jayinsat

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.

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!
 

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.

We have for IgG XM but not IS.  The latter is very fast in tube and we don't do it except during computer downtimes and some rare occasions.  We use the electronic XM for most.

Wow, reading the challenges my American colleagues are having!  I thought it was bad here in Ontario, Canada.  The hospital laboratories here generally pay the same - unionized or non.  And we don't generally have any sign on bonuses outside of working in the North, although I have been hearing some nursing/physician incentives.  And I don't think I have ever heard of travelers here.
We are starting to get creative with scheduling (looking at 12 hour shift models) and using more lab assistants to do work that does not require the MLT (or lab scientist in the US).  Even in the blood bank.  People are tired and burnt out.

We have had several openings for many months.  One problem in this tourist town is that no one can afford to move here.  We have 3 travelers in the lab in our hospital and several more in our smaller hospitals.  One tiny rural hospital in our region has zero lab employees--only some travelers and a respiratory therapist trying to supervise the lab.  We have been sponsoring lab assistants and other current lab employees to take online MLS programs for a few years so we grow our own, but we don't have the bandwidth to do the clinicals for more than a few per year and that won't fill all of our positions.  The next few years will be rough as the college students who may have taken a pause going to or through college in the past two years will slow the pipeline of outcoming new grads.  And this is a smaller generation than any before.  I suppose the peak of boomer retirements may have happened already but there are still some of us left.

WOW just WOW!!!  Although I new it was bad everywhere reading all your comments is so disheartening.  Before COVID started the state of CA was already talking about using nurses in the lab with no requirement for the post graduate training we all had.  This didn't go through.  But I also understand CA gave CLS licenses to international physicians without a training requirement.  So these staff come in and have clinical knowledge but know nothing about laboratory work.  This means we're now basically training college graduates that have no laboratory experience which takes significantly longer to train and with no experience they have no self-confidence.  It's really quite horrifying.  

We are seeing the same issue in our rural hospital lab (170 bed hospital). Using a traveler on evenings and one on nights right now, 3 open positions with 2 more resignations expected before the end of the year. We offered to 4 students who trained here - no takers. All of them are off to the bright lights, big city and sign on bonuses.

We are also experiencing this.  My system isn't offering sign-on bonuses for technical staff but up to $30,000 for acute care nursing.  Our lab has at least 12 vacancies on 2nd shift and similar for 3rd shift.  1st shift technical staff are working incentive contracts for bonuses  - double shifts for some or weeks without days off - and are burning out so morale is at an all time low.  Retention of staff is a big problem.  My lab is staffed by long-term staff - all the recent hires (within last 4 years) have quit - gone to school, out of the profession completely, gone to other facilities that are closer to home and pay more, gone to other labs that pay more for less work stress.  We just started hiring travelers for some of the technical positions and phlebotomy because there just aren't applicants for full-time, permanent positions and the pay just isn't enough and there are so many vacancies - definitely a buyer's market for lab staffing.

We are experiencing all of that.  
The fact that my hospital refuses to even think about sign on bonuses makes it even worse.  The hospital down the street has an $8-12K bonus and their benefits and pay were already better than ours.
I saw a few weeks ago that a hospital in Philadelphia is offering a $20K sign on bonus.

We've had staffing issues (CLS/MT less so with MLT) not just in the blood bank but the entire laboratory.  With COVID on top of retirements, we lost a lot to the COVID testing in our MDL and they haven't come back.  Plus we are increasing in acuity and volume of patients to the point we're now trying to increase staffing on all shifts.  We have 3 travelers right now, with one working for us for many years (night shift is the hardest to fill) and 2 newer travelers that have just renewed their contracts.  The younger people don't want to stay in the same place, they like being able to take as much time off as they want when they want, and they like the money.  I know COVID hasn't helped but I think the problem is more the fact there just aren't enough CLS/MT's out there and there's no schools anymore that you can get a BSMT vs science BS (like biology) + post grad training.  Most of us in the lab aren't vocal enough at the state and national levels like the nurses and RTs (glamor jobs of the hospital) to get the word out that lab is necessary/required and we don't have support.  There is a CLS program in our area but we're so short staffed we can't bring in the CLS trainees because we can't even staff without supervisors and technical specialists on the bench as it is.  

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!
 

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?

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?

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?

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?

Hi Malcolm,
What terminology is recommended in these situations? We have always used "least incompatible" in the states. I think, probably, the majority of our databases have that option listed besides "compatible" and "incompatible." What terminology should replace "least incompatible?"

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.

To emphasize Exlimey's point: 
"One event does not indicate a trend - changing the whole system to address a single cut-finger incident is unreasonable". Also of concern is the use of plastic, who knows in the near future if this will be available in test tube form in abundance? We need to look at how and why this accident occurred? Everything in our lives cannot be padded so we don't fall, trip, get our feelings hurt (sorry had to add that), or get a cut. I know it's very serious to get a cut from a blood-contaminated item but I personally would look at what is reasonable and prudent. I know we have 'seasoned' techs on this site, probably 20-30 years in the field that would think it strange for that incident to happen, I would think getting a cut from grabbing "clean" tubes from the dispensary would be more likely because you are grabbing a bunch of tubes but normally you grab tubes with samples in them (contaminated tubes)  from either the centrifuge or tube rack and can clearly see what you are grabbing. 

@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.

Excellent. It's not often that the IFU comes to our rescue.

I did check our IFU and they did specifically state to use glass tubes.  No more arguments.

@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.

This issue - the switch to plastic - seems to bubble up every few years (pardon the minor pun). When I was a puppy in my early years, last century, labs were already tossing around the idea to avoid potentially dangerous, sharp glass tubes. When broken, the plastic used for test tubes is also sharp, possibly worse that glass, as Malcolm suggests.
As others have mentioned, static is always an issue with the plastic version, rather than occasional with glass. Other than that, and in my experience, plastic test tubes tubes work almost as well as glass for serological testing. However, many "tube reagents" are not formulated for, or qualified in plastic. The Directions for Use/ Package Inserts may be restrictive.
Two points - personal opinion of a cranky old man:
1. One event does not indicate a trend - changing the whole system to address a single cut-finger incident is unreasonable.
2. The various safety apparatuses (however they be mis- or confusingly named) exist to limit institutional legal liability, i.e., prevention of legal action ("please don't sue us"). The workers' actual safety is often secondary.

Ah, inform them that by their logic; phlebotomist's should not use needles due to the many unintended sticks in hospitals each year