goodchild

I was having that same problem on my grossly outdated version of IE, so I switched to Chrome (which work has only recently permitted as an alternate browser).

Technical Manual, 18th edition, Chapter 17, DAT/Immune Hemolysis, page 428. Test an eluate prepared from the DAT-positive red cells with reagent red cells to determine whether the coating protein has red cell antibody specificity. When the only coating protein is complement, the eluate is likely to be nonreactive. However, an eluate from the patient's red cells coated only with complement should be tested if there is clinical evidence of antibody-mediated hemolysis, for example, after transfusion. The eluate preparation can concentrate small amounts of IgG that may not be detectable in routine testing of the patient's plasma.

Have you checked with the manufacturer?

I've definitely wanted to get my hands on a copy - we don't even have a copy of the prior versions - but I can't swallow a $750+ price tag.

How does your institution handle the charges for routine antibody identification? When a full panel is performed, 86870 is charged. When selected cells are used, 86885 can be charged per cell. How do you populate this to a patient's record? Is it some sort of data entry submitted by the technologist working on the ABID? Manual charge entry after daily review? What LIS are you using? Please help!

NY State requires MLTs to be directly observed at all times by a bachelor's degree tech when doing high complexity testing? How has that impacted the ability to maintain staffing in blood banks/laboratories? Especially considering that many labs employ generalists who cover BB on evening/overnight shifts. I'm only going to elaborate because qualification of testing personnel is a hot button item right now with CAP, TJC, AABB. And regionally, this has been a hot button issue with personnel/staffing. The minimum educational qualifications for testing personnel in high complexity environments (not including those grandfathered by pre-92/95 clauses) are license from state (if required by that state) 60 credit hours from an accredited institution that includes 24 semester hours of science courses (of which at least six must be bio and six must be chem) laboratory training (either a clinical laboratory program [MLT] or 3 months training in the specialty relating to the high complexity testing) An MLT (with their licensure, per state guidelines) would be eligible to work independently in blood bank once they completed training.

Oh and in regard to MT vs MLT; they're both qualified to do high complexity testing. An MLT with two years of experience in a particular field is qualified to be a general supervisor for the department. Research the history/intent behind policies that don't make sense to you.

Being a new blood bank supervisor can be a real trial by fire especially depending on how good of a ship your predecessors kept. (the following is not all inclusive and is definitely my opinion only) You should review each blood bank procedure/policy/form. Are they in line with blood bank regulations and generally accepted practice standards? Does practice match policy? Are you well versed in your blood bank's accreditation manual? If not, become so and/or work closely with your quality assurance team. Are you well versed in the hospital accreditation manual to where it applies to blood bank? If not, same as before. Get familiar with laboratory/hospital procedure/policies/protocols and how they intertwine with the blood bank. Develop a relationship with your medical director/sectional medical director. They will be a huge resource for getting things done. If you use an LIS, review the entire blood bank dictionary (tests, products, antibodies, antigens, billing codes, etc). If you have CPOE, review every blood bank order. Carefully review recent occurrence reports (nonconforming events, incident reports, sentinel events, whatever your institution calls them) for compliance/patient safety issues. If you don't have a good occurrence reporting system, work towards developing one. Promote a just culture. Be prepared to revise basically anything and everything. Be prepared for resistance from your technologists, even if what you're doing is what the rest of the world has been doing for years and/or is a federal mandate.

I still see the same thing as Sko681, occasionally. We're about the same size as your institution kirkaw but ~10 miles from our blood supplier. We keep one pheresis platelet on hand at all times.

I'd also be happy to be a contributor if you ever tried to set up periodic articles.

Somewhat misleading title! In the case of a delayed serological reaction identified 60 days post transfusion. We wouldn't do anything extra. In the case of a delayed serological reaction identified <30 days post transfusion. We would document our workup, with a pathologist interpretation, but wouldn't notify the physician specifically. This is mostly for data purposes. (See CDC Hemovigilance) In the case of a delayed reaction identified 60 days post transfusion where we identify that the patient had a previous history of the antibody we may do a little more but it would depend if we could identify that the transfused unit had an incompatible phenotype, any laboratory results from relevant time periods, and any subjective history (symptoms) from the patient.

This question brought to mind Title 21 CFR 660.33: "Group O Reagent Red Blood Cells used in the detection or identification of unexpected antibodies shall include at least the following common antigens in each lot of the product: D, C, E, c , e, K, k , Fy a, Fy b, Jk a, Jk b, Le a, Le b, P1, M, N, S, and s ." http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=660&showFR=1&subpartNode=21:7.0.1.1.8.4

Our grossly outdated IE at work caused this site to be unwieldy after the latest theme upgrade but switching to Chrome has worked out nicely, for me at least. IE9 and Chrome 41.

I'll be the first to note that this is from way out in left field but it's something that occurred to me when there are periods of time without any content. I don't know how many other BBTers are guilty of this but I'll pop on to see what's new AT LEAST once or twice a week, if not once a day. Has there been any thought to generating periodic (weekly/biweekly/monthly?) articles?

Become accustomed to grey area.

Amy I would also recommend reading the manufacturer's instructions for your fetal screen kit. What does it say about weak D mothers, weak D babies, other special scenarios?

I'm guessing it would still be considered high complexity testing and all applicable regulations would need to be met for individuals performing the test.

Will anyone who is willing explain how they apply charges when these products are transfused to their neonates and what codes are utilized? Thanks in advance.

That's an interesting and ultimately highly subjective question. A lot of people would posit that a TSO should have a clinical background to be effective. https://www.linkedin.com/title/transfusion-safety-officer Curious of the opinion of BBT.

We do the same thing. And for training new techs things like washing blood/aliquots. Though secretly I long to get rid of our cell washer and my medical director is in support of it.

Amy, who accredits your blood bank? CAP?

It definitely looks good. I haven't used the search function yet, which I find to be the greatest indicator of success. On a side note: Cliff you're administrator for another website, in addition to this one, while also being a blood bank manager for a huge institution? Do you ever eat or sleep?

I just read a DTS from Meditech regarding this issue: CS LAB 8340. It still displays the information immediately prior to any issued products or test results, but in the header it displays: "History comments too long for the report header. Please see below."

We also do the same as Molly.

The package insert for Rhophylac specifically mentions the IM half-life as 18±5 days and that it's expected to see results at least 9 weeks post injection. http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/ucm119473.pdf We'll routinely see 1+ reactions from presumed RhIg, three months post. Anything more than that and I get really curious.