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Everything posted by profbaud
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What kind of projects have been done in the past? perhaps designing some flow charts for hospitals or MLS programs to use for trouble shooting positive antibody screen or ABO discrepancies
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we require 2 blood types on file, so one can be historic. I do require a current blood type on this admission, since patients tend to borrow insurance cards and you don't want to give someone 300-600 cc of incompatible plasma
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We are starting a transfusion committee because it is required by CAP and JACHO and now by HFAP [our accreditation organization]. Before I was the pathologist and I were the 2 person transfusion committee. It does help to have one so the blood bank doesn't look like the bad guy when it comes to blood utilization.
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Crossmatch by gel technology only - Is it sufficient ?
profbaud replied to subbusp58's topic in Transfusion Services
AABB stds requires you to perform a crossmatch for ABO incompatibility. This is done by immediate spin [in a tube] or by electronic crossmatching -
30 minutes for return blood and blood products
profbaud replied to AMER's topic in Transfusion Services
we did a validation last week with some expired AB+/AB= rbc units and we found that in our blood bank, [Temp 72F], all 4 of these units warmed upto 6C within 15 min, and 7-9 at 20 min. This was confirmed by a hemotemp sticker on unit and with wrapping unit around immersion bottle from portable cooler alarm. We did 1 unit everyother day for 1 week. We are changing our policy and procedure so we don't get hit at our next CAP inspection. -
Positive DAT on Cord blood intefering with weak D test
profbaud replied to John Bowers's topic in Transfusion Services
The Rh interpretation should be reported out as Rh inconclusive and your Fetal Screen kit should say it is not accurate if weak D+ in Mom or Baby, so do a Kleihauer betke to calculate RHIG, this mother needs RHIG. you can't assume baby is Rh neg -
Colleen Our OB dept treats it like a drug and the doctor writes an order to transfuse RhIg, then the blood bank signs it out. Good to hear from you, long time no hear Debbie Rush [uIC] SBB program
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I would be happy to send you my antibody ID procedure. It is step by step for my staff and MLT students who do their clinicals at our hospital. send email request to profbaudler@sbcglobal.net
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By any chance did this group AB person recently receive several group A single donor platelet transfusions somewhere. I had a patient a couple years ago that was a Group A that received 2 group O platelets before being transferred to our hospital and the Anti-A from the platelets showed up in her back type.
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Verbal Orders for Blood/Blood Products
profbaud replied to Llehman@ecmc.edu's topic in Transfusion Services
We used to accept verbal orders from the ER and OR but are changing our policy. We will be requiring the OR to put something in the computer or use a manual form with patient label on it. The ER will be using the same form unless it is ER release. This is due to a recent citation given by CMS [Medicare inspection] that inspected charts from OR patients, found the transfusion slips on the chart but NO ORDERS TO TRANSFUSE! -
We issue O Negative if its a woman <55 years old or O Positive if a man or woman > 55 years old regardless of historical blood type unless the patient has Anti-D. my policy states that type specific blood can only be issued if a current blood type has been performed on a banded blood bank specimen and a 2nd blood type [historical or 2nd draw] has been done. If only one blood type is available on current specimen, the O Positive is given or O Negative. I have been at other facilities where immigrants get one insurance card and pass it around to relatives who go to the ER. one time a patient changed blood types, from O+ to A+. /We later found out is was not the same patient, so I do not recommend using historical blood types. Debbie Baudler MS, MT(ASCP)SBB
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working up pos DAT not associated with transfusion
profbaud replied to tkakin's topic in Transfusion Services
If we receive an order for a DAT, we report it out as Pos or Neg and leave it up to the physician to order further testing. Most of the times they suspect it will be positive if the pt has a hemolytic disease process. For babies, if mom has a negative antibody screen and we can explain it by ABO incompatible blood types [Mom is O baby is A or B] then we are done. If not, then we will do an eluate to see what is coating baby's cells, keep in mind it might be due to a low frequency antibody not on the current screen or panel. -
As long as each tech that handles the specimen performs a complete clerical check between the specimen and the computer record, it's not necessary to repeat any testing. This procedure should be written in your SOP. Crossmatching at IS will catch any ABO discrepancies if there was an error made in the typing. We use 2 blood types on file, 2 current or 1 current and 1 historical in order to crossmatch type compatible units. Also your computer system should be set up to catch patients with antibodies if someone tries to crossmatch a unit that is not antigen negative.
