lalamb
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Posts posted by lalamb
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"I'm sorry but I'm am confused with this. Was the saline with the pH of 5.6, 5.9 taken directly from the cube? Did you do anything to alter the pH to get the 6.5, 6.7? Just what reagent is Immucor working on? When the pH was at 6.5, 6.7 were the check cells working as expected?"
The original pH was from the cell wash dispense. That was repeated and slighlty different values were obtained. The saline was also pH'ed directly from the cube. Not felling too good about the varied answeres. The reagent in question was Immucors Check Cells - we've noticed weaker readings and have tried to troubleshoot.
As far as I know, theres been no difference in shipping. The cell washer manufactureer suggested a slight change in the "decanting' rate/speed.
For now - we are useing the freshest cells (usually have 3 lot #'s on hand), and if the CC is 2+weak or less, we are hand washing. I'm wondering if the CC's aren't as stable as they used to be...
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Echo rep visited w/us yesterday. She said validation for us wouldn't be that bad, as we do tubes w/PEG, and the LISS for capture had a similar potentiating strength/sensitivity as PEG. Woundn't be as hard as compareing tube LISS (less sensitive) to ie gel (more sensitive).
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Yes- i so agree.
So now we are hand washing, to see if that makes a difference. If so, we'll rpt w/hand washing any CC value less than 2+s (on every patient?????) have the cell washers maintenanced, (what are the chances that 2 different cell washers both have a decanting problem at the same time???), and whatever else I can come up with...gggrrr
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We have been noticing weaker check cell reactions, sometimes variabley, for the past ~2 months. This kinda coincided w/when we changed from a 20L cube of saline to a 10L cube of saline.
Use to get strong 3+'s, now get from weak 3+(gently shake) to srtong 1+. We use tubes w/PEG.
Checked the cell washer dispense volumes = ok
Checked the saline pH (on a lark) = 5.6, 5.9. aahhhhh. (Subsequent pH checks were ok-6.5, 6.7)
Called Immucor - they have had customer complaints of "weaker check cell reactions" for about 2 months. (Our sister hospital has also noticed some weaker rxn's.) Per Immucor, they are working on it. Unsure of the cause.
Anyone else see this?
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WE also have PathNet, and the Emergency Dispense is nice. Just freetext in a name. When ER askes for emergency O neg, we ask ER for a name. Sometimes the patient is known. ER also has a list of made up names, but in our location, they could be real!
We also photocopy the unit and attach segments to it w/the unit stickers, time permitting - makes it easier to do computer work and follow up XM later.
Question about getting a Dr's signature for issuing uncrossed blood:
We have an ancient form the Dr signs. Usually write in the name or use a hospital label, and have the Dr sign it, when things calm down. Have never had a problem with not getting a signature.
Our new LIS, PathNet, has a place for the Dr to sign, on the actual BB Emergency Tag. HAve not used it though, as I assumed the Dr would prefer to sign 1 document , instead of multiple documents (each tag). The benefit of the Dr signing each emergency tag would be that the signature is in the patients chart, but it would not reside in the lab.
Where should the Dr's signature for release reside? In the Blood Bank, in the patients chart or both?
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We accept verbal orders during emergency situations- trauma or OR. This generally happens with uncrossmatched for trauma or OR patients who start massively bleeding and we run out of what was originally set up.
Same here. Our ER is good about signing releases after the chaos has calmed down.
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~5 years ago we had a Rh "Pos" adult who was given Rh pos blood and developed and anti-D. Checking the pt's history , turned out he was a Du pos. So, we stoped testing/reporting Du status on adults.
If D = neg at IS, they are reported as Rh neg.
This, of course, has led to discrepancies w/some OB patients. Sent and explanitory letter to OB saying what had historically been done and why, and whats done now.
We only do Du testing on Rh neg babies of Rh IS neg mom's.
I am interested in the verbage of "Rh indeterminate" for the baby.
