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BankerGirl

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  1. Like
    BankerGirl reacted to Malcolm Needs in positive dat w cord blood   
    This case worries me.
    The screening cells in the UK also do not have to express the Cw antigen, and yet there are several examples of anti-Cw appearing in the literature where the antibody is blamed for severe (and, in at least one, if not two, fatal) HDFN.
    Those mentioned by Geoff Daniels (in Daniels G.  Human Blood Groups.  3rd edition, 2013, Wiley-Blackwell) include:
    Lawler SD, van Loghem JJ.  The Rhesus antigen Cw causing haemolytic disease of the newborn.  Lancet 1947; ii: 545-546.
    Kollamparambil TG, Jani BR, Aldouri M, Soe A, Ducker DA.  Anti-Cw alloimmunization presenting as hydrops fetalis.  Acta Pediatrica 2005; 94: 499-507.
    Byers BD, Gordon MC, Higby K.  Severe hemolytic disease of the newborn due to anti-Cw.  Obstet Gynecol 2005; 106: 1180-1182.
    May-Wewers J, Kaiser JR, Moore EK, Blackell DP.  Severe neonatal hemolysis due to a maternal antibody to the low frequency Rh antigen Cw.  Am J Perinat 2006; 23: 213-217.
    Chu H-P, Kanagalingam D, Chan DKL.  Severe intrauterine hemolysis due to anti-Cw.   Am J Perinatol 2007; 24: 623-626.
    A further case is Macher S, Wagner T, Rosskopf K, Reiterer F, Csapo B, Schlenke P, Klaritsch P.  Severe case of fetal hemolytic disease caused by anti-Cw requiring serial intrauterine transfusions complicated by pancytopenia and cholestasis.  Transfusion 2016; 56(1): 80-83.
    I would, therefore, be far happier if the Cw antigen were expressed on both UK and US screening cells (as I believe it is in Finland and Latvia).
     
  2. Thanks
    BankerGirl got a reaction from bevydawn1 in Specimen Expiration   
    bevydawn1,  Here is the rule I had in 5.67.  Hopefully it helps.  The Data Flds From is BSP.
    (([f bsp ctime]-2400)/100)^X,
    (72-X)^Y,
    [f bsp exp hrs set](Y);
  3. Like
    BankerGirl reacted to jalomahe in Anti f?   
    Thanks Malcolm. I don't know why but f has always confused me way more than it should and now that manufacturer's have taken it off the panel antigrams it becomes an enigma that I have to try to explain to techs with less experience than I .....
  4. Like
    BankerGirl reacted to Neil Blumberg in Neil Blumberg   
    And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses.  In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).
  5. Like
    BankerGirl got a reaction from AMcCord in Performing Antibody Screens As Part of RhIG Workups   
    We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it.  We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.
  6. Like
    BankerGirl got a reaction from Ward_X in Performing Antibody Screens As Part of RhIG Workups   
    We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it.  We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.
  7. Like
    BankerGirl got a reaction from Ensis01 in Performing Antibody Screens As Part of RhIG Workups   
    We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it.  We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.
  8. Like
    BankerGirl got a reaction from AMcCord in Nursing Order   
    True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab.  My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used.  I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though.  I have learned never to respond in the heat of the moment if it isn't absolutely necessary.
  9. Like
    BankerGirl got a reaction from John C. Staley in Nursing Order   
    We set our blood product orders to reflex off of the transfuse order.  This accomplishes two things for us:  the physician only has to enter one order, and we don't have staff calling us and asking if they need to order irradiated, cmvn, leuko-reduced, etc.  We perform electronic crossmatch (sorry Malcolm, that's the term) so we do not set units up unless they have a transfuse order unless they have a clinically significant antibody (or history of one) or the patient is in OR and the physician requests units be packed in a cooler for quick access.
  10. Like
    BankerGirl got a reaction from John C. Staley in Nursing Order   
    True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab.  My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used.  I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though.  I have learned never to respond in the heat of the moment if it isn't absolutely necessary.
  11. Like
    BankerGirl got a reaction from jnadeau in Nursing Order   
    True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab.  My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used.  I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though.  I have learned never to respond in the heat of the moment if it isn't absolutely necessary.
  12. Like
    BankerGirl got a reaction from SMILLER in Nursing Order   
    True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab.  My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used.  I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though.  I have learned never to respond in the heat of the moment if it isn't absolutely necessary.
  13. Like
    BankerGirl got a reaction from John C. Staley in Nursing Order   
    Thank you for your comment, John.  My statement is also not popular with my Laboratory Director, but it is true none the less.
     
