Sko681

We have a rehab facility next to our building that is not part of our hospital system (its actually part of a much larger hosptial system located about a half hour away) and we have a LTS (limited transfusion service) license from NYS.  We have also done this for a dialysis center next to one of our other hospitals.  We regularly send and provide blood products to other hospitals within our system- we have had no issues with it regulatory or otherwise.   Good luck!  I can't say as I blame you though- its kind of a pain to set up.

It would do her less harm than her bleeding to death.

And the above reasons is precisely why I have put off ordering new ones.   

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

Well, it is never easy to make a hard and fast rule for all cases.  However, thinking back to first principles can help.  Anti-D is to avoid at all costs in women of child-bearing age who can still have children (For example, I mean in a 25 year old woman who is having her uterus removed for cancer is of child bearing age, but can't have children).  You have finite stocks of D neg blood, and your young women should be the priority.  Your second priority should be your patients who are transfusion dependent for life - like sicklers or thalasssaemics. For other chronic transfusions, well, it depends what 'chronic' means, and how much blood you have available and how often the patient needs blood.  I would argue that probably for a 90-year old who is not likely to live more than 6 months who needs 2 units of blood every month, you could probably switch to D+ if you needed to without much of a problem.  I wouldn't do it on a 40 year old who was receiving blood regularly now but with hopes of remission.   Then you have to think that in cases of massive bleeding, the blood doesn't usually stay in the patient long enough for the immune system to 'see' it, so in cases of heavy bleeding it's better to give your D+ first and then switch to D- once the patient is stable.  But that's only my opinion.....

I don't know about every time, but I would certainly want to do it after each transfusion

Nursing fills out a suspected transfusion reaction form and sends it to the lab. They document the time, symptoms, vitals etc.  Our BB director reviews all forms whether a transfusion reaction work up was ordered by the physician or not.  It is stated in our SOP that the BB medical director can order testing at his discretion.  Honestly (and fortunately), he has never had to do that.    

Nursing fills out a suspected transfusion reaction form and sends it to the lab. They document the time, symptoms, vitals etc.  Our BB director reviews all forms whether a transfusion reaction work up was ordered by the physician or not.  It is stated in our SOP that the BB medical director can order testing at his discretion.  Honestly (and fortunately), he has never had to do that.    

Agree with Sandy L; agglutination viewer seems to be fine.
And also goodchild; I believe that's really the intent is to base your interpretation/result on the macroscopic reading. Nothing prevents a tech from using a microscope, as long as they are following the manufacturer's instructions on how to result the test macroscopically only. The risk is that you see something in the microscopic that then leads a tech to chase a rabbit trail that wastes time.

It was the physician's call on if the patient was in need of a transfusion reaction workup so in the case you described we would refer the nurse to the physician who ordered the transfusion.  More often than not the physician would not order a workup and it ended there.  If I remember correctly we actually became involved when a physician would order the workup and everything started then including the documentation.  Usually in this case the nurse would call and say, "Dr. So and So wants a transfusion reaction work up on patient XYZ.  What do I do now?"  We would then take it from there.  These were so rare that the nurse seldom if ever remembered what to do. 

In both cases, as far as I am aware, a large FMH would only be obscured if the maternal ABO antibodies had removed the foetal red cells, rather in the same way that the passive anti-D would remove the foetal red cells, and so the obscuring of the large FMH would make no difference?  It is known that a major ABO incompatibility between a D Negative mother and a D Positive foetus can, to a certain extent, mitigate against the mother producing an immune anti-D (see several editions of Mollison's Blood Transfusion in Clinical Medicine).

I have never qc'd panels and will be ending my career with that same statement, mostly, because at my current and final employer we don't perform antibody id's.  This discussion is not a new one and will continue to pop up with new inspectors and new interpretations of old rules.  Frankly, there is not anyway to realistically QC a panel and have confidence that the every antigen listed is detectable.  Frankly I am surprised at the number of folks responding that they do some form of panel QC.  In my ever so humble opinion you are providing nothing but smoke and mirrors to pacify some inspector.     I suppose that as long as you are successful at this it's worth the effort.

Yes it would however the majority of us small hospitals do not have the luxury of FLOW.

We use the Kleihauer-Betke stain to evaluate antenatal trauma/hemmorhage - esp since there is no knowing the Rh type of the fetus.

I call that the "baptism of fire".  Just remember that experience is the best teacher.  If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to?  As a newbie there really should be some kind of support for you in these situations. 
 
