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Posts posted by jayinsat
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I like StevenB's answer. Like most above, we always do a screen first. However, A select cell panel that rules out everyting significant and includes at least 1 cell containing the antigen of the known antibody (proving reactivity), technically could be considered a "screen" could it not?
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In all honesty, there is no "one size fits all" answer here. It depends on how the facility operates. Smaller facilities that are staffed by generalists will differ than larger, specialized facilities. You have to do what works for your environment. Your procedures should clearly reflect what your facility does.
- Dr. Pepper, Baby Banker, Yanxia and 1 other
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We switched about 3 years ago. Our facility does not have OB or Pediatric services so the only time we see RHIG orders is from our Emergency Department on pregant females threatening miscarriage or trauma. Our physicians order an ABO/RH and, if rh negative, we perform an antibody screen and they request the rhogam through pharmacy via OE.
Our pharmacy generates a daily report on any patient who receives RHIG, Fludarabine or IVIG. If I see a patient on the report having received RHIG, I go and check to make sure we performed an Type and Screen and the patient was indeed a candidate. We've only experienced a few instances where the E.D. physician gave RHIG without first performing an ABO/RH based solely on the patients word that they were RH negative. Our Pharmacy is supposed to check to see if a completed TS has been recorded before dispensing the RHIG.
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What issues are you having? What lot is your indicator cells?
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Why would you dilute it?
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Our facility is strongly considering switching to the TANGO due to the high number of unexpected positive reactions we see on the ECHO. To now read that you are having similar issues with the TANGO unnerves me. I'm wondering if Solid Phase is in itself overly sensitive.
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jayinsat "When they come to pick up the units, the Blood Product Request form we use must have the physicians signature."
It seems like you have a two-step process, one electonic and one paper. I like the electronic part where the order gets entered and must be acknowledged. How long do they have to acknowledge the order? Is it easy to find when an inspector wants to see your process?
If they are having to sign the request form before they come to pick up the units then doesn't this duplicate the electronic order?
What happens to the signed Blood Product Request form? Do you save it?
Our physician and nursing staff want to get away from having to sign any hard copy/papers at all. They think it should be done as part of the electronic medical record (EMR). The problem is getting something that they (physician) can do quickly at the time or more likely something that can done retroactively once the crisis is past. What I want is something that is consistent so that it shows up in one place in the EMR so that when an inspector wants to see the authorization we don't have to look to see where the physician put their "signature".
The pick up slip is a "soft" requirement. We do not save that slip past 30 days.
The electronic order is easily reviewed under the review orders routine. When acknowledged by the physician, an "A" will appear in the acknowedged column. That happens pretty quick as they are always having to acknowledge telephone orders for all sorts of things.
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We use Meditech 5.6.6. and have switched to a paperless process. When the physician calls requesting uncrossmatched blood, an emergent CPOE order is generated by the Blood Bank staff which, according to our Lab IS staff, must be acknowledged by the ordering physician or privileges are revoked. When they come to pick up the units, the Blood Product Request form we use must have the physicians signature.
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No additional testing required. We would electronic crossmatch this patient with random units
We would do the same.
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For those of you you only charge the first patient, how do you efficiently keep track of when that unit was charged? I could see missing a lot of charges this way. Very few techs ever enter the charges at my facility, leaving that responsibility to the Lab Manager and myself. We usually retroactivily enter those charges a day or two later. I can't imagine how I'd be able to definitively recall if the antigen typing on those units had already been charged to another patient.
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We call this an "Anti-ECHO" antibody. We see this often and believe it is somehow related to the stroma process. We have no problem defaulting to the back-up negative results. We have wasted too much time, money and resources investigating these false positives. We have sent them out to our reference lab only to get back a report of " NO ANTIBODY DETECTED".
Since about March of 2014 ECHO has had a huge problem with false positives. Normally they are weak 1+ or ?'s but we have seen 3-4+ reactions across the board that will be completely negative in GEL (our primary backup) and tube with LISS. We have noticed that if the DAT is positive, expect all sorts of sporatic positives in the READY ID!
Just my 2 cents.
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We had been seeing this problem for several months, different lots and having to use our backup gel method and report those results. The last lots of screening cells we didn't call as we switching to the Provue.
Same here. This has been an ongoing problem since the summer. At the end of the lot, every antibody screen had ?'s. Very irritating. I clean the washer manifold every week and decontaminate twice/month. Still have this problem.
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We run Meditech 5.6.6 and use both eMAR and BCTA (Barcode Transfusion Administration). Implementing it was bumpy, mainly because nurses, (and people in general) don't like change. Almost a year into it now, and it is the best thing that has happened as far as documentation and Unit traceablility. There are some important steps that must be followed: Units must be scanned into inventory and not manually typed in. Unit barcode labels must be legible and accurate (ie: if you thaw a component, the new ISBT label must be affixed). There are a few other things, but it is wonderful!