  14. Like
    BankerGirl got a reaction from Ward_X in Nursing Order   
    This is how we treat it.  I have no way of verifying that there wasn't a verbal order from the physician to transfuse.  We do have the physician order to transfuse on their checklist as well, and there have been nurses who just checked it and went about their transfusion without an order.  I have to explain several times a year that it is the Dr.'s responsibility to order what he wants, Lab's job is to prepare what the Dr. orders, and the RN's responsibility to carry out the physician's orders.  Not always popular, but we can't babysit everyone.
  15. Like
    BankerGirl got a reaction from John C. Staley in Nursing Order   
    This is how we treat it.  I have no way of verifying that there wasn't a verbal order from the physician to transfuse.  We do have the physician order to transfuse on their checklist as well, and there have been nurses who just checked it and went about their transfusion without an order.  I have to explain several times a year that it is the Dr.'s responsibility to order what he wants, Lab's job is to prepare what the Dr. orders, and the RN's responsibility to carry out the physician's orders.  Not always popular, but we can't babysit everyone.
  16. Like
    BankerGirl got a reaction from Dansket in Nursing Order   
    This is how we treat it.  I have no way of verifying that there wasn't a verbal order from the physician to transfuse.  We do have the physician order to transfuse on their checklist as well, and there have been nurses who just checked it and went about their transfusion without an order.  I have to explain several times a year that it is the Dr.'s responsibility to order what he wants, Lab's job is to prepare what the Dr. orders, and the RN's responsibility to carry out the physician's orders.  Not always popular, but we can't babysit everyone.
  17. Like
    BankerGirl got a reaction from Malcolm Needs in BloodBankTalk:Antibody/Antigen Reaction   
    I just answered this question.


    My Score PASS  
  18. Like
    BankerGirl got a reaction from jayinsat in Emergency Release Blood   
    One thing I would add to Dansket's post is that the standard says group O, it does not say O Neg.  If your specimen types Rh Positive, you may, according to the standard, switch to O Pos and save your O Neg inventory for actual Rh Negative patients.
  19. Like
    BankerGirl got a reaction from tkakin in Red Cell coming from other institution with a patient   
    This does not happen often at my facility, but our policy is similar to AMcCord's.  If already infusing, the nurses continue the transfusion and document that.  If not infusing on arrival, we are rarely notified prior to the ambulance departing, so we rarely get to send the units back.  If there were appropriate shipping conditions/paperwork, then we would accept into our inventory; if not then the units are discarded and the transferring facility notified.
  20. Like
    BankerGirl got a reaction from Malcolm Needs in BloodBankTalk:Antibody/Antigen Reaction   
    I just answered this question.


    My Score PASS  
  21. Like
    BankerGirl got a reaction from gagpinks in When is Rhesus D positive in test tubes?   
    I have a question about the "newborn card".  I am not familiar with this card, so forgive me if this is the case.  Does this card contain IgG, and is it incubated at 37 prior to centrifugation?  And when you perform the testing in tube, do you incubate and carry it through AHG phase?  This is how we detect weak D.
  22. Like
    BankerGirl got a reaction from TreeMoss in Communication between shifts   
    We also have a communication log.  It doesn't have to be anything fancy, ours is just a spiral bound notebook.  We also give verbal report to the oncoming shift.  This isn't fool proof, but it helps.
  23. Like
    BankerGirl got a reaction from Sue Arata in Transfusion documentation   
    You don't say who "upper management" includes, but this might help.  We struggled greatly when I first started doing the transfusion review several years ago.  The Quality Review department (all nurses) used to do the reviews and we were always at 100%, partly because they didn't audit all transfusions but mostly because they only looked at blood pressure for vitals documentation.  I couldn't believe that a nurse didn't know that temperature is part of vitals!  When I started doing it they were shocked that our compliance was <50%.  Fortunately for me, our Director of Nursing and Risk Manager were appalled and very adamant that we fix this.  It wasn't easy, but we have been at >95% for several years now.  I would enlist the help of your Risk Manager if you haven't already.  I became a pro at completing incident reports in several systems over the years, but writing up every single instance was what finally turned the tide.  The nursing managers were fed up with investigating incident reports very quickly!
  24. Like
    BankerGirl got a reaction from Texas Lynn in Daily QC (again)   
    We do the same.
  25. Like
    BankerGirl got a reaction from Malcolm Needs in ABO Investigation With Wide Thermal Range AB's   
    I agree with Malcolm.
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