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Everything posted by Stoogiesfreak
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Would anyone like to share criteria you use for documenting emergency release vital signs? We are currently relying on the patients chart for that information when needed. Thanks, John
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Thanks! This does help, and I appreciate the information! John
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We want to have our Pre-op joint replacement patients come in 14 days prior to OR and have their Type and Screen performed. With a negative ab screen, and a negative history we want to use that initial specimen for x-matches. We are using Meditech. Is anyone out there using this with the Meditech BBK module and if so I sure would appreciate some advice! Thanks, John
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Sometimes I wish I had kept a running diary of the things I have seen over 42 years. One thing for sure, you never know what the next sample or phone call will bring you!
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Yes they are! Congratulations to you too! I still remember my first antibody when I started. It was my first night working by myself and I have a lady that turned out to be an A2B with an anti-A1. We had four AB units on inventory and 2 of the 4 were A subgroups, compatible and given with no problems. Sometime things just go your way. Have a good day. John
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Hi Malcolm, Yes, we have had two! I have done this type of work for 42 years and this is a first for me. We sometimes see a lot of antibodies that are "unusual" for the general population as I live is a tourist/ resort community. We have a lot of people that have moved here for retirement and sometimes we see some pretty strange stuff! I think our demographics is somewhat skewed because of the retirememt, vacation location. Yes, you did read that correctly! Your eye did not fail you. I thought mine did, but it turned out to be two Coa antibodies on two seperate patients. It is one of those things that make this occupation interesting. You just never know what the next patient sample and/or phone call will bring you. It is the same, but different everyday. Regards, John
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Hi Malcolm, Trust me, I am beginning to think we have "spirits". In the last 5 weeks we have had 2 stat alone Anti-Coa antibodies and a Lua antibody. We have recently switched to the Tango automated BBK system and really enjoy it. It has been a very nice addition. I don't mean to be greedy, just one of those time when the moon is in the wrong position - or right position - whichever way you want to see it! Thanks, John
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Hi Malcom, I know this may be unusual, but I just identified a second Anti-Cob in a patient with no history of receiving blood - at least at our facility. No other antibodies were identified. Crossmatch compatible units were transfused and no issues were identified. According to the literature I find, 92% of all units should be crossmatch compatible and there is no Cob typing sera available. Thanks, John
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Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
Yes, we are also on the conservative side and I agree with you. We are just getting into this arena and looking for the best way without going overboard! thanks, John -
Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
Hi Deny, I found some documentation on holding samples for T/C from pre-op patients with negative histories. Check out the AABB Manual, 16th Edition, page 442, bottom paragraph on the left of the page. I think this answers the question as to how long samples may be held as AABB is leaving the door wide open on this one. Your thoughts? thanks, John -
Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
For this situation we would perform an antibody ID with the T/S specimen. If transfused we would repeat the ID with every new sample collected as the patient is being transfused. It is doubtful that an antibody would develop in 72 hours, but currently that is our practice. John -
Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
Thanks Deny that helps! I have been in this business so long that I have old age attacks sometimes. Thanks for clearing that up for me. Regards, John -
Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
Thanks Deny, I appreciate the information. John -
Pre-Op Type/Screens and Crossmatches
Stoogiesfreak replied to rjjosvai's topic in Transfusion Services
We are being asked by our physician's to "extend" samples for possible transfusion during surgery. These are scheduled surgeries, mostly total hips and total knees. The issue is we want to do all pre-op testing at one patient visit. We can do the Type and Screen on that day, but how long can a sample be held for future possible crossmatching. This is all pending that there is a negative transfusion history, etc. Also, does anyone know of any documentation on this. Thanks, I appreciate all responses in advance! John -
Thanks Anna, The one we have had seem to be random. If these people have been transfused before we do not have a record. One patient, however, has had multiple transfusions, but to date has no evidence of an antibody. Her antibody screening has remained negative. Your thoughts make sense and I can see that on the one patient with multiple transfusions. The others are random. I like to do a pre DAT as a baseline, but find the orders for this perplexing. Thanks! John
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Donna, You may be very correct! Sorry to hear you are facing the same issue. John
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I don't think so - the nursing notes on the patients do not imply any kind of reaction process. The physician is an Oncologist with a tendency to think everyone has a hemolytic process! I am beginning to think this is more of an education issue that an actual reaction or in vivo process. John
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A little differecnt twist on DAT testing. We have a physician that orders a DAT on his patients post transfusion. We have tried to get him to be sure and place the order pre-transfusion, but so far no luck. When we get orders for DAT on his post transfusion patients we pull the pre-transfusion sample and perform the DAT on both samples. I am thinking that a weak positive may be missed on the post sample by the donor cells. Help! Thanks, John
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Thanks Malcom, That is what we did and with the exception of the one incident of a drop in BP the patient received 3 units and had no other issues. I appreciate your input! John
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Another quick note about the Colton b. If this patient had not had an Anti-Kell this may have gone unnoticed. The screening cells are all negative for the Cob antigen. I checked with ARC Reference lab and about 8% of the population is Cob antigen positive. Coa antigen is prevelant in about 99.8% of the population according to ARC and AABB. Anyway, ARC suggested crossmatch compatible only as they only had unlicensed typing sera. John
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We just identified a Colton b yeterday on a patient with a previous Anti-S, and probably Anti-Kell. She received one unit yesterday with no issues, but on the second unit she had a drop in BP. No other symptoms and her DAT is negative pre and post transfusion. Any other issues to be looking for? This is a new one to me. thanks, John
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We do have in our policy not to thaw more than 2 FFP at a time. The strange thing about our recent usage is we have not destroyed a single unit. All have been used. You are right, it is difficult to assess. We do have our QA department taking a look at it since this is a shift is usage we have not seen before. How often do you obtain a new INR when a patient is using FFP. We do not have that in any policy that I know of. I don't think nursing does either. That is a great idea. Thank you, John
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That is what we have informed our physicians to do. It has seemed to work, we suggested five to seven days prior to a procedure. Since we haven't had the issue come up again we did not develop a specific policy either. Our issue now is FFP - we have had a 100% increase over "normal" for the past two months. Ideas?? John
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David, Oops! You are correct - my error. Got to typing too fast and not thinking! Anyway, we do not have a policy as I said before, since we have only had this two or three times. We have found that the two or three requests for platelets on "hold" for OR have never used the platelets. Thanks for pointing out my boo-boo. John
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We have had a couple of issues with physicians wanting platelets on hand for OR when patient's have been taking Plavix. As far as I can find out aspirin is a reversible reaction with regard to platelets, but Plavix is not. Once platelets have been "inactivated" by Plavix they will not reverse back to functional platelets as they will with aspirin. The platelet count will be normal, but I have no idea how one would determine how many platelets are functional, and how many are not fully finctional. So far, we have gone with the physician requests. If this starts getting more common we will deal with it more agressively, but as of now we have only had this happen two or three times. Good point! John