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Posts posted by jayinsat
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On 7/18/2019 at 8:53 AM, LabLion said:
Thank you Ward_X, SMiller and Dr. Blumberg for your time and reply.
I Agree with the above: There is so much extrapolation and assumptions involved in the decision to use Low titer O group in Hospital settings. Like for e.g. the proponents are showing military data as evidence, but the military uses WARM Fresh whole blood. Secondly, data is about penetrative trauma and whole blood is giving at site or within the golden hour. Urban hospital settings are so much different. Third, the proponents claim success of programs at Utah, Pittsburg, Mayo etc. However, so many questions (see below) are unexplored or unanswered.
I agree with SMILLER about practicality of use. If one were to set up Low titer whole blood:
1). In which scenarios or patients would you use? (trauma or other massive bleed?, penetrative trauma vs blunt trauma, is there a time limit within which it has the best beneficial effect? What sex and age group to use for?
2) What titer is acceptable? IgM and IgG, whether the titers are done in viv from Patients draw or from the unit, whether the titer is historical or done every time the donor donates?
3) what anticoagulant is used for storage....whether titers should be different for different volumes of anticoagulant (dilutional effects?)
4). Leukoreduction?
5). Is old whole blood (>14 days) as beneficial as fresh cold whole blood (1-14 days) or as WARM whole blood?
Too many questions
But the most significant if wish to explore is, How to set up hospital criteria to issue whole blood?
Thanks again for you insights and time.
Lablion
South Texas seems to be the vanguard on this issue. It is worth time reading through their information at www.strac.org/blood. In response to Lablion's points:
Leukoreduction reduces platelet function drastically on whole blood therefore it is not leuko reduced.
Some data suggests that platelet function rapidly deteriorates after 21 days in CPD. However, STRAC's data shows the units are adequate up to 28 days with CPD-A1
Titers on our donors are < 1:250.
All of these questions were addressed in depth at the National Whole Blood Summit. I think we will all be feeling the push. I can tell you from personal experience, its use pre-hospital (ambulances, air life helicopters) have been very successful. By the time patients arrive, the transfusion need is minimal if at all! Use in hospital is pretty much for to continue care and rotate out expiring units. Wastage has been > 30% when used pre-hospital alone.
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Does the patient have thrombocytopenia? Could they possibly be treating him for ITP using WinRho?
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16 minutes ago, Mabel Adams said:
Does anyone know of a remote community hospital (~250 beds) that is using WB for traumas that is not a satellite hospital for a level 1 trauma center? I just can't figure out the logistics for making the cost benefit ratio work here. We are 3.5 hours' drive from our supplier, transfuse an average of one "real" massive transfusion patient a month (one that uses over 6 units of RBCs) and cover a land area the size of the Netherlands (as I recall). The price for LTOWB is about 3X that of a RBC unit. Would it do any good if our helicopter carried 2 units of whole blood even if we didn't keep it at any of our hospitals?
Also, can anyone share their QC process for packing the WB to packed cells once it is too old to use as WB? You have to prove you get the right Hct at least a percentage of the time, correct? Does the packing process require FDA registration? It didn't use to.
Mabel, helicopter (and ambulance) use is the ideal place for LTOWB. The main reason we are even considering its use is to cut down on wastage. Without trauma center and other hospitals becoming a rotation site, LTOWB wastage can easily exceed 30%. Like you, the cost is the reason we have not moved forward.
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Here is a link to excellent resources regarding studies and risks for Low Titre O Whole blood. https://www.strac.org/blood. I think this may help answer a lot of questions.
Here in San Antonio, I have seen great results from pre-hospital (ambulance and helicopter) use of cold-stored LTOWB. Patients who have received units have arrived stable where, in the past, would have surely been an MTP activation. Our local trauma centers are using it, up to 8 units before switching to components. The results have been positive.
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Yesterday I attended the first of what I am sure to be many National Whole Blood Summits here in San Antonio. https://strac.org/summit/
If your facility or trauma surgeons are not already pushing it, be prepared. It is coming back. The conferences was excellent. The information and statistics presented was compelling. Low Titre O whole blood is coming (back) and will be the preferred product in traumas and hemorrhagic shock. Get ready!
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Considering the push to using Low Titre O Whole Blood for MTP and trauma's, i'd say the benefit outweighs the risk. I have personally seen two incidents where a panicked Blood Banker accidentally issued O FFP in emergency release situations. In both cases, the patients turned out to be incompatible blood types (one A one B). Guess what, there was no adverse effect whatsoever in either case. No sign of hemolysis or transfusion reaction weeks later.
- ANORRIS, Yanxia, Malcolm Needs and 1 other
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We are evaluating this as well. It will be an emergency release product only meaning no pre-transfusion testing. If our patients have a current Type and Screen or have already been transfused, they will not receive whole blood. We will stock O pos Low Titer whole blood that will be given to Adult men and woman >50, only for hemorrhagic shock. We do not receive traumas at our facility.
Currently, our EMS ambulances and helicopters stock the O pos Low Titer whole blood and administer it en-route. They do not do any pre-transfusion testing. Our trauma centers are the same. Whole blood is issued as emergency issue only without pre-transfusion testing. Post-transfusion monitoring for hemolysis is done per AABB recommendation.
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Reviving a dead post....
I am growing increasingly concerned about staffing shortages in the Blood Bank. I'm in Texas and most of our good techs are aging out of the field. It is almost impossible to find and experienced blood bankers that are not already working full time somewhere. Filling positions with techs that have blood bank or micro experience is HARD! New techs are not staying in the field and lack the experience to work alone. At 51, I am at least 10 years younger than blood bank staff on all shifts and am worried about filling those roles over the next 5-10 years. What are your experiences?