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The time frame according to AABB tech manual for look back: HCV extend back indefinitely for computerized records if supplemental testing was not performed or back to Jan 1 1988 if computerized records not available. For HBV: indate components extending back 5 years or 12 months from the most recent negative test for units that were RR confirmed or if confirmatory testing not performed. HIV: Test recipients of units that were donated at least 12 months before last known negative tests and if these are found to be negative, then you don't need to go back further. This is taken from Chapter 26 of 15th edition. the 16th ed. of the technical manual is not as clear as this copy, so I keep it on hand.
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I just went through the HFAP survey and THEY NOW REQUIRE A TRANSFUSION COMMITTEE LIKE JCAHO. So you don't have a choice in this matter. I had to start documenting our meetings in the lab since they discontinued the transfusion committee before I started last year. You will get cited. Show this to your lab manager and blood bank pathologist to start forming one. AABB has a wonder book on how Guidelines for Transfusion Committee that I just ordered.
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We look to see if the patient has had a CBC or another EDTA specimen drawn within the past 3 days and then use that for the retype. It's just to confirm that the right patient and correct typing was done on the original specimen. Most of the time this works because the low H&H triggers the T&S or T&C order. In cases were we can't get a second type [ER or OR] then we set up O Pos or O Neg units. for electronic crossmatching you require 2 types. If you can't get the 2nd draw, we performed a retype on the SAME specimen by a different tech, but I prefer the 2nd draw if at all possible.
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Cephlasporins do cause a strong positive DAT with IgG. The mechanism is like penecillin where the person makes an antibody to the drug and attaches to red cells. If you perform an eluate and run it against a regular panel, it will be negative.
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You must be using Ortho gel technology. This problem pops up 2-3 times a year and I finally talked with Ann Steiner from Ortho after our state BB meeting and she says there is an association with Bg-EE on some R2R2 cells that causes this to occur that they can't explain. When this does happen, they eliminate that donor from the screening pool.
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Yes this is correct. My blood bank pathologist shared the notice with me. It is in effect beginning July 1st 2011 and it states that it is for revisions and new procedures only.
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I am trying to form a Transfusion Committee to decrease our blood usage. We have old-time country doctors who want to transfuse when the Hb drops below 9! I want to make it 8 gms. I need to find supporting articles to show them that 8 or even 7 is best practice. My blood bank pathologist is trying to find some but its difficult to find something in print. Anyone have any recent articles?
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we use Meditech 5.4 so I know what you mean. I recently had a meeting with the OB charge nurse and we are now labeling the cord bloods with baby's name and MR number and they hand write mom's name on it or put a piece of mom's label on it too. Meditech then links the two together under Mom's name and MR. At a previous hospital [sSM], they had the last name of baby, mom first name and baby girl on the tube for the cord blood.
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Other Possibilities: 1. Any transfusion history available? DAT results? Perhaps you have a low frequency antibody that you are missing in your screen and have picked up in the crossmatch. Also a strong cold agglutinin may be missed on the screen if you are using the Provue since the cards are preheated, but if you do the crossmatch in manual gel, it will be incompatible.
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Brenda, I too have seen several Anti-f antibodies in recent years and they have always been on multiply transfused patients. There is only 1 cell on the panel that separates if from an Anti-c so I think in years passed it has been overlooked. I recently got a notice from Immucor that they are dropping f from their panels. UGH!!!!!!!!!!!
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How good is your prenatal testing on Mom? friday we had a cord blood from an O Pos Mom and the Baby was O pos with a weak positive DAT. Mom had a negative antibody screen at her prenatal visit last fall. [We only do blood types on all delivering moms.] Guess what! Mom had a 4+ Anti-E! Just when it doesn't seem practical to do all this cord blood testing, something like this happens. Baby's bili was only 7.0 so no exchange transfusion needed.
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Color of plasma and the bilirubin numbers certainly indicate there is a hemolytic process going on. Since this patient is a renal patient, have you tried to get a transfusion history on her? She must be periodically transfused somewhere. Next thing is to get a list of meds. Perhaps she is getting something that can cause a hemolytic anemia or perhaps should not be administered with blood, 3rd, you can try doing an eluate if you suspect a delayed reaction. Sometimes it can be positive for a weak antibody when the DAT is negative. Let us know what happens.