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simret

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  1. Like
    simret reacted to Neil Blumberg in Who can order blood products?   
    It's a state law issue. Each state sets its own regulations about who can order what, if I recall correctly.  It sometimes may be an institutional issue.
  2. Like
    simret reacted to David Saikin in Who can order blood products?   
    nurse practioners and pas can order blood components.  At least any place I've ever worked.
  3. Like
    simret reacted to sgoertzen in RBC Transfusion thresholds for pediatrics   
    I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
    Neonates: Term and near term neonates and infants < 4 months of age*
    Hgb/Hct < 7g/dl / 21%
             Stable anemia with no clinical manifestations
    Hgb/Hct < 10 g/dl / 30%
             Moderate cardiopulmonary disease
             Major surgery
             Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
             Significant apnea or bradycardia, tachycardia or tachypnea
             Low weight gain
    Hgb/Hct <12 g/dl / 35%
             Fi02 requirement greater than 35%, on CPAP higher setting
             Recovering from major surgery
             Severe traumatic brain injury
             Significant deterioration of cardiorespiratory status
    Hgb/Hct < 15 g/dl / 45%
             FiO2 requirement > 35%
             Severe cardiopulmonary disease or congenital heart disease
             On extracorporeal membrane oxygenation (ECMO)
    *No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
     
    Pediatric patients >4 months old through adult
    Not bleeding
    Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
    Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
    For Hgb between 7-10 g/dl (Hct between 21-30 %):
             Based on organ dysfunction and ability to handle inadequate oxygenation
             Respiratory or cardiac failure
             Chronic disorders of red cell production, severe platelet dysfunction
             Oncology patients
    Intra/perioperative conditions or significant bleeding
             Rapid blood loss exceeding >15% blood volume
             Intraoperative period as clinically determined by anesthesiology and/or surgeon
             Immediate postoperative period to restore hemodynamic stability
     
    We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
    BPA Overrides: RBC Orders (in mL) and (in Units):
    Warning if: No Hgb result or Most recent Hgb > 7 g/dl
    Appropriate criteria:
    Neonate w/Cardiopulmonary Disease
    Respiratory or Cardiac Failure
    ECLS Patient
    Sickle Cell Patient
    Thalassemia Patient
    Active Chemotherapy/Immunosuppressed Patient
    Hematopoietic Disorder
    Rapid Blood Loss
    HOLD for Pre-Op/Procedure
    Post-Op Hemodynamic Instability
    Other – specify as Comment
  4. Like
    simret reacted to jshepherd in MTP Charge   
    There isn't an extra charge that I'm aware of for an MTP. We charge for all the blood products transfused, and all the work done by techs like crossmatching etc, but there is nothing else. 
  5. Like
    simret reacted to David Saikin in Therapeutic Phlebotomy Competency??   
    If Lab is not performing this why are you responsible?  Get a letter from Admin exculping you from responsibility. 
    Though I am not conversant w JCAHO in the lab.  All they ever do here is ask about transfusions.
  6. Like
    simret reacted to tbostock in Blood Warmer Validation   
    This is what I have in my validation procedure.  The IQ (did we "install" it the way the manufacturer wants us to?) and OQ (does it do what the manufacturer says it does?) I get from the user's manuals.  The PQ is to make sure it opererates the way YOU need it to at your facility.
    Equipment only: prior to validation, the BioMed department will inspect the equipment and perform an electrical safety check.  The equipment will then be assigned a unique tracking ID#.  The following elements will be performed: Installation qualification: demonstrates that the equipment is properly installed in the environmental conditions specified by the manufacturer. Operational qualification: demonstrates that the equipment operates as intended. Performance qualification: demonstrates that the equipment performs as expected for its intended use and that the output meets expectations in a normal working environment.
  7. Like
    simret reacted to Malcolm Needs in Last Wash run in parallel with Eluate   
    I agree entirely that this process is not efficient working in a busy Blood Bank, or any other sort of Blood Bank.  There a re many occasions when a patient can wait for the next transfusion, whilst various tests are performed, but we, as Technicians/Biomedical Scientists (or whatever else we are called around the world) are not in a position to "call the odds".  We MUST react quickly.
    Granted, most of these tests will be "false alarms" (or so I would hope!), but when the test is genuine, it is necessary to react quickly.  The clinician needs to know, and so does the person working in the laboratory - THEY have got to get antigen negative blood available pretty damn quickly, while the clinician is sorting out the acute haemolytic transfusion reaction.

