jcdayaz

WHAT THE He**? Apparently Administration decided to dispurse stupid fumes through the hospital that day and she overdosed!

Oh My!! How scary is this scenerio.!? She apparently has no business working in the Health Care field or lab at all, much less the Blood Bank. Your story made me shudder!!!!:eek:

Had one the other day (and many more I'm sure I am not remembering). Nurse calls the Blood Bank to inquire about blood for a patient. I confirmed we had 2 units crossmatched and ready to be picked up whenever they needed them. Her response was "Well I don't know if I need them yet". My response was "well they will be available until XXdate at XXtime"--which was two days away. The nurse then proceeded to tell me there was a CBC pending and untill they got the results they weren't going to decide whether or not to transfuse. She said "Can you please hold those units for me for another hour?" I said the units will be "Held" for your patient for two days. She replied. "Well, I need you to hold them for another hour until I get the results of the CBC". I then said--"Your patient will have blood available, crossmatched, tested, and ready to be picked up until xxdate at xxtime". Her response? "Well I need another hour to determine whether we need them or not. Please hold them for her." WHAT THE He**? Apparently Administration decided to dispurse stupid fumes through the hospital that day and she overdosed!

[quote=lgabbert;278 Phlebotomy drew blood and banded. Patient stated name as "Smith," and computer labels are "Smith", therefore banded with that name. Before phlebot leaves room, admitting personnel enters, and patient says she has recently been married, name is "Jones." ER changes name in computer system, so "Smith" is no longer being used. I made phlebot redraw and reband patient. My question is, where do I draw the line? Did I do the correct thing, or should I have let the phlebotomist reband and relabel the patient and blood tubes? I thought the phlebotomist should have rebanded and relabeled in the room before leaving the patient. What do you think?[/quote If the knowledge was acquired before the phleb left the room with the specimen, you can be fairly sure that you have a correct specimen. But "fairly sure" is not okay in Blood Banking.

Thank you! I couldn't remember the %. When the blood is going in as fast as it is coming out it is relatively uncommon for an Anti-D to be formed. The "foreign" blood..ie..Rh pos is not in the recipient's system long enough to stimulate an immune response. Any ideas on how to side-step a BB Medical director (Pathologist) who is totally opposed to switching a person to Rh Pos even in extreme trauma cases? We have to get Pathology approval prior to switching a patient. Our BB Medical Director told the last Tech who called him attempting to switch a male patient to Rh pos units to use O Negs until our inventory got down to 2 and then he had approval to switch! Our normal(desired) inventory of O Negs is 20.

An O Neg person who receives O Pos blood has a good chance of developing an Anti-D. It is not guaranteed. I agree with you..start with O neg (even in Males) until you can determine the possibility of massive transfusion need. Then you have to determine your stock status of O Negs, etc etc before more decisions are made.

I knew I could count on you Malcolm! That was my stance in the debate. I guess I just wanted some reassurance! The whole "size of..proximity of.."didn't seem at all valid to me and nothing close to what I was taught. Thanks!

My turn to throw a "Does anyone remember this" question out there for all of you. (Sorry, I'm too sleepy to start a new thread!)... We were having a debate at work yesterday about the reason the R2R2 cells have a stronger expression of the D antigen. Is it the size of the C versus E molecule, or is it the number of them, or is it the proximity of the C antigen to the D antigen on the red cell producing a "blocking effect"? Anyone remember?

I might get blasted here....but on rare occasion we will issue a unit and do the computer issue later. Rare occasion--Emergency release situations where you have no patient ID whatsoever, computer being down and having a critical patient anywhere in the hospital, etc. We are "paperless" but still have a printed transfusion form that is associated with each unit crossmatched. There is a place to note that the unit has been inspected and is suitable for transfusion on the form. We are an AABB certified Blood Bank and our procedure has never been questioned by AABB, FDA, CAP or JACHO.

Malcolm, You're killing me here. I know that there could be certain cases that As-1 has to be used for a neonate. Having an Anti-k would certainly be one (I'm guessing) of those circumstances. If I EVER get a neonate with an anti-k..that might be the day I just up and walk out of the blood bank!:D

[quote=Dr. Pepper;27 I also ask my core BBer and the top 2nd and 3rd shifters if they have any issues they would like addressed. As a manager you can't see everything that happens, and if you're not routinely on the bench you don't have the point of view of a front-liner. Your last statement is HIGHLY intelligent and well said. It is unfortunate that some managers lose sight of the "front-line" work. I applaud you for not doing so.

YOU ARE SO RIGHT!! We are fortunate to have a job! Each and every one of us that is still employed should be thankful. No one got raises last year. This year it is being called "possible". I am guessing we won't this year either. The possibility of a raise to complete compentencies, etc. keeps everyone doing them. Money talks, even if it doesn't materialize.

Wow L106 and Brenda, seems like you both have struck a nerve with a bunch of people!! I think we all want a copy of your checklists...me included! jcdayaz@yahoo.com Thanks a million!

