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About butlermom

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  • Birthday 12/30/1951

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  1. Our Reference Lab has informed us that a patient's sample we sent to them has anti-Dib (Diego b), anti-Fya, and anti-Jka! The patient is pregnant and due the end of July. All 3 antibodies are capable of causing HDFN, although usually mild from what I have read. My concern is if we have to transfuse the mother. The prospect of getting blood is problematic. Most likely the units would be frozen and our local supplier would have them shipped in already thawed and deglycerolized, plus the time of flying them here is a challenge with flight schedules to our area. From my reading the Diego antibodies are more commonly associated with HDFN than transfusion reactions, and anti-Dib typically causes mild HDFN. Therefore, my strategy is to have units that are at least antigen negative for Fya and Jka for the mom in case we cannot obtain units that are negative for all 3 antigens. If we can get units that are antigen negative for all 3 that's great, but the patient is not a scheduled C-section so the timing will be next to impossible. Any thoughts or ideas for a different strategy? Thanks for any input!
  2. butlermom

    Heat Blocks

    Does anyone know a vendor that sells a heat block that will reach a temperature of 120C? Our pathology department is looking for one. Thanks.
  3. Does anyone know if there is another company in the U.S. that distributes the plasma thawing devices, i.e. microwave? We have been wanting to order two more (we currently have one), but there is an FDA hold up on it right now for the device that comes from Canada. It has something to do with paperwork, nothing to do with the device itself!
  4. My hospital blood bank has only been in existence for approximately 11 and a half years. I have been the only supervisor for 11 of those years. During this time we have grown so much so fast, that it has been all I could do to keep up and stay ahead of inventory, procedures, staff training, competencies, teaching students, all while moving 3 times, designing and implementing the blood bank section of our LIS, bringing in and validating two generations of automation (8 years apart), and working the bench when needed. We are a CAP accredited laboratory and it has always been my desire for my blood bank to eventually become AABB accredited. Other than the prestige that it would bring, how might I justify the cost to my administration of the benefits of becoming AABB accredited? Even though we have the latest and greatest tools in our lab, I need to be able to explain why spending $$$ dollars on a voluntary program is a good thing. Thanks in advance to those of you who are AABB accredited and can advise me! Kathryn
  5. As for the signed Emergency Release form, we have always sent the original to the chart and kept a copy in the blood bank. CAP says that "records" of the emergency release must include the authorization of the physician; AABB says the "records" must contain a signed statement from the requesting physician, etc....... . Does this form actually need to be placed in the patient's chart or is our blood bank file a sufficient "record?" We are exploring the possibility of obtaining an electronic authorization and signature for emergency release. Thanks
  6. I am currently trying to implement this at my hospital. I do have a question for all of you at trauma centers: do you use the same form that the physician signs for emergency release as you do for an MTP? At our hospital many MTP's start out as emergency release, but we do have MTP's on patients in surgery sometimes and there's already a type and screen so no need to sign a form there. We are also trying to have the form in an electronic format that the physician will electronically sign. How do others handle Emergency Release vs. MTP? Thanks in advance!
  7. This thread is very timely as my hospital is a level 3 trauma center in active pursuit of level 1 trauma. (Yes, you read that right, we plan to skip level 2.) I am currently working with our trauma coordinator on an order set for MTP. She asked me just today if the emergency release form could be electronic with an electronic physician signature. We have always included the emergency released unit numbers on the form that the physician signs. Of course, this info is easy to obtain from our patient and unit history. After reading through this thread it seems reasonable that we really could eliminate this piece of paper and go to an electronic physician signature. I apologize for this being so lengthy, but I do have a question or 2– do any of you have order sets in your LIS for MTP? Also, in the midst of an MTP, how do you keep track of which “cooler” you are on? We give a plateletpheresis with every 6 RBCs and FFPs. Cooler 1 is 3 RBC & 3 FFPs, cooler 2 Is 3rbc, 3ffp, & 1 plateletpheresis (obviously not IN the cooler), cooler 3 is 3rbc & 3 FFPs, cooler 4 will have RBCs, FFPs, and platelet. My trauma coordinator is proposing to have this be electronic too, so that as soon as we verify the first order, it will reflex an order for the next set of products and so on until we get an order to discontinue. Does anyone have anything like this set up? Thanks for bearing with me. We have Cerner Millennium if you were wondering. Kathryn