    If it is a query delayed HTR, given that in most cases the patients are transfusion dependent (and, therefore, venerable - or even vulnerable!), why take the risk?
  8. Like
    simret reacted to Ensis01 in Last Wash run in parallel with Eluate   
    Run side by side. Does your SOP, or manager (or anybody for that matter) give a reason why it is eluate first then Last wash? It would make more sense for a policy to state run the last wash prior to the eluate (especially if there are few red cells) to ensure sufficient washing.
  9. Like
    simret reacted to exlimey in Last Wash run in parallel with Eluate   
    I have always run the eluate and last wash in parallel, but the question did make me think.
    I appreciate the attempt to reduce (potentially unnecessary) work, but don't like the idea of doing two-stage testing (eluate first and then Last Wash, or the other way around). If this happens, you've lost any efficiency (and time) you believed you gained by not testing the eluate and Last Wash in parallel. However, the cautious approach to a low volume (rare) specimen may have some merit - checking the Last Wash first adds confidence that any eluate prepared from the washed cells will be more likely to be valid.
    The two-stage testing concept has crept into the laboratory over the last couple of decades and is completely valid for follow-up or reflex testing. But.....one of my peeves: Reagents that suggest "Immediate spin, incubate negatives". If you're running a negative control anyway and/or most of your tests will be negative (DATs with anti-Complement reagents), you'll almost always be incubating, so why bother with the Immediate Spin ?
    Bottom line: Do what the eluate kit manufacturer says (unless you've validated otherwise).
  10. Like
    simret got a reaction from Sonya Martinez in Ortho MTS Gel Workstation Validation   
    Sonya,
    Thanks!
  11. Like
    simret reacted to MAGNUM in Blood Bank Record book vs Meditech   
    I use Meditech and do not have any paper. As to histories, we look up each patient history when we get specimens on the patient.  Normally on Monday, Wednesday, and Friday, I download a copy of patient histories onto a DVD in case of Ransom Ware Attacks. The file is downloaded and saved as a Word file that is accessible from any PC.
     
  12. Like
    simret reacted to David Saikin in Blood Bank Record book vs Meditech   
    if you have a BBIS you should stop using a paper log and just enter your results directly into the system.  Eventually you will miss something important.  I've seen this multiple times when doing inspections, complete with errors due to back entry of data during the inspection.
  13. Thanks
    simret reacted to cheru26 in Emergency Released RBC   
    No need to keep. We shred them right away.   
  14. Like
    simret reacted to Neil Blumberg in Patient Blood Management   
    Patient Blood Management is a comprehensive, multi-modal approach to reduce/prevent anemia prevalence and reduce transfusions to only those that are life saving or absolutely essential.  While the AABB has some materials and interest, they are relatively less likely to explain to you that the primary rationale is that anemia and transfusions are mostly harmful to patients in current practices.  The pre-eminent organization in the USA in this matter is SABM.  The founders of PBM include anesthesiologists such as Aryeh Shander at Englewood Hospital and Tim Hannon at St. Vincents, who saw that (1) Jehovah's Witnesses who refused transfusions actually had better outcomes than similar transfused patients and (2) transfused patients had dose dependent increases in nosocomial infection, thrombosis, multi-organ failure and mortality in the literature and their own practices.  In other words, less is better.  None is best when possible.  Needless to say, the initial reaction in the blood banking and transfusion medicine community was lukewarm at best when these ideas were first put forward a couple of decades ago.  But preventing anemia by doing fewer lab tests, and less frequent lab tests has begun to catch on in some places.  See:
    https://www.sabm.org/patient-blood-management-programs/
    Good place to get some initial education and join if of interest.
    A typical PBM program will include a part-time medical director (often an anesthesiologist, intensivist or hematologist, but also surgeons, transfusion medicine physicians, and other specialties) and one or more full-time nurses or medical technologists who focus on educating practitioners about current practices.  You need a clinical champion at the bedside who other practitioners respect and will listen to. Changing practices is arduous and sometimes rather unpleasant work.  When Bernard Fisher showed that the Halstead radical mastectomy for breast cancer was harmful to patients, the initial reaction was anger, disbelief and pushback. So it sometimes is with PBM.  Physicians change their practices slowly or not at all.  At our institution, PBM is heavily weighted towards collaborations between specialties, including, for example,  an anemia management program prior to cardiac surgery, advocating restrictive transfusion practices where there is evidence (and there is tons of evidence that liberal practices are lethal at worst, wasteful at best).  Happy to answer further questions.
  15. Thanks
    simret got a reaction from Malcolm Needs in Why is recon. whole blood required for neonatal exchange transfusion?   
    This is how we calculate our volume:
    Volume reduced RBC~ =150cc (g) =70% hct
    X= total volume
    Goal HCT= 45% 
    (Volume reduced RBC * Volume reduced RBC HCT) = (Total Volume * Needed HCT)
     
