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Posts posted by lateonenite
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But seriously, can I ask a dumb question? Why is the Rhogam dose so high? We give 250iu first trimester, 625iu at 28 weeks, then another 625iu post partum if bub is Rh positive. We did have a 600iu dose in there somewhere for quite a while, but it was discontinued because bubs were showing signs of HDN from the prophylaxis. I think. I type this out and have a creepy feeling that I've misread something somewhere.
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are these incidences apocraphal?
Is that another way of asking if they're crap Malcolm? *snicker snort*
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some Clinicians (not all, by any means) see the Technician as having little, if any, knowledge.
Except, lol, when they want reassurance that the transfusion will be or has been "safe" and don't necessarily want to be the only responsible party. Admittedly that's usually toddler doctors (as opposed to baby-doctor-interns). It's equal parts amusing and frustrating in the middle of the night, because they don't want to wake up either the hematologist or haem reg.
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We have an automatic test added to anyone with a positive antibody screen or history of a positive antibody screen that comes up on their side as "Crossmatch delay" and we answer it with a comment. We also notify the treating clinician if the patient has an antibody.
If the phenotype is difficult, or there are multiple antibodies, we will order two units at least from Red Cross (but we also look at the Hb incase we need more). We have high enough stocks most of the time for straightforward things like Rh or Kell we can find units in our own fridge.
The only time we will crossmatch without an order (which we soon rectify by either explaining to the doctor, or getting our hematologist involved to speak to said doctor) is if the patient has an auto and compatibility is impossible; then we get our hematologist to liaise with the clinical team - all incompatible units must be approved by our docs first.
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We do all Rh neg and O positive mums and prems; but if the likelihood is an ABO, we don't elute if we have mum's history (meaning we have performed her antenatal screens and they're clear).
I don't think it matters whether they act on the workup from our end of it (because presumably if they don't, the jaundice, if any, is mild); a lot of docs use the group and Coombs as exclusion of other things. Hmm, will ask resident brain box, however.
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By the way, we have 99% of that book online
here.This makes me wish I could thank you twice. Or even thrice.
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Thanks everyone!
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That doesn't sound right. I've moved to a different health service using a different build - you should be able to have whatever you want. Then again, we only screen in one phase; if we use another phase (depending on the patient's requirements), we don't put that in Cerner. Maybe that's the difference.
I'm not following why you have a different number of keystrokes for positive or negative. Can you tell me what the DTA's are? (You might be guessing I've worked on an implementation - you'd be right. I don't like it or hate it, but then I came from an old, old, OLD computer system prior. Most of the work was on the bench. That's right, gasp, immediate spin crossmatching. In 2009. )
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I'll check them out, thanks.
I just checked our library - we have five copies of the AABB manual - snicker - including two each of the tenth (1990) and eleventh (1993) editions. They'd be old enough to vote and get drunk by now. Love it.
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Hi Malcolm,
We're a staff of 12, a central lab servicing four satellite labs (meaning we are their reference for antibodies). The general level of staff knowledge is quite high, but we also train our own staff and those working in the satellite labs (satellites are usually multiple-disciplinary). I'd say on the basis of that, we need either a bit of both (general and reference) or one of each.
I think we have at least 30 - 100 specimens per day, plus a lot of antenatal work, we'd crossmatch at least 20-40 units per day all up.
Cheers,
Fran
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Hi,
can anyone recommend a good reference text for blood banking? We have the usual lab collection of old ones, but I wondered if there was anything new out there.
Cheers,
Late.
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Sorry, I haven't been checking the forums often enough.
The only thing I'd bring up with anyone using emergency dispense, is once you assign the units to a patient (correct inventory, etc.), the time and date of dispense is set to when the emergency dispense happened, not when the units were actually given to the patient.
Did you find this?
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Patients are becoming better educated as time goes on. A problem we have run across is a lack of education for patients by the physician and /or office. Some of this occurs because the office has not been educated. Once the office has been educated I feel they are doing the patient a dis-service if the office fails to educate the patient. Just my opinion and .02 worth.
