have a TACO while you ride the TRALI.:cool:Anyway, dabigatran is not reversible so really, transfusion medicine should not even be involved in overdose cases. From my understanding, Dialysis would be the best option.
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The test you are referring to is, I believe, Verax, distributed by Fenwal. They've gained some ground trying to sell the product as an additional method to ensure patient safety (they have data showing that 1 in 15,000 (or some such) platelet products that tested negative at 24 hours, end up positive at expiration. So, they're trying to drum up some business.)
Most of my answers are guesses, but logically based answers.
I would imagine that this would be considered just like additional disease testing, but you could probably define it however you want ... and I would be it would be in addition to the initial platelet culture performed by your supplier. I don't know why you'd need to be registered to do an additional test like this - but it is sometimes difficult to apply logic to FDA decisions.
So long as you do not enter the product or compromise its sterility - I can't see why your blood supplier wouldn't let you return it for "fresher".
Seems like the easiest way to "keep track" of a test that needs to be performed every 24 hours - would be to start out your day performing the test on all products in your inventory so that you're then covered until the next morning. Sort of like morning QC.
Tubing sealers aren't really all that expensive (a couple grand) and you'd probably find that there are other things you never realized you could use them for ???
All that said ... I wouldn't start to panic just yet. Fenwal has been trying to gain momentum in the industry for a couple of years, and I don't see anything changing overnight just yet. It could still happen, FDA is very concerned with bacterial contamination ... but I think it will still take some time.
I was always under the impression that once you start making aloquots from units, which is what you'd have to do to remove a sample for testing, the FDA considers you a manufacturer, thus opening you up for FDA inspection/regulation. Using a sterile docker/tube sealer would throw you into that catagory wouldn't it?
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Read all responses previous to mine before replying, but I am wondering why not the obvious: Patient is Oneg. Antibody Screen Negative. You wanted to give him Positive units. Perhaps he had a previous exposure and had a weak Anti D? So crossmatches were positive? Like everyone else wonder if ABS done on tube instead of gel (less sensitive). Regardless I think its an Anti D.
Verify with enhanced ABS and ABID... But that would be my first thought. That and maybe Biorad D cells not strong? (Unlikely).
Good point Barbarakym! Seems like we blood bankers like to overlook the obvious.
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With every ounce of strength in me I would fight that transferrence of responsibility! Does pharmacy have to monitor clinical values and automatically send drugs when certain criteria are met? If a patients BP drops to below a certain value or Potassium level hits 2.5, the pharmacist doesn't automatically send dopamine and Potassium to the floor. It must be ordered by the physician and requested from the pharmacy. The same goes true for transfusions.
:confused: Maybe you can have a TACO while you ride the TRALI.:cool:
Return of Pooled Cryo
in Transfusion Services
Posted
There's a 28th edition????:-O