Deny Morlino

Many thanks for the replies thus far.

MLT's are invaluable in the rural setting. Other than the supervisor of a given section MLT's perform the same duties as MT's here. I also agree with the thought that it is not the "degree" so much as the person performing the job. VERY rarely do we concern ourselves with the alphabet soup behind the name. As has also been stated, the biggest challenge in a rural setting is the distance and time issues. The upside is familiarity with the patient histories due to frequency of contact. Hang in there. The adjustments will take a bit, and you are bringing a wealth of experience from a different world. Some of the experience will be very applicable and some not so much. The challenge will be deciding what fits your new world. Good luck!!

Looking for a quick bit of information. How often do we see a change from a negative antibody screen at the prenatal workup to a positive antibody screen at delivery (excluding the obvious of RhIg administration causing a change in the Anti-D)? Anyone with some sort of guestimate? I do not recall many changes, but we do not routinely perform a type and screen at admission. Thanks in advance for the replies.

The blood bank band is placed on the patients arm during the presurgical draw at our facility. The admission band from the hospital system is placed the morning of surgery when the patient arrives.

That is a great idea! Glad you thought of it! Thanks.

This has been my understanding as well.

Educational as always Malcolm! Thanks for the lesson!!

Obviously they weren't thinking! That was the same concern I had with the recent case here. Thankfully all appears to be well with the patient. This is a topic on my list to discuss with my pathologist.

Also agree David and Liz. When talking to the reference lab I am often reminded that practically every patient presents to them as having a positive antibody screen!!

This is the sort of question I hope to determine better answers to in the coming year. AABB has a webinar series starting January 12th covering the topic of patient blood management. I hope to gain some solid information to effect (affect?) adjustments in the transfusion practices in my facility. I tend to agree with Auntie-D on this. If the patient is not symptomatic to trigger a transfusion, then avoid transfusing.

Cardiac function was part of my concern with our recent case. She has had no negative outcome to my knowledge and the units were all administered within a 24 hour period.

OK that is truely incredible!! The human body is amazing.

Merry Christmas everyone who celebrates this holiday. Any other holidays, enjoy a good celebration as well.

We had an extreme case roll in yesterday. A patient with a history of Chronic Mylogenous Leukemia (in remission I guess) had a bowel resection performed at the end of November. She presented yesterday with a hemoglobin of 2.6 g/dL!! Was feeling a bit run down, but was still holding a conversation with the ED staff. Today she is up to a 9.8 and feeling better (I would imagine so!!). The hematology supervisor said it was the lowest he had seen in his 35 year career. We checked and the draw site was not anywhere near an IV. How low have you seen and the patient pulled through the situation? Mostly a curiosity question.

Currently use their Anti -A, -B, and -D reagents for retypes mostly. Also use their Anti-D delta to detect -D VI in our cord bloods (direct agglutination vs. weak D protocol saves a good bit of tech time). Have been happy with the items we use here.

Highly in doubt!!

Our LIS is SCC and works well. The ED is using Allscripts. There are issues between the two still to be addressed. Similar to AMcCord there are limited order sets to try to guide the physicians the correct direction, and thankfully a ward clerk handles the paperwork necessary for blood bank. This minimizes the mistakes as they must get the correct order from the physician to complete the paperwork. Our biggest issue seems to be when a physician from ED attempts to place a timed order following their initial order. It frequently attaches to the original order and shows up as STAT with the only indication of it having a specific draw time is whatever comment the physician may have entered. I think part of the problem is an understanding of how the program is designed from the physician standpoint. Still a work in progress.

We are paper as well. My techs document when they go to tube method (primary is gel) in the workbook so it is easy to track. Just thinking about the two methods I would be inclined to set up both testing methods in the software since there are different resulting schemes for each. With tube there is IS, AHG, and Coombs so that would require three results per screen cell anyway vs tube method needing only a single entry per screening cell. Just my 2 cents worth.

Can't help with the inpatients. Our ED physicians went live with physician ordering within the last year. Sounds like we are in the same boat as you are. They just don't understand all of the ins and outs of the system they are using and it causes no end to the problems.

Lisa, Any possibility of your pathologist educating the ordering physician or lab regarding the reasons for not performing the Weak D protocol? Just a thought.

I am pulling information from the 17th edition of AABB's technical manual and giving our facility's interpretation : Because patients can experience transfusion reactions several hours to days after the transfusion is complete, medical staff should continue to monitor the patient periodically for 4 to 6 hours after the end of the transfusion to detect febrile or pulmonary reactions that may be associated with blood administration. If the patient is not under direct medical supervision after the transfusion event, medical staff should provide written instructions to the patient and caregiver about signs and symptoms to be aware of and report, and they should ensure that the patient has a phone number to call or a person to contact should a reaction occur later. We monitor the outpatient transfusions for 1 hour after the completion of the transfusion and then the patient has written instructions detailing transfusion reaction signs and symptoms, a contact number to call, and further instructions to present to the Emergency Department if symptoms progress. Hope this is what you were looking for.

Daily here as well.

We are certified by HFAP. They follow the CMS/FDA rules here in the States.

Shhhh!! These are all secrets!! In all sincerity it would be invaluable to the physicians as well as to the lab as we would all be closer to the same page.

True as long as the patient is not symptomatic.