  8. The topic came up recently regarding specimen collections from patients while the patient is receiving a transfusion. In general the phlebotomists will not draw a patient for any lab test while they are being transfused, but is this an unnecessary practice? Does anyone have any information or a reference that addresses this? We have no policy on the subject, but it seems to be what is currently being practiced here.
  9. Is there anyone with a Vision and Cerner Millennium who has upgraded to the new Vision software version 5.10 that was released in August 2017? If so, would you be able to share your experience, specifically, how many Visions do you have and did the upload go smoothly? Did you experience any major issues during or after the upload? Did you perform the upload through e-connectivity? We have 2 Visions and are getting ready to upgrade one instrument at a time (different weeks) through e-connectivity. We had major LIS issues before we went Live a year ago that delayed our plans almost a month! Thanks for any insight! Kathryn
  10. We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow: Transfuse order for RBCs is received in blood bank We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC." Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup) We look up the mom's record to see her antibody status If no antibodies, we result the "mom absc" as negative. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.) I hope this is helpful.
  11. Occasionally we have neonates who are still in the NICU after they become 4 months of age. At that point we begin treating them like any other patient in that we must do an antibody screen on the baby's blood every 3 days if they are receiving RBCs. My practice has always been to use the pedi lavender in hematology or maybe a pedi red from chemistry to do the baby type and screen. One weekend the blood bank tech actually was able to have a phlebotomist collect a small sample on a 4-month old NICU baby and place a blood bank armband on the baby too---we have NEVER armbanded babies in the NICU. (Had the 4 month old baby been in our pediatrics center he would have been armbanded.) I'm just curious how others handle neonates who are still in NICU after 4 months. Do you go find their other lab samples to perform the screen or have the baby stuck again? Also, if you have a BB armband system, do you armband babies in the NICU? Thanks!
  12. We have had our two Visions for about 6 weeks now and love them! We routinely run Panel A on them. Each shift has two panels. We take the panels out of the fridge and let them come to room temp. The Visions are configured to reflex the panel when an antibody screen is positive. (Note: if you have to manually review a positive screen, it will not reflex) When the instrument reflexes a panel, it will beep and the bubble will turn red if the panel is not on board. That is our cue to load the panel. We will put Panel B on if we want to run it, but it is not routinely taken out of the fridge until needed. If we don't get clear-cut results with Panel A, we will use Panel B, or maybe selected cells to help confirm an antibody. As for the second question, I have never heard of extending the incubation for weak to 1+ reactions on antibody screens and panels in gel. I don't think this is necessary at all. Gel is very sensitive already and the instructions are for a 15 minute incubation. I seem to remember reading that gel cards should not go past a 30-minute incubation due to dissociation of antigen-antibody complexes if formed.
  13. We are validating our two Visions currently. It was suggested that we perform roughly 20% of our monthly volume for correlations with our ProVue. This would be a LOT! I'm just curious what are others using?
  14. As an update we now have 1,000ml and 2,000ml transfer bags for pooling plasma and we have built several pools based on anticoagulant in our computer system. The FDA does not recommend pooling plasma with different anticoagulants, therefore, we are only pooling plasmas that are the same anticoagulant. The process is going smoothly except for the billing. I have to e-mail my billing person with the patient's information and the number of plasma units we used so she can manually post the charges. The only CPT code I can find is for solvent and detergent treated pooled plasma. I'm thinking of just creating another orderable (we have Cerner Millineum) that we could use to submit the charges--something like "pooled plasma X 4" that has a specific charge since this would usually be the minimum number of plasmas pooled into the 1,000ml transfer bag. We could then just order it however many times needed for larger quantities.
  15. I've just ordered a Helmer BB fridge and even though it comes standard with a chart recorder, I don't plan to use charts. I am told I can download the temperature data to a USB and print the report. Would that also be an option for you amym1586? I'm curious if others still change charts every 7 days or are most of you using the download option? I read on another thread where alarm checks may be done electronically rather than using the ice/warm water bath. I really like that idea too!
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