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Everything posted by butlermom
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Therapeutic Phlebotomies
butlermom replied to Amber Gaucher's topic in Donor Services and Donor Recruitment
A few of our top phlebotomists are trained to do them. The phlebotomy supervisor was in charge of them when I arrived at my present job and I haven't messed with it! I do, however, review the paperwork, orders, H&H and keep the records for inspections. -
Our BB samples come to us with the typenex armband label only. We then print and apply the barcoded label to the specimen ourselves.
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I've always interpreted the phrase "...may use an optical aid" in the manufacturer's package insert to mean the microscope. I'm now beginning to think it only means the magnifying agglutination viewer and I should quit reading everything under the scope (except fetal bleed screens and DAT's of course).
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I would like to get your thoughts. Mother is O neg and baby has a positive DAT. Baby is group A but did not react with anti-D at immediate spin. I have always reported these as "unable to determine Rh due to positive DAT" and given the Mother RhoGam. One of my younger techs on evening shift performed the weak D testing and called it negative. What I discovered was that she only read the Coombs phase MACROscopically. When I repeated the weak D and ran the Gamma-clone control, both were positive under the scope. Obviously the positive control makes the test invalid. We gave the Mother RhoGam. Am I out-dated to still be reading these microscopically? How do you handle these?
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We are a 525-bed hospital with a NICU, a Pedi-ICU and Pedi-oncology. The physicians order specifically what they want--irradiated, CMV-neg, etc. and we require a copy of the physician's written order for all patients younger than 18 years of age. We enter these "Special Needs" into our computer system in the patient's record. The computer will not allow any units to be crossmatched or issued that do not meet the patient's Special Needs.
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I, too, have been wondering about microscopic examinations. We use the microscope to read all DAT's, Coombs crossmatches, as well as tube antibody screens. It seems that any time we use PeG in an antibody screen, the microscopic reading looks weakly positive. Are others reading screens and Coombs crossmatches microscopically?
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David, I think in an earlier post you stated you use the PeG autoadsorption for everything. I notice the procedure states to incubate at 37 degrees. Do you also use it for COLD autoadsorptions? I would think there would be problems incubating anything with PeG at 4 degrees.
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I like the idea of doing away with the term "least," in favor of "serologically" incompatible. For those of you who occasionally have to issue blood this way, does the patient's physician sign a form or does your pathologist? Thanks for your input.
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I prepare a report for our Compliance Department each month which includes, among other things, all transfusion reactions and the type of reaction (Pathologist's interpretation). They are asking me if there are any national standards, or statistics for transfusion reactions. In other words, they want to know if we are below or above the national average for numbers of reactions. I think this would be a percentage based on the number of units transfused. So far I have not found any such data. Does anyone know if there are such statistics in the U.S? Thanks.
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DAT Controls for Automated Gel Systems
butlermom replied to cajcpsbb's topic in Transfusion Services
This is what my Blood Bank Technical Specialist told me to do when I was validating our ProVue. Using either the #4 AlbaQ-Chek control OR any Rh positive blood sample that you have, follow this procedure: 1. Spin down the sample and remove the plasma 2. Add 3-4 drops of Anti-D reagent and mix 3. Incubate at room temp for about 5 minutes 4. Wash one time with saline to remove excess anti-D 5. Return plasma to sample and spin down again. This has worked well for us. It gives about a 3+ reaction for the DAT control -
We are preparing for our CAP inspection and there is a new item on the checklist that has us baffled. It is TRM.42305 "Has a designated physician developed a therapeutic plan for patients undergoing therapeutic phlebotomies and have the goals for the therapeutic phlebotomy been clearly stated?" We do these occasionally mostly on outpatients but the Pathologist approves each prior to the procedure. Does anyone already have this process in place with a "plan....and.....goals....clearly stated?"