lalamb

edited - I got off topic...

Immucore. We get shippments every 2 weeks so we usually have 2-3 indate panels at any one time, plus ~2 expired panels

S was only ruled out on 1 cell...she already had 1 ab...why give her another? But you are right, guess technically I didn't have to worry about the S

S was only ruled out on 1 cell...she already had 1 ab...why give her another? But you are right, guess technically I didn't have to worry about the S

WE just had a pt, who had very weak rxn's...might have been a newly forming Jka. Pt had 1+ rxns on Jka homozygous and heterozygous cells...no classic doseage pattern.?????...so maybe there were 2 ab's? Tho the ref lab did say that Jka doseage may show variable expression. M and S were initially ruled out using heterozygous cells.....I reviewed the panel using only the homozygous cells and M and S were not ruled out. Ran a Jka-/M+, Jka-/S+ cells , which were neg...so these ab's were each ruled out w/1 cell. Phenotyped the pt who ended up being M+, S-. Ended up crossing Jka- S- units. By using homozygous cells to do the 1st look, I feel more comfortable that I'm getting a better (safer) picture. We will phenotype the pt for things that can't rule out. If the pt is pos...no worries. If pt is ag neg, we'll give ag neg units. We usually have 2 indate, 16 cell panels. I have used E heteozygous cells (as they are rare), but try to include at least 1 E homozygous cell. A lot of work but I have to sleep at night.. I appreciate all the FAST input

Current (old) policy had us perform the aborh and set up DAT and DAT ctl at the same time - in case DAT is needed. Make a 3-5% solution and wash all 6 tubes at the same time...seemed to save time by doing it all together....guess we don't need to...

On panel cells that don't react w/my pateint plasma, I have been ignoring the heterozygous cells..... I don't look at them to do rule outs (Rh's, Kidd, Duffy, MNS) and only look at the homozygous cells to rule out, irregardless of the reaction strength. Reaction strenght may review a doseage pattern, but I look at that later. A coworker is concerned that there is no reference specifically for "ignoring heterozygous cells altogether"....just seperate references for: ruling out w/3 cells is optimal and ruling out w/2 cells is sometimes all you get looking at the cells w/the stronger antigen strenght, which is usually a homozygous cell for Rh's, Kidd, Duffy, MNS Other thoughts ? :eyepoppin

Links might be helpful

Our ER has ready made "Trauma" Id packs....hospital labels w/fake names (Sunset, Obee One Kenobee) and fake MRN's. Our trigger to get uncrossmatch O neg units ready is a phone call (we need blood) and a name (fake one or a know one) We have Cerner and freetext the name in so there is a name that prints on the tag...no MRN at this time is on the Emergency tag. Red "uncrossmatch blood" labels are put on the unit and all 3 copies of the tages. Once pt is ID'ed, the info is merged.

I emailied it to you...will try again to post it policy...quiz...Immucor Interp aid

See attached immucor bullitin w/pics

Regarding how many specimens to test : our reference lab made 1 set of the dilutions in duplicate (Immucors dilution protocol) and had multiple techs read the tubes. A large university hosp had up 15 positives and 5 neg's and had different tech read the tubes. I went nuts and made Immucors dilution protocol 2x. and read them all myself : was kinda freaking out that my # of rosettes didn't appear to have a linear relationship w/my dilutions !! but I also thought to rosettes looked bigger. Then found out the Technical Manual had a recipe and I did that 3x - the recipe was actually easier to prepare, although I still chose R2r cells, as recommended by Immucor. Took this opportunity to revamp our fetal screen procedure - old one was accurate but clunky and vague. [ATTACH]688[/ATTACH][ATTACH]689[/ATTACH] It and the quiz are attached if anyones needs on--they are simple...we're all generalists

we also got sited for the hemo and coag QC. They are now run every 8 hr, +/- 15 minutes. Our automated UA QC is just once every 24 hours. ?maybe cuz its simpler technology?

we are redoing our cord policy---I have learned a few thing--hope I have it straight......any input would be greatly appreciated, esp a Cord Blood Workup Flow Chart!!!! If baby is weak D pos: fetal screen testing shouldn't be performed and mom should have a KB (weak D pos may give a false neg fetal screen and if fetal screen is pos, you need a KB anyway) , and a DAT must be performed to rule out a false pos Weak D (agglutination seen could be caused by a weak D or a pos DAT, can't tell which) so, if cord = Weak D pos: cancel fetal screen on mother and order a KB mother gets 1 dose of rhogam do DAT if DAT is pos, contact provider mothers specimens get a KB if DAT is neg mothers specimen gets a KB

My reactions on the new FMH kit were also weaker than on the Fetal Screen Kit, but they still correlated. ?? Maybe some of the FMH clumps were bigger?? The free kit expired before I could do more parallels so have ordered another kit . Attached is a "cheat sheet" for preparing the samples, from Immucor.

Attached (I hope) is the Conversion Protocol.

Correct - we have no nicu. It seems strange to issue a unit to a patient (baby) and the baby isn't banded / linked to the pretransfusion specimen.

WE rarely transfuse babies. Have a current situation where mom = A pos (R1R1) and has a current and known anti little c. Mom is being induced tomorrow - have ordered up 2 units of ag neg blood for mom, and 1 unit of O pos, little c and big E neg blood for baby, just in case. (ordered O pos as baby is expected to be Rh pos, and O neg , little c neg is rare, per ref lab). We will crossmatch baby's unit against mom's plasma. Our policy doesn't say how to "band the baby"...just says get a banded specimen from the mom and crossmatch her plasma to the pedi unit. How do others link the recipient-baby to the mother?

WE rarely transfuse babies. Have a current situation where mom = A pos (R1R1) and has a current and known anti little c. Mom is being induced tomorrow - have ordered up 2 units of ag neg blood for mom, and 1 unit of O pos, little c and big E neg blood for baby, just in case. (ordered O pos as baby is expected to be Rh pos, and O neg , little c neg is rare, per ref lab). We will crossmatch baby's unit against mom's plasma. Our policy doesn't say how to "band the baby"...just says get a babnded specimen from the mom and crossmatch her plasma to the pedi unit. How do others link the recipient-baby to the mother?

Our pathologist also stands by "techs can't order tests 'cus that's practicing medicine". Of course, if we run a test in error / mistake or a partial panel is ordered ,and we get a critical results, we are obligated to inform the provider. Regarding discussing cases, if no names (and I guess cities) are used, isn't that sufficient to protect everybodys HIPPA rights? This is a professional discussion site.

We do keep an "extra" rack for specimens that are duplicates of the ones in the tracking system/day. We tend to get "exta" specimens mainly w/ER. If we have to go fishing for a tube, it's in a smaller pile ...

Our computer prints a report of all work done the prior day. This is reviewed for accuracy and completeness (was proper follow up testing done?). The daily qc is reviewed-mostly to make sure it wasn't forgotten. In lieu of a computer report, you could go thru the previous days specimens and check for completeness, in the LIS or the paperwork.

....how about adding a Point Of Care Testing section?...that ain't going away...it's gonna explode