Just a battle story to share....  we are not a trauma center either and a while ago when I was new,  we had a patient that came in as a trauma and they wanted emergency release.   Blood was issued and then we found out the patient had multiple antibodies.  I believe that one was a Kidd.  Of course, the units that the patient was given were incompatible.  Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this.    I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction.  They just need the oxygen. 
 
Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore.  Don't be discouraged, you will gain the knowledge over time to be confident in your decisions! 

All this just reinforces my opinion that one should never, never, ever
 get sick, because then you can get treated and all sorts of bad things can happen!

I call that the "baptism of fire".  Just remember that experience is the best teacher.  If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to?  As a newbie there really should be some kind of support for you in these situations. 
 
Just a battle story to share....  we are not a trauma center either and a while ago when I was new,  we had a patient that came in as a trauma and they wanted emergency release.   Blood was issued and then we found out the patient had multiple antibodies.  I believe that one was a Kidd.  Of course, the units that the patient was given were incompatible.  Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this.    I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction.  They just need the oxygen. 
 
Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore.  Don't be discouraged, you will gain the knowledge over time to be confident in your decisions! 

Hi Kirkaw, there is a topic in the 'Off Topic" section that will answer some of your questions.  http://www.pathlabtalk.com/forum/index.php?/topic/7817-mlt-vs-mls-in-the-blood-bank/
 
In our lab we have mostly MTs but some MLTs.  At this time, all persons who work in BB are MTs.  We have had MLTs in the past and I would say some were a success and some were not.  The time training for us is sometimes longer depending on experience and willingness to learn. 
 
We do take MLT and MT students on clinical rotations.  Typically MLT students are here for only 2 weeks and we cover everything because at our facility, MLT's are expected to function in BB the same as an MT except they cannot be in charge.  We do not cover adsorptions becasue we do not do them here.  Those would go to a reference lab. 

I call that the "baptism of fire".  Just remember that experience is the best teacher.  If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to?  As a newbie there really should be some kind of support for you in these situations. 
 
Just a battle story to share....  we are not a trauma center either and a while ago when I was new,  we had a patient that came in as a trauma and they wanted emergency release.   Blood was issued and then we found out the patient had multiple antibodies.  I believe that one was a Kidd.  Of course, the units that the patient was given were incompatible.  Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this.    I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction.  They just need the oxygen. 
 
Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore.  Don't be discouraged, you will gain the knowledge over time to be confident in your decisions! 

At minimum we do a DAT in addition to visual inspection for hemolysis on the post transfusion sample but I would caution that unless the post transfusion specimen is collected right away- hemolysis can be missed (I have personally seen it happen). 

I call that the "baptism of fire".  Just remember that experience is the best teacher.  If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to?  As a newbie there really should be some kind of support for you in these situations. 
 
Just a battle story to share....  we are not a trauma center either and a while ago when I was new,  we had a patient that came in as a trauma and they wanted emergency release.   Blood was issued and then we found out the patient had multiple antibodies.  I believe that one was a Kidd.  Of course, the units that the patient was given were incompatible.  Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this.    I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction.  They just need the oxygen. 
 
Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore.  Don't be discouraged, you will gain the knowledge over time to be confident in your decisions! 

I call that the "baptism of fire".  Just remember that experience is the best teacher.  If you find yourself in such a scenario where you do not feel comfortable or need help with a decision, is there a supervisor or on call person that you can reach out to?  As a newbie there really should be some kind of support for you in these situations. 
 
Just a battle story to share....  we are not a trauma center either and a while ago when I was new,  we had a patient that came in as a trauma and they wanted emergency release.   Blood was issued and then we found out the patient had multiple antibodies.  I believe that one was a Kidd.  Of course, the units that the patient was given were incompatible.  Because "universal donor" is really kind of a misnomer in scenarios like this. I had obviously never been in a situation like this.    I learned a few things after that incident- the first is that we aren't a trauma center. Almost always the patients that we get are not stable enough to go to another hospital which leads me to my next tidbit... if the patient is bleeding so bad that they cannot wait for crossmatching and antigen typing- the immediate risk to the patient of not getting blood is greater than a potential transfusion reaction.  They just need the oxygen. 
 
Since that time we have had this happen on occasion and while it still makes me nervous it isn't that drop in the pit of my stomach anymore.  Don't be discouraged, you will gain the knowledge over time to be confident in your decisions!