Jump to content

jayinsat

Members
  • Posts

    360
  • Joined

  • Last visited

  • Days Won

    41
  • Country

    United States

Everything posted by jayinsat

  1. This is one of the biggest frustrations of my job, exactly as you have described it. Our Medical Director does not want to direct contact patients/family members. Some treating physicians do not want to take responsibility for this. I would meet with your director of quality and facility chief medical officer and get them involved by first helping them understand the FDA requirements. They can help educate treating physicians on their responsibility when they order transfusions. A lot of these physicians do not understand that this is a real risk. Perhaps that will tighten up some of their maverick blood ordering practices. I recently had one where the donor tested repeated positive for HIV. The patient is now deceased but did spend time with his family between the time of transfusion and his expiration. 2 years later, we are battling how to contact his spouse and mother, both of whom cared for him in the interim. We do not even know what primary care physician to contact in this case. If we did, I guarantee they will not want to cause that kind of alarm in the surviving family, possibly risking a law suit.
  2. At our facility (MEDITECH User), when we bring units into inventory, the LIS automatically orders a retype test (front type only) and generates a specimen barcode label. That is matched up to the unit and is placed on the specimen tube that is loaded on the analyzer (we use IMMUCOR ECHO Lumena). The LIS programs the analyzer just like any other patient specimen and results are transmitted back to the LIS when complete. This is a very efficient system. Have you considered that route?
  3. @rmilford, have you considered the DCLS program at UTMB? Since you are considering the SBB, which I think is worth the knowledge alone, you may find that the DCLS program will do the same and more, giving you a terminal degree. I anticipate the role of DCLS will become important in healthcare in the near future. It also opens up more possibilities outside traditional lab roles, including teaching higher education. Just another thought.
  4. There are several layers to this question. First, you will need a fresh O negative, CMV-, irradiated prbc available rather quickly. We are not small but we only transfuse neonates about 3-4 times/year yet we receive a fresh unit every Monday to use for emergency transfusions. If it is non emergent (say for iatrogenic anemia), then we order from our supplier a fresh unit with satellite bags sterile docked so we can continue to use that unit for future transfusions on that baby. The goal here is to limit donor exposure. You may not need to worry about that if you do not have a high level NICU. Are you aliquoting the unit into syringes? You will need a procedure and supplies for that. You need to meet with your Neonatologist and work out your logistics. Those are just a few things to think about. I assume you already have policies and procedures in place for this.
  5. I believe it is because the average time for the immune system to mount a primary response is 90 days. Therefore, if they have had exposure within that time, detection of a clinically significant antibody may not happen. Of course, transfusion and pregnancy are significant exposures that would elicit a primary immune response
  6. As far as I have been able to ascertain, unless your facility provides the units to the air ambulance, you have no responsibility for their crossmatching or transfusion. Those records should be kept by the donor services that provide them. Our ambulances and helicopters carry low titer O pos whole blood provided by our local blood supplier. When they are given en route, the EMS is supposed to give the record of transfusion to the Emergency Department staff, and that staff is supposed to forward one copy of it to us in the blood bank, along with the bag, so we know the patient received the unit (as it may interfere with blood typing). That, however, rarely happens. It is not until we have an ABO discrepancy (mixed field in the front group) that we begin to realize what happened. For your responsibility, it is the same as if a patient were given uncrossmatched blood at a remote hospital and then transferred to your hospital. The responsibility of the crossmatch and transfusion is on the prior facility.
  7. We use Mobilab so it pretty much accomplishes that for us with MEDITECH. However, with so many agency nurses and the incredibly high nursing turnover since COVID, we still have to contact the floor to inform them of the need for the specimen. Nurses have so many areas of responsibility to learn and master and, in many cases, are not given sufficient time to learn them, nevermind master them. Our agency nurses only get 4 hours of training before being assigned patients. That's 4 hours to learn MEDITECH, Mobilab, IMobile, Point-of-Care usage and access, Pharmacy Pyxis, Radiology, and everything else they need to interact with for patient care.
  8. I would be interested in knowing how many antenatal RHIG doses the mother received. While it is possible for RHIG to cross the placenta and cause HDFN, seems to be extremely rare. The probability increases with each antenatal dose. That said, I agree with you that the baby's own cells should have sequestered any residual RHIG in circulation though I probably would not change my policy. I would just document the deviations when necessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877609/
  9. If @Malcolm Needs doesn't know...nobody knows. Lol!
  10. yep. I've seen that too.
  11. @Okie, we started doing the whole panel (on the eluate only, not the last wash) because we had an elution CAP survey that had a Di(a) in it. The screen cells, of course, did not pick it up. It was an ungraded challenge but we decided in the long run to perform a full panel on the eluates in case an antibody against a low frequency antigen is causing the positive DAT. @AuntiS, I'm curious, why are you running Acells and B cells on the last wash? I understand the eluate but I do not see why you would need to ever run more than the screen cells on the last wash.
  12. Agree with @donellda. Running the antibody screen on the last wash is all that is necessary. It will show that there is no reactivity verifying adequate washing for the elution procedure, which is why you are testing the last wash.
