Dr. Pepper

Kaleigh, whenever we encountered a specimen showing nice rouleaux I would gather all the old lab specs on the patient, pool them and freeze aliquots to torment future generations of students. You could also have your buddies in Hematology be on the lookout for them as well.

Sorry for the delay but I've been retired for 2 years and have not been hitting this site much. We would order the blood on a new accession number that also had a nonreportable test SAMPLE USED to record/trace the original sample.

Sigh - I guess I'll go bck to cleaning off my workbench in the cellar....

Although the baby seems to be doing well, it would indeed be nice if the father's cells were available to test with the eluate (and Mom's serum). Or you could have a reference lab take a look for antiboduies to low-incidence antigens. Identifying the antibody might also be helpful in managing future pregnancies which probably would have a 50% chance of the same serologic scenario. I would think that no clinical signs of HDFN are no guarentee that the next child would fare as well. And if nothing else, the ex-blood banker in me would just want to know what the darn thing is!

The accompanying quote was "Cute little s..ts, aren't they?"

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired! Doc1.docx

Thanks to all for the kind wishes. I have 1.6 days left to try to break people of the habit of leaving things on my desk. With no replacement in sight, it may take a bit for someone to do something about them. We had dinner last night with an old friend who gave me a nice bottle of pinot noir and a splendid T-shirt which reads: I AM RETIRED Don't ask me to do a damn thing I'm going to wear it under my dress shirt tomorrow and show it off at the obligatory retirement tea in the cafeteria. (I've always wondered why they give you a clock. I thought time was supposed to have no meaning when you're retired....)

Thanks Malcolm. I will certainly give Sue your regards, and definitely will drop in to the site. I plan on staying active in our local professional society for this year at least, will offer CAP my services for a couple of freelance inspections a year, and try for a couple of overseas volunteer gigs a year. Otherwise, it's time to spoil the grandkids, indulge in hobbies, and chip away at a honey-do list that's been accumulating for, oh, some 43 years..........

I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)

Just had an AABB assessment - her take on this subject was to follow the manufacturer's recommendations to the letter. If they say go one way or the other, go that way. If they give you options, then you can take your pick.

You have probably transfixed the vein, half in and half out, so the bag is filling but they're also bleeding into the surrounding tissue, as David suggested. Goodchild's advice about the shallow angle is right on. Your insertion should be like tracing a J that's lying on its back. Down and in to puncture the vein, then slide the needle a bit into the vein parallel to the arm. It's a big lumen to the needle and needs to be all the way in the vein.

Mollyredone, you are lucky indeed. And they trust you enough to input the data that you have found yourself! Our two local suppliers will gladly furnish you antigen-negative units - for a price, despite that they are undoubtedly going through a computer search of historical typings.

Yes to what everyone has said. We calculate the number of units you would need to screen, with average luck, and start with that. If we have bad luck and don't find enough, we recalculate and look some more. If we find extra units, we celebrate our good luck and buy a Powerball ticket on the way home. Our LIS doesn't really have a convenient way of making a digital worksheet, so we have a paper worksheet to record our results, and to copy from to enter results on the units in the LIS. We order the appropriate # of bill-only tests (as in Goodchild's x 27 example). We also record on the worksheet the spec # we billed on. If we were ever audited we could easily demonstrate why we were billing the 27 CPT codes. It's also an easy mechanism to review the results and to catch the wastrel who does the 20 K typings to find the one unit, or types for c and E simultaneously and finds a half dozen E(-) units that we can't use because they're c(+)......... Besides telling the LIS, we put stickers on the units indicating the typing results, and that the typings have been billed out.

Welcome back!

I'm sorry I missed it - I'll be 165 when it rolls around again.

You could always make your beef wellington look like this.....

And I have the utmost respect for you as well. I'm also not disagreeing with you, Anna, or anyone, I guess it's just a point in semantics.