We currently call Rh IS neg, Du pos baby as Rh pos, to trigger Rhogam for the mom. But you are correct - don't want the "fake" Rh status of Pos to follow the baby into adulthood. Will have to look into that...
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We use hand written Typenex bands (name, MRN, Date, Time , Phelb/rn identifier). DOB or finanical biling # (which is unique) is accepted but rarely used. MRN's can turn over and be reused.
We don't want pre typed labels - to easy to pick up the wrong one, and the print is so small, it's easy to miss subtle spelling variations. Labeling aliquote tubes forces one to look at the spelling, date,etc.
We don't let the phlebs/RN's correct anything on the labels -not the date or adding their initilas, or fixing transposed letters, or missed double letters. Don't want the staff in the position of " well, she let me change this, why won't you?"
The dialoge of "this would not be good in court" seems to be working. We get less grief now when/if we need a redraw.
I'm content to be the *$(%(# in BB.
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Form signed once per admission.
but nurse brings it down to sign out every unit.
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We are a small hospital and we do require to have a copy of all blood bank orders, esp for out patients. This is mostly to make sure unusual/infrequent items aren't missed (do titre if AB ID is pos, need irradiated products). Also to have dates of surgeries and to confirm DOB. No good way to document surgery schedule in the LIS (in a place that won't get missed).
When nurses come down to check out a unit of blood, they need to bring down a signed copy of the "patient has been informed of transfusion risks and has consented to recieve blood" document. (we had to start doing this as of our last inspection. If the Dr hasn't signed the document, we send the nurses back to get it. Not so much of a problem now as everyone is used to it and they are prepared)
The nurses stick the patients hopital label on this signed doc , so we have their Med Record #, DOB, acct #, and name, all on 1 document. All of this info is read to the nurses and they read it back to us, before they walk out w/the blood.
We actually feel good about this as some rare tagging snafu's have occured. Better to fine out BEFORE the unit leaves the lab.
Might not pharmacy and blood bank have something in common?
We are issuing something that will be inject INTO the patient. Miss labeled/wrong test hemo,chem specimens have the possiblity of being recognized as wrong, via the delta check. If a Dr gets a test s/he didn't order, oh boy, will you hear about it. Can always rerun a test.
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Well I hope I attahced these files correctly.
I have included checklists of our
- Core 1 and Core 2 areas - Daily
- Instrument Problem Log - as needed
- Daily Chem analyzer - daily
- QC result check off sheet - daily
- Dep Supervisor Monthly Checkoff list -monthly
- Daily BB check off list - daily
Boy, we kill a lot of trees. These do help us stay on track. Little things can easily get lost.
[ATTACH]408[/ATTACH]
Instrument Problem Log ver 2.doc
- Core 1 and Core 2 areas - Daily
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WE do have daily check lists, for individual areas, and 2 Overall ones. They list maintenance and QC items, and a check to see it the prior shift did their stuff! It is tedious but we have come to find that they are memory joggers and we rely on them. Esp good for people who float.
The dept supervisors also have monthly chek off list - reviews of stuff like QC, calibrations, inventory are here.
These list have gone through many changes, but if you're interested, I can send you some.
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I like Lisa's idea.... call the home page LabTalk.com, then name each of the sections accordingly as BloodBank Talk, Micro Talk, Pathology Talk, etc.
Totally agree here - the organization will be very clear and defined.
Calling it PathLab may be confusing for people looking for clinical lab info.
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What do you mean by "calculation"?
The only time we perform weak D testing is "on Rh neg babies of Rh neg moms".
If the cord blood is Rn neg and Du neg - baby is reported out as Rh neg only. (Our LIS has a place to record the Du testing but Dr never sees it - too confusing).
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We do microscopic exams on neg Cord DAt's, and add a comment "DAT is negative microscopically"
Gives us confidence that a weak/scratchy pos isn't missed.
