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Posts posted by cbaldwin
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Thank you David and David. This information is very helpful!
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Our NUrses use Lipppincott - they can edit the procedures to accommodate local/internal policies.
Standard blood transfusion set should suffice for your pooled cryo. Did they use filtered syringed when they did the cryo before? - just curious
Thank you! When they used syringes to administer cryo, they also used a component infusion set that had a filter, so there was a filter.
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Just found the information I was looking for--cryo needs a filter.
But still would like to know a good reference for the actual transfusion procedures--tubing, filters, etc. I seem to be in a position where nursing asks me for advice. I guess I'm qualified to give advice because I don't know anything.
In the past when nurses have asked me questions about what tubing to use, I have suggested they consult nursing procedures. But now I am being asked to look over the nursing procedure for transfusion to see if it looks good to me. I have made some changes. For instance, I stated that the IV should be started before the unit is obtained from the Transfusion Service and added that pRBCs need to be transfused within 4 hours.
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Hello,
I am helping nursing update their transfusion SOP and a question about pooled cryo has arisen.
In the past we used single units of cryo which were infused with syringes. We now stock pooled cryo. Nursing has asked me what kind of tubing and filters should be used for the pooled cryo. I am thinking they should use the same set-up they use for FFP.
Please help me answer this question correctly.
Also, since I am being approached with these questions, what is a good reference I can use for nursing transfusion procedures? I have looked at AABB publications but don't see anything that actually addresses tubing. There is an excellent AABB publication, free to AABB members, "Primer of Blood Administration", which is loaded with great information, but there is nothing about tubing, filters, and the actual process of transfusion.
Thanks so much!
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Hi everyone,
I am thinking about taking the SBB exam and I am trying to figure out my best study options. Has anyone taken the SBB exam review course that is offered online at George Washington University? It consists of 10 modules and a practice exam that you do at your own pace. It is quite expensive...not as expensive as a year long SBB course, but I don't want to waste the money if it is not worth it. It seems quite extensive but I am hoping someone here has taken it or heard something about it.
Thank you all so much for any help you can give me.
Lynda
Hi Lynda,
I was wondering if you ended up taking this course and how you liked it. Are the 10 modules self-paced also? Can you sign up for it anytime or is there a schedule. You said it is expensive....how expensive?
Thank you!
Catherine
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The SCABB just announced "The Last Chance Review" for the SBB exam will be in Houston February 9th and 10th. You don't have to go to Texas--you can view it as a Webinar. Here is the information:
http://www.giveblood.org/services/education/sbb-last-chance-review or contact Clare Wong at cwong@giveblood.org
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Thank you for your reply. Do you acceptable even though it is a draft guidance?
I hope someone with more knowledge of FDA guidances and regulation will chime in here.
I do know that this is what the FDA says about draft guidances: Draft regulations and guidances are documents that have been proposed, but FDA has not made a decision as to whether the proposal will be adopted in whole, in part, or not at all. Each FDA draft document lists how to submit comments to the agency concerning the draft.
Donor centers follow approved and published FDA regulations and AABB standards for donor qualification. For situations that are hazy or not specifically addressed by the FDA or AABB, the medical director of a donor center will make a policy (and this is just my observation). Usually these policies are very conservative. Often donor centers have donor qualification policies that are more conservative than the FDA regulations or AABB standards.
The donor center where I donate blood accepts donors who have recently traveled to Quintana Roo, as long as they stayed in urban areas and did not travel far into rural environments.
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I just noticed my link will not take you to the guidance....sorry. I copied it from the address bar that appeared when I had the guidance open. If you just type in "FDA Guidance for Malaria Deferral" in a search engine, the link to the guidance will pop up.
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Here is a link to the latest FDA draft guideline on Malaria, published June 2012:
It states:
You may accept a donor who is a resident of a non-endemic country and who has traveled to the Mexican states of Quintana Roo or Jalisco without any deferral for malaria risk. However, we recommend that you defer for one year after the last departure from a malaria-endemic area a donor who is a resident of a non-endemic country and who has traveled to or through any of the malaria-endemic areas in Mexico other than the states of Quintana Roo and Jalisco. After the 1-year deferral period, the donor may be eligible to donate provided the donor has been free from malaria during this period and meets all other donor eligibility criteria.
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Well in my lab we use Oh red cells, but I know these are not available to most people.
Hi Malcolm! Are those reagent Oh cells or patient? Thank you! CLB
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I looked up the records. Yes, A3 did demonstrate mixed field (mf) agglutination with anti-A,B (2+). Ax had weak reaction with anti-A,B (+/2+), but the reaction with anti-A was still weaker (0 /w). Also this patient had anti-A1 in serum (+).
The A3 blood group was a 23 year old male pre-employment health check-up patient, whereas the Ax blood group patient was 53 year old male CABG patient. We crossmatched O group blood for him, but his surgery was postponed for some reason(s)?? unknown to us.
Thank you! I am a student and one of the test specimens I've had was an A3. The clue was the mixed field--all the books say that A3 demonstrates mixed field. It's nice to know that sometimes the cells do read the books and behave the way they are suppose to! CLB
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Just curious--what is used for a negative control for anti-A?
OOPS!!!!! I MEANT, what is used for a negative control for anti-H!!!!!!
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Just curious--what is used for a negative control for anti-A?
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I wholeheartedly agree
I don't think I qualify as a nerd, at least not now. I have a long way to go, but I am learning new things, getting help from all the discussions that are ongoing. Also I still haven't found a really exciting elusive antibody that many of you all have - but we did have one A3 blood group and one Ax blood group in the last few months.
Yes, do count me in one of your wannabes!!
Did the A3 demonstrate mixed field agglutination? Isn't mixed field agglutination a characteristic of A3? And did the Ax react with anti-A,B weakly?
