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Sandy L

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Sandy L last won the day on November 11 2017

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About Sandy L

  • Birthday 03/11/1949

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    San Diego California USA
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    Clinical Lab Scientist
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  1. We've seen this same phenomenon in a couple of K negative patients over the years. Do you think this is like the autoantibodies that mimic an Rh alloantibody in a patient negative for the corresponding antigen?
  2. We print all transfusion requirements on the transfusion tag regardless if they are associated with a unit attribute
  3. When that CAP standard was 1st written it was worded differently and we interpreted it to mean that if there was no history for the patient, you had to have a disclaimer. At that time we implemented the disclaimer. We have a result field in our ABO/Rh test that we answer either "No ABO history found" or "Previous ABO in history". Based on that result the LIS woud automatically add the disclaimer to the "no history" patients, all patients, not just OB. After 1 or so years CAP revised TRM.40820 to indicate "add a disclaimer if history checks are not performed at all". We called CAP and were told that this was written for reference labs receiving samples from many different facilities and that did not do the history checks for any of their patients ABO/Rh results.
  4. We rotate diluents every 12 hours on the Visions, plus we have one bottle of MTS2 open in the refrigerator for manual testing. Diluent 2 is used more slowly than 2plus. We did have an issue where a bottle was in open and in use well over a month and it grew mold. We now check all of the bottles weekly and discard anything that is a month old.
  5. Perhaps there was confusion between training and competency. CAP requires training: TRM.40900, Blood/Tissue Sign-Out The procedure for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient. NOTE: A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the procedure is dispensed. Evidence of Compliance: Written procedures for the issue of blood components and tissue AND Written policy for the instruction of transporters on the proper handling of the product
  6. I interpret "Transfusion Requirement" to mean the PATIENT's requirement, i.e. "this PATIENT requires Irradiated products". Irradiation is a unit ATTRIBUTE. So you would need to print that patient requirement on the compatibility Tag/Label along with the other required patient information. Our tag (Cerner) would include both unit attributes and patient requirements.
  7. I just answered this question. My Score PASS
  8. We get about 800 cord samples per month. We test all cords for Rh Neg mom's and perform ABO/Rh and DAT (IgG) on the cord. If mother is O pos, we do ABO only on the cord. If cord turns out to be other than group O a Cord DAT is reflexed. If Mom does have a clinically significant antibody, we always perform Cord DAT. For all other mom's, no testing. We run all of our cord testing on Ortho Vision.
  9. I am looking at the Participant Summary for latest CAP proficiency, anti-D titer. For tube testing using the "uniform procedure tube method" that CAP suggests, they reported the following results: 333 participants, mode 64, consensus range 16 to 256. For Gel testing "uniform procedure gel method", 138 participants, mode 256, consensus range 64 to 1024. Per CAP, Consensus is determined by the Mode +/- two of the most frequent titers. It looks like in the previous 2 surveys for the gel anti-D titers, the mode for gel was 1 to 2 dilutions higher than tube, but so was the consensus range. It seems like there are a fair number of labs reporting gel and if you report that as your method you should be compared to other gel titer users. I would also think as more instruments are implemented that can do gel titers, the number reporting gel will go up. And of course what ever you do, perform method correlation and communicate with the obstetricians any changes they may see in titer results. We are contemplating this also. Also I am little confused by ""Do you want it to be faster and more hands-off or more exact?" It seems to me that automated titers in gel should be much more reproducible. We are just starting to look in to performing titers on Vision.
  10. We get our cords collected in a sterile Screw top tube, no anticoagulant. We've been testing on our analyzer for years now, 1st ProVue and now Vision. For some reason, after these clot and retract there is very abundant serum with lots of free RBC's. We just pull a small aliquot of serum and RBC's off, ream for clots (which are rare using this method) and then centrifuge.
  11. Thanks to Malcolm for your explanation auto-antibody with a specificity that closely mimicked an anti-K. Over the years I have seen a few patients that continued to elute anti-K for up to a year after the last transfusion.
  12. We place our limit at 12 group A for a patient with unknown blood type. Mabel makes a good point, by then the patient has been issued 12 group O red cells. We start thawing AB plasma after the first 12, but it's pretty rare that we don't have a blood type by then.
  13. We do the same as Kate, i.e. pull at receipt; would not like to try pulling segs from every unit during a Massive Transfusion episode. Each days segs go into a ziplock bag labeled with the date. We have a giant ziplock label for the month. At midnight the previous day's bag goes into the month bag and a new daily bag is created. The month bags are kept two months after the end of the month and then tossed so that the most recent segs are kept 2 months. It works well for us and we've never encountered a problem retrieving a seg for a delayed transfusion reaction investigation
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