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We have had open heart surgeries here for years. A few years back, anesthesia and one of the heart surgeon got a wild hair to have TEG. It has been a major waste of time and money. We had the results feed live into the OR so that they could see them. The company came in a gave them all instructions on the system and how it could help them determine what blood products they needed. They have never used it to make decisions during surgery. Regardless of the results, if their patient is bleeding, they are going to want plasma, platelets, and possibly cryo. We are currently keeping 1 plt pheresis. 2-4 prepooled (5 cryo/pool) cryoprecipitate in house on the days that we have surgeries. We've started keeping 2 A plasma thawed at all times. Most CABG procedures require few products, Valves Replacements can be bigger users.

Does anyone have experience with CAP or API fetal screen proficiency testing. We are using API but am considering CAP. Any advice or experiences that anyone could share would be much appreciated.

We are still using 4.6, but we can access the users manual by clicking on Help at the top of the screen then and opening the contents option. You can also click on F1 from inside the program and it will open to the section of the user guide that corresponds to that application. I don't know if this is available on your version, and it isn't always a perfect resource. It is better than nothing though. Hope this works in your version.

We also perform one type per admission. Our one exception is for Outpatient Oncology when the patient is coming in frequently for platelets.

We fought autologous units for years. Finally, with some help from Tim Hannon's blood management group, we convinced most of our Ortho MDs that autologous units weren't really good for their patients. We used to have two shelves full of autologous blood and now we only get an occassional unit (for a 300 bed hospital). Basically, the physicians finally realized that they were making their patient's anemic prior to surgery and then giving back "stored" blood that wasn't expecially good at moving through capillaries and transporting oxygen. Good Luck, it's a hard battle.

This was a somewhat frustrating inspection, obviously. We weren't cited for anything. My manager was told that she needed to change our application (during the inspection) to reflect that we qualified as a donor center because we collected therapeutic phlebotomies. Like most of you, we perform the procedure and discard the blood. I just wanted to know if anyone else had ever run into this situation. I appreciate the feedback because it is nice to know that others find this as odd as I do.

During a recent Joint Commission inspection, we were told performance of therapeutic phlebotomies met their definition of a donor center. We collect the blood and immediately discard it. We don't store it, and we most definitely don't transfuse it. Has anyone heard of this? If so, can you explain the rationale?

Do you have access to AABB.org? They have an HCV lookback packet with some form letters. If you will search for HCV lookback letters you can find the packet.

Basically we use the high protein D because it was the only thing that we could get to work and not elute off the cells by the end of the week. All of the clonals, would work for a day and then we had to make more. When we make the check cells, we usually pull some donor segs off of two or three different units of blood rather than use patient cells. The cells seem to hold up for a week.

oops sorry about the o=, meant to say o+.

Ortho's high protein D will work. We place about 1 ml of O= packed rbcs in a 12X75 tube, fill the tube to about an inch from the top with saline, add about 10 drops of high protein D, incubate at 37 degrees for 30 minutes, wash 3-4 times. We usually aliquot this and use a new aliquot each day for a week. Good Luck.

My understanding of FDA requirements for HIV lookback is that family needs to be contacted if the patient has expired. However, if the patient shortly after transfusion and without being discharged, is it still necessary to contact the family. (It just seems cruel and unnecessary.)

Just to add a little to this discussion. We don't normally test for weak D on adults, unless they have an Rh positive autologous unit. We recently had a patient with an autologous unit who tested weak D positive. The zinger was that he also had anti-D. (Last transfusion was 20-30 years prior.)

We were having the same problems with (forgive the term) nonspecific reactivity. We started aliquoting our 0.8% screening cells. We take out just enough to get through a 24 hour period. It has really helped cut down on those crazy reactions.

I just wanted to say thanks to everyone for the input, especially the article from transfusion. It's nice to have some positive reinforcement.