Stoogiesfreak

Can't argue with that! So far Quality has not stepped in. They look every once in a while, but don't cross the threshold! As long as we keep our Crossmatch to Transfusion ratio below 1.5, no one looks real hard. If a product is wasted - such as unused FFP or Platelets, they are all over that! Many time our ER patients are discharged before the Type and Screen is finished. ?? Waste!

Interesting you bring that up. We have a OB physician that ordered 2 units on every procedure he performed in OR. After pulling him aside and having an "educational" meeting he now uses the Type and Screen approach. He also had no idea of how fast we could get units to him once we had the T/S finished. He still orders T/S's on all his OR patients, but it sure saves us time not having to crossmatch every patient! Thanks, John

Whoa! Ease Up! Don't misunderstand - this patient was not in a life threatening situation. This was more of a leap before you look situation. The patient never received any blood. This incident was many years ago and by today's standards a Type/Screen would have been sufficient. Delayed transfusion vs exanguination was never an issue in this case - I'm not that hard hearted.

That's better than the time a surgeon asked to have 2 O Neg units sent to OR on a patient with an antibody yet to be identified. He assured me that he would not use them until I called to with the "all clear". He needed them just in case things went bad! Anyone want to by some swamp land? John

Hi Malcolm, We do our correlations between the Tango and tube method every 6 months. We also use "inhouse" QC for the Tango and that is another weekly correlation as we type samples used for QC on the Tango and with the tube method. Another question: We do the automated CAP survey JAT on the Tango. Can we use the JAT survey as an adequate method for proficieny testing with the tube method? I don't really want to purchase two seperate surveys, but if I need to I will. Also, what about antigen typing as it is not offered on the Tango JAT survey. Thanks - as always I look forward to your expertise! Regards, John

Update: Patient came in last night and delivered a healthy baby. So far no blood use, but all is going nicely. No blood necessary at this point. Crossmatch compatible, ABS - negative, and DAT negative. No evidence of any issues at this point. Good News! Thanks for everyone's help. John

Hi Deny, I can agree - we also have never had a patient's physician refuse to make contact with a patient. John

Once our pathologist reviews the lookback he/she notified the patient's physician for the actual patient contact.

Thanks Eoin, That part of this story has not been investigated. The patient is current ih-house and her pregnancy continues with no additional problems. She is about 31-32 weeks now. I will check on the items you mentioned. We just may find an answer! Thanks for your input - alway nice to hear from an Irish! With the surname of Orr it is pretty obvious where my family came from. Thanks again, John

That was the other oddity. Her chemistries were not outstanding. They matched previous results with only very minor increases in liver enzymes. Her liver enzymes were just barely above the reference ranges. The increases were not enough to trigger out delta checks. The only test we could find that increased significantly was her D-Dimer - somewhere around 4000. Our pathologist said that could be associated with the placenta previa. Thank for the input - it is appreciated! John

The original sample was not hemolzed and had a "normal" appearance. The unit was started and the "post" sample was collected within 4 hours of the start of the transfusion. It was icteric. We have pretty much ruled out a hemolytic reaction, and the patient received an additional unit with no problems. The serum returned to "normal" appearance within 2 days. Cultures were negative. She is also a placenta previa which may account for some of the issues we are seeing. So far the patient is doing fine and her pregnancy continues with no problems to date. ?? thank! John

Hi Deny, Glad we got your Monday off to a good start! I had a professor in college tell my class that anyone that worked in a medical lab was a little "left of center". At the time I thought that was an awful thing to tell us. Over time I have grown to accept his comment and even admit that he was correct! Regards, John

Malcolm, You are still a "puppy" - I am 62 with an artificial hip! Have certainly gone from an A Pos to an A Neg though! John

Me too! John

Jeanne, I love it! Found another that probably started out doing major and minor crossmatches! Thanks, John