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MAGNUM

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  1. Like
    MAGNUM got a reaction from Ensis01 in Microscopes   
    They are AO's, then I am sure that they are still working. Why is your upper management trying to mess with a good thing?
  2. Like
    MAGNUM got a reaction from John C. Staley in Critical values   
    I have no critical values in our blood bank. Although if we have a positive DAT on a baby we call it, and we call the floors to update them if we have antibodies.
  3. Like
    MAGNUM got a reaction from Sherif Abd El Monem in Critical values   
    I have no critical values in our blood bank. Although if we have a positive DAT on a baby we call it, and we call the floors to update them if we have antibodies.
  4. Like
    MAGNUM got a reaction from mollymotos in Blood unit patient label   
    PAPER TAGS PRINTED ON A DMP PRINTER
     
  5. Like
    MAGNUM got a reaction from Malcolm Needs in Rh antigen typing on Vision   
    Hey Malcolm, I especially like the bottom right quadrant that says "Date Bled".  We really need the phenotypes included on the unit face label.
     
  6. Haha
    MAGNUM got a reaction from AMcCord in Patient hx   
    Jason Bourne all over again!!
  7. Haha
    MAGNUM got a reaction from Ensis01 in Patient hx   
    Jason Bourne all over again!!
  8. Haha
    MAGNUM got a reaction from jayinsat in Patient hx   
    Jason Bourne all over again!!
  9. Like
    MAGNUM reacted to John C. Staley in Patient hx   
    The USA is considerably larger, we do not have a national healthcare system (which I personally hope we never have), and there is not a central data base that is accessible to all.  I'm afraid the cost / benefit analysis of establishing such would not favor attempting one.  Just my opinion.  

  10. Like
    MAGNUM reacted to John C. Staley in CAP Inspector Requesting Documents in Advance   
    Just curious, do they want the documents sent electronically or hard copy?  Either way, especially since you referred to the request as a "big list" I would probably, respectfully decline.  I would indicate that the listed documents would be readily available upon their arrival.  But that just me and I never had an inspector request anything like this.  I'm sure things have changed since my last CAP inspection.

  11. Like
    MAGNUM reacted to RichU in Post-partum workup   
    How do you know a positive screen isn't caused by an alloantibody underlying the prophylactic anti-D unless you do an ABID?
  12. Thanks
    MAGNUM got a reaction from RRay in Post-partum workup   
    We used to include a type and screen in our Rhogam workups, but about 15 years ago we opted to just provide the fetal screen. There is no requirement to provide a screen at that time.
  13. Like
    MAGNUM reacted to Malcolm Needs in Prenatal Antibody Titers   
    Well, the first thing to say is that red cells CANNOT be either homozygous or heterozygous (or, come to that, hemizygous).  These terms apply ONLY to genes, and red cells do not contain a nucleus.  The antigens can only be described as, at best, "homozygous", "heterozygous" or "hemizygous" expression, or, alternatively, "double" or "single dose" expression.

    Then, it HAS to be accepted that, unless the maternal antibody is an autoantibody, it must be an alloantibody (or, possibly, an isoantibody), which means that to mimic the state of the foetal red cells, the red cells used to titrate the antibody MUST have a "single dose" expression.  However, that in itself presupposes that the foetal red cell antigens are all expressed at the same time, which we know is untrue (just look at the A, B and H antigens as an obvious example, but also the Kell antigens that are expressed much earlier than are the Rh antigens) or are ONLY expressed on foetal red cells, as opposed to other tissues (such as on the placental cells, which have, in some cases, been proved to adsorb the maternal antibodies).

    Then, there is the fact that not all antibodies can be detected by all techniques.  This is why Reference Laboratories SHOULD have more than one technology available (and their workers should be provably competent in these techniques.  However, even then, not all techniques can predict the severity or otherwise of HDFN.  For example, antibodies within the Indian Blood Group System always show that they can cause severe HDFN by certain techniques, such as MMA, but they don't!  There is also the fact that the immunoglobulins may be IgM, IgA, IgG1, IgG2, IgG3 and IgG4 (to mention just a few), and I have yet to come across, or read about, an IgG4 immunoglobulin causing HDFN.

