BankerGirl

When I was looking at the new and improved Tango Optimo, the rep told me that the current Tango "has a known problem with carryover..." and they have fixed it with the new one. Funny how they didn't mention that when they were trying to sell me the current analyzer.

I believe after looking at this several times that it may depend on what product you start with. The answer to the original question, "...what the product code is for TH pooled cryo NS" was answered correctly with "E5821 Thawed POOLED CRYOPRECIPITATE|NS/XX/rt". We have a few different pooled cryoprecipitate products and we use this one if we manually pool after thawing (extremely rare these days), but if the product is pooled and then frozen by our supplier, we use the thawed code that corresponds to the one the supplier uses for the frozen product.

That's what I had too, Terri. Glad you mentioned that.

We have seen immune, IgG anti-M formation as well, most recently 2 days ago, but the issue in this post is that the antibody is undetectable in tube. Were it positive in tube as well, it would have to be considered clinically significant, but since it is only detectable in solid phase (or gel, in my case) I don't believe it can be considered significant. Reaction strengths in my case are 4+ in gel, which if truly IgG in nature, should also be detectable in tube. I don't have any experience (YET!) in solid phase, so I can't speak specifically to that aspect.

I was on vacation when her second titer came through or we wouldn't have sent it out. I have put a comment in her history file so she doesn't get sent off again unless her tube screen becomes positive. Hopefully this will put an end to this nonsense.

We recently had a pregant patient who came in for an evaluation of a positive antibody screen in gel. It was not a definitive pattern and the technologist decided to send it to our reference lab. The results came back anti-M and the IRL deemed it clinically significant since it reacted in gel with IgG cards. I disagreed because it was not detectable in tube (by us OR them) and their titer came out 0 with a score of 0 since they titer in tube. I reminded them that anit-M is notorious for reacting in gel regardless of the nature of the antibody, but they still reported it as clinically significant. We just got back the second titer and the results are the same. I can't really argue with the Dr. since the IRL states that anti-M has been known to cause HDFN, but I really hope this patient has good insurance, since the initial workup was billed at more than $6000.00 and this last one was collected just after RhIG administration, so they had an anti-D to work with as well. How can titering something in tube make sense if it isn't detectable in tube to begin with?

I added that just for you, Malcolm, I really did.

We do pretty much the same as Terri. There are only three times we crossmatch units: 1. we have a give order, 2. the pt has an antibody or history, or 3. the OR requests blood in the cooler, usually for CVOR cases. Love, Love, Love that Electronic Crossmatch, even if the name is a misnomer.

We do the same as above for scenarios A & B, but for C we treat them like A. We don't make them register everytime, but if it is within the 3 days, they must keep their armband on.

From our blood administration policy: NOTE: No blood components will be issued from the blood bank to personnel carrying any food products into the lab. All lab staff have been instructed to stop any person entering the lab with food or drink on their person. Our secretary is very vigilant and strict on this policy. Haven't seen them bring the blood to the cafeteria, but we still have nurses come to pick up blood after picking up their lunch. They had no idea that was against policy. (It is at the top of the policy, in bold type and highlighted in yellow. Hmmm...)

We have a 6 RC, 6 Plasma and 1 Platelet Pheresis prescribed in our MTP policy.

When I became pregnant with my first child it was discovered that I had developed an anti-K from a previous blood transfusion. After I returned to work I discovered that the blood banker doing my type and screen forgot to crossmatch antigen negative units. Now granted, if I had needed blood, the odds were in my favor for receiving K neg units, but that didn't seem to work out too well with the first two units I received. With Baby #2 I reminded them to crossmatch the units this time.

My microbiology supervisor just told me this morning that if she ever needs blood on second or third shift, her husband has instructions to call me at home.

This all sounds VERY familiar!

We do not pool them, but rather have nursing do it when they start the transfusion. This avoids the issue all together.

We do the same as ANORRIS.

We went live with TAR several years ago and it has made my life much easier. I think there is a way to document the vitals through TAR, but even if they don't do it that way, all of the vitals entered into Meditech end up in the same "bucket" eventually, so I had our NPR writer design a report for me that pulls all vitals entered on the patient from 1 hour prior to 15 minutes after the end of the transfusion. This can pull a lot of vitals if the patient is being monitored very closely, but I would rather have too many than not enough.

We have Client Server v. 5.66 and I believe that was the version we had when we instituted this, but it might have been 5.65. I don't know anything about character limits, we just told IT what we wanted it to say and they figured out how to word it so it fit.

We ordered our product labels from Shamrock. The problem we ran into was the occasional "oddball" product that our supplier (ARC) would get from a different region which would have a different preservative formulation and we wouldn't have those labels. We have such a large number of different labels that it is very difficult to find the correct label, and that's assuming the techs noticed the difference in the original label to begin with. That is why we decided to switch to Hematrax. Quite expensive, but much easier and accurate.

Also, if you are handwriting the expiration date and time, you might consider converting directly from frozen FFP to Thawed Plasma. You will confuse the nurses greatly if you change the expiration date twice, with the last one being LATER than the previous one. Experience speaking here. It also save you from having to process the unit twice.

I managed to get the education handout uploaded to the library section under SOPs. Not quite sure this is the perfect place to put it, but that's where it is. Since we made the type and screen order the same as a RC product order due to physician request, we decided to not reflex any products since it is an all or nothing reflex situation. Otherwise we would have to cancel the RC order on all type and screen specimens. If anyone has any other questions, I would be happy to address those.

Same thing here.

We are on version 5.66 right now.

Well I can't seem to get the attachment to show the CPOE screens, so I will email them to Susan, and anyone else who wishes to see them.