I think there are universal "requirements" for the patients to choose the worst possible weather to come in for general, non-critical lab work. If it is not the worst snowstorm of the winter, then it is the hottest, most humid day of summer
.Patients will be patients though. Had one Friday of last week that was an elderly woman of 88 who fell at about 0200. She waited until 0400
to call her daughter for help since she knew her daughter gets up at 0345 to get ready for work. Long story made short, she arrived at our facility with a 4.6g hemoglobin. We transfused her 7 units of LRBC's over the weekend and she is feeling a bit better now . When her daughter asked why she waited to call her the patient indicated she knew her daughter was sleeping and did not want to disturb her! (And she had a low hemoglobin and was a little bit tired!) People never cease to amaze me with their priorities. We had a lady who had an AIHA (and eight alloantibodies). Her Hb would drop fairly regularly, to the tune of about every three months she would reappear in the hospital. At 2 a.m, usually. She wasn't feeling very well, so she would sit up and watch her stories, in case her hospital stay this time went on for too long.
Every three months meant that she would arrive in ED just after the new rotation started, so these poor fresh-faced baby docs would be faced with an antibody list as long as the metaphorical arm (she was very helpful about that with them, bringing in her Ab cards) and ring the lab in a panic.
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How about answering the Blood Bank phone after being paged by the central lab to take a call "Hi, this is Jane in the......um(long pause), um(long pause)...How can I help you?":redface:
How sad is it that your brain can get so fried by some ridiculous antibody you've worked on the entire day that you can't even remember which department you work in????
:cries:"Hi, it's Frances from...where the hell am I?"
"I don't know...you called me."
It's always nice for them to turn the tables isn't it? (Usual is "I need product for my patient?" "Which patient?" "err, umm, hang on, I'll just get their details.")
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I have been known to call our reference lab and say, "Hi, this is Miriam in Blood Bank." Well, duh, I am in blood bank, but which blood bank? Fortunately, the staff there know me pretty well, and since my name is fairly uncommon, they always know who I am and just chuckle.
I did that to Red Cross once. "Hi, this is Frances from Blood Bank, can I order a unit of apple platelets?" "Where are you calling from?" "Oh! You don't get calls from any other blood banks in Sydney, do you?"
Yes, we were both laughing. It was 2am.
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Hmm. Here a clinician (or reg, resident or intern under a clinician) must sign the request (either electronically or on paper) because of Medicare billing - a doctor with a provider number must request a test for that test to be billed back to Medicare by the pathology service. I think (not sure, but I think) that private health insurers use the same requirement - easier than re-creating the wheel for themselves.
Tests performed in the lab are covered by a declaration on most requests which says something along the lines of the clinician assigning rights to the pathologist to perform tests as necessary (so...my Ab screen is positive, guess I'd better run a panel...LUCKY!) "as defined by laboratory procedure". If memory serves. I've only read it on requests a million times.
The only time it causes a lot of drama here is when a doctor wants an add on and doesn't see why they need to fill in the paperwork - the rules say 14 days to chase up an appropriately signed request, or Medicare will not pay - in general pathology it's a golden rule that no paperwork, no test. Of course, what usually happens is the tech will run the test (it's usually a fibrinogen on a bleeding patient, natch, would you like some cryoprecipitate with your order?) and put nothing in the LIS until the request is received. Blood Banks are a little different. In one health service, no paperwork, no crossmatchee with limited use of phone requests (or billing throws a major spit). In another, phone requests are the only way product orders are placed - beyond the original signed group and hold.
Medicare rules say fourteen days, sure, but NPAAC guidelines say that a phone request is acceptable, since a group and hold is collected and requested in the expectation of the requirement of products. I don't think it's ever gone to court...could be interesting as to whose cojones would win that fight.
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We've used pink tops for about 10+ years with very few problems - although K3 EDTA in biovue can sometimes give positive auto (roughly 1+) with negative DAT in BioVue cards. With grouping in cards no problem, although question - when your techs are doing the group, are you talking in tubes and are they chintzy with their antisera? i.e., do they use two drops or one? Because I think a one vol to one vol can give the "graininess" they're describing (but it's easily (and gently!) shook out - it doesn't look like agglutination).
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I donate, though not that regularly, because of working in blood bank, but I started in the first place because my mum was in hospital and the mobile van was there that day.
