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conwaysbb

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conwaysbb last won the day on October 18 2007

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  • Gender
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  • Location
    Paterson, New Jersey
  • Occupation
    Blood Bank Manager

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  1. The package insert for Fludarabine, states the following: TA-GVHD has been observed after transfusion of non-irradiated blood in Fludarabine Phosphate for injection, USP treated patients. Fatal outcome as a consequence of this disease has been reported. Therefoe, to minimize the risk of TA-GVHD, patients who require blood transfusions and who are undergoing. or who have recived treatment with Fludarabine Phosphate for injection, USP should recieve irradiated blood only. It is also recommended for patients receiving other purine analogues, such as Claribine, Deoxycoformicin, and Campath and patients on anti-lymphocyte globulin should also recive irradiated blood products. in fact, thier have been some law suits against hospitals that did not follow this policy, as the package inserts state this in the Warning statements for the drugs. We have arranged with the pharmacy departmetn to get a list of any patients on therapy of any of the drugs stated above. The question I am posing is does anyone know if this is a permanent special requirement/instruction for irradiation of blood the patient or is this a temporary one and if so how long after the patient stops the treatment with these drugs should the special irequirement/instruction for irradiation stay with the patient
  2. We perform a bacterial contamination workup immediately, without waiting for our pathologist's request, when the temperature rises 4 degree F above the baseline. The standard orders are for a stat gram stain of the unit, blood cultures on the unit and blood cultures on the patient. The floor is to be called to order the blood culture of the patient immediately and also to draw the blood from a separate access than that used for the IV access line used to transfuse the patient. This is to eliminate the possibility of a bacteria coming from a contaminated IV access line. Also, the patient's blood culture should not be delayed as antibiotic therapy may be started from the increased temperature seen during transfusion. A bacterial contamination workup can also be ordered by the pathologists during his/her review of the transfusion eraction work up and is often requested when symptoms are rigors and chills with a rise in temp > 2 degrees F. If there is a positive gram stain result, this is immediately called to the floor, to the pathologist and to the blood bank manager. It is one of our panic values.
  3. Fortunately for us, I have access to at least 4 blood centers that want my business. Hospitals around our area (Northern NJ) change Blood Suppliers based upon "What can do for us now". Definitely pricing is the major issue, especially because of the high cost of living, which results in a high cost for blood and components in our area. Because of this, the blood centers are becoming very competitive in their pricing, so I have been able to reduce my costs/unit on several blood components. I also need to have at least one extra blood supplier for my needs, as there are also a ton of hospitals vying for blood products. As DNV follows ISO standards and Supplier Qualification is a big part of the ISO standards, I need to develop some quality indicators to determine how well my supliers are doing, with lookback and recalls being suggested by our inspector. Knowing that changes in deferrals have constantly been increasing, I would agree that determining a baseline % of recalls/lookbacks and then stipulating that the recall rate should not increase more than a certain % would be an appropriate practice and 5% is reasonable. Thanks for the comments.
  4. We have changed our hospital accreditation form the JCAHO to DNV. One of the inspectors asked me during the DNV inspection whether I evaluated my blood suppliers on the number of recalls and/or lookbacks recieved from them during the year as part of the Supplier Qualifications (they follow ISO standards). I am bringing this issue here as I have no idea if anyone has a benchmark for the number or percentage of recalls/lookbacks recieved from a blood supplier. Alhtough I know that there have been several additional reasons added because of deferral requirements, most of the recalls I get are because of incomplete medical evaluations or errors in manufacturing, and would certainly be a valid issue to be looked at when performing annual supplier qualifications. Of course, I will be asked where I got my information for the bench marking. Would anyone know if this issue has been bechmarked any where this information can be assessed? Does anyone hava na opinion on this? If so are you a Transfusion Service/Blood Bank or a Blood Supplier? Just for comparison, I have a hospital based donor room which supplied us with 1800 units last year we issued unfortunately 2 recalls for a recall/lookback rate of .11%. However, with a total of 10, 000 received from my blood suppliers I received a total of 42 recalls and 1 lookback resulting in a recall/lookback rate of 0.40%. Thanking you in advance for your thoughts and direction.
