[Handheld phlebotomy with Meditech]

We also have used Mobilab for about 5 years.  It is much better than the PHH feature that comes with Meditech.

[Anyone using Ortho Vision and Meditech Expanse?]

We just went LIVE with Expanse and use the Vision.  Send me an email and I would be glad to help

Thomas.upton@thomashealth.org

[Antibody Problem, Mysterious]

Contaminated diluent should have been discovered when running QC

[Meditech - warning for patients with special transfusion requirements]

If your rule syntax is causing the application to crash, you need to open a task with Meditech and have your BBK/NPR specialist take a look at your rule.  It is often as simple as a space in the wrong place.

[Complement Control]

I have been using them for about a year now. The reactions are usually 1+ when incubated at RT for 5 min

[Complement coated sensitized cells]

Question - why are you making these cells in-house when they are readily available from a manufacturer? Cost?

[Use of CPT Code 86885]

Thread back from the dead..........

 

I just recently had an issue from the coders at my facility concerning 86885.  They say I can only bill 3 of code 86885 per day.  The problem is with reference lab testing.  On AB ID's we get billed for 20+.

 

If anyone has more input, I would welcome it.

 

Thanks

[Routine use of Anti A,B]

No value for routine patient testing.  Ditched it a couple years ago.

[How would you have handled this?]

 

 

Rh negative units that are retyped from a blood supplier do not need to have a test for weak-D

[If no filter, wash?]

FDA requires all products to be filtered before transfusion.

[To send or not to send (to a reference lab)?]

We would have also sent to the IRL.  The incompatible crossmatches are a dead give-away something is formed or forming.

[Expired ABID Panels]

We use expired panel cells for rule-outs up to 4 months.  We did get cited by CAP for not running controls, so we had to change our SOP to included QC of the panel used. Usually a D+ cell with Anti-D and a D-control (either saline or dilute albumin).

[Need opinions...Giving Ag neg units vs. antibody "rule-out"]

I think I see what Dansket is referring to.

 

Because of this one time scenario is this patient going to receive Kell-neg units for all future transfusions?

What would individuals do at their own institutions presented this same scenario? One time only for Kell-neg or is it part of their history now?

 

In this situation this would be a one-time scenario for K-neg units.  However, as Galvania posted, because this patient has already formed 2 antibodies, her chances of forming another are greater.  Thus, giving phenotypically similar units would be advantageous, if at all possible.

[Complement Control Cells]

We switched to Bioscience from Immucore because of price

[Blood Bank or Pharmacy?]

Blood Bank only handles Rhogam. All others by pharmacy.

[How many rule-out cells does your lab require for antibody ID?]

Just wondering what the prevailing practice is for antibody ID rule-out cells.

At our facility, current SOP states 2 cells are needed if 1 is homozygous, or 3 heterozygous cells.

I'm looking to change it to 1 homozygous cell would be sufficient for rule-out.

Opinions?

[Pros And Cons Of Different Blood Bank Banding Approaches]

We use option B.  We are currently evaluating some of the new Typenex barcoded bands.

[Using blood tubing to administer drugs]

I would ask the manufacturer of the tubing to get their recommendations

[Eluates on babies with positive DATs]

We stopped doing LUI elutions last year as routine testing (thank goodness).  We still have the option to do them upon request.

 

If an IgG antibody was suspected of causing a positive DAT on a cord sample we would do an acid-elution.

[Eluates in GEL]

We have seen similar problems at our facility Brenda.  Our last CAP survey did just as you described.  after reading the Survey Discussion, this problem was widespread and caused CAP not to score that sample.  Investigation revealed manufacturing issues that are to be corrected before the next survey.

[Need opinions...Giving Ag neg units vs. antibody "rule-out"]

Thats basically what I would have done. Do you only have one panel? Do you save outdatedd panels for selected cells, so that you could find more than one "rule-out" cell. That is a great help, as long as you run appropriate QC.

 

We use 2 0.8% panels and we keep outdated panels (up to 4 months) for rule-outs.  QC is performed when the expired panels are used.

[Autologous blood]

We haven't seen any autos for at least 2 years

[Need opinions...Giving Ag neg units vs. antibody "rule-out"]

Hello all,

 

I have encountered some controversy regarding a few of our patients that have historical antibodies.  As a general policy, at our facility a patient that exhibits a positice Ab screen must have an Ab ID.  Normally, we do our own identifications which includes antibody rule--outs using at least 2 cells, preferably 1 that is homozygous (when applicable).

 

However, we have had a couple patients recently that didn't quite fit the criteria.

 

Example:  Patient has a historical Anti-D and Anti-C.  Using our panel cells, Anti-D and Anti-C were confirmed (again), with 2 stray reactions in gel.  Autocontrol was positive.  DAT was negative.  Reviewing these 2 stray reactions, based on my experience, they looked kinda "funny."  I suspected some proteins in this patient's system were causing the stray reactions (patient was on chemotherapy).  All clinically significant antibodies were ruled out using at least 2 panel cells, EXCEPT for Kell.  I could only find 1 rule-out cell.

 

So, instead of sending this patient to the Refence Lab to investigate the stray reactions, I (as supervisor of the department), screened units that were negative for C and Kell (as a precaution).  Both units were XM compatible through AHG and transfused without incident.

 

Later, another tech (who happened to be the supervisor before me) questioned this strategy.  She claims this patient should have been sent to the IRL from the begining.  I disagree.  In my opinion, she is being to strict.  Even if we would have positively identified an anti-Kell, we still would have given Kell-neg units!  Clinically, either way results in the same outcome, the difference being using my approach saved at least a $500 Reference Lab bill and the patient got their blood at least 24 hours sooner.

 

My Lab Director responded to the other tech's request and a sample was sent to the IRL anyway.  The results from the IRL confirmed Anti-D and Anti-C.

 

So, did I do the right thing? Is this a decision that should be based on judgement or policy?

 

Thanks for the replies!

 

Tom

[Provue monthly back up]

We were given a thumb drive to use for transferring backup files by our Ortho FSE. I transfer the files (monthly) to a server that gets backed up nightly.

[Switch from gel ABO/Rh to tubes for cost savings?]

Biorad (owner of Biosite) just had the FDA clearance on their version of Gel (which was developed in Europe way before Ortho got their hands on it. Once the US patent for Ortho's Gel expires this Fall you will see the price of Gel fall dramatically. I would bet it will be cut in half. Competition is a wonderful thing!