Brenda, Every Technologist has an annual "Competency File" that we keep in a separate filing cabinet. Each department of the laboratory has it's own specialized check-off list. All the departments a Tech works in they are obligated to keep this check list done. We document through the year when we perform each procedure and we have a direct observer. Both must sign the list--Tech and the direct observer. We also have many (too many, in my opinion) annual computerized tests that everyone must complete before their annual evaluation. If you don't have your competencies complete and ALL of your computer tests complete, you can't schedule your annual evaluation. No evaluation=no raise! Money is always a motivating force.

Re. Yta patient... Guess what dawned on me at work today?! (Why did it take so long?) We crossmatched all the known E,c,K negative units we have in stock at the moment and found one to be perfectly compatible! We then sent segments from the compatible unit to our reference lab for Yta testing. I left work before we received any results. It seems reasonable to think we just might have found a new Yta neg donor.! I certainly don't know, but it seems logical to me. I guess I'll find out when I get to work tomorrow. I appreciate your advice on dealing with a Yta. We were gearing up to go with units untested for Yta, but it requires Pathology approval, the surgeon's signature on a special form, etc etc. Basically more trouble than we want to deal with IF it is avoidable. I do, however, have no doubt we will have to go that route for the patient's actual surgical amputation. Hopefully there will be no flesh hanging from from any bone when the surgery is done!:D:D:cries::eek:

AH, You meant 3+ in tube. Now I understand. You are VERY correct in your comment about gel detecting clinically insignificant antibodies and enhancing their strength. We also start with gel on the Ortho Provue and then go to tube testing if we need specialized work to identify an antibody. Typically its in Cold auto antibody cases and we are doing a cold screen and/or a prewarm screen/crossmatch.

I don't know all of the testing that was done at the previous hospital....the brother option just may well be worth pursuing. Thanks again!

Thanks for the reminder. I feel retarded now. I never even thought of that! We "inherited" this patient from a local hospital. I had conversation at length with the surgeon when we first got the patient about the possibility that we would not be able to find compatible blood. He knew of the "difficulty" (haha) of finding compatible blood from the previous hospital's blood bank. I gave him directions on how to transport this patient back to the previous hospital!! Thank goodness he laughed!:D

Malcolm, You never cease to amaze me with your knowledge and/or your ability to make me laugh! I'm laughing right now! Histology, I know received multiple pieces of bone and flesh after her last surgery. I certainly don't know what was left, but suffice it to say it wasn't her first "partial amputation"(whatever that means). I wish the job would have been thoroughly done that time when we were actually able to have 2 liquid(not frozen) units for her here that were crossmatch(AHG) compatible. The units for the last transfusion were located at some rural community blood donor center in New York. Not even a place our red cross would go to/accept blood from under normal circumstances. The patient's brother is a "big-wig" on the board of a large, well-known hospital in New York. He was able to get done what we couldn't. How sad is that?

What do you consider "seriously strong"? Do you foreign Techs:D have the same grading system we do here? As in 1+, 2+, 3+, 4+? If you do, what number is "seriously strong"?

Yes, pre-op transfusion needed to get the patient stabilized (one of which we did yesterday morning) and 2 for surgery. This patient is a "special case" in that she has used multiple units over multiple years. I don't know the etiology of her anemia, but I do know the surgeon has done only partial amputations (I don't know what that means), but now is doing a full amputation. Or, needs to do one and will only schedule surgery when/if we find compatible blood.

Malcolm, We have a patient right now that we & our reference blood center are furiously trying to find units for. The patient has anti-Yta(proven to be clinically significant by MMA testing), E, c, K. The surgeon wants 2 units infused before surgery (total amputation planned) and 2 on hold during surgery. We were able to locate 1 frozen unit and transfused it this morning. Unfortunately, finding 3 MORE units is almost impossible. Our latest thinking is to transfuse (if totally necessary) with E,c,K negative blood and take our chances with the Yta. In our research clinically significant Yta causes "mild to moderate" reactions. Do you have any experience with clinically significant Yta's and the reaction it might cause? Thanks in advance for your input. This is a nightmare!

If the "crisis" situation you are referring to is a trauma/massive bleed I do know from experience the blood is often times coming out as fast as it is going in. In most cases (not all, certainly) the blood is not present in the recipient's body long enough to stimulate a reaction. No specific procedure in my current facility. Anything that deviates from protocol has to be cleared through the Blood Bank Medical Director (Pathologist) and have an "Emergency Release" form signed by the patient's physician In a crisis situation obviously there is no time for the treating physician to sign a form. There is a line on our Emergency Release form that the nurse picking up the products can sign on behalf of the physician. Then after the crisis is over we get the treating physician to sign it. They always do.

Check on the AS-1 anticoagulant use in neonatal transfusion. We won't use AS-1 units for a baby...to my knowledge, it can lead to renal failure in a preemie and/or multiply transfused neonate.