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Posts posted by cbaldwin
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This position is still open. Listed under "Northern Inyo Healthcare District Employment". Lots of beautiful social distancing space.
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I am the transfusion service coordinator in the lab of a small rural hospital. I am retiring at the end of the year and my lab manager has posted my position on this site. I thought I would add some information.
Bishop California, population around 5,000, is located on the east side of the Sierra Nevada mountain range near the Nevada border. We are 200 miles south of Reno, 300 miles northeast of LA. We are a vacation destination/retirement community. In the Sierra to the west, and the White Mountains to the east, there is hiking, backpacking, fishing, camping, hunting, skiing, biking, rock climbing, bird watching and more. In town there’s a golf course and a bowling alley, two excellent bakeries, several coffee shops, numerous restaurants, a really great hamburger joint and several yoga studios.
The hospital is small. We have 3 orthopedic surgeons, 2 general surgeons, 3 OB/GYN doctors, a few specialists and numerous ED doctors, hospitalists and generalists. We transfer critical patients to larger health facilities with higher levels of care.
In the transfusion service, our inventory includes 10 units O positive, 6 units A positive, 2 units A negative, 2 units B positive, 8 units O negative and 10 units frozen plasma. Our blood supplier is Vitalent in Reno. Monday through Friday a courier delivers and returns blood products. On weekends and outside of courier hours we make other arrangement with the California Highway Patrol or a hospital courier. (We seldom need to make such arrangements).
We use Ortho MTS gel (manual) and tube. We perform antibody screens with a 3 cell screening panel. We send out positive antibody screens (maybe one every one-two months). We perform 30-45 type and screens a month. We transfuse monthly 10-40 pRBCs, 0-4 frozen plasmas, and 0-1 platelets.
It was odd that I became the coordinator in 2007 because I had little blood banking experience. But I managed to get into a SBB program and pass the SBB exam. I also read the Blood Bank Talk site daily. With my SBB and information from BBT the department is compliant with standards and regulations. Joint Commission surveyors visit us every two years. Usually they find one or two “observations” but we passed the last survey with no “observations”.
In our lab we have 10 lab techs (generalists), 4 lab assistants, 5 phlebotomists. We are a happy, friendly group. I enjoy working with our team. I have an excellent relationship with the nursing staff and meet with the nursing executives monthly to review transfusion documentation of signatures and vital signs and other transfusion issues.
If you would like to live in a quiet town with amazing scenery and great recreational opportunities, and if you would like to run a small transfusion service in a lab with great people, this job is for you!
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Has anyone been recently surveyed by the Joint Commission? We are expecting a survey in May, I am preparing for it, and I wondered if there were any trends this year in what they are “observing”.
I am responsible for a small transfusion service in a 26 bed rural hospital. I am checking that documentation for reagents, QC, competency, training, proficiency testing, and patient testing is complete. I’m updating my P/Ps, and going over the QSAs.
The Joint’s observations in 2017:
1. Not labeling uncrossmatched O negative units with patient’s name, DOB and MRN during traumas. (QSA.05.10.01)
2. Not periodically reviewing with our medical staff information regarding our BB inventory. (QSA 05.02.01) (The inspector explained that a new physician unfamiliar with our BB inventory could start a procedure that required more products than we have. The procedure could fail because of inadequate blood products, resulting in possible patient death and legal action)
3. Not always having the time of signature on transfusion consent forms— “in 3 of 3 consents for transfusion documents reviewed, the time of the patient consent had not been recorded.” (QSA.05.17.01)
4. Not readjusting the set point to simulate a high alarm when doing quarterly checks on our plasma thawer alarm. Biomed was checking the alarm, but not simulating a high alarm as the manufacturer requires. (DC.02.04.03)
Around the time of the 2017 survey I remember others on BB Talk mentioning that they were cited for not labeling Uncrossmatched O negative units. That observation caught me by surprise. My reactions to the other observations were…well, I should have known better. We have a lot of traveling MDs and communicating with them regarding our inventory is very important. And I should have read the plasma thawer operator’s manual more carefully.
I’m just wondering if surveyors are concentrating on anything in particular this year….
Thanks!
