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DPruden

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Everything posted by DPruden

  1. We have 4 O- units pre-tagged to Trauma, Patient. We photocopy the face label of the unit and then all we have to do when a trauma is called is pull the photocopy out and pull a segment and put the units in the cooler. We can then use the photocopy to issue the blood in the computer. We have enough time to setup and tag more blood before it is needed, usually.
  2. I worked with a new MT who could never seem to master the fibrometer QC (remember those!). All of a sudden, he stopped having issues with his QC. I asked him what he had done and he told me that he would run the QC see how many seconds over the limit the result was, and then run the QC again and start the timer and wait to add the CaCl for however many seconds he was off. Shudder.
  3. My question is, in the age of solid phase and gel testing in which you have no IS reaction, do you treat all anti-Lea and anti-M as clinically significant and provide antigen negative blood?
  4. I could send you our policy and form if that would be helpful.
  5. I don't know if our process is "fun" but we assign teams for annual SOP review. We include a management representative, someone who trains the SOP, our technical specialist, and a couple of bench techs and then the team goes through a chunk of SOPs and evaluates for regulatory changes, current practice, etc. and then the team decides if the SOP needs to be revised or not. We handle annual competency from CLIA/Joint Commission viewpoint and include 1. Direct observation of test performance, 2. Direct observation of instrument maintenance, 3. Monitoring of recording and reporting of test results, including a review of intermediate test results, worksheets, or QC, 4. Assessment of problem-solving skills, and 5. Test performance assessment using a blind sample. We hand out the forms at the beginning of the year and allow the techs to use their daily work to meet the requirements.
  6. We are using Cardinal Health Certified Blood Bank Saline and add the pHix. We only decontaminate once a month with the RelyOn. You should check with Immucor, but I thought that the PM's were included in the contract.
  7. We have had similar problems with the Bga+ cells on the Ortho Panel A. And it always seems to be on one of the cells that we use for the shortened panel on passive anti-D's from Rhogam.
  8. We have been using our Echo since October 2008 and we have not had hardly any hardware problems. We had to have the motherboard replaced, but I think that was our fault (incorrectly replaced probe leaked onto it)! I agree with L106, could someone be using bleach?
  9. I think that would probably be Sky Ridge hospital, they are right off of the interstate. I don't blame you for avoiding Monument hill in the winter!
  10. Hi, I joined in January, but I just found the introduction forum! I am a blood bank manager at a local hospital in Wheat Ridge (suburb of Denver, CO) and have been a MT for 18 years. Thanks for all the helpful information! Dianna
  11. We only do cord blood workups on Rh negative mothers and any other cord that is requested by the physician. If we have a positive DAT and there is an ABO incompatibility, we append a comment that the DAT is presumbaly due to the ABO incompatibility. I attached our flowchart. Cord DAT flowchart.doc
  12. METHOD CORRELATION OR MADNESS? By Suzanne H. Butch, MA, MT(ASCP)SBB First, let me say that quality control is important. As laboratorians, we have a responsibility to follow federal regulations. Furthermore, we have a responsibility to bring to the attention of our regulators when there are illogical and time consuming quality control requirements that fail both the purpose and spirit of quality management. One such example has recently come to my attention. In the newest (6/15/09) CAP Transfusion Medicine Survey is question TRM.31450 that asks “If the laboratory uses more than one instrument/method to test for a given analyte, are the instruments/methods checked against each other at least twice a year for correlation of results?†The question and the explanatory note below is word for word the Chemistry/Toxicology question CHM.13800: “NOTE: This requirement applies to tests performed on the same or different instrument makes/models or by different methods. This comparison must include all nonwaived instruments/methods. The laboratory director must establish a protocol for this check. Quality control data may be used for this comparison for tests performed on the same instrument platform, with control materials of the same manufacturer and lot number. Otherwise, the use of fresh human samples (whole blood, serum, plasma, urine, etc.) rather than stabilized commercial controls, is preferred to avoid potential matrix effects. In cases when availability or pre-analytical stability of patient/client specimens is a limiting factor, alternative protocols based on QC or reference materials may be necessary but the materials used should be validated (when applicable) to have the same response as fresh human samples for the instruments/methods involved. This checklist requirement applies only to instruments/methods accredited under a single CAP number.†My interpretation of the above is that every six months blood bank laboratories must now document correlation between all methods used to perform a Type, Screen, Crossmatch and antibody identification whether by tube, manual or automated microtiter plate, manual or automated Gel and by different phases. We must document that we get the same answer, regardless of method. The rationale behind this CAP question is that correlation studies are a required by CLIA regulation. This appears to be an unintended consequence of the most recent revision of the CLIA quality control regulations where individual laboratory requirements were eliminated in favor of a single set of requirements. This requirement makes sense when the results being reported vary from day to day and instrument to instrument. However, blood types do not change without cause. They are not variable from day to day. In addition, the ABO type is “controlled†by the use of a forward and reverse grouping. Tube Rh typing result vary by the clone(s), enhancement media, incubation time, cell suspension and other patient variables. It is well known that the various methods used for antibody detection and identification have differences in sensitivity and specificity. In addition, some antibodies are only recognized under very specific circumstances. No two antibody detection/identification methods get the exact same results. In fact, we employ this variation in methods to obtain different results when we use enzymes, PEG, LISS, etc. to help us problem solve when a patient has multiple antibodies, non-specific reactivity, and warm and cold auto antibodies. The most important “control†we do in the transfusion service is the history check. We do this for every patient. If we find a discrepancy, we investigate. Doing a method comparison every six months will not improve patient care. Applying what is a rational requirement when doing biochemical tests to the serologic results produced by immunohematology testing is not appropriate. If the method comparison was easy to perform, one might decide to just comply. In this case, however, meaningful testing is cumbersome, difficult to structure and execution is expensive to execute. Significant time and resources would need to be devoted to this task. Testing enough samples to provide a valid comparison of methods is time consuming and illogical. The references given for this new requirement are based on biochemical and hematological studies: 1) Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare, Medicaid and CLIA programs; CLIA fee collection; correction and final rule. Fed Register. 2003(Jan 24):5236 [42CFR493.1281(a)] 2) Podczasy JJ, et al. Clinical evaluation of the Accu-Chek Advantage blood glucose monitoring system. Lab Med. 1997;28:462-466 3) Ross JW, et al. The accuracy of laboratory measurements in clinical chemistry: a study of eleven analytes in the College of American Pathologists Chemistry Survey with fresh frozen serum, definitive methods and reference methods. Arch Pathol Lab Med. 1998;122:587-608 4) Miller WG, Myers GL, Ashwood ER, et al. State of the Art in Trueness and Inter-Laboratory Harmonization for 10 Analytes in General Clinical Chemistry. Arch Pathol Lab Med 2008;132:838- 846 5) Clinical and Laboratory Standards Institute. Verification of comparabililty of patient results within one healthcare system: Approved Guideline. CLSI document C54-A (ISBN 1-56238-671- 9).Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 190871898, USA, 2008. For those of you who share my opinion and believe the arguments against method correlation on a 6 month basis are cogent, please write Judy Yost Director, Center for Laboratories US Dept of Health & Human Services Commission on Medicare & Medicaid Baltimore, MD or CLIA staff at (410) 786-3407 or (410) 786-3531. Her email is Judith.yost@cms.hhs.gov . I have heard her speak and she is a proponent of reasonable and effective quality control.
  13. If you use Ortho or Immucor reagents, I believe they both have posters of common antigens and their frequencies. We have a couple posted in the blood bank for easy reference.
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