  13. We had an over zealous infection control team (made up of 100% nurses) come to our lab last year making the same demand. We told them, in essence, we will not comply because the risk of injury from handling those containers were greater than the risk they were trying to alleviate. Furthermore, the risk of accidently confusing saline with formalin, whose containers look exactly alike, was to high when removing from the cardboard containers. In addition to that, we told them the man hours required to keep up with that would require additional FTE's, which would not be approved. They conceded and we continued on, business as usual. TJC does not really inspect labs that are CAP, AABB, or CLIA certified. Those organizations understand the logistics of the cubes and do not have a problem with it. Most infection control officers are nurses and think from the nursing perspective only.
  14. My guess is the reason your process is "a little over the top" is because, like us, we were cited for non-compliance with COM.30450 New Reagent Lot and Shipment Confirmation of Acceptability - Nonwaived Tests Phase II New reagent lots and shipments are checked against previous reagent lots or with suitable reference material before or concurrently with being placed in service CAP checklist item. According to this checklist you must do one of the following: Examples of suitable reference materials for qualitative tests include: Positive and negative patient specimens tested on a previous lot; Previously tested proficiency testing materials; External QC materials tested on the previous lot (eg, antigen testing kit controls, immunohematology antisera and reagent red cells) Control strains of organisms or previously identified organisms for microbiology reagents used to detect or evaluate cultured microorganisms; If none of the above options is available, control material provided by the assay manufacturer with the new test kit. For our regular antisera (anti-A, B, D), reagent red cells (A1 cells, B cells), we can prove that the new lot is tested using pos/neg controls used on previous lot in accordance with the first option. This is easily verifiable on both the analyzers and our manual recording of daily reagent rack QC. For Fetal Screen kits, we started testing the new lot against the controls from the old lot upon receipt of the new kit. This is in accordance with the first option, or using a previously tested specimen in accordance with the 2nd option. This is documented on a manual log. It seems to me that, primarily, the fetal screen test kit is where inspectors have caught us on this checklist item. Hope this helps
  15. We did this 3 years ago. We did a minimal validation. The reagents were all the same so you're only really validating the mechanical components of the new analyzer. Therefore, we did just enough to show that the new machines got the same results as the old in regards to blood types, antibody screens (no identifications), DAT, and crossmatches. I think we did 10 specimens of each representing each blood type.
  16. No here as well. Curious though, is there a standard or regulation that forbids autoverification in Blood Bank? I have always heard that it is not allowed in blood bank but why? Can someone point me to the standard? This question has come up where I work several times and I have always just said it is not allowed but can't say why.
  17. Cold-stored platelets are being used in limited situations in the US. To my knowledge, they can only be used for active bleeding, which FDA has loosely defined. Most hospitals are not yet using them because of this loose definition of "active bleeding" and reimbursement. Here are some articles: https://www.fda.gov/media/132379/download https://mrdc.amedd.army.mil/index.cfm/media/articles/2015/FDA_approves_cold-stored_platelets_for_resuscitation#:~:text=The agreement by the FDA,33.8 to 42.8 degrees Fahrenheit.
  18. I would report the crossmatch as compatible and recommend use of a blood warmer for transfusion. No further workup necessary.
  19. We use Immucor ECHO Lumena and, as of right now, it does not do the IS XM. If it did, I would absolutely validate and run them on the automated platform. The reason I say that is because of the staffing and competency issues we are currently experiencing and is forecasted to only get worse. I cannot keep consistent blood bank techs in the blood bank and the generalists, who are often new and weak, do not remember to do the IS portion. I am constantly having to remind them and perform the retroactively. Sure, I can write them up each time but then I would have no one to work the blood bank. Having that on automation eliminates the problem. I did the same with antigen typing, cord bloods, unit retypes, and anything else I could move to automation, simply to make it easier for the generalists. It also provides peace of mind and a level of safety, where I can go back and clearly see what was done. No more wondering whether they added plasma to the tube or not. Just my two cents.
  20. Finding and retaining competent blood bank techs post-Covid has become a real challenge. We have lost so many techs to retirement or travel agencies that it has created a logistical nightmare staffing the blood bank 24/7. There just aren't enough techs to go around. Those still working are all close to retirement (myself included) and are all burnt out. Is anyone else experiencing the same issues? The looming lab staffing crisis is now upon us. Help!
  21. Does the patient have ITP? Is it possible that she is receiving WinRHO (same as RHIG) for ITP? Does she have a low platelet count. I haven't seen this situation in several years but there was a time when patients with ITP who were rh pos would be treated with WinRHO (as long as they had their spleen). It would present as this very scenario you are describing. Another possibility is anti-Lw?
  22. My experience is a little different. We actually had a CAP inspector cite us for not performing qc (1 pos, 1 neg control) on our in lot, unexpired panel cells (Immucor Panel 16) with each run about 7 years ago. We have been doing it since. We only use the liquid panels when we need to rule out additional antigens that the ECHO (solid phase) panel did not exclude. Since we are going from solid phase to ECHO, it does make sense to be sure that the antibody does react in the additional matrix via controls. However, I still disagreed with the need to run a positive and negative control on an in date panel.
  23. Well...I just noticed this post is more than a year old. Not sure why it was revived.
  24. @DARREN, can you order partial sleeves from Ortho? Will they sell them in smaller packages? Another thought is, if you are part of a system, perhaps you can get your supply of cards from your sister facilities that use more volume. That would alleviate the wastage. Just a few thoughts.
  25. @Sonya Martinez, I also would like to know who it is telling you this. My guess is it is some infection control nurse during an inspection that has no idea about immunology, just following a checklist. I experienced that years ago and simply pointed them to similar information that @Malcolm Needs stated. I have always been taught that plastic tubes were not acceptable in blood bank for that reason.
×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.