Thank you!
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Nevermind. I just looked at the AABB TM 17th ed and it is stated that a quantitative test should be done.
Should I explain that in this case the baby is Rh positive and it was not known that the mom was a weak/partial D until the result of the fetal-maternal screen was strongly positive and further investigation led to the Rh IAT that showed the mom was a weak or partial D.
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I have both books. Human Blood Groups covers blood groups 001-026 extremely thoroughly. The chapter on ABO, Hh and Lewis groups is 91 pages, and 28 of those pages are references (881 references for one chapter). It is excellent. There is a lot of biochemistry and molecular genetics. Geoff Daniels explains things well.
The Essential Guide to Blood Groups is a small, beautifully-made and illustrated paperback that covers the essential facts of each blood group, but it also has some nice information on testing techniques, antigen/antibody biochemistry, flow cytometry, molecular testing, QA in the immunohematology laboratory, trouble-shooting and problem solving. I think this book is great for a Blood Bank beginner or a generalist. I like using it to illustrate points to my coworkers. The information is basic, but it is easy to read and, as I said, beautifully illustrated.
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If a mom turns out to be a weak or partial D, the fetal maternal screening test result will not be reliably valid. Wouldn't the next step be to run a Kleihauer-Betke or a flow cytometry to assess how much fetal/maternal bleed there was and how much Rhogam the mom should get?
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The SCABB (South Central Association of Blood Banks) sponsors a 3 day review in Galveston Texas in March. I have been told by recent SBB exam takers that this review is excellent and it helped them a lot! You can go on the SCABB web site for more information, although I just checked the website and the exam review is not listed yet. You could contact them and ask for more information.
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Thank you! They have sent the specimen for DNA sequencing. It was a good case to be exposed to because I got to do the adsorption/elution and it forced me to read more about the RH system.
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Thank you Peter for this information. I am reading in the Antigen Facts Book that RH48, JAL, has a strong expression of D and weak expressions of C and e in Caucasians. (In Blacks there is a weak expression of c)
What is the difference between R1R1 with a weak expression of C and e and JAL? Are these two phenotypically similar but molecularly dissimilar? Can you test for JAL molecularly?
I'm a little confused and hope my questions make sense!
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Yes, this family still lives in Turkey! One daughter lives in the US near the Reference lab where I did my 2 week rotation.
After the Reference Lab did the workup on this patient and she was told she had an interesting phenotype, she said she would arrange to obtain specimens from her family in Turkey. A cousin of the family in Turkey is a physician and arranged to have everyone drawn and the samples were FedEx'd to the Reference lab.
They saved a little bit of sample for me so I could practice, so that was my part of it.
When I got home from my 2 week sojourn I started reading whatever I could about D-- and am trying to make sense out of it all.
Thank you Peter for your feedback! I would like to understand the Rh system better!
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I just finished a two-week rotation at an IRL for school. The reference lab had a case that phenotyped as D- - . The genotype performed at a DNA lab was R1R1. The patient was from Turkey. The genotype of both of her parents was R1R1 and their phenotype was R1R1, as were the genotypes and phenotype of 4 of her 5 siblings. She had one sibling that had a genotype of R1R1 and a phenotype of D--.
There were a few cells left, and my instructor had me adsorb anti-C and anti-e from human plasma, elute it, and test for anti-C and anti-e. The results were weakly positive, very weakly positive.
I was just thinking that maybe we should have also treated the cells with ficin—that would have enhanced the reaction of C and e. And I also wondered: when a sample tests serologically as D- -, wouldn't a natural next step be to treat the cells with ficin since ficin enhances Rh antigens?
Could this be Rh32, the “R double bar N”?
Also, what is the DBT phenotype? Is that a partial D phenotype with a weak expression of C and e? I read that when Rh32 occurs in Caucasians, it is the DBT phenotype.
Would this patient be capable of making anti-C and anti-e, and if it is the DBT phenotype could she also make anti-D? I think the answers to these questions are yes.
What would be transfusion recommendations if she needed blood? I think maybe she should donate blood for herself and have it frozen in case she needs it.
I am a student, but these are not exam questions or questions from an exercise. They are questions that arose when I came home and started reading about D- - and Rh32.
Thank you!
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In The Blood Group Antigen Facts Book there is a section for each antigen titled "Molecular basis associated with antigen". In this section is the name of the restriction enzyme that is used for PCR-RFLP. For instance, on page 236 of the second edition, the restriction enzyme for Kpb is Nla III and the site is ablated.
I have a question about the terminology used. If you look through the book and note the restriction enzyme, sometimes the site is "present", sometimes it is "lost", sometimes "ablated", sometimes "gained". What do these terms mean? I understand "present" but what is the difference between "ablated" and "lost"?
I gave a presentation on molecular testing methods for my class and I noticed this and no one I have asked has been able to answer, even a fellow student with a Masters Degree in Molecular Biology.
Thank you!
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We have tried that but the MD's state they have to do something and giving FFP won't hurt them. Shows how well MD paid attention in coag class.
That's right--TRALI is no big deal.........
Variance Needed for 5 day Thawed Plasma?
in Accrediting Agencies
Posted
I am resurrecting this post. I am about to discard 2 units of FFP that were thawed yesterday and have reached their 24 hour expiration date. According to the AABB TM (page 204), I can relabel the units as Thawed Plasma and keep the units for 4 more days at 1-6C. According to this thread, I don't need a FDA variance to do this.
How many of you in Transfusion Services relabel FFP as Thawed Plasma after 24 hours? Do you relabel by adding a tag and what other information do you included on that tag. Do you inform the physician that the product is Thawed Plasma and has reduced levels of factor V and VIII?
It seems that if I am going to do this I should write a policy first and get the pathologist's approval.....
Thank you!