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Posts posted by jayinsat
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Though it's not FDA, this webinar was put out by CAP and may be helpful addressing issues of data security and ways of submitting.
https://www.cap.org/calendar/virtual-cap-inspections-two-laboratories-shared-perspectives CAP Virtual Inspection Webinar
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What methodology are you using? Are you using tube reactions, Gel technology, or solid phase?
If tube, what enhancement medium: PEG, LISS, Albumin?
My vote is for an auto antibody, either cold or warm. I would doubt that these are antibodies against high frequency antigens showing up in the proportions you describe.
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Hopefully ARC will change their policy and allow you all to stock CCP. That was a life-saver for keeping up with the orders. We fill orders within minutes now instead of days.
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On 12/30/2020 at 9:14 AM, MAGNUM said:
ARC does not allow stock supplies of the COVID plasma.
On the somewhat same note, how do you take care of your AB patients when the blood center cannot or will not supply AB convalescent plasma?
We do not use ARC. Our supplier is South Texas Blood and Tissue Center. They have done an excellent job recruiting donors and have an abundant supply of CCP. As for AB units, they have been able to keep up with the demand. Only once during this pandemic have we needed to give A to and AB. That is how we would handle the situation if necessary.
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When the FDA issued the EUA on August 23, 2020, we started stocking convalescent plasma in house from our supplier. We fill the orders once they come in. Before that, it was a pain.
Are you able to make a stock order with ARC for, say, 5 O's, 5 A's, and 2 B's? Our supplier prefers it that way here in South Texas.
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I just finished listening to this webinar. Excellent Job @Malcolm Needs. Your south London accent was not at all distracting and your presentation of the material was sufficiently thorough and relevant. Hopefully I get to meet you face to face one day.
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On 11/30/2020 at 9:38 AM, slsmith said:
thawed cryoprecipitate is to be stored at room temp for 6 hours.
The product under question was thawed FFP, not thawed CRYO.
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I just saw this seminar being offered by Bio-Rad with our own, infamous, Malcolm Needs as the presenter. I registered and thought I'd pass the word to all of us here. Here is the link:https://info.bio-rad.com/ww-IHD-transfusion-w-registration-lp2.html?elq_mid=48765&elq_cid=10201434&elqCampaignId=30837&utm_campaign=30837&utm_source=eloquaEmail&utm_medium=email&utm_content=Email 13ER EM-R-CM-385201-FY21-TCHS-AWEN_BR-JRNL-TRF News 19 Nov&elqTrackId=6ecbbea5f2bb46849981687404578a8e&elq=7c5f74470efa434dbd4351e512f7ae7a&elqaid=48765&elqat=1&elqCampaignId=30837
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17 hours ago, lef5501 said:
We recently had a situation where the physician ordered Irradiated units on a new patient through CPOE. He placed a comment in CPOE in all capital letters to give Irradiated units. Even with the comment in all caps, we had 2 techs miss the fact that he wanted irradiated. It was a new patient to us so no history in SoftBank. We now need to figure out a way to make sure it does not happen again. Does anyone have anything in SoftBank that may work that is not a manual process, such as us just adding the Irradiated into the history once the physician orders it. I don't know how 2 techs missed the all caps comment but here we are. How does everyone else make sure they don't miss special product needs?
The age old problem of how do you make people pay attention to the details...If you figure this out, let me know. I haven't yet.
Do you not have an "IRRADIATED RBC" product in your dictionary that the physician could have chosen? That puts the responsibility on them, where it should lie. A comment is not an order and, if they are relying on that, they are forcing your techs into a position of failure. I would suggest you add an irradiated product order to your dictionary. If the physician wants that product, they must order that product that way.
- Henrique, John C. Staley, Ensis01 and 2 others
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20 hours ago, exlimey said:
This scenario doesn't explain why the donor red cells react with the serum from most patients. For this to be a "low incidence antigen" issue, ALL of the patients would have to have an antibody to (probably) the same low incidence antigen. That is very unlikely. As Malcolm suggests, this sounds like an abnormality of the donor's red cells.
I believe Hemo bioscience have a lectin kit, but it may only be available in the USA.
Yes. I missed that part about it being crossmatch incomplatible to other normal donors.
I would definitely return the unit to the supplier.
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I would suggest running a select panel of low-frequency antigens against your patient's plasma (V, Cw, Jsa, Kpa, LUa, Bga, Ch, etc). If the patient has one of those antibodies, the antibody screen would still be negative and, likely, so would your panel if there is no positive cell included. The unit may have the corresponding antigen. I have seen this several times. Since we don't routinely do serological crossmatches in the presence of a negative antibody screen, these antibodies are normally not found until a transfusion reaction investigation.
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The current COVID crisis has exacerbated the ongoing issue of the shortage of technologists in the field. In San Antonio Texas US where the virus is peaking, our systems are strecthed to the limit and many of our techs are burned out. Most of our techs are 50 years old or older and just can't work anymore hours. The younger ones are doing as much overtime as possible but they are complaining. We cannot fill any new positions because, frankly, there is no one. Is anyone else experiencing increased staffing issues highlighted by COVID?
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On 5/18/2020 at 2:46 AM, diplomatic_scarf said:
We got a blood sample for ABO/Rh and Antibody screen testing.
Results:
Forward typing:
Anti- A : Negative
Anti-B : Negative
Reverse typing:
A1 cells: 4+
B cells: 4+
Antibody screen and auto-control:
Cell 1: 4+
Cell 2: 4+
Cell 3: 4+
Auto-control: Negative
Patient is from Mumbai.