I asked a friend of mine who works in publishing, because she does donate regularly and said:
I'm up to about 28 donations now. I started when I was at uni, a friend
of mine took me along. On the first one I was rejected because I was
anemic. The main reason I kept doing it was because I got a meal out of
it, and at uni I was massively broke so that was a real drawcard. The
other reason I kept going at uni was because I got the motorbike, and I
figured that given the possibility of accidents it was in my own
interest to make sure the blood stocks were up (never actually had a
blood transfusion though, or a bike accident). Anyway after that it
became a habit to go a couple of times a year.
One of the reasons I still donate is because its like a mini-checkup a
couple of times a year, where I get my iron levels and blood pressure
checked, and now they record your weight (which I'm not fond of!)
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Two unit of O Neg, tagged with a dummy pt name (Emergency 101 or Trauma 1), segments previously taken off, and stored in refrigerator. The blood is handed off immediately (in cooler) and issued under dummy name, along with request for uncrossmatched blood. When pt demograpics arrive, the units are returned in computer, then allocated to "real" pt, and tags are sent along. Proceed with testing on pt's sample, when it comes.
No waiting, no pressure.
Too bad it's not being done in my present institution!
We do this regularly, although we give out four units. One advantage of the PathNet is Emergency Dispense. Half the labs in our area have blood fridges in the ED and keep two units down there. Does it work? Hmmmm.
We enter whatever information we're given (so often, "resus 1") - I've also been putting in the time the blood was requested so there's tracking that way - we get a lot of returns where they didn't need the whole four, so has to be returned within the hour. (Before anyone asks, it's 30 minutes by guidelines, but because we send it in an esky/cooler with an ice pack, we extend).
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It's a wonderful idea, and we have a similar process here, although not the pop-up you're describing. I'd love to give that a try!
We have a couple of options here with our system:
duplicate check warnings on orders
patient-product inquiry where the doctor can (and should be looking to) see what is available.
PPI is our best friend but has suffered with implementation (read: not enough training in it - and it's a bit of a pain; being PathNet it makes you enter the patient's MRN again, even though you're in "their" chart).
For our lower-order doctors (you know, the ones who do the ordering), I'd be heavily advertising first that there will be a pop-up box stating how many units were available, and/or specimen expiry, etc.; because after the fact, if you get them on the phone and say "there was a pop-up..." they'll swear black and blue that it never happened, isn't working, etc.
Still a great idea.
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We do every three days for women of childbearing age and those transfused in the last three months. Everyone else is every ten days.
We've had a couple of cases now where the patient has gone to a private hospital, come back to us and had a subsequent antibody develop from transfusion we knew nothing about in the intervening period (*shudder* at the thought of not ID'ing that one). The best one was ten days in between admissions, the longest about three months.
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Just had to put in (from Demotivational Coffee Mugs:
Quality: The race for quality has no finish line, so technically, it's more like a death march.
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I'm with everyone else here, we only phenotype if the patient has not been transfused in the last 3 months. Obviously when the three months is nearly up, we might try it - although with a number of ours they're transfusion dependent anyway. D'oh.
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One of ours for new staff members was sending them down to stores for a box of fallopian tubes.:eek::redface::eek:
Did you keep the staff members who looked at you and said "Awww, you guys ...."?
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to call her daughter for help since she knew her daughter gets up at 0345 to get ready for work. Long story made short, she arrived at our facility with a 4.6g hemoglobin. We transfused her 7 units of LRBC's over the weekend and she is feeling a bit better now 
. When her daughter asked why she waited to call her the patient indicated she knew her daughter was sleeping and did not want to disturb her! (And she had a low hemoglobin and was a little bit tired!) People never cease to amaze me with their priorities. 
:cries:
Distinguishing between prophylactic and immune anti-D
in Immunohematology Reference Laboratories
Posted
Cheers shily, I was asking a general question about the Rhogam dose rather than this patient - I have the creepy feeling because it's been a long time since I looked at our guidelines in Australia. I had assumed though (bad thing in a blood banker) that anti-D was given at the same or similar dosages everywhere.
Do you mean that in China that prophylaxis is only given in certain cases and tailored to each patient? Thanks,