Catherine
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4 hours ago, Malcolm Needs said:
But THAT is EXACTLY the beauty of our profession Catherine! I am now retired, and have since learned about a novel antigen in the Gerbich Blood Group System and a novel antigen in the Kell Blood Group System. Problem is, I no longer get paid for this knowledge!!!!!!!!!!!!!!!!!!
So now you have an exciting hobby?
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Just found out...our reference lab charges $305. Thanks all for your replies...I am learning...have a lot to learn. Catherine
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On 1/17/2017 at 6:12 PM, Mabel Adams said:
The companies are all supposed to offer the test for around $300 as I recall. They are charging that much but then we can't charge any markup on the test if we are to keep it so that it is cost-effective for the patient relative to the cost of RhIG. ARC National has it listed on their price list but, as those above said, they are doing only the full genotype now.
Thank you for this information.
I just found the handouts from a lecture Sue Johnson gave in March 2016 at an Immucor Users meeting and I have attached them in case anyone is interested. It's very good. She discusses the molecular basis of weak D and partial D and the variability of reagents and methodology, also the recent recommendations of the Inter-organizational Work Group on RHD genotyping for managing pregnant women and transfusion recipients who have a serologic weak D phenotype.
On page 18 she states that there is a new CPT code 81403 for RHD genotyping (Tier 2 molecular pathology procedure, Level 4) and that reimbursement rates for the Tier 2 code are being established. Also that the ACOG is updating its Practice Bulletin to recommend molecular testing.
I just got a new phone number to call to see if I can get the price that we will be charged if we request this test. My OBGYN physicians would like to know.
Catherine
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On 1/17/2017 at 6:32 AM, SBBSue said:
Where are you located? Our Immucor rep supplied us with a coding guide for reimbursement, and you can also send specimens directly to Immucor for testing. We send ours through our Red Cross IRL. At this time, the last information I received is that reimbursement is for a complete HEA Genotype only, Rh genotype for weak/ partial D is NOT reimbursed because only the complete genotype is FDA approved. I reached out to our Immucor rep for more information if you are interested.
Thank you! This is good information. I will call our Immucor rep. Catherine
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I am working with our OB/GYN MDs on how we will handle weak D OB patients. First of all, we would like to know how available the test is and how expensive it is. When I contacted our IRL to inquire about the price of this test, which they list on their menu, I can only speak with technical people who know nothing about billing, and I do not expect them to--I am a technical person and I know nothing about billing. They did tell me they send the test to Grifols and they gave me a contact number which didn't work out. The very nice people at the other end of the line did not understand my question. (My fault?). Using the term "genotype" to describe the test sent them down the wrong rabbit holes--interesting but not helpful. Today I called our IRL again and they gave me another number. Nobody answered, but it is MLK day.
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Those of you who send out samples from weak D OB patients for molecular testing, do you know, approximately, how much the test costs and whether insurance companies willingly pay for it? I am having trouble finding this information. Thank you! Catherine
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On 6/22/2012 at 7:57 AM, Dr. Pepper said:
Same here. Do make sure though, that BioMed follows manufacturer's and regulatory standards in their QC protocol and that action is taken for any QC test that falls out of range. Also, I would suggest your medical director be involved in choosing the particular blood warmer rather than letting the OR be the only voice.
What are the regulatory standards for checking the temperature alarms and verifying the temperature calibrations on blood warmers? Our BioMed guy has been doing these checks quarterly but just noticed in the operator's manual that the manufacturer's recommendation is to perform the checks annually. He asked me if AABB or the Joint Commission had standards for the quarterly checks. I looked through the AABB standards and TJC QSAs and can't find anything about quarterly checks.
I will stay with the quarterly checks because that is good practice, but wondered if I missed the regulatory standards somewhere.
Thank you!
Catherine
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On 6/22/2012 at 7:57 AM, Dr. Pepper said:
Same here. Do make sure though, that BioMed follows manufacturer's and regulatory standards in their QC protocol and that action is taken for any QC test that falls out of range. Also, I would suggest your medical director be involved in choosing the particular blood warmer rather than letting the OR be the only voice.
What are the regulatory standards for checking the temperature alarms and verifying the temperature calibrations on blood warmers? Our BioMed guy has been doing these checks quarterly but just noticed in the operator's manual that the manufacturer's recommendation is to perform the checks annually. He asked me if AABB or the Joint Commission had standards for the quarterly checks. I looked through the AABB standards and TJC QSAs and can't find anything about quarterly checks.
