jsherrie
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Posts posted by jsherrie
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I use to pool plasma at the American Red Cross to be sent for fractionation. The only discoloration of plasma I noticed that was not hemolysis was a definite GREEN color I told was due to copper in the blood from birth control pills ???? and extremely milk colored plasma from a recent high fat meal.
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I guess disposable pipettes are not an option?
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Some things, like cleaning up and properly filing paperwork, I think, are just a professional courtesy for the techs following you. Every lab professional, regardless of what department they work in, should know that.
I think that checklists and charts do help. They not only serve as a reminder, but also enforce accountability. When I worked at ARC, I had to sign my initials so many times everyday, I felt like I had to initial a form to go to the bathroom.
I found that when someone new comes to the blood bank it helps to not only explain the rules, but explain WHY that rule is in place and some possible negative consequences that could occur if these rules are not followed.
- BBK710 and rravkin@aol.com
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As in life.....remember......in blood banking, ANYTHING IS POSSIBLE !!!!!!!!!!!!!! Never assume.
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We use gel as our first line of attack, and tube as our second.
We've found, as a Reference Laboratory, and following a lot of samples being sent to us in which we can find nothing in the way of atypical antibodies, that certain solid-phase technology, and I am not saying which, has a good correlation with super-glue!
:devilish::devilish:Good one Malcolm!
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We currently require a type this admission or 2 types one of which is within the past year. So yes, we do use historical types in some cases. We keep thinking of changing it to require it per admission due to people swapping IDs or Admissions making a mistake and using the record of a different John Smith but we haven't done it yet.
I believe that you should retype on every admission, for the very reasons that you mentioned. Someone may have a false ID, you don't really know for sure. And as for getting patients of the same name mixed up.......could happen especially with the increasing Latino population, which all seem to have a last name of Lopez! (no prejudice intended....just an example)
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first some background that i hope will help with understanding your test results. Your immune system can make antibodies to foreign substances when it is exposed to them (like the chickenpox virus or the killed virus or bacteria particles in a vaccine). The part of these foreign substances that your immune system recognizes and makes antibodies against are called "antigens." red blood cells have lots of different kinds of antigens on their surfaces--the ones most people have heard of are those of the abo system and rh antigens. These are what give you your blood type of a positive or b negative. The positive and negative part refers to the rh antigen "d." there are actually quite a few additional antigens in the rh system (and many others) that most people have never heard of. One of these is cw. Red cell antigen variations are inherited from your parents and you and your husband will pass red blood cell antigens on to your baby. The genes on your dna that you pass on for these antigens come on pairs of chromosomes--you get one of each pair from one parent and the other chromosome of each pair from the other parent. Because you have never been transfused, you probably were exposed to the cw antigen during a previous pregnancy through a small amount of blood leaking across the placenta (usually at delivery) from the baby's blood system into your blood stream. That baby must have had red blood cells with the cw antigen on them that he or she inherited from his/her father (since you must lack the cw antigen yourself in order to be able to make the antibody against it). Still with me? Now that they have found this antibody they will try to predict if the baby you are now carrying will have that antigen on his/her red cells and also how strong the antibody is. The cw antigen is pretty rare so the first question would be if the father of this baby is the same as that of all previous pregnancies you have had. If you have remarried, the chance of both fathers being cw positive is pretty small. Even if previous pregnancies had the same father, due to its low frequency, he is not likely to carry cw on both of that pair of chromosomes so he would probably have only a 50% chance of passing the cw antigen on to this baby. If this baby does not have the cw antigen on its red cells, there is absolutely no risk to it from your anti-cw antibody. So, they are probably testing the father's blood for the cw antigen. This is not a test that every lab can perform so it may take a week or more to get results back from the lab they sent it to. If his blood is cw negative (lacks the antigen) then the baby can't inherit it (unless the baby came from a donor egg or some such) so then you have nothing to worry about. If his blood is cw positive then the baby probably has a 50% chance of inheriting it. They will probably do an antibody titer on your blood to see how strong the antibody is in your blood. If it stays weak throughout the pregnancy, the baby will probably be fine. If it is strong now or gets strong later they may choose to do other tests to monitor how the baby is doing. A special ultrasound test is common. If those look fine throughout the pregnancy then the baby will probably be fine or maybe jaundiced after birth (skin turns yellow from too much bilirubin in his blood). If the baby is too jaundiced, they will put him under special lights that help his body break down the bilirubin. If they see signs of problems on the ultrasounds they may choose to deliver a few weeks early or some other intervention. The antibody is crossing the placenta into the baby just like all those good antibodies to everything you are immune to, but, if he has the cw antigen on his red cells, the antibody will attach to it and his immune system will destroy those red blood cells. Bilirubin is a breakdown product of this process. If there is too much antibody (and he is cw positive) it could even make him anemic but they will find that on the ultrasound tests and know to intervene before it does him any lasting damage. Odds are that this baby will be cw negative and you don't have to worry about anything. If you have more questions, please post again. I know that pregnancy can be a great time for worrying.