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I have seen at least 1 delayed mildly hemolytic transfusion reaction due to Dia. That's is how it was discovered. Antibody screens were repeatedly negative pre and post. DAT postitive (IgG) post transfusion reaction. 1 cell positive on panel that was Dia positive. A few more Dia positive cells run from expired panels to confirm. Now we transfuse AHG compatible PRBC'S as antisera for Dia is not available in the USA right now to antigen screen. Not that we would antigen screen anyway because giving AHG compatible PRBC's is our protocol for these low frequency antigens.
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Almost impossible to call based on 1 image. Would need to see more to be sure. Some suspects: Malarial parasite (low probablility), degenerated neutrophil (how old is the sample?).
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Basicallly, a mini-panel is running the 4 cells with the "@" in the "SPECIAL ANTIGEN TYPE" column on the ORTHO 0.8% PANEL A panel. These cells are r'r,r"r, and 2 rr cells that, if all 4 are negative, will rule out all other significant systems homozygously. It is the same thing as running only the minimum number of rh negative panel cells to rule out all other antigen systems.
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What is her transfusion history? Recently transfused with O Neg? Not enough info given to go on.
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We run the DAT on the ECHO with the Ready ID panel. I set up a Ready ID/DAT profile for this. We only do Autocontrol if using our back up method.
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Have your LIS Coordinator change the setting. Ours is set to auto transfuse 24 hrs after issue for PRBC and FFP, and 8 hrs for Platelets. 4 hours for Cryo.
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This is taken from a CAP competency this year. I find it interesting that they seem to imply that vortexing the sample may be a valid tool.
2014 Pro Course: White Blood Cells
Identify non-white blood cell particles that may interfere with automated white blood cell counts and interpret general instrument flagging messages.
Particle Interference: Platelet Clumping
In many laboratories, platelet clumps are a more common interference with accurate WBC counting than NRBCs or lyse-resistant RBCs. Image 1 shows clumps of platelets in a peripheral smear. Platelet clumps in peripheral blood samples are most often due to preanalytic errors, such as inadequate or delayed mixing of the sample after collection. Platelet clumping can also occur in patients with antibodies that can bind to platelets and are activated by EDTA.
Image 1
Individual platelets normally shrivel and disappear when exposed to the lysing reagents used to obtain automated WBC counts. However, when clumps of platelets are present, the lyse used may not be strong enough to shrink these clumps to a size that will not interfere with the WBC count. This is especially true if the instrument uses a "soft" lyse. Analyzers that use a "hard" lyse to determine the WBC count are less likely to have inaccurate WBC results due to platelet clumps.
In extreme cases, the platelet clumps may be large enough that they appear at or beyond the feather edge, rather than in the body of the smear. The feather edge of the smear should always be examined when platelet clumps are suspected, i.e., WBC interference or an unexpected low platelet count. Image 2 shows numerous large clumps at the very edge of the smear.
Image 2
It is not always possible to distinguish WBC count interference caused by platelet clumps from that caused by lyse-resistant RBCs or NRBCs, as all three may appear at or near the same area on scattergrams and histograms. It is imperative to understand and correctly interpret histogram and scattergram displays on the analyzer in use.
Platelet clumps can often be dispersed by vortexing the sample for 30-60 seconds and quickly reanalyzing. However, if interference is still evident, an alternate method must be used to obtain an accurate WBC count, such as collecting a new sample with a tube containing sodium citrate anticoagulant.
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We purchased a digital Jewelry scale off amazon I believe. Was less than $50! It was precalibrated and comes with a calibration weight. Works perfectly. Looks the same as what the service techs used.
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So refrozen cow OK, refrozen turkey, not so OK.
I imagine refrozen fish would be even worse!
Scott
Well, the cow was not really "re-frozen". I took it out and cooked it when I noticed the door partially cracked and the food defrosted. The other stuff was later after I refroze it.
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I once left my freezer door partially cracked at home while full of food. It was that way for almost a week before I noticed. By the time I opened the door to get some steaks out to cook for dinner I noticed everthing had thawed completely but was still cold to the touch so I took out the steaks and closed the door hoping for the best for everything else. I cooked the steaks and they were fine. A few days later I took out some ground turkey and let it thaw in my refrigerator over night. When I opened the package to cook it the next day it smelled horrible, as did the rest of the meat that was previously defrosted and refrozen. I lost the entire freezer full of food. That's what my earlier comment was referring to.
Ortho Notification 7 Oct 2015
in Transfusion Services
Posted
This was the theoretical basis for reticulocyte harvesting with microhematocrit tubes when you wanted to phenotype a recently transfused patient.