I agree with all that it makes no sense. It does make sense for quantitative tests, like glucoses and platelet counts, are essentially the same from lot to lot. But testing new qualitative serology kits against the controls of the old lot and vice versa is pointless. That being said, this is interesting news because I asked CAP on 6/15 if we had to do lot to lot and they said yes indeed. Here's my question and CAP's response if you're patient enough to wade through it. ---- Original Message ---- Name: Mr. Philip Hoffman The customer sent us the following question or comment: Hi - I have a question as to how COM.30450 New Reagent Lot Confirmation of Acceptability pertains to routine blood bank reagents, many of which are approved by the FDA with a defined potency before release. Do you have to run new and old lots of reagent antisera, both routine (anti-A, anti-D etc.) and rare (anti-K, anti-Jkb etc), and antiglobulin reagents, together against positive and negative cells OR will just testing them against appropriate control material on each day of use suffice? How about reagent red cells, do they need to be tested against antibody-containing material or will routine daily QC suffice? Can they be tested against reagent antisera or do you need patient samples? Do panels have to be performed old and new lots against a random antibody? Thank you. Phil Hoffman Hello Philip, For COM.30450, the intent is to check a new lot and/or shipment of reagents before use in patient testing in order to confirm that proper shipment conditions were followed (to the best of the lab’s ability), and that the new lot of reagents gives the same results that your old lot did. This applies to all reagents, routine and rare. As COM.30450 includes below, external QC materials tested on the previous lot, and compared to the same material tested on the new lot, is acceptable. Reagent cells can be tested against an antibody of known reactivity; again the intent being to be sure the level of reactivity with your new lot is within acceptability to the reactivity of your old lot. Question: What does my laboratory need to do to QC antibody panel cells when they are received? Answer: Antibody panel cells are considered critical materials in a transfusion service. Laboratories must follow the requirements in TRM.312441 stating, “New lots of reagents and critical materials are inspected and tested, as applicable, before use, with documentation of acceptance”. The inspection of the reagent involves a visual assessment to check for hemolysis or signs of contamination. The findings must be documented on a inventory log or other quality control record. Quality control of a new antibody panel presents a challenge because it is not feasible to check the reactivity of each antigen on each panel cell. In addition, antibody panels have a short expiration date and many laboratories order multiple panels to ensure that they have sufficient selected cells available for ruling out antibodies. An antibody panel is an investigational tool used to identify the specificity of red cell antibodies and is never used alone when interpreting the results. In addition, laboratories follow defined rules for confirming or ruling out antibodies on the panel, including comparing the results from the panel with the patient’s antigen typing for the antigen of interest, the antibody screening results, patient history, and additional special studies when indicated. For quality control, the laboratory must follow procedures for interpreting the results and follow the manufacturer’s instructions for quality control, at minimum. While not ideal, the laboratory may also use the following processes to check the reactivity of the panel cells: - Confirm the reactivity of one or more panel cell using a reagent antisera or a dilute antibody - Select a known positive and known negative panel cell as the controls when performing an antigen typing - Run a panel with a known antibody prior to use - Since the red cell panel is an investigational tool to identify the specificity of red cell antibodies, labs can show that when they confirm the patient for the corresponding antigen and select a known positive and known negative panel cell as the controls, if the positive and negative cells react as they should, the lab would be satisfying this requirement. I hope this helps. Sincerely, Kathy Passarelli Technical Specialist, CAP

Which is why I'm retiring at the end of the month so I can stay home and still not get anything done.

No, Heather, it's why I can never get everything done at work! Phil

Some contests we've had over the years, fun but not particularly educational, with a prize for the winner: Match the employee with baby picture, prom picture, pet, parent, favorite vacation spot. Guess the # of candies in a jar (you win the candies). Various scavenger hunts. Hula hoop contests. Silly hat contests. We usually raffle off tote bags, coffee cups, duncan donuts gift cards, lanyards, pens, other swag from vendors and institution and virtually anything we can get our hands on. Each day has a food theme, funded by vendors, management, pathology, or the hospital: bagels, ice cream sundaes, pizza, lunch buffet, dessert pot luck (from the techs). We often coordinate a health fair with cholesterol screens.

That's what I was getting at.....but then, I got curious, and looked it up to see if it was actually true about water draining one way or the other. It turns out that in a perfect, static state of affairs, Coriolus forces can indeed cause the hemispheric effect, BUT in the real world those forces are vastly weaker than other influences at play and are overcome by variations in the shape and structure of drains and tubs, motion of the water in a basin caused by use or a slightly off center (which they all are) faucet filling it up, and so on. Hence it joins a long list of charming but untrue urban legends. There's an equatorial nation where, for a modest fee, you can see a toilet on the north side of the line flush in one direction and one on the south side flush the other. They're rigged.

They do fly but they spin around in the opposite direction.

We hired one last week for 3rd shift.

We also get a list of CPTs from the reference lab and pass them on to fiscal. But as AMcCord points out, whether your hospital gets paid for them or not is another matter entirely.