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butlermom

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About butlermom

  • Birthday 12/30/1951

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    Texas
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    Supervisor

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  1. This happens a lot at my hospital. How do you take the temp of the platelets?
  2. Wow, thanks Malcolm! I shall give this info to my supplier.
  3. We have a 63 year old female, never transfused, 4 children, generally healthy until a few weeks ago, who came in with a 6.7 hemoglobin. Our work up looked like a warm auto, so off it went to the reference lab. It’s not a warm auto. She has anti-Sciana 3! We tested 2 sisters, a brother, and a son and she is incompatible with everyone. Meanwhile samples are in process for MMA testing as well as a search of the rare donor registry. Her hemoglobin has dropped to 5.1 and doc wants to perform a bone marrow to try and figure out what’s going on. She also has a DVT that needs a procedure but doc won’t touch her until she can get some blood. The MMA results will not be available for another 5-7 days. We have 2 phenotypically matched (except for the Sc3) units that they want to give her under close observation (in ICU). I have read where there have been no reports of hemolytic transfusion reactions with this antibody, but that it may cause a mild delayed transfusion reaction. I’m trying not to lose sleep over this, but as I’m writing this I SHOULD be sleeping, so….. I do have a question about issuing the blood, IF in fact, we give it to her. We cannot issue it “Least Incompatible,” (which I don’t like anyway) because there is no warm auto. The units are negative by tube at 37 but 3+ at AHG. We have a Special Methods form which we mainly use for warm autos but there is a comment section which would include the units are phenotypically matched (except for Sc3), and a comment regarding the rarity of finding compatible donor blood. The form is sent with the blood when issued. It seems clear to me to issue the units as emergency release because we would knowingly be giving incompatible blood (and they can’t wait for antigen negative donor blood). Does this seem reasonable or is emergency release not warranted in this type of rare situation? I’m getting a little push back about wanting to do emergency release. Thanks!
  4. Mabel, That's a significantly detailed SOP, well written! How often do you repeat the workup on a patient taking Darzalex who is getting frequent transfusions? Since we're only transfusing phenotypically matched units in these cases, it seems we would not necessarily have to repeat everything every 3 days when we collect a new sample. We don't perform the Darzalex workup in house and would have to send it to our reference lab. It doesn't seem logical or feasible to do that every 3 days. Is there any guidance about how often the DTT treatment should be performed? Thanks for sharing your SOP. Kathryn
  5. Recently we had a pediatric patient with an allergic reaction to platelets. In this case, the reaction workup was completed in a timely manner, but the patient could not provide a urine sample until about 14 hours post transfusion. The urine was sent to Blood Bank and the tech called me to see if it could still be resulted as part of the reaction. I told him it seemed like that was probably too long, but since it was sent, to go ahead and test it. We don't always get a urine with the post sample, and certainly have never received one this long after the reaction. The tech asked how long after a reaction could we use a urine sample. Any thoughts on this?
  6. We are about to become the blood bank (and laboratory) for another hospital that is being built across the street from us, but is not part of our "system." Because of this we are going to register with the FDA. The other hospital will be storing a few O negative packed cells from us in an under counter refrigerator in their ER. My question is: When we get inspected, will the FDA need to go see their refrigerator? The reason I ask is that I am beginning the process of registration, but don't want to do it too early and have an inspection before the other hospital is open for business. Do I wait until closer to their opening to submit my application, or will the FDA likely not want to go see their fridge with my 2 or 3 units of blood in it? Thanks for any feedback! Kathryn
  7. I know this is an old post, but we are about to apply to become registered with the FDA, and I was wondering how long it takes after we submit our application to be notified of approval/registration.
  8. 6 months ago we had an Rh negative OB patient who delivered an Rh positive infant, and subsequently required 4 doses of RhoGAM. I'll also mention that we re-collected and re-tested to be sure. We also tested for weak D and she was indeed Rh negative. Her antibody screen was negative prior to her pregnancy. Now, 6 months after delivery and 4 RhoGAM doses, she is still exhibiting a strong anti-D. I contacted the manufacturer to see if they had any literature or information regarding how long the 4 doses could still be detected. They only sent me a link to some online information that I had already read! I know the half-life is only about 3 weeks, and everything I've read says it may be detected up to 12 weeks post injection. Additionally, we did a titer on the anti-D and it was 8, which leads me to believe this is an immune anti-D and not passive from RhoGAM since RhoGAM normally will not titer beyond 4. The physician and I have discussed it and the patient will be tested again in another 3 months. Has anyone had a similar experience? At this point my only explanation is that she could have developed the anti-D AFTER our initial testing and PRIOR to her 28-week prenatal dose.
  9. I get what you're saying, but remember, with the antibody screen and panel you are using sensitive methods to detect the presence (and i.d.) of a clinically significant antibody. The titer is merely measuring the "concentration," if you will, of the antibody in solution. They are really two unrelated attributes. We use gel method for screens and i.d., but perform the tube method titer in saline using the CAP recommended Uniform Method.
  10. It doesn’t appear that anyone answered this 4 years ago. I am at a level 2 trauma center, functioning as a level 1 in hopes of getting designated as such this summer. You’ve given me something to think about for sure. I do have a question about the second sample type prior to switching to type specific blood. We are about to implement this policy and I’m wondering, when and who draws your 2nd blood type sample?
  11. Our digitrax printer needs a software upgrade to be able to print the labels for the newer CCP products as well as the new platelet products that will be available soon. We have contacted Henry at digitrax and we have to have some sort of credentials to be able to do this. We are up to date with our registration for the ICCBBA database, so is it the same username and password that we have for ICCBBA? Thanks, Kathryn
  12. John, no, there were no temperature monitors attached. Also, our supplier says they cannot accept it back because it was transferred within facilities. I do hate wasting the units, however, I cannot 100% guarantee the storage conditions of the units during transport. Specifically, were they removed at any time for a prolonged period of time then put back into the cooler. As much as I hate to discard them, I believe the safety risk outweighs the benefit of keeping them. Thank you all for your responses.
  13. What do you do when you receive blood from another facility that comes with a trauma patient who is brought to your facility? The blood came in a Styrofoam cooler with the solid ice packs that our supplier uses in their red cell transport boxes. The units are from the same blood supplier that we use. Thanks for your insight. Kathryn
  14. I will add some info here to clarify our situation further: We do not have a helicopter. It is a local company that wants us to provide the blood to them and administration wants us to do this. If our blood is on the chopper but they pick up a patient and take him/her to another hospital, the patient would not be registered here and there would be no record of us giving the blood. Possibly we could have documentation from the helicopter personnel with patient info and the unit they gave and we could have some sort of quick-registration process on our side so we could at least show the patient received the blood in an emergency situation. I guess asking the crew to bring a sample back to us would be asking too much, huh?!
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