I will stay with the quarterly checks because that is good practice, but wondered if I missed the regulatory standards somewhere.
Thank you!
Catherine
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Our rapid HIV kit is non-waived for plasma/serum and waived for whole blood. We just went through a Joint Commission inspection and the inspector, when giving us the heads-up about IQCP, suggested we only perform the rapid HIV testing on whole blood. It seems like a simple solution. Does anyone see a problem with it?
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Thanks Liz for the explanation of the 3 month period. It makes sense and it will help me explain to physicians why we need to be concerned about more antibodies forming.
- Liz0316 and Malcolm Needs
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R1R2,
No, our antibody screen on 4/18 showed the Jka reaction was definitely stronger.
Also, I did not mention this before, in order not to distract from my main question, there was an antibody present to the 0.8% screening cell preservative.
When we performed the gel antibody screen with our usual 0.8% cells, all cells were positive at 2+. The auto and DAT were negative, and when I XM'd all of our (8) units of O negative units, those XM's were compatible at gel IgG. So I suspected an antibody to the preservative in the 0.8% cells. As a backup, we have 3% antibody screening cells for tube, and I made 0.8% cells from these cells. The antibody screen with the 3% cells made into 0.8% cells was negative.
On 4/18 I ran a antibody screen with the 0.8% cells and the 3% cells made into 0.8% cells. The 0.8% cells showed the Jka antibody and the antibody to the preservative. The 3% cells made into the 0.8% and tested with gel IgG showed just the Jka.
- Malcolm Needs and Yanxia
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I apologize for posting because this subject has been covered many times. Before posting I read some of the related threads, and I think I am on the right track, but I just want to make sure.
I have a specific situation, and 2 specific questions:
The situation:
Patient, GI bleeder, is O, Rh negative. Patient received 2 units O, Rh negative pRBCs on 4/2/15 at another facility.
On 4/10/15 the patient shows up at our small hospital, where we only perform tube ABO/Rh and manual gel antibody screens. Antibody screen is weakly positive.
We send the specimen to our reference lab where a weak anti-Jka is identified. However, the patient stabilizes at 9.0 hgb and does not receive any blood products. Patient is discharged 4/12/15.
On 4/18/15 I receive a call from the patient’s physician. The patient has been bleeding. His hemoglobin is 6.5. The physician would like to order 2 units O, Rh negative units that are negative for Jka and transfuse the patient.
I tell the physician that because the patient was transfused so recently (4/2/15) and because the antibody workup was done on blood drawn 4/10/15, that, on 4/18/15, I would need to draw another sample and send the specimen to the reference lab for a repeat antibody workup. The patient may have developed another antibody. This is the policy at our facility.
We ended up sending the patient to a larger facility capable of a higher level of medical care.
My first question:
Was I correct about needing to test for additional antibodies? A knowledgeable friend suggested it would have been okay to transfuse Jka negative units that were compatible at IgG....but but but... how could I be sure that another weak antibody wasn't lurking? I think Malcolm has covered this subject in a related thread--the donor cells may be single-dose, etc etc.
I am looking at AABB Standards 5.14.3.2 and 5.14.3.3--A specimen from a patient that has been transfused in the last 3 months is only good for 3 days and patients with previously identified antibodies must be tested with a method to identify additional clinically significant antibodies. A 3-cell antibody screen is not really a good method to identify additional antibodies
My second question:
In AABB Standard 5.14.3.2, how did the creators of this standard decide on three months?
I appreciate any comments and advice. And thanks for your patience at revisiting this subject again!!!!
Catherine
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Thanks Whitney for posting this question! I do not have an answer, but your question is an opportunity for me to learn.
I was wondering how low prevalence antigens from the MN CHO collection would cause steric hindrance. After reviewing information in The Antigen Fact Book, I am reminded that the MNS antigens are on GPA and GPB which are single-pass membrane sialoglycoproteins. One of the major functions of sialoglycoproteins is to contribute to the negative charge of the RBC glycocalyx.
The antigens in the MN CHO blood Group Collection, which are more frequently found in Blacks, are also on GPA and GPA and have altered sialic acid.
