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butlermom

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Everything posted by butlermom

  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?!
  15. We are being asked to supply blood for a helicopter. My question is, how do we properly account for the unit(s) if a patient is picked up from an accident scene, transfused in flight, but taken to another hospital? The patient would never be registered at our facility so would we then make a “transfer” of the unit(s) to the receiving hospital? I’m just trying to figure out how to keep track of the blood since it’s from our inventory.
  16. We are a 540-bed Hospital functioning as a Level I Trauma Center. I need help with setting up an MTP for infants and small children. Recently we had a two-year-old who had been hit by a car. They could not use the rapid infuser on her because it would be too much too fast for her weight so they pulled blood from the bags with syringes and pushed it in. The trauma team is asking me what supplies they need to handle pediatric traumas. All we have are syringes with an in-line filter that we aliquot for our NICU babies. How do others handle small pediatric patients? Do the nurses use syringes to pull and push the blood as I have described? Is that allowed? I’m pretty sure there was no filter involved either. So far we have only had older children and adults for MTPs and we have a good process in place—just need to provide for the smaller patients too. Thank you for any suggestions/recommendations.
  17. We are a 540-bed Hospital functioning as a Level I Trauma Center. I need help with setting up an MTP for infants and small children. Recently we had a two-year-old who had been hit by a car. They could not use the rapid infuser on her because it would be too much too fast for her weight (which I don’t remember)so they pulled blood from the bags with syringes and pushed it in. The trauma team is asking me what supplies they need to handle pediatric traumas. All we have are syringes with an in-line filter that we aliquot for our NICU babies. How do others handle small pediatric patients? Do the nurses use syringes to pull and push the blood as I have described? Is that allowed? I’m pretty sure there was no filter involved either. Is there such a thing as a syringe blood warmer? So far we have only had older children and adults for MTPs and we have a good process in place—just need to provide for the smaller patients too. Thank you for any suggestions/recommendations. Kathryn
  18. I tried validating antibody titers when we first got our Visions. I had the same issue as you due to the sensitivity of the gel. I listened to a webinar on the subject once and those who have successfully done it recommend contacting the clinicians to inform them of this significant change in test method. This would come from your blood bank medical director and he or she would have to work closely with the OB/GYNs. Therefore, I decided to continue doing titers by tube method. Good luck if you do decide to pursue this further.
  19. Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!
  20. 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!
  21. 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.
  22. 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!
  23. 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
  24. 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
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