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Is there such a beast? Like transplant anti-rejecion meds but for transfused blood?
If so, why doesn't averyone get it? No Ab's would be made, no Ab:Ag reactions to worry about and we'd all be out of a job...
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As for the comment above - the flippant/jokey tone was easily
indentified for me... same way I used to feel about WARM AUTOS...
just send and wait... jajaja!
Anyhoots, am awaiting fruther word from Lisa as to how their patient
tolerated the washed units....
Well, our patient tolerated the washed cells well...no temp spike. All of you, and our pathologist all agreed
!So our pathologist says all future RBC's will be Washed RBC's (for this guy). As this is pallative care, at this point, there is no urge to find out what was causing the spike (wbc's, cytokins, rxn to preservatives...)
thanks again
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Patient has been seen/treated at another hoospital and was transfered to us last thurs. Got ahold of the patinets workup from the BB ref lab (that both hospitals use), and in included negative eluates , some weakly pos and some neg DAT's,and a neg platelet antibody.
Current dx = fever, leukemia, anemia, thrombocytopenia. hgb (2 days ago) = 7.2
Thank you all for yor FAST input. This indeed may be coincidental to his current fever (cultures are still neg), but is still unsettling. This doesn't happen often so after having 2 i n a row, want to try to have it not happen again.
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Would Irradiation of the PRBC's be of any assistance?
Platelets were originally requested to be irradiated, so all of his stuff is now irradiated
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How high is the temp spike and for how long? In almost 40yrs of laboratory/blood bank experience I have seen more than once where fooling the patient has prevented fever and/or rash. The way we have done it is to use a leukoreduction filter (even though the blood is leukoreduced) and tell the patient that it is a very special filter that works better than the regular filter. This has worked more than it hasn't. Never underestimate the power of the mind.
1st rxn: temp went from 99 to 103.5, after 106 ml of blood
2nd rxn: temp went from 99.2 to 102.4, after 18 ml of blood
Pt was given Benedryl pre-transfusion on both occassions, tyleno on the second.
Pathologist asked about washing the RBC's but the blood bank ref lab seemed to think it wouln't make a differnce : the amount of WBC's in a leukoreduced PRBC unit is about the same as in a platelte pheresis pack (which the patient rec'd with no temp spike). Also, that the preservatives are very similar - so washing that out might not be useful.
Redrawn specimen today: DAT and Auto are weakly/barely positive , microscopically, so I sent the specimen out. I keep thinking the patient is starting to develope another AB...
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Problem w/ a patient having temp spikes after A pos, E-, c- units is started.
Hx = A pos w/ an anti-E.
Rh phenotype = C+ E- c- e+. No other phenotyping done.
Patient knew to ask for Benedryl before recieving blood.
Units transfused since 4-14 = 15 LRBC, 20 plts
Pt given benedryl and tylenol, pre transfusion.
ABSC = neg, DAT at this time = neg
What could be causing the temp spikes? (current cultures are neg)
One suggestion was to give washed cells - would this help?
Planning on giving more blood in 2 days...if he spikes another temp, what can we do?
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As has been stated elsewhere in this forum, with apheresis platelets, you have to consider the large volume of plasma that is riding along with the platelet transfusion. You wouldn't give 200 ml of incompatible ffp...
You are right-and that has always bugged me. How 2000ml of ffp has to be type compatible but not plts?
Talked w/my pathologist yesterday and he will sign a policy change to do aborh and absc on all ffp recipients. Asked him about platelets and he was aware of concerns and recent publications regarding type.
Now, can I get my blood provider to give me more type specific plts??...
Thank you all so much for your input, for this post and others.
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What do you do w/ the thawed FFP after is expires?
Which expiration date - the original frozen one or the thawed one?
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I thought typing a pt was unneccessary for issuing platelets?, yet I have seen some people post that they do.
!
Vote for BBT's new name / address
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When will the new sites/tabs be available? Am anxious for CoagTalk...