So, if cell #6 of this Ortho panel has one of these low incidence antigens, there is a stronger negative charge and this stronger charge is weakening the anti-M/M antigen reaction? Is that correct? Wow--that would never have occurred to me.
I hope you get an answer! A call to Ortho seems to be in order!
And, I hope I do not change the course of this thread too much when I ask if others have seen cases where steric hindrance has caused negative reactions when a positive reaction would be reasonable.
Catherine Baldwin CLS, MT(ASCP)SBBcm
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You can purchase the handout from last year's review separately. Two of my friends were unable to attend the review but purchased the handouts and used the handouts as a study guide. They both passed the SBB exam.
Here is the contact information for the 2015 Last Chance review. You can call Clare Wong about purchasing the handouts:
SBB review - onsite or by webinar
Details and Registration: http://www.giveblood.org/education/sbb-last-chance-review/
Who should attend?
- Individuals preparing to take the ASCP Board of Certification examination in the SBB or BB category.
- Physicians preparing for the Board examination in Blood Banking
- Individuals who wish to take a refresher course in blood banking.
What is included?
- 13 hours of continuing education credit
- Handouts with references and case studies
- 100+ practice questions
- Breaks and lunches for onsite participants
Clare Wong, MT(ASCP)SBB,SLS
Manager,SBB School External Education
Phone: 713-791-6201
Toll Free: 1-888-482-5663
Fax: 713-791-6610
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I work in a critical access hospital. When our hospital purchased a new information system--Paragon--in 2012, a blood bank system--Horizon--was included. I think the BB system cost $30,000.
We have not yet used the Horizon system because our IT department is busy fixing problems they find with Paragon and keeping up with updates. Although we have a small workload I would like to use the system. I see a lot of typos and data entry errors (data entry errors into the LIS) in our transfusion service. My understanding is that the Horizon system would alert us to some of these errors.
In 2012 we had no problem convincing the administration that a BB system would improve our TS by cutting down on errors.
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A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.
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I just thought it was interesting that it was the group B samples that gave negative (compatible) IgG Gel crossmatches with incompatible blood, just as Mabel remembered. And, as Mabel said, the electronic crossmatch could be more sensitive than the IS crossmatch.
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I know someone that did testing of Ortho MTS gel for ABO incompatibility and found that it failed sometimes, mostly with group B patients.
I believe that the CMS rules are that the patient must be tested in a way that detects ABO incompatibility. I don't believe it stipulated that the test be serological. The computer algorithms will not miss the incompatibility if the reverse antibody is very weak but the IS xm could, therefore the computer is the more sensitive (and specific) test. We see both AABB and JC this summer so I will let you know how it goes.
The following is an abstract that was presented at the October 2013 AABB meeting in Denver. I thought it was interesting and remembered this subject had been discussed here, so I dug up this thread and am posting this....
SP219 Detection of ABO Incompatibility in the Extended IgG Gel CrossmatchR M Barrett1,2(Rachelle.Barrett@salemhospital.org), T Kasper1. 1Blood Bank, Salem Health Laboratory, Salem, OR, United States; 2SBB Program, University of Texas Medical Branch, Galveston, TX, United States
Background/Case Studies: AABB Standard 5.15.1 states: “The crossmatch shall use methods that demonstrate ABO incompatibility and clinically significant antibodies to red cell antigens and shall include an antiglobulin test.” When a clinically significant antibody other than ABO is detected during pretransfusion testing, the crossmatch is performed using the same method used in detection. Many extended crossmatch methods do not have an immediate spin reaction. The testing facility for this study uses MTS IgG Gel cards for detection of clinically significant antibodies other than ABO in extended crossmatch. To meet this standard, an immediate spin crossmatch is required in addition to this extended crossmatch. If it could be proven ABO incompatibility is detectable even by methods not designed for such purposes, the extra step of completing an immediate spin crossmatch in the case of the extended crossmatch could be eliminated for the sake of efficiency. Study Design/Methods: Twenty randomly selected samples of each ABO blood type were crossmatched with known ABO incompatible donors at tube immediate spin and on MTS IgG gel cards. Known ABO compatible crossmatch donors were used as controls. Randomly selected samples were also tested for complement activity using commercial anti-c3b-c3d in tube. Results/Findings: ABO incompatible crossmatch was apparent 100% of the time at immediate spin for all samples tested. Type O and A samples demonstrated incompatibility in 100% of samples tested on MTS IgG gel. Type B samples gave negative reactions on IgG gel in 15% of samples tested. Furthermore, type B samples had significantly lower grade reactions on gel as compared with Type O and A samples. Samples that were negative on gel were also negative for complement activity. Positive gel reactions correlated with positive complement in the few samples tested. Conclusion: The clinical significance of the ABO antibodies made by the % of patients testing negative in gel is questionable. If the ability to fix complement is diminished for these antibodies, are these patients then protected from hemolytic transfusion reactions when exposed to type incompatible blood? Until further study determines the clinical significance of these differences in antibody activity, this study suggests completing an immediate spin crossmatch in addition to extended crossmatch methods when extended crossmatch testing methods do not already include an immediate spin reaction.
