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rravkin@aol.com

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Everything posted by rravkin@aol.com

  1. rravkin@aol.com
    Malcolm, It is gemes of information like this that keep me so fasinated and interested in BB. But I have to ask, outside of collecting a second specimen later on, do you have any recommendations on reaction enhancement? Thank you, Ronald
  2. rravkin@aol.com
    It is possible that you are witnessing the development of a new antibody whereby the patient was sensitized by the transfusion received 5 days prior. The additional reactivity (IS and 37C) would be caused by a higher concentration of IgM class antibody which is normally the first immune protein produced follow by the IgG class upon persistent exposure of the immune system to the non-self protein (aka antigen) and may account for the increased reactivity noted in the second specimen.
  3. rravkin@aol.com
    Is there any possibility that this is an Anti E like antibody and not an actual Anti-E? The reason I ask is that we recently had a case where our reference lab sited an Anti-C like specificity and did not call it an Anti-C.
  4. rravkin@aol.com
  5. rravkin@aol.com
    JUST CURIOUS; AFTER READING THESE POSTS, EXPERIENCING AND KNOWING THE IMPORTANCE OF PATIENT TRANSFUSION, AND ANTIBODY HISTORY; ARE WE ANY CLOSER TO SOME UNIVERSAL SYSTEM WHERE SUCH HISTORY WOULD BE READILY AVAILABLE TO THE MEDICAL COMMUNITY? WE HAVE ISBT AND NOW AN SDS (UNIVERSAL CHEMICAL ID SYSTEM REPLACING THE MSDS) SO IS IT POSSIBLE THAT A UNIVERSAL TRANSFUSION AND AB HISTORY IS IN THE MAKING?
  6. rravkin@aol.com
    KEITH, WHEN TRANSFUSING RBC'S TO A NEONATE OUR PRACTICE IS TO TEST FOR HGBS PER STANDARD PROTOCOL, AS WELL AS IRRADIATED, CMV TESTED NEGATIVE, AND LESS THAN 7 DAYS SINCE DONATION. AND READING OVER THE POLICY THAT YOU PRESENT; IT SEEMS INCONSISTANT, WHY WOULD INTERUTERINE TRANSFUSION BE DIFFERENT THAN THE NEONATAL TRANSFUSION, AT LEAST WITH RESPECT TO HGBS TESTING OF THE DONOR UNIT?
  7. rravkin@aol.com
    What do you do about an unresponsive patient brought to the ED by Emergency Responder with no ID and accompanied by no one and requiring blood products?
  8. rravkin@aol.com
    We require a Request for Blood Products document which provides two unique patient identifiers, a date and time of the order and issue, a doctor's or RN's signature and the printed name of the transporter. Upon issue we place a sticker on this document that provides the patient info and the unit number, expiration, and volume of product. This document is required for OR as well as floor issue of products.
  9. rravkin@aol.com
    Tkakin, we have an Exsanguination protocol for massive bleeding, and now I know why, because our massive protocol is the same as yours. Our exsanguination protocol calls for the ordering of a test, Xsang, which provides fields for filing date/ time and doctor who calls and ends the exsanguination event, along with Type and Screen testing, if able, and emergency release of products.
  10. rravkin@aol.com
    Goodchild, it has been my experience that although Gel testing of Cord DAT, manually or automated, is very work-flow friendly it is not more sensitive than the microscope which can readily be used to confirm negative or positive DAT's. I know that I may have just said a bad word, microscope, and I empathize, but it is still more sensitive than Gel and equally as user friendly, but not so work-flow friendly; and the only way to get to it is to use the tube method. So if you are having problems with gel, tube is the best way to go, at least for the Cord DAT.
  11. rravkin@aol.com
    Sandy, how, and with what frequency do you test these SDP aliquots for bacterial contamination??
  12. rravkin@aol.com
    Brenda, since these problems are sporadic have you checked your Gel Card Centrifuge. At maximum speed the cards are suppose to orient to a horizontal position; this ensues even migration of the cells through the gel of each column in the card. If these cards do not orient horizontally then the cells do not migrate evenly and can give the appearance of reactivity. This can happen in any of the gel card seats on the wheel lending to the sporadic nature of the problem you are experiencing. Just a suggestion and let us know what you find if and when you can.
  13. rravkin@aol.com
    Hi Brenda, it has been a while since we have heard from you. Were you able to resolve this problem? If so, how? Thank you in advance.
  14. rravkin@aol.com
    Sandy, I have practiced reserving a unit of packed cells for exclusive use by one neonatal patient once that unit is deemed compatible and an aliquot is taken. This practice ensures limited exposure for this neonatal patient and others. Do you do the same with the single donor platelet?
  15. rravkin@aol.com
    I agree with Dave. You are augmenting a received product from your supplier and there needs to be a new product code, expiration, and ultimately a complete explanation of what this new product is and it's intended use, as well as some documentation of the rest of the medical staff having been made aware of this new product.
  16. rravkin@aol.com
    Hey Dr. P I saw this at work as well n it is f....'n Awesome!!
  17. rravkin@aol.com
    Hi Malcolm, it's good to have you back. I sent you an email prior to reading this so there may be some redundancy.
  18. rravkin@aol.com
    Just goes to show what we have experienced where rbc's transfused into an opened circulation does not give the immune system an opportunity to become sensitized.
  19. rravkin@aol.com
    Brenda, also are gel reactions occurring primarily at the top of the column or are they dispersed throughout the gel? One other item; have you considered trying a reagent grade water to make your 10% Wash solution? I am not sure that it would make any difference but it's something else to try.
  20. rravkin@aol.com
    Hi Malcolm, can you give detail of your testing method; or is it the same as described here??
  21. rravkin@aol.com
    Wrong question
  22. rravkin@aol.com
    John, thank you for your post and your wisdom. It is their shout for their need of blood that I have experienced myself, and was certainly trying to address in my post. I think that DogLover, for which I am one as well, and David Saikin probably have the better ideas here. If I could speak further about the logic; here, as I stated, the logic would be that the OBG docs would have some assurance that blood products would be available when needed despite their operation being located in a different building. This assurance would come in a written policy, a procedure, and practice that would directly address their needs and concerns.
  23. rravkin@aol.com
    John, I deffinitely agree as far as inventory management is concerned. However, we have OBG clinic opperating in a separate building from the BB and the OBG docs, I would think, want some assurance that when they need PC's emergently, they will get them. These docs, as you know, can be very anxious when the BB is in the same building; imagine how anxious they are in a separate building, and all understandably so.
  24. rravkin@aol.com
    You might consider keeping O Neg Emergency Issue RBC's ( 2 to 4 or other; your choice) that are pretagged for Emergency Patient (in your case, would cover ER trauma, if needed, and/ or L&D, or separate emergency issue units available for each); segments prepulled and labled with unit# lable for crossmatch after issue; and cooler/ ice and/or other means of tranport predetermined.
  25. rravkin@aol.com
    Has anyone given any consideration to the storage conditions of the eluate kit and how that may play a role in your findings?
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