                      (150g)                 *      (70%)                               =       (X ml)         *     (45%)
    = (150g) (70/45)
    X ml= 233ml total volume
    233-150=83 plasma
    ∴      - Plasma needed = 83ml
    -        Total volume = 233 ml
     Simret G.
  16. Like
    simret reacted to jayinsat in Multi-Hospital Blood Transfusion Committee   
    We are a 7-in-1 system and our committee meets quarterly.  We provide blood usage statistics on a common spreadsheet monthly.
  17. Like
    simret got a reaction from Malcolm Needs in Multi-Hospital Blood Transfusion Committee   
    Currently, I have two hospitals join out Blood Transfusion Committee meeting. Our hospital consists of physician representation from multiple disciples such as hematology Oncology, medicine, surgery, OB, Anesthesia, pharmacy, and RNs' representation from highly transfusing locations like ICUs.  We have an agenda for the meeting that will engage/ affect the physicians' service; thus, they are engaged with the discussions. There is also a dialogue in our meeting agreeing/ disagreeing in the approach that is proposed and why... So they are often engaged.
  18. Like
    simret reacted to David Saikin in Feto-maternal Screen Lot to Lot Testing   
    I just run the old controls with the new lot kit.  Never had a problem with inspections.  My anticipated results are positive with the old and new pos cts and negative with the old and new neg cts.
  19. Like
    simret got a reaction from Eagle Eye in Neonatal Exchange-FDA Registration   
    Yes you do! In accordance with 21 CFR 607.21, you must register and list the blood products you manufacture ( when you reconstitute, you are manufacturing a new product = whole blood ( new ISBT #) for commercial distribution every year between October 1 and December 31 and you must update your blood product listing every June and December. I hope that helps.
    Simret
     
  20. Like
    simret got a reaction from tricore in Neonatal Exchange-FDA Registration   
    Yes you do! In accordance with 21 CFR 607.21, you must register and list the blood products you manufacture ( when you reconstitute, you are manufacturing a new product = whole blood ( new ISBT #) for commercial distribution every year between October 1 and December 31 and you must update your blood product listing every June and December. I hope that helps.
    Simret
     
  21. Like
    simret got a reaction from Eman in Neonatal Exchange-FDA Registration   
    Yes you do! In accordance with 21 CFR 607.21, you must register and list the blood products you manufacture ( when you reconstitute, you are manufacturing a new product = whole blood ( new ISBT #) for commercial distribution every year between October 1 and December 31 and you must update your blood product listing every June and December. I hope that helps.
    Simret
     
  22. Like
    simret got a reaction from exlimey in Neonatal Exchange-FDA Registration   
    Yes you do! In accordance with 21 CFR 607.21, you must register and list the blood products you manufacture ( when you reconstitute, you are manufacturing a new product = whole blood ( new ISBT #) for commercial distribution every year between October 1 and December 31 and you must update your blood product listing every June and December. I hope that helps.
    Simret
     
  23. Like
    simret reacted to CM2 in Matched Unrelated Donor sample (MUDS)   
    My short answer would be No, it is not necessary UNLESS you have a conflict between your results and the donor workup documents that come with the product. 
     
