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applejw

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Everything posted by applejw

  1. I can describe how it works for our healthcare system and PM a copy of our policy. The pre-hospital transfusions on the helicopter pre-dated me at this facility but I have expanded to ambulance pre-hospital transfusions on 3 ambulances with begging to increase to 4 ASAP. We maintain sets of 2 O NEG RBC and 2 low-titer liquid Group A plasmas for 1 helicopter and 2 ambulances that work out of the level 1 trauma center. We set up a dummy patient for each vehicle and units are pre-labeled for that dummy patient, segments are retained at the Blood Bank, each unit wears a Saf-T-Vue10 indicator and a triplicate Emergency Release form with unit numbers documented on the form with one copy of the form retained in the Blood Bank to keep track. Each vehicle uses the Pelican Biothermal Credo and changes out each blood product set once every 24 hours. The crew at the vehicle base is responsible for exchanging the cold panels for the credo. Each credo carries a datalogger and the datalogger report is downloaded and emailed to the Blood Bank at least weekly for review. Each credo is validated to maintain temperatures for up to 3 days prior to being released for active use. When a patient is transfused, the flight/medic crew is responsible for returning one of the copies of the emergency release form signed by the crew's MD to the originating Blood Bank and one copy goes on the patient's chart. Units are released from the dummy patient, crossmatched (if we get a sample), and transfused in the LIS to the actual patient. The crew returns to their base to replenish the units that were transfused. If the patient is transferred to a hospital that isn't part of our healthcare system, we still have a copy of the form returned to us and the crew will tell us where the patient was transported to and we "transfuse" the dummy patient with unit comments in the LIS with whatever information we received from the crew .
  2. I suggest to my techs during training that it may be prudent to test the last wash before preparing the eluate - especially when additional red cells are not available. I'm sorry to report that I have seen several elutions where the last wash never became negative..... usually with cord cells where the mom had a VERY strong antibody - even changing tubes with every wash. I'm sure that if I had had the patience and persistence, it might have become negative but I gave up at 10 washes.
  3. Our facility has built the attestation statement as part of the Emergency Released order set. We implemented this after our last FDA inspection in 2019 so don't have any feedback from them yet. We also use a triplicate form that documents the diagnosis, date and units that were issued during the process.
  4. AABB Transfusion article from February 2019 discusses anti-CD47 interference and possible mitigation methods. It discusses how PEG adsorption may not be valid due to precipitation of the anti-CD47 which carries the risk of also precipitating out any alloantibodies rendering the tests negative (but invalid). It also discusses the blocking of antigen sites causing a negative or weakly positive DAT but a strong panagglutinin in the eluate. The conclusion was that multiple alloadsorptions using papain-treated red cells and use of Gammaclone anti-IgG may mitigate the reactivity. My question is whether anyone is using these methods for mitigation, were they successful, and how are you obtaining papain-treated RBC for the adsorptions? Can you use W.A.R.M (ZZAP) for the papain pre-treatment? I ask this because my facility is the 'reference' lab for a large hospital system but doing a 2-stage enzyme procedure is not feasible with my staffing and workload.
  5. Change your setpoints to 2.5-5.5 - that way you are covered for both RhIG and blood products
  6. Back in the 80's, had a cardiac patient undergoing CABG and received 8 units B NEG RBC during surgery. Three days later, a new specimen was received that typed mixed field AB POS with a reverse type group A. Supervisor retrieved the chemistry specimen from 3 days prior and it typed as A POS. Turns out the phlebotomist drew the patient in the other bed and this was long before second sample requirements .... Patient was a little "oozy" post-operatively but survived the experience. Same hospital, elderly female patient typed as O NEG. Blood was crossmatched and issued during the weekly computer downtime. As I went through the stack of units that had been issued updating the computer records, got a major flag as at computer issue - the unit was A NEG and that was just the first of 2 units that had been issued during this 2 hour downtime. Investigation revealed that 2 A NEG RBC were placed in the O NEG inventory, were crossmatched using immediate-spin and were compatible, and out the door they went. The patient was fine.
  7. We use Pelican ProMed credos for carrying blood on ambulances and helicopters. To what extent to we need to go to re-certify these credos annually? Every payload includes a datalogger. Would it be acceptable to review temperature data during certain months, verify that the panels are within expiration dates and that the containers appear undamaged to consider them to be re-certified for another year?
  8. We have 6 of the MaxQ MTP coolers and they work very well for us - we run over 225 MTP per year with a Level 1 Trauma Center and High-Risk OB. We keep liquid plasma and thawed plasma on hand and haven't had a problem with the validation. Biggest issue was OR runners going up and down stairs with them and not banging themselves up. I liken it to parking at the airport with your roller bag and not bruising yourself getting into the terminal. We also purchased the blood shippers and use them for inter-facility transport of RBC and plasma. We decided to go with the R-12 instead of the smaller R-10 (we couldn't get the validation where we needed it to be). We use Coleman coolers for platelets because the smallest of the blood shippers intended for platelets was the same color as the RBC shippers and didn't want any confusion.
  9. I'm a huge fan of dedicated BB staff for larger facilities. Currently, only day shift is comprised of dedicated staff and 2nd and 3rd shift manned by generalists who work in at least one other specialty. With a 6 on/8 off schedule, some of the 3rd shift work only 1-2 days per month and are VERY uncomfortable given that we are a Level 1 trauma center, large outreach services and serve as the "reference" Blood Bank for 7 other satellite hospitals. Turnover is a problem on 3rd shift because of the extra stress caused by only being scheduled 1-2 days per month and being responsible for at least half of the massive transfusion activations. My Medical Director wants dedicated BB staff but with the current administrative/financial climate it is a steep hill to climb.
