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Posts posted by applejw
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So, CAP is pushing back on my challenge to the argument that an antibody detection and identification use the same method and for which we ARE performing comparability studies using the different testing method platforms. I'm still arguing but I'm not hopeful. Has anyone else run across this with recent CAP/AABB inspections?
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You will be limited by the size of your frozen plasma bag. It takes about 20 minutes to thaw a bag with 200 ml in it. If your bag is larger, it will take longer. If you are going to compare thaw times with a waterbath, the Sahara will lose. We have both a Helmer and Sahara. The Sahara is used to thaw for stock plasma (we keep 6 thawed A,B, and O) - for patients, the waterbath is quicker. Cleaning the Sahara is much easier than a waterbath and that was the big selling feature.
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I also fill in on the bench and do the same competencies that my team does. On a slightly different note, CAP cited us recently for not having the person assessing competency evaluated for their ability to assess competency (I think that makes sense). So now we have a document stating that the person assessing competency has been reviewed as able to assess competency (team member levels and managers)
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WE provide Adsol units, predominantly and our NICU is over 70 beds. Prisma Health Greenville Memorial Hospital
- Cliff, John C. Staley and SbbPerson
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My experience came from transfusing a patient with an Adsol unit that was unwashed containing plasma antibodies. The patients were transfused with the unit and subsequent sample showed demonstrating antibody - it was more than 5 years ago so I can't remember how long the reactivity lasted. There was no transfusion reaction as the recipient, as I recall, was Rh negative and transfused with a unit containing anti-D. We could come up with no other reason for the patient to have a sudden appearance of anti-D when only transfused with Rh negative RBC - record check revealed that one of the transfused units contained anti-D.
- John C. Staley and exlimey
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We have always changed the label stating a 'frozen' product to a thawed product so I'm unfamiliar with the issue of a visibly thawed product stating that it is frozen and to store at less than -18C.
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At this facility, we do not have the readily available option of washing units that contain plasma antibodies. The policy has been to only transfuse these units to patients that already have the identical antibody (anti-D in patient and unit). Even though Adsol units contain less plasma, I have seen several examples of passively acquired antibody in post-transfusion samples from recipients of units containing antibodies.
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If you are not changing the component label, doesn't the storage temperature also need to be modified in addition to the expiration date/time?
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We use tap water, add Clean Bath after disinfection and rinsing. Clean at least weekly - deionized water is the corrosive one, I think - Distilled water is fine but a pain to get enough to the bath to fill it. Our baths are next to a sink so easy drain and refill.
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You did everything necessary as others have said. At our facility, physicians seem to be unphased by the use of emergency released blood - we issue a lot of it. It is not uncommon to discover that the patient has a historical antibody that may or may not be demonstrating. The physician and pathologist are notified when the history is discovered and the physician makes the medical decision to continue or stop the transfusion at that point. We perform antigen testing of the unit(s) and perform AHG compatibility testing of all units that are issued. Further laboratory testing is ordered by the physicians caring for the patient. The most immediate concern is an acute hemolytic reaction and that is rare. Shortened survival of incompatible transfused red cells is expected.
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I see now that you must have the on-line presentation which does not provide the answers. I don't have the book so am unable to help you.
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I just looked at the sample pages for this publication - the feedback is after each question with multiple questions for each case study.
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I'll be the curious mind for today - what addition are you wanting to add to your procedure to "deactivate insignificant cold antibodies"?
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In my experience, the 30 minute rule is a holdover from the past. There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C. We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside. If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only. If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.
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Unfortunately, that was the case with my patient - truly a Group O that received 4 units of Group A RBC. The patient survived the error.
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Was the patient recently transfused? We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube. I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are. This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A. This patient was discovered to be Group O after receiving several Group A RBC transfusions. The reverse typing showed reactivity only with Group B red cells at that time.
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I wouldn't think they would use contrast during CABG - my guess is that it was given prior to Cath Lab but charting caught up later after patient went to the OR. I've never seen a specimen like that - very interesting.
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Because there are work arounds to the Rover collection process, we still require a second sample or historical lab-reported result before RBC products can be issued (or issue Group O). Our hospital uses the Rover but some floors are designated nurse-collect and with this comes the non-Rover process where the electronic ID verification can be circumvented (circumvention is not nursing specific by any means).
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We have an active pre-hospital emergency service with both ground and air transport that carry blood products. If the patient doesn't come to a facility within our system, we don't have a specimen or even a system-generated ID, so the blood is issued in our LIS with a comment describing what happened in case of collection facility lookback.
An alternate scenario is where the patient expires prior to specimen collection - if you don't have the specimen, you can't test it and we document that the units were issued emergency release and cancel the system generated crossmatch with a comment that no specimen was received.
- Mabel Adams, SbbPerson, jayinsat and 1 other
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There is a Prepare order that transmits to the Blood Bank LIS and a matching Transfuse order that is used as part of BPAM. They open the transfuse order and scan in the patient information and then the blood product information. It also captures vitals and adverse reactions - we use a functionality of "Screen Shot" that displays cumulative transfusion records which are hyperlinked to the Transfuse Order (that's my best interpretation of BPAM without actually using the program).
The nurses have to have training to use it and buy into it for it to work best but it's a permanent record that can be seen at multiple facilities that are part of a multi-facility healthcare system.
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Epic has a module to document transfusion information called BPAM (Blood Product Administration Module) - it communicates with BB LIS and has fields for all of the appropriate documentation.
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Just last month, we had a unit from our supplier labeled as O+ but retype showed that it was AB+. I personally don't mind re-typing units so that we can do an electronic crossmatch.
- Malcolm Needs, exlimey and jojo808
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Well, (drumroll please) is my answer from CAP:
COM.04250 is for comparing test results. I do suggest comparing the antibody screen and ID for the different methods used in your laboratory.
Thank you,
Amy Meier, MBA, MT(ASCP)
Technical Manager, Laboratory Accreditation Program
So I guess I will be figuring out how to have adequate sample for comparability studies across 3 methods with tube being the problem child
CAP ALL COMMON CHECKLIST COM.04250
in Accrediting Agencies
Posted
Challenge defeated. 'The CAP considers the antibody screen result of pos/neg and identification of the antibody specificity as different analytes.CAP occasionally sees differences in results between some methods e.g. tube vs gel. Because there are differences in results, CAP feels this meets the intent stated in the note of the requirement 'to evaluate the relationship between test results using different methodologies.' Please note the transfusion medicine committee members will be reviewing this requirement regarding ID and specificity in the future but at this time, CAP is requiring a comparison."