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Posts posted by goodchild
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1 hour ago, SMILLER said:
What Malcolm? No anti-weak D antisera available in the U.K.?
(There is such a thing as an auntie weak D, however.) My father's sister was a terrible center-back when playing for Suffolk.
Scott
That was beautifully random and much appreciated on a Monday morning.
- Malcolm Needs and Ensis01
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If your hospital is using "Temporary Locations" it will populate the temporary location (e.g., Dialysis, OR1). You can have your IS team design "customer defined screens" with fields in the issuing units screen that could cover things like cooler IDs/etc.
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9 minutes ago, John C. Staley said:
Kate, there is a phone app that will calculated down to the second for you. My wife used it to drive her co-workers crazy. Nurses can be evil when the urge strikes.
I remember continuously calculating the remaining seconds until graduation while I was in army basic training (did the same thing in sergeant's school). The drill sergeants thought it was hilarious and would call on me randomly to sound off the countdown while we were in formation or in line for "chow."
Congrats Dave.
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On 3/22/2017 at 9:15 AM, cswickard said:
If this is for Meditich 5.6.7 - could either of you share what you did to get it to warn when you are crossmatching non-type specific units? Meditech used to have it and then they took it out - last I was able to see. Never understood that reasoning!
Carolyn, do you want it to warn if you have an A Pos patient being crossmatched O Pos units? Tell me the specific and I can help you build an assign/issue rule. Do you have Magic or C/S?
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On 3/27/2017 at 7:15 AM, galvania said:
It depends what type of population you are testing. If you are testing patients, then ideally you need to have those antigens where antibodies may only react against homozygotes present in a double dose. It is almost impossible to do that with just two cells - regardless of whether you are testing in gel or in tube. So, three cells for patients. Two cells is fine for donors where very weak antibodies are less important
I completely agree. I have no intention of switching to 2-cell screen, but these sorts of discussions always give me pause. We identify so many antibodies in patients who are transfused, where the reactions are only identifiable on cells with homozygous expression.
On 3/27/2017 at 8:35 AM, AMcCord said:The Echo runs a 3 cell screen so we have continued to run a 3 cell screen for tube testing. Sometimes that extra cell means you've got the rule out you need for an antibody ID without running more than one panel on the Echo.
I am also a fan of free rule out cells on the screen itself.
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Terri, who collects blood in the ED?
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On 3/21/2017 at 4:54 PM, StevenB said:
Interesting topic. In just a few posts, it is easy to see there is a variety of ways labs approach the "how often are elutions performed" question and under what circumstances. I too agree with Malcolm; in the presence of AIHA and a positive DAT, most likely you will get off a panagglutinin every time you perform an elution. Once this occurs, there is no point in performing additional elutions on a routine basis.
In the patient though who has a positive DAT and is transfused on a regular basis, and has a negative eluate (yes, this does occur) the elution question is a bit different. Technically, any transfusion can result in the production of an alloantibody that may or may not present itself in a hemolytic fashion. It is possible to have a "delayed serologic transfusion reaction" that shows no signs or symptoms of a hemolytic process. In this scenario, the idea of not doing an elution on a regular basis because it has never revealed anything in the past, may result in missing a newly formed, clinically significant antibody that is only detectable in the eluate. Not performing an eluate in this scenario is not without risk and should not ever become "policy" without proper overview of the clinical situation.
To bounce off what you're saying, I don't think I've seen any studies that looked at an increased rate of "informative eluates" based on changes in the DAT strength since last testing.
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We notify ED/OR/Oncology by phone when blood is made ready. We expect every other department to use their nursing status board, which has an indicator for blood being ready. When a nurse wants blood they send a request slip through the pneumatic tube system (or in person).
We print the labels after the blood is crossmatched/assigned. We also have two orders set up in Meditech. The order for blood bank to set up the blood and the order for the nurse to transfuse it.
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We switched to labels this year, from a 2-part continuous feed paper form. Love it.
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I just remembered what else I saw at that hospital! (I was racking my brain yesterday trying to coax out the memory.) They also did autocontrols with every antibody screen and were using albumin as their routine enhancement medium.
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31 minutes ago, SMILLER said:
By "full" crossmatch are we talking doing it through AHG here? We have never done that here for all patients and I have been around since 1988.
Does anyone really still do this? In an era where everyone is switching to electronic crossmatches for most patients?
Scott
Way more than you'd think Scott. There's plenty of resistance to change in our industry. I inspected a transfusion service where the entire hospital was on EMR, the laboratory had an LIS, but the blood bank supervisor had won their case to keep blood bank computer-less. They also did all IAT crossmatches. Interestingly enough, most of the techs weren't even aware that you could opt for IS crossmatches, leading me to believe that most other hospitals in that region were doing something similar.
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13 hours ago, Dan87 said:
.....among few, one of the reason cited by our BB leadership for not switching into IS or electronic XM was our patient population. Most of our patient are Sickle cell patients who get chronically transfused and leadership are right to some extent as we have been able to detect rare/weird antibodies during our full XM.
Would be interested to see some of these findings published.
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My impression is Ortho used the "periodically" term as a CYA. I think it's sufficiently vague to be defensible by Ortho when there are problems with the reagent: "well, did you do your periodic QC?" and also vague enough that people like me can completely disregard it without being out of compliance, technically: "I define periodically as the 7th of never, unless inconsistencies are noted."
- Sandy L, exlimey, John C. Staley and 3 others
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I think I'm with you exlimey. We don't do any QC with our Ortho gel panels, other than review every antibody ID within one business day and monitor for trends.
- Malcolm Needs, John C. Staley, MOBB and 2 others
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3 hours ago, ANORRIS said:
I may be in the wrong "blog", but my question is, how many of you XM units first then type the compatible ones for the necessary antigens as opposed to antigen typing the units first then cross matching the antigen negative units?
That might happen depending on what antigens we're talking about and the strength of the patient's antibody, but generally no.
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We avoided this issue by never creating a comment/marker.
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I'm surprised that I haven't seen that flowchart before. I'm impressed with how comprehensive and simple it is, at the same time.
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17 hours ago, Brenda Hutson said:
When we first saw the Erytra (at another Hospital) and they showed the enlarged gel card picture, I thought "uh oh, this is not going to be good." I could see every little red speck in there and wanted to call it Positive, but the TSA said it was Negative. So, I try not to look at those enlarged pictures. If I need a close-up on something questionable, I will pull the card out and look at it.
Brenda
That was my exact reaction when I saw them. Thanks for the quick reply!
Antibody Screen before Issuing RhIg
in Transfusion Services
Posted
There's also something to be said about Generally Accepted Practice/Performance Standards for a particular industry, from a healthcare quality/risk perspective.