MT15

We have never seen RBC or WBC fragments on a slide after vortexing EDTA samples. The RBC and WBC counts do not decrease between the runs before and after vortexing and are well within what you would expect between replicate runs on the same sample. Whether the technique seems logical or not is an opinion. Until an opinion is tested, it is only an opinion, not a fact. I was surprised to discover that vortexing does not damage the cells, but the results were clear. Try it for yourself if you want proof. It isn't hard to test it out. Take some CBCs that you have just finished with, and vortex them for about a minute on the highest setting. Then immediately rerun the tube. Compare your WBC, RBC, and PLT counts before and after the vortexing. We found no significant difference. We do exempt hem-onc patients from this practice, even though we found no differences there either, I think it was just to make the pathologist feel better. I will say it usually only works on patients who have no other major issues, but the collection was less than optimal resulting in a small amount of platelet agglutination, but no apparent clot. Just enough to cause the analzyer to flag for platelet clumping. It's not a magic trick, it won't clear up EDTA platelet clumping, and if it doesn't work, you can always recollect anyway.

We have also validated vortexing in our lab years ago. We saw no differences in WBC, RBC or indices between pre-vortexed and post-vortexed runs. Slides made post-vortexing show no red cell fragmentation, we do check every vortexed specimen with a slide. When you think about it, red cells are really not fragile and must do extreme contortions to fit through the capillaries. When I first heard about it, I had a similar opinion to TVC15, but luckily we tested it out for ourselves before making assumptions. It's really rewarding to learn something new, test it out, and put it into practice. We save some patients the trouble of a recollection this way.

Thanks, it works pretty well (I can't take any credit, though, it was in place when I got here). Oh, we still have problems, no doubt, just like anyplace else.

We also use Cerner. When the physician places an order, we get a paper printout in the Blood Bank. We get a separate paper for the ABO-Rh, the IAT and the product. The floors can look on a Blood Bank tab in the EMR that will show them if there is a valid specimen and when the specimen becomes outdated, if there is product available, and transfusion history. When the floor is ready to transfuse, they put a Dispense order in Cerner, which generates a piece of paper in BB. We then dispense the blood in Cerner, and get a "packing list" which is sent along with the unit to the floor by pneumatic tube. We call the floor to tell them units are ready for STAT orders, but routine orders we expect them to monitor their EMR. We also call the floor once the blood is in the pneumatic tube, and we monitor the return of the signed packing list to verify that they have received the unit and done the first check. We do still get calls asking if the blood is ready, but before I tell them I walk them through looking in the electronic chart. They are usually happy to find out a way to get that information without a phone call, and the number of phone calls has steadily decreased. IMO, the separate BB tab in the EMR is a necessity. Everything is displayed in an easy to read format in one location.