jnadeau

On the topic of passive antibodies, I have a student in transfusion services right now who wants to know why we don't have to respect zygosity when ruling out on an abbreviated panel (Ortho 0.8%) performed when passively acquired anti-D is suspected to be the reason for the positive antibody screen. I have emphasized the importance of ruling out using zygosity or possibly missing an antibody. Now with the abbreviated panel I tell them ruling out with zygosity is not necessary. Anybody have any history on this?

Sorry no, I'm not that clever Mable. Came across it a while ago (2009) researching best practices on consents to update our P&Ps. Obviously it's much older with that language (wantonly!). Maybe some youngster can find out. My search engine is tired.

I came up with the attached and had them laminated and distributed to every unit - can't confirm that the info is always presented in full but...all we can do is try to help.informed consent2.docinformed consent2.docinformed consent2.doc

A gentleman and a scholar (and a natural comedian). Thanks for sharing your knowledge in such an understandable way through the years - and now with this pic I can point to my reference! Congrats again

Will you please post a picture receiving the medal - then when I quote you I can show them my reference! Congrats Malcolm!

After being cited by a NYS inspector a few years ago for vital signs not being documented as described in the blood administration policy (some pre- and post vitals were documented with the same time as the start and end times) I searched through numerous P&P's and regulations from around the world (English speaking anyway) to find a fix. The citing was legitimate (pre=BEFORE START, post....) and I wanted the corrective action to reflect the most up-to-date best practice I could find. There was an almost universal policy/regulation for pre-, 15 min and post vital signs. The variations in the timing of vital signs (other than the 15 min ) was all over the map. The multitude of situations patients are in make it difficult to be cut and dry in a P&P. Decided to go with pre- and post within 30 min of start and stop; must stay with patient first 15 min so that was easy. More frequent vitals if provider indicated (almost never) or transfusionist deems patient requires - or if I recommend with my knowledge of the patient history / lab results. You know though, that as soon as there's an incident they'll "fix" it by requiring more frequent vitals and the loop continues...keep your old policy handy.

I have noticed this too, more recently in the past couple of years - they're coming up in gel which we know enhances the "M"s but...why enough times to take notice now? We report them as a cold autoantibody mimicking anti-M. The providers never call to question this ...aren't you surprised?

I've taken an outpatient sample (so I know it won't be needed again), added 3 drops of anti-s (BioRad - IAT), mixed and put it in the water bath agitating for about an hour. Works like a charm. I've also used Coombs control (labeled as a patient sample) - they elute anti-D as expected-much less of an eluate volume but we use gel so there's enough.

Thank you very much Malcolm. I'm going to read this over again at home - maybe with a cold beverage in hand - and let it sink in. I appreciate the time you take to answer these questions and my student will be very pleased with your compliments.

My student asked about the original natural antibodies in the plasma - I assume they're "wiped out" with patient's B cells in the chemo/radiation and the transplanted B cells in the donor's marrow makes the appropriate antibody(ies) for the patient's new blood type. What about the tissue/organs that express ABO antigens though? Please help Malcolm.

Sorry but the "Help" content at the Emergency Issue for Products prompt says that the system references this prompt only if the patient has no current blood type - if the patient has a blood type history that would normally be considered incompatible with group A FFP the system puts a hard stop on it.

Does anyone know of a dictionary setting in Meditech 5.67 that will allow emergency release of group A FFP/FP? I've looked in Meditech's "knowledge based" articles but...nothing found. I don't want to change the blood group settings dictionary - just want to be able to override the pop-up for this blood type and product. Paper (as in downtime) is the only option I can think of with this old mind - and in an emergency setting that is not ideal.

We're moving to eliminating the saline bag and using a 50cc saline flush (syringe) at the end of the transfusion. A bag of saline will be at the bedside in case of a transfusion reaction. This has been prompted by the saline shortage - the pharmacy is very happy with the move. The saline flush was suggested because the nurses said patients notice if they don't get all of the blood they're paying for...not worth the argument.

Clear bags - blood products are not considered a biohazard (I thought - if my memory serves me correctly on this "Friday where have you been?!!)

We started doing this every 6 months for CAP years back. I now just assign 2 pos and 2 neg samples from our proficiency samples (AFTER the due date of course) and techs will perform in gel, PeG and albumin. Reaction strengths vary of course but it keeps techs comfortable with the tube methods which we rarely use.

Thank you BankerGirl- it worked! What do I owe you?

We can't enter these units into inventory without differentiating the DIN somehow - even with scanning the product barcode (which is obviously different) first. Meditech is not that smart or I missed a setting in the product dictionary (and am not that smart either). Is there a TAR consultant for hire out there?

How are you handling the labeling of two units with the same DIN when nursing is using TAR in Meditech? We now manually add an "A" to one of the units but nursing doesn't want to have to override the scanning of labels at the patient's bedside when TAR goes into use.

Years ago I worked in micro exclusively for 8 plus years. In my experience, especially with normally sterile fluids (e.g. CSF, blood) it was not unheard of to have a negative smear (NOS) followed by growth (usually rare colonies). We would review the slide to ensure we had not missed something on the smear. I always thought it was ALOT easier to call a "rare gram pos cocci" on a smear AFTER you got the growth on the plates - many times it looks like stain artifact / debris on initial read. You are initiating treatment on patients (many truly negative) calling a positive smear. This was a real problem with AFB smears and cultures with rare to few colonies growing weeks later. Now on review of the slide, the supervisor "sees" 2 small bacilli amid a lot of sputum debris! Really! That's why micro is a specialty - but still not perfect. Molecular testing has made a big improvement in this arena.

A long time ago, some old SBBs told me the "national average" for red cell outdated units was 2%. We have stayed at <1.5 for many years now - mostly AB units. Don't know about % for wasted units - I investigate the circumstances with everybody involved (nurses, physicians, anesth docs) and educate them if necessary. They get the idea that they better not make that mistake again. Obviously, sometimes it can't be avoided (e.g. patient expired) but our expired units outnumber wastage by far.

Just got an under counter Helmer freezer a few months ago David. What was your "bad luck" with them? Got a Helmer refrigerator coming in a few weeks too - please do tell.

I believe the Kidds are known to react best using PeG. You didn't indicate what enhancement you used in tube.

Wow folks - didn't mean to start an assumption feud. Has anybody ever seen O.R. staff in scrubs in the cafeteria?

Thank you all for your confirmation of my take on this and Malcolm for giving us a laugh. I guess what fueled me is the nurse's statement that the "lab techs needed to be properly trained ON infection control practices and she didn't feel it is her place to train this area of the hospital". REALLY??!! Emailed her explaining a little about microbiology and the need for her to concentrate on using sterile technique when spiking the bag and connecting to the patient's venous access. Hope I've heard the end of this......if not it's radiation for her.

They're handling the transport bag though David. We don't have staff wearing gloves in public / visitor spaces (e.g. elevator). It would look like they were in a contaminated area and forgot to take them off when they left.