Disclosure of Commercial Conflict of Interest
R. M. Barrett: Nothing to disclose; T. Kasper: Nothing to disclose
Disclosure of Grants Conflict of Interest
R. M. Barrett: Nothing to disclose; T. Kasper: Nothing to disclose
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We are TJC and AABB but not CAP inspected. Does anyone know how JC surveyors might react to using the QC antibody for comparison?
We are TJC inspected only.
Last year we were cited for using QC material for correlation between gel and tube. The inspector said QC material was not acceptable because it has strongly positive or negative reactions. Using patient or proficiency samples is better because there is more variation in the reaction strengths.
Now we use proficiency samples for correlation, as others have stated. We do the proficiency testing in gel since that is our "main" method and submit our results. After we have submitted our results, I assign the same proficiency samples to different techs to repeat in tube testing. So we do the correlation 3 times a year, since we have 3 proficiency events a year, and the techs can get signed off on competency.
The inspector was happy with this solution and approved of the policy I wrote.
Catherine
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For those of you that do not do the antibody screen, did you do one prenatally or have access to the prenatal records to determine that the mom is not alloimmunized?
Yes
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Never mind--I found the threads posted earlier on this subject.
$15,000 sign on bonus for Transfusion Service Coordinator
in Job Postings
Posted
I first posted this position in October 2020. The position is still open and there is now a $15,000 sign on bonus.
Go to https://www.nih.org/careers/
This site states that the sign on bonus is $10,000 but my lab manager assures me that the bonus has been increased to $15,000. You can phone the hospital at 760-873-5811 and ask to speak with Human Resources or with the Lab Manager to confirm.
Bishop California, population 7,000, is located on the east side of the Sierra Nevada mountain range near the Nevada border. We are 200 miles south of Reno, 300 miles northeast of LA. We are a vacation destination/retirement community. In the Sierra to the west, and the White Mountains to the east, there is hiking, backpacking, fishing, camping, hunting, skiing, biking, rock climbing, bird watching and more. In town there’s a golf course and a bowling alley, two excellent bakeries, several coffee shops, numerous restaurants, a really great hamburger joint and several yoga studios.
The hospital is small. We have 3 orthopedic surgeons, 2 general surgeons, 3 OB/GYN doctors, a few specialists and numerous ED doctors, hospitalists and generalists. We transfer critical patients to larger health facilities with higher levels of care.
In the transfusion service, our inventory includes 10 units O positive, 6 units A positive, 2 units A negative, 2 units B positive, 8 units O negative and 10 units frozen plasma. Our blood supplier is Vitalant in Reno. Monday through Saturday a courier delivers and returns blood products. On weekends and outside of courier hours we make other arrangement with the California Highway Patrol or a hospital courier. (We seldom need to make such arrangements).
We use Ortho MTS gel (manual) and tube. We perform antibody screens with a 3 cell screening panel. We send out positive antibody screens (maybe one every one-two months). We perform 30-45 type and screens a month. We transfuse monthly 10-40 pRBCs, 0-4 frozen plasmas, and 0-1 platelets.
In our lab we have 10 lab techs (generalists), 4 lab assistants, 5 phlebotomists. We are a happy, friendly group.
If you would like to live in a quiet town with amazing scenery and great recreational opportunities, and if you would like to run a small transfusion service in a lab with great people, this job is for you!