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I had been a MLT (ASCP) since 1991 and recently completed my Bachelor's degree. I have worked exclusively blood bank for the last 12 years. I wrestled with whether to take the BB (ASCP) or the MT (AMT). I went with the MT (AMT) because the hospital systems here in San Antonio prefer the more generalist MT level certification for supervisory and off-shift positions. My HR department said they would only be able to hire me at the MT level for BB only if I went that way. Having an extensive generalist background, I decided MT (AMT) was the best option for me. I used LabCE's Medialab practice tests and Patsy Jerreau's CLS Review to prepare for the exam. I studied about 2 months and passed first time around on November 30th 2017.
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We have always done our own calibrations. We use the PCS 2 system that is shared between our sister hospitals. It's cheap and easy to use.
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We just went live 3 weeks ago in 5.67. We chose to keep all significant except Cold-Auto, passive C,D,E's and Warm-Auto's with no underlying significant ab's. As has been said, the current antibody screen must be negative in all cases. We love it btw.
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On 10/20/2016 at 11:16 AM, exlimey said:
What do you mean by "validated" ? Have you actually validated your ABO grouping process?
Yes I have for both our automation and back up methods. Any methodology, or change in methodology, used in blood bank must be validated before it is implemented. That means, you must run tests using the new method in parallel with the old method and prove that it yields acceptable accurate results, sensitivity and specificity. After that initial validation, you only need to perform QC on a daily basis.
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I say change your SOP to match your practice, as long as it has been validated, passes daily QC and doesn't contradict manufacturers requirements. I don't know of any transfusion services that wash the cell suspensions routinely anymore.
- Gnapplec, tbostock and Kandahlawi
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On 2/28/2016 at 7:46 AM, ckuehnl said:
Negative and Negative. Patient isn't on TPN or any thrombocytopenia med either.
His confirmation type specimen was drawn at 6am and all negative- Ran fine on the Echo.
RN said both draws were in non-IV arm.
You state that the patient isn't on any thrombocytopenia meds. Does that include WinRHO or RhoGAM? Is the patient being followed for thrombocytopenia? I'm sure you're aware that WinRHO (which is ANTI-D) is a common treatment for ITP when the patient is RH Positive and has not had a splenectomy.
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We don't use anything in ours. Although we are a small 175 bed hospital, we do an inordinate amount of plasma exchanges here. I'm talking 3-5/week with a minimum of 3 liters each! With all that thawing, we are bound to have a unit break about every 10 days making us have to clean it out each time.
For some reason, our Heme/Onc prefers FFP over albumin for all his TPE's, regardless of diagnosis.
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What methodology are you using for antibody screening and identification? Is there a significant rate of unexpected positive reactions with this methodology? That helps determine how far down that rabbit hole I will travel.
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17 hours ago, tricore said:
I am missing something. What does pathogen inactivation have to do with irradiation? As a substitute?
Tricore, pathogen inactivation alters the DNA of pathogens AND lymphocytes, which greatly decreases the probability of Graft v Host. It has become an acceptable alternative to irradiated platelets.
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We had a situation like this recently. A patient was sent to our hospital from a near by free standing minor Emergency Room for direct admission and transfusion of RBC'S due to low H&H. The minor Emergency Room reported a hgb below 6.0. I don't recall the exact number. Normally, these orders aren't questioned and the blood is prepared as requested. In this case, the night shift supervisor, uncharacteristically, questioned the order and insisted the floor send down a new CBC for confirmation. The patient's Hgb was above 11.0!
That makes you question your policies for sure.
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It's been years since i've worked in a donor center so my knowledge of what goes on today is a bit out of date (1980's was the last time). What is done differently in the UK that allows hospitals and transfusion centers to skip the confirmation of the donor blood type? From my memory, each donor unit was typed by two separate technologists at two separate times before the unit was labeled with a blood type. Those results were also compared to historical records for the donor (if they weren't new). Is there something else that is done there? I don't understand how the donor facilities could be able to affect a change in this policy as long as they are in compliance with FDA, CAP, AABB etc standards. Wouldn't lobbying AABB and CAP be the way to go?
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I hate those things! If I could get rid of them I would. So few facilities are doing them still. Even our regional donor center stopped doing them. Most in this area are done in the physicians office.
That said, from my experience, the higher the pre-hct, the slower and more viscous the blood flow, which makes a normal gravity collection very difficult. Combined with poor veins, you have a difficult situation, even for the best, most experienced phlebotomists. I've seen large men with huge pipeline veins that were easy to stick but were impossible to collect a full unit with a normal bag. I truly believe it was the 60 hct that caused the issue.
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We have a patient with a history of Lua. According to our policy, if her screen is negative....
If the antibody screen is negative, regardless of whether there is a Lua positive cell on the screen or not, we would give AHG compatible XM units and never look back.
- AMcCord, AuntiS, Malcolm Needs and 3 others
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Why do they come in the two separate bags to begin with ?
A single donor platelet pheresis must have a final platelet count between 3.0x1011 and 6.0x1011 to be considered a full platelet dose. If the final count is, say, 6.1x1011, that unit can be split and made into two separate units. If the final platelet count is, say, 5.9x1011, the volume of the platelets and plasma may be too high to assure adequate oxygen exchange in one single bag but the count too low to make two separate units. Therefore, the unit will be separated into two attached bags in a closed unit to allow maximum storage but is still only 1 unit. Hope that helps AMYM1586
To all my BB Guru's here: If I am wrong, please feel free to correct my understanding.
- amym1586 and catchmenow51
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Pre/Post Implementation Analysis Form
in Computer Systems / Software / ISBT128
Posted
Have you reached out to your vendor? The vendor usually provides an excellent validation guide for this. At least Meditech and Orchard did. It has hundreds of scenarios that test the system.