    So, my answer is that there is a HUGE amount of knowledge known about the various antibody specificities, their titres, the expression of their cognate antigen, etc, etc, that there CANNOT be a single answer to your excellent question, but that the best thing that can be done is to read around the subject - and read around the subject from every source available - not just from a single country.

    OKAY THEN, RIP ME APART!!!!!!!!!!!
  14. Like
    MAGNUM got a reaction from BldBnker in Helmer Plasma Thawer-water change frequency   
    I have one and if I am not mistaken, it recommends against DI water, so we use tap water and change it weekly as suggested by the manufacturer.
  15. Like
    MAGNUM got a reaction from Bet'naSBB in Helmer Plasma Thawer-water change frequency   
    I have one and if I am not mistaken, it recommends against DI water, so we use tap water and change it weekly as suggested by the manufacturer.
  16. Thanks
    MAGNUM got a reaction from Mabel Adams in CPT codes used for PEG crossmatches   
    we treat PEG as another enhancement, so no difference in charges
  17. Like
    MAGNUM got a reaction from Bet'naSBB in CPT codes used for PEG crossmatches   
    we treat PEG as another enhancement, so no difference in charges
  18. Like
    MAGNUM got a reaction from John C. Staley in CPT codes used for PEG crossmatches   
    we treat PEG as another enhancement, so no difference in charges
  19. Like
    MAGNUM got a reaction from Kelly Guenthner in Pipettes (droppers)??   
    I have not used glass pipettes in quite a few years, ever since the powers that be determined that they were unsafe. We use the Cardinal pipettes now.
  20. Like
    MAGNUM reacted to applejw in Blood administration   
    In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
    Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.
  21. Like
    MAGNUM reacted to sgoertzen in PEDIATRIC MASSIVE TRANSFUSION PROTOCOL   
    I've attached our MTP procedure and worksheet.  We are a children's hospital with a level 2 pediatric trauma center.Massive Transfusion Protocol - MTP.pdfMassive Transfusion Protocol - MTP Worksheet.docx.pdf
  22. Thanks
    MAGNUM reacted to Mabel Adams in PEDIATRIC MASSIVE TRANSFUSION PROTOCOL   
    I tried hard a few years ago to find evidence for this but found nearly nothing in terms of evidence-based guidelines.  I will try to add here what I came up with, but it is fairly arbitrary.  It is part of our MTP document.  It loses a lot of formatting here.  Sorry.  Broselow Tape is used in ED to estimate the size of a child.  Maybe see if your ED can share what this looks like.  This information is intended to be of practical use as a loose guideline for the poor blood banker working on the unusual day that we get a pediatric hemorrhage in.  I am very open to improvements.   Good luck!
    Broselow Tape Patient Size Correlation:
     
    Grey
    3-5 kg
    Pink
    6-7 kg
    Red
    8-9 kg
    Purple
    10-11 kg
    Yellow
    12-14 kg
    White
    15-18 kg
    Blue
    19-23 kg
    Orange
    24-29 kg
    Green
    30-36 kg
    Wt. in Lbs.
     
    7-11
     
    13-15
     
    18-20
     
    22-24
     
    26-31
     
    33-40
     
    42-51
     
    53-64
     
    66-79
    Approx age
     
    < 3 mo.
     
    3-9 mo.
     
    4-15 mo.
     
    1-2 yr.
     
    2-3 yr.
     
    4-5 yr.
     
    6-7 yr.
     
    8-9 yr.
     