What is the patient's Rh type?
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What is the patient's transfusion history? Did you perform a DAT or elution? These tests need to be done next.
My initial thoughts are you may have a warm autoantibody and, if the patient has not been recently transfused, try a W.A.R.M. adsorption. What enhancement medium are you using? Try to run the screen using a different enhancement (ie LISS vs PEG).
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At our facilities last week, we implemented a temporary "no return" policy during this COVID crisis. Only exceptions are those issued in ice chest to O.R., massive transfusion, or ECHMO, provided they are not COVID patients or patients under investigation. The nurses have become much more compliant with completing the pre-transfusion checklist before picking up the unit as a result.
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On 10/24/2019 at 5:14 PM, chupert said:
I am considering getting my master's and was looking for input. Has anyone been through GWU master's in immunohematology and biotechnology program or UTMB master's in transfusion medicine? I am also considering a more general master's in CLS. Thanks for any info you can send my way.
UTMB is an excellent program. I have not been through it but, living and working in San Antonio TX, I know many CLS and SBB's that have. I considered it myself but decided to go a completely different way and pursue ministry, earning my M.A. in Theological Studies and working on a PhD now.
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Our supplier is looking at adding a COVID modifier like CMV to existing plasma products. Thant was the direction they were leaning in our conference call yesterday.
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On 2/3/2020 at 8:08 AM, Ward_X said:
How does your facility comply with the newer AABB standard 5.16.2.2? Wouldn't compliance with having two determinations of an ABO group prevent erroneous admission?
We are not AABB accredited. Only CAP. We do, however, comply with the two determinations of blood type. My point is, we would never issue plasma products based on historical blood type ONLY. We require a current blood type on that admission before plasma products can be issued to mitigate the risk of erroneous admissions due to name similarity.
sorry for the late reply.
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This may be a silly question but are you sure the patient was treated with DARA (CD38)? Could they have received the new CD47 drug that is not neutralized by DTT?
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We require a current ABORH for all plasma products. The reason is not because of the possibility of a blood type change due to bone marrow/stem cell transplant, it is because of the probability of an erroneous admission. Every facility I have ever worked have had instances where admitting has registered a patient as someone with a similar name or merged a record with a similar name, resulting in an inaccurate blood type on record. We mitigate that risk by requiring a new blood type each admission before giving plasma products. Once the type has been verified, we will issue plasma products until discharged, regardless of how long ago the type was done.
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I just answered this question.
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My ScoreFAIL
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On 7/26/2019 at 5:13 PM, LabLion said:
Thanks all for the good discussion.
I would like to point that STRAC is NOT a transfusion related service, and their data is primarily based on outcomes of ambulance and air care patients. How many of such patients have hemolysis, and morbidity related to all things Dr. Blumberg points out, is neither studied OR reported properly.
Secondly, I believe (I may be wrong
that STRAC is involved in and researches whole blood transfusion in trauma settings. Whereas we are talking about using whole blood in in-hospital and L&D settings which it totally different and uninvestigated.
Hence, I used the words "extrapolation" and "assumptions" at the begining of this thread. What I meant is, STRAC is extrapolation data from Military, and Hospitals are trying to extrapolate from data from Ambulances and fire fighters.
Lablion
You are absolutely correct Lablion, which is why our transfusion services medical director put the brakes on our implementation just last week.
From our perspective, it seems that the push to use whole blood after arrival at the hospital is to decrease waste and continue treatment with like product.
I want to underscore that pre-hospital whole blood use has been a positive change. We had a patient arrive by helicopter last night from a rural area that received 2 units of LTOWB en route. The patient would not have survived the trip without it and it turned what would have been a massive transfusion activation into a semi-routine (but emergent) transfusion.
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On 7/25/2019 at 7:23 AM, Neil Blumberg said:
I don't believe the word drastically is correct.
True for the first 14 days in CPD or CPD A-1 according to STRAC's literature. Our supplier go with a 28 day expiration and, with leukoreduction, even with at platelet-sparing filter, the platelet function (as measured by thromboelastography) is significantly diminished.
Keep in mind, these are the conclusions of STRAC and our blood supplier. We are not using it yet because of many of the concerns you and others have mentioned. What is being pushed is non-leukoreduced for longer shelf life and platelet activity.
that STRAC is involved in and researches whole blood transfusion in trauma settings. Whereas we are talking about using whole blood in in-hospital and L&D settings which it totally different and uninvestigated.
Retention of records for patients with passive Anti-D injection
in Transfusion Services
Posted · Edited by jayinsat
forgot to add something
We use MEDITECH MAGIC 5.6.7. Long ago, we started entering our Immucor Cell Panel lots into the QC function, along with the individual donor cell reactions. Over the years, our database has grown to where, every month, we only have to enter 1 or 2 new donor cell, out of the 16 on the panel, into the database when entering the new months donor panel. When we have a Passive D, we enter the cell reactions from the panel in the antibody ID field, which stores the reactions indefinitely in MEDITECH. That allows us to not have to keep the antigrams for passive D's. Everything is in the computer and easily accessible. BTW, doing it like this allows MEDITECH to calculate the antibody ID probability. It's a nice feature if you have the time to build and maintain it.
For all antibodies, we only keep the antigrams. Every other reaction is recorded and maintained indefinitely in MEDITECH and the ECHO backups.