    Here in the US, the NMDP coordinates the majority of our searches. We get paperwork from the collection center that screens the donors which includes donor virals and the blood type they got in testing on the donor.  We also get the HLA results performed (here in NJ by the sharing network) which also includes the blood type.  So you already have 2 separate sources of a blood type which are done with a high standard of accuracy.  So if they say A neg, and I test and get an A neg on immediate spin, why would I spend energy looking for zebras? The worst that is going to happen is the patient will receive Rh neg units unnecessarily. It is also possible for a tiny subset of weak D people to make anti-D anyway, so to our minds it is taking the path of caution.  If you work in a region with very limited blood supply this might be a stronger factor to consider.   But Im guessing if you have the capability to perform bone marrow transplants, you have a fairly robust transfusion service as they can be pesky to support (HLA immunized patients needing lots of platelets comes to mind).
     
    A few thoughts. Its great you do the antibody screen, I was suprised to learn the NMDP does not require these to be done on donors, and we had one case where a transplanted patient who was rh Pos suddenly acquired an anti-D, which caused a bit of confusion. We never knew if it was because the transplanted T cells from Rh neg donor decided they didnt like the recipients Rh pos remaining circulating cells, or whether the donor was already immunized from a pregnancy/rhogam greater than a year ago (thats the time frame on donor questionnaire) and already had circulating anti-D in the plasma which was also infused with product. (gel method is so darn sensitive) In any event it did not cause any harmful sequelae/DTR or anything.
     
    My other thought is, you can probably save yourself the crossmatch, unless you are at one of the unlucky institutions that still has not instituted electronic crossmatch (patients with a negative antibody screen receive ABO compatible units without a physical crossmatch of serum and donor cells).  The hct on products we receive is 4-8% which usually translates to around 20-40 mls of rbcs. Much less than a unit of blood.. if electronic crossmatch is safe for 250mls, why not 20-40?   
     
    We have a cap of 10mls of mismatched rbc allowed per day.  If we have a patient with antibodies or a major ABO mismatch we prefer to go the conservative route and break up infusions either into sessions 4 hours apart, or over 2 days, with hemolysis workups in between issuing the next piece to be sure some crazy hemolytic cascade hasnt started.  With this amount of rbcs and good kidney hydration, its a pretty self limiting reaction.. once those rbcs are gone, no more is coming in.  At least not until the recipient immune system finally dies out and the new one is established and starts making rbcs..and the new immune system doesnt fight itself. 
  24. Like
    simret reacted to David Saikin in Refrigerators in Surgery   
    My experience with OR refig is similar to those above. In the OR - that staff took daily temps; we did the maintenance and alarm checks. I STRONGLY recommend a temp monitor on each bag signed out to the OR. The staff there will remove the blood for the case and then return it. Unless you monitor closely your products will be compromised and you will not even be aware. Our OR staff insisted they never took the blood out - ALL of our monitors were ALWAYS converted. Your Medical Director will need to take a firm stand on this issue. Another anomaly I encountered was: at night, if we sent for extra blood, it was always brought to the OR ref and not the Blood Bank. I found surgical residents taking blood from the boxes and transfusing it when there was labeled, crossmatched product in their ref. Their comments were: "We know you got that blood for this pt." Can't believe we did not kill anyone.
    Good luck and be firm.
  25. Like
    simret reacted to simret in Matched Unrelated Donor sample (MUDS)   
    Hello all,
    We are in disagreement among technologists at the hospital that I am working regarding "Match Unrelated Donor samples". Once the MUD sample is received, we did type and screen on the sample and were done until recently. Regardless if the donor sample is RH negative or positive. When the HPC product comes that is from this donor, we do retype on it, immediate spin cross-match with the recipient and issue it to be transfused ( we issue it even if there is ABO disagreement/ discrepancy).
      Now, my question to you all is, is it necessary to perform weak D (Du) on this sample if it is RN negative? Can you share with me what you ion your hospital.
    Thank you
    Simret
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