    10-11 yr.
     1 unit Platelet order at SCHS = 1 apheresis platelet = 6 units of whole-blood-derived platelet (6 pack)
    Product = any and all types of blood component therapy, to include RBC, plasma, platelets, and cryoprecipitate. Bend only: Group A plasma may be used as universal donor plasma for adults and children over about age 5. Blood Products
    Grey
    3-5 kg
    Pink
    6-7 kg
    Red
    8-9 kg
    Purple
    10-11 kg
    Yellow
    12-14 kg
    White
    15-18 kg
    Blue
    19-23 kg
    Orange
    24-29 kg
    Green
    30-36 kg
    Adult
     
    MTP Round 1
    10 ml/kg is ~equivalent to 1 unit RBCs to an adult.
                                
    Red Cells
    1 unit *
     
    1 unit *
     
    1 unit 
    1 units
    1 units
    2 units
    3 units
    3 units
    4 units
    4 units
    Plasma
    1 unit †
     
    1 unit †
     
    1 unit †
     
    1 unit †
     
    1 unit †
     
    2 units †
    2 units
    2 units
    2 units
    2 units
    Platelets





     
     
     
     
     
    Cryoprecipitate
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    MTP Round 2
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
     
     
     
     
     
    Red Cells
    1 unit *
     
    1 unit *
     
    1 unit *
     
    1 units
    1 units
    2 units
    3 units
    3 units
    4 units
    4 units
    Plasma
    1 unit †
     
    1 unit †
     
    1 unit †
     
    1 unit †
     
    1 unit †
     
    2 units †
    3 units
    3 units
    4 units
    4 units
    Platelets





    1
    1
    1
    1
    1
    Cryoprecipitate
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 single cryo as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    MTP Round 3
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
    Repeat Round 1
     
     
     
     
     
    Red Cells
     
     
     
     
     
    2 units
    3 units
    3 units
    4 units
    4 units
    Plasma
     
     
     
     
     
    2 units †
    3 units
    3 units
    4 units
    4 units
    Platelets
     
     
     
     
     
     
     
     
     
     
    Cryoprecipitate
     
     
     
     
     
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    1 pool of 5 as ordered or if Fib <100
    Continuing Rounds
     
     
     
     
     
    Repeat Rounds
    2 & 3
    Repeat Rounds
    2 & 3
    Repeat Rounds
    2 & 3
    Repeat Rounds
    2 & 3
    Repeat Rounds
    2 & 3
    * If < 4 months old (grey & pink)
    ·         Irradiated blood & platelets not required unless specifically ordered by physician.
    ·         Continue to give only O RBCs & AB plasma regardless of baby’s blood type.
    ·         Unless AB platelets are available or they request otherwise, wait to give ABO-incompatible platelets until the baby has had a partial transfusion of O RBCs to reduce ABO incompatibility.  Avoid giving O platelets on a non-O baby.
    ·         Syringes with filters issued with RBCs and platelets in case preferred over blood administration set.
    ·         Still must use blood warmer for massive transfusion if syringes used.
    ·         All blood products must be filtered, either by blood administration set or syringe with filter.
    † Thaw AB plasma as universal donor on all peds under ~18 kg (40 lbs.—around age 5). Don’t use A plasma for them as universal donor without physician/pathologist approval.
    ‡ Issue platelets with instructions to give only part of the unit or run it as needed over 4 hours (or can aliquot if time).  These are the fractions of a unit proportional to the RBCs being given in each round. Communicate this information to nurse.
    Grey
    3-5 kg
    Pink
    6-7 kg
    Red
    8-9 kg
    Purple
    10-11 kg
    Yellow
    12-14 kg
    1/5
    1/5
    1/3
    1/3
    1
    This policy does not apply to exchange transfusions of neonates.
     
     
  23. Like
    MAGNUM got a reaction from Kelly Guenthner in Same Day Survery ABO Confirmation process   
    We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.
  24. Like
    MAGNUM got a reaction from Mabel Adams in Same Day Survery ABO Confirmation process   
    We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.
  25. Like
    MAGNUM got a reaction from Ensis01 in Same Day Survery ABO Confirmation process   
    We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.
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