  10. I'm back at this question and it's been over a year. Current discussion is whether to continue with Typenex bracelets for RBC transfusions or.... no Typenex bracelet requirement. We are in discussions with other facilities within our system who only use Typenex bracelet for patients who are unidentified or have other "identity discrepancies" - we are all moving to Softbank within the next 6 months. I'm looking for both Pro and Con opinions to bring to the workgroup. If you know of any literature on this subject, references are great. I would like for the group to make a system decision based on evidence and not feelings.
  11. The requirement to perform a donor retype also plays into whether or not the LIS is used for electronic compatibility testing. AABB 5.16.2.4 The system contains logic to alert the user to discrepancies between the donor ABO group and Rh type on the unit label and those determined by blood group confirmatory tests and to ABO incompatibility between the recipient and the donor unit. * *FDA Guidance for Industry: Computer Crossmatch"
  12. I highly recommend having a separate product build for convalescent plasma - enough so that it clearly distinguishes the order from a routine thawed plasma product. If you don't, beware of the possibility that a random donor plasma can be substituted for convalescent plasma especially if you don't have a lot of COVID19 patients receiving this product.
  13. We have just implemented this in Epic. Haven't gone through an inspection yet but I can't see that the FDA would have a problem with it as it is documenting a medical decision.
  14. We have added the AABB attestation statement regarding the release of uncrossmatched, emergency released blood to an Epic order that is electronically signed. We still send a form but it is more of a back-up now for those instances where the MD did not sign the form from the OR and once the patient has been transferred, it is virtually impossible to find someone willing to sign the form after the fact.
  15. Repeat testing used the cells that were originally placed on the Vision for compatibility testing . These were incompatible using the lavender-top tube but compatible when tested with the 2nd pink top. I think that, whatever the cause , the answer is found with the 2nd pink top tube. Two possible scenarios: 1) 2nd pink top collected from a different patient who coincidentally was also B POS and in the ER around the same time 2) Antibody titer decreased due to transfusion or dilution. At this point, it is a conundrum and might be academic but an interesting story. Thank you, everyone, for your thoughts!
  16. So, this patient was initially seen as a trauma with an unidentified "identifier". The 2nd sample labeling was verified (by several people including myself) - collected at a different time according to the label. Patient's initial sample was B POS and this sample was also B POS. It is always possible that the second sample was collected from a different trauma patient in the ER that was also B POS around the same time but, because of the probability of another B POS patient in the same vicinity in the same time period, I don't believe that is the cause but cannot exclude this possibility. The hematology sample was also B POS. I did check other trauma samples received during that time and there were no other samples tested as B POS.
  17. I initially thought that some of the antibody would be adsorbed onto the transfused positive cells but wasn't sure if that would be enough to completely remove the reactivity - but apparently it sure helps!
  18. Situation - RBC and plasma issued emergently to patient. 2 units RBC and 2 units plasma transfused in ER. Testing on patient specimen drawn pre-transfusion showed 2+ reactivity with screening cells and anti-K1 was identified. When performing compatibility testing, the 2 transfused RBC were compatible when tested on the Vision using a 2nd specimen collected after the original specimen used to perform Type and antibody screen (insufficient plasma remaining from pre-transfusion specimen to perform any additional testing). After performing antigen testing on all units, unit #1 was tested as K1 positive and unit #2 was K1 negative. Compatibility testing using manual gel technique was performed on unit #1 to verify the negative test result - but was found to be 2+ incompatible. This testing was performed using a 3rd specimen collected at the same time the initial specimen was collected (CBC specimen obtained from Hematology). This was repeated on the same Vision instrument and was 2+ incompatible using the CBC specimen. Is it reasonable to assume that the plasma transfusion (along with associated IV fluids used in resuscitation) would have diluted the existing antibody enough to yield negative test results with an incompatible RBC unit?
  19. We routinely test cord blood samples on Vision. We do not autoverify results from the instrument so are required to check results before crossing over interface. Requirement to perform weak D testing is verified on daily work review.
  20. Update: Blood supplier now short on blood transport boxes - especially platelets.
  21. Today, we received notification that our blood supplier will no longer be entering the hospital building. We are expected to meet the courier outside to take delivery of the shipment. Additionally, we will be charged for each of the shipping boxes since they are no longer going to be re-used. Has anyone else encountered this as part of our brand new CoVID-19 world?
  22. When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) Positive DAT with anti-IgG if being tested as part of transfusion reaction investigation or antibody identification or at physician's request. Positive DAT with neonates are called to the provider and eluate is required if no history or Mom has positive antibody screen or there is no ABO incompatibility between baby and Mom What method is utilized for the elution? EluKit II What method is utilized for testing the eluate? Gel or modified AHG in tube How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) Full panel unless sample size is limited then perform a selected cell panel Feel free to mention any special notes/criteria for which I may not have though to ask. I prefer gel but sometimes tube is cleaner. Some of my techs have a problem with anomalous gel results and I think it is due to stroma contamination.
  23. I added a statement about either not transfusing or splitting units for patients that are at risk for circulatory overload and that it was the provider's responsibility to identify patients who are at risk . We use Epic and after the last JC inspection, transfusion rates were amended to specify urgent, normal or slow rates at the time the transfusion order is entered.
  24. Just saw this topic - we are 700 bed facility with 35 bed NICU and are the Mother Ship to 5 satellite facilities that offer Labor and Delivery. We probably do 1-2 per year and they seem to come in clusters. More often than not, there is a panicked phone call ordering exchange transfusion STAT before Bilirubin levels and Hgb are performed. Did I mention that we are also a teaching facility? After calling in someone to perform the reconstitution, it is usually cancelled because phototherapy was initiated and the bilirubin levels dropped below the "Exchange Transfusion" threshold. Other hospitals I have worked at had similar rates of exchanges for infants.
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