  5. Not to cause anyone to have a stroke, however, there have been some transfusions of what we would normally consider ABO incompatible transfusions via intrauterine transfusions. I believe the specific article I saw was an A Negative washed red cell transfusion from a mother with anti-D and other multiple antibody specificities to her baby that was O Positive and severely affected with HDN. This was done several times during the pregnancy and the baby was finally delivered with a blood type of A Negative who subsequently reverted back to O Postive
  6. Having changed myself from Hemocare to Sunquest in the last two years, I personally would not recommend this system to anyone!!! Here are a couple of reasons. The primary reason is that Sunquest does not have a QA warning for when an individual has either a present antibody or a history of an antibody from performing just a immediate spin x-match. In order for this to be accomplished in any form, you need to purchase the electronic crossmatch module and even then it is not complete. If I had known this one issue, I would have highly reccommended that we not go back to Sunquest. (we previously had used sunquest prior to hemocare). This is a very basic idea and requirment!!! All the other systems I had looked at had this basic QA warning. The reply form Sunquest that my staff have some responsibility to know that they need to include an AHG phase of testing, is just plain ignorant. There is no QA warning when you send a unit back to your supplier for an unacceptable reason and you get the same unit back (they told me this would never happen. I guess they forgot about Murphy's Law). At this time, when you modify a unit changing the ISBT product code, there is no QA check for extending the expiration date and/or time of the modified product from the original product. I.E. irradiating a unit/ splitting a unit, etc. This problem has been known for several years. There was even a bulletin sent out to tall Sunquest users (happened before my going live, so I didn't know about this issue). In addition they stated it was slated for an enhancement at a later date. When they finally admitted to me there was an issue and sne t me the bulletin, they still hadn't even begun to work on getting this into a future release and could not tell me when they would. Having to bring this up on to different facilities, there were some other issues that are unique to a multi-system site. If you would like to contact me, please e-mail me at conwaym at sjhmc dot org. The assistance during implemetation is OK. Not any better or any worse from any other system I have ever implemented. However, after implementation, the assistance and follow-up is poor. The actual cost of the system from what they stated is also not what it cost us to re-build it to our needs as there was additional assitance to what we needed. As we were also coming back to Sunquest we had old codes in there that we could not get rid of so our maintenance files are enormous. With the requirement that you can only use up to a certain amount of characters, this is also problematic. Of course you also know that this is not a true windows based platform and maintenance files and reports are also still a roll and scoll (menu) driven system. But that is just my opinion :-). Alas, because this was our legacy system and we use Sunquest as our main LIS, it was far cheaper to go with Sunquest and since we were in a financial bind that is what we did. I guess the old adage that you get what you pay for still applies.
  7. As our blood suppliers only supply us with apheresis platelets we normally never have any trouble with having to use surrogate testing to detect bacterial contamination, as the blood supplier performs bacterial testing on all thier apheresis platelets. However, about 3 times a year we will have to take bacterially untested platelets from our supplier during a time of short supply and high usage. We have used both the PH and glucose strips as our surrogate test, but also must find an alternative test as the AABB ( 01/31/2011) and CAP (6/2011) will no longer allow this surrogate testing. As the Verax Platlet PGD test is used for whole blood derived platelets, is there another FDA approved test for testing single units of apheresis platelets for bacterial contaminiation when recieved in a hospital untested? Would the EBDS system mentioned above be acceptable for this purpose? Does anyone know where I can get information about these systems, including who makes them?
  8. This is of course based upon hand-writing label at the patient bedside. Preprinted computer generated labels, using a barcode scanner that generates the patient label at bediside, handwritten labels, typenex or additional blood bank numbering; it doesn't matter what you use, if the label is not placed on the specimen at patient bedside. As for allowing additions or changes to the specimen label after reciept, we have made it a policy that no changes can be made. If there is a complaint from a physician or nurse, only the blood bank manager or the medical director can approve the exception. My staff is not authorized to make these decisions. If the error includes either the patient name or medical record number, no exception is made and a new specimen is requested. Reponses to physicians or nurses telling us the patient will bleeed to death, is to inform them that emergency release blood is always available, but the paitent's physician will have to sign the emergency release form. Exceptions are made in regards to date or initials, but on irretrievable specimens (neonatal specimens where the patient is extremely anemic; patient in OR and bleeding). However, the only individual that can come down and correct/add is the individual whp drew the specimen,, which includes physicians, so we document on the request form that specimen was corrected in blood bank. We also have the support of a NJ State Dept of Health regulation , which specifically states " In the case of a discrepancy or doubt, another specimen shall be obtained and used for these procedures". So we have the law to back us up. I regularly educate medical students about specmen errors due to patient ID errors or specimen lableing errors. 1 specimen error in 100 specimens is 99% compliance. 1 in 1000 specimen errors is 99.9% compliance, 1 in 10,000 specimen errors is 99.99% compliance...pretty good odds. However, no one wants to be that 1 patient who recieves that wrong unit of blood. there goes my diatribe on the subject
  9. Since you mentioned molecular testing, has the FDA approved this technology to be used for resulting antigen typing on units? From my knowledge, molecular testing is still used for research only.
  10. We use the Sunquest blood bank system and each unit is brought in to the system by supplier, unit # and ISBT 128 product code so we can easily distinguish both units. I have decided, for the exact same reasons as mentioned here, to be consistent and not have too many exceptions, so we will be antigen typing each unit of a double red cell unit. As we have a large sickle cell population and tend to transfuse multiple units, it is to the patient's advantage (and to ours to a certain extent) to be transfused both units of a double red cell transfusion to reduce donor exposure (most of our multiple antibody patients ar sickle cell patients). We also give RH and K matched units to these patients and it helps when a unit of a double red cell collection is found to be that match. We just look in our inventory to see if we have the other unit available. It would be even better for our budget, if I didn't have to antigen type that second unit. Again thank you all for you replies.