This antibody does not mean you are sick. The only other thing it means for you beyond pregnancy is that if you were ever to need a blood transfusion, it might take a bit longer to find you compatible blood. It would be a good idea for you to let the lab/blood bank department of any hospital you go to know that you have this antibody because it will make preparing blood for transfusion easier, faster and safer for you. If you live in a place where you are likely to go to only one hospital, i would suggest phoning the hospital and asking to speak to the lab, then someone in the blood banking dept. Tell them what antibody you have and they will either record it in their system for the future or ask you for a copy of the report (which your doctor can send). When you change hospitals, you can have the lab at the new hospital phone the old hospital for this information (you might have to sign a release form). Blood bankers understand all of this well, but not many others do so it is easier to let them speak to each other. Again, please post again if you have more questions. I hope this answer hasn't totally befuddled you.
very well written!
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From a transfusion services perspective, I cannot think of a situation that I would select non-group O rbcs for transfusion to a patient whose blood sample is not agglutinated with anti-A,B, regardless of the ABO reverse grouping test results. Having said that, I do believe that a negative result with anti-A,B is a decision maker that does mandate that group O blood be selected for that patient.
I do agree with your donor center experience, but you certainly would not distribute a donor unit with the test results you described?
If a donor unit is labeled group O, it most likely is correct and confirmation with anti-A,B only, would save on reagents, and time.
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Having been the supervisor of a Red Cross blood typing laboratory for many years...I must mention that you must be aware that some weak subgroups of A or AB may front type negative with anti-A,B. Sometimes it is best to see the whole picture before making a conclusion.
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he-he-he....funny
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Roger that!
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Recent ASCP notification concerning the proposal that Dr.'s must sign for all test requisitions -
Physician Signature Requirement Burdens Labs, Jeopardizes Patients
ASCP urges you to act before the Jan. 3 deadline
Recently, the Centers for Medicare and Medicaid Services (CMS) finalized its Medicare Physician Fee Schedule final rule for the 2011 calendar year. The rule includes a troubling policy change requiring a physician's or qualified nonphysician practitioner's (NPP) signature on requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule (effective Jan. 1, 2011). CMS defines a requisition as "the actual paperwork, such as a form, which is provided to a clinical diagnostic laboratory that identifies the test or tests to be performed for a patient." Currently, a physician signature is required only on orders for laboratory services.
ASCP believes the new rule could adversely affect patient care and complicate the provision of the laboratory services. In cases where a signature from the ordering physician or NPP is absent, laboratories could be left scrambling trying to obtain the signature.
Late Breaking News Rule: Recently CMS has partially agreed to a delayed implementation request from ASCP and other members of the clinical laboratory coalition organizations. CMS will delay implementation of the rule for three months. During this period, ASCP will continue to pressure CMS to withdraw its new proposal.
ASCP urges you to contact CMS and tell them of your opposition to the policy change.
Contact CMS before the Jan. 3 Comment Deadline to maximize the effectiveness of your voice.
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OMG, I didn't know this was happening now. How did u find out?
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UHHH! Frustration. After all that work. They really need a global database for patients with pre-identified antibodies and to log in newly identified antibodies. That way we can all help each other out.
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Yes I think that is a good suggestion.
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Yes, something like that was my worst nightmare. Patient had previously identified 2 significant antibodies and this time I could not rule out 3 more antigens.......and anyway.....he wasn't gettin' anything too fast......I had to call the Rare Donor Registry to try and just get something that may have been compatible. I'm in a Red Cross reference lab trying to work, and the hospital lab called, and called, and then the nurse called and called.......then finally the Dr. called and said "IF MY PATIENT DIES I'M GOING TO HOLD YOU PERSONALLY RESPONSIBLE!!!" I then decided I wasn't getting paid enough!
:devilish:
Reducing reactions in young donors
in Donor Services and Donor Recruitment
Posted
Try handing them a video game during the donation (ie distraction).