  11. My staff has asked a question that has stumped me. :-) We have been getting both units of a double red cell collection. When you antigen type one unit of a double red cell collection can you use the results obtained for the other unit or do you have to repeat the testing on an integral sample from the second unit. Part of me says that when we do donor testing on the donor specimen collected at the time of donation, we use these results to release both units of a double red cell collection. Part of me says that even though they share the same unit number, they both should be tested separately using an integral segment obtained from each unit at time of testing. I am leaning towards having each unit tested, as I would still require a x-match be performed from an integral segment from both units and I retype of both units. What say you?
  12. I would defer you to the manufacturer's information on the particular platelet collection system that is used to collect the platelets that you receive, as there are several different platelet apheresis systems out there, for information on how much residual red cells may be contained in a apheresis platelet product. This is the information that they have supplied to the FDA and has come from hundreds of products that were collected. As the volume of apheresis platelet products vary greatly, the very term "Visibly Tinged" is highly subjective and may indicate a vast difference in red cell contamination of the product transfused. I am sure if you contacted the platelet collection system manufacturer's technical support line you could get this information and then use it to make your decision. I am equally sure your blood center will be able to provide the phone number of same. My understanding is that you will never get visibly tinged apheresis platelets, as these platelets would be non-leuko-reduced and not be able to have bacterial blood cultures performed. but I may be wrong :-)
  13. On page 586 of the 16th edition of the AABB Tehnical Manual, it talks about giving RhIg to prevent D alloimmuniztion when giving Rh Positive platelets to Rh Negative patients. Even platelet apheresis products can contain an immunogeneic dose of red cells. From past experience, the manufacturer of the apheresis sets and collection system indicates that there may be up to 2 mL of RBCs in a unit of apheresis platelets. Therefore, attempts should be made to provide Rh negative recipients with platelets from Rh Negative donors (although the platelets do not have the Rh antigen). ALthough the clinical magnitude of this issue is less than one might expect, the production of anti-D in the female patient of child bearing potential is of concern, so most facilities would recommend RHIG to these patients if Rh Positive platelets were transfused. This would support AABB Standard 5.20. In past AABB Technical Manuals there was a formula for how much RhIg to reccomend. as follows "A full dose of RhIG, which is considered immuno-prophylactic for up to 15 mL of Rh Positive RBCs, should protect the red cells in a minimum of 30 units of Rh Positive Platelets or 7 units of platelets apheresis" Pg 457, 14th Editiion, AABB Technical Manual.. As for ABO matching, it is preferable to give ABO matched platelets first, then ABO compatible and as a last resort, ABO incompatible. The rise in platelets is higher in ABO matched platelets. In Pediatric patients is is more critical as ABO incompatible plasma may have more serious effects due to the reduce blood volume of the recipient. If ABO matched or compatible plateles are not available, we would give volume reduced incompatible after the patient's physician is notified and they agree to transfuse. We also titer the ABO anitbody and only transfuse if the titer is less than 1:100. Of course in the end, we would rather take care of the underlying condition and save the life of the patient and worry about what happens later than not give incompatible platelets ,if they were the only ones available. Incidentially, we have had two serious hemolytic transfusion events when we have transfused ABO incompatible platelets. Both cases the titer of the offending ABO antibody was greter than 1:1250. Both cases the supplying blood center was notified and they removed the donor from their apheresis platelet program.
  14. On page 586 of the 16th edition of the AABB Tehnical Manual, it talks about giving RhIg to prevent D alloimmuniztion when giving Rh Positive platelets to Rh Negative patients. Even platelet apheresis products can contain an immunogeneic does of red cells. From past experience, the manufacturer indicates that there may be up to 2 mL of RBCs in a unit of apheresis platelets. Therefore, attempts should be made to provide Rh negative recipients with platelets from Rh Negative donors (although the platelets do not have the Rh antigen). ALthough the clinical magnitude of this issue is less than one might expect, the production of anti-D in the female patient of child bearing potential, most facilities would be inclide to recommend RHIG to these patientsif Rh Positive platelets were transfused. This would support AABB Standard 5.20. In past AABB Technical Manuals there was a formual for how much RhIg to reccomd. as follows "A full dose of RhIG, which is considered immuno-prophylactic for up to 15 mL of Rh Positive RBCs, should protect the red cells in a minimum of 30 units of Rh Positive Platelets or 7 units of platelets apheresis" Pg 457, 14th Editiion, AABB Technical Manual.. As for ABO matching, it is preferable to give ABO matched platelets first, ABO compatible and as a last resot, ABO incompatible. The rise in platelets is higher in ABO matched platelets. In Pediatric patients is is more critical as ABO incompatible plasma may have more serious effects do to the reduce blood volume of the recipient. If ABO matched or compatible plateles are not available, we would volume reduce after notifying the patient's physician. We also titer the ABO anitbody and only transfuse if the titer is less than 1:100. Of course in the end, we would rather take care of the underlying condition and save the life of the patient and worry about what happens later than not give incompatible platelets ,if they were the only ones available.
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