goodchild

Good morning everyone,
There is a familiar name on the Canadian Society of Transfusion Medicine (CSTM) blog.
http://www.transfusion.ca/Resources/CSTM-Blog/February-2017/Musings-by Malcolm-Needs-Notable-Colleagues
http://www.transfusion.ca/Resources/CSTM-Blog/January-2017/I-will-remember-you-Malcolm-Needs
http://www.transfusion.ca/Resources/CSTM-Blog/January-2017/Malcolm-Needs-Special-Moment-for-A-Blood-Group-S-en
Generous is a great word
sandra

In addition to current editions of AABB Standards and Technical Manual, we have Modern Blood Banking and Transfusion Practices 6th edition, Human Blood Groups 3rd edition, The Blood Group Antigen FactsBook 3rd edition, Mollison's Blood Transfusion in Clinical Medicine 12th edition, and Practical Guide to Transfusion Medicine 2nd edition. I also have a copy of The Quality Toolbox 2nd edition in my office.
 

In addition to current editions of AABB Standards and Technical Manual, we have Modern Blood Banking and Transfusion Practices 6th edition, Human Blood Groups 3rd edition, The Blood Group Antigen FactsBook 3rd edition, Mollison's Blood Transfusion in Clinical Medicine 12th edition, and Practical Guide to Transfusion Medicine 2nd edition. I also have a copy of The Quality Toolbox 2nd edition in my office.
 

Thanks for the help everyone - I think we are going to stick with glass, but Fisher Sci is having shipping problems in this area (USA Southwest) and we are getting a lot of broken tubes.  I was having to explore the plastic tube option again.....sigh.
Yes, we read several things under the scope with "tube rolling" - probably always will.  It is very difficult to correlate an antibody found on Solid Phase with any of the tube enhancement medias , including PEG, so sometimes you need help.  Also DATs (looking for mixed field) and Fetal HGB stains need the scope too.
As for the static issue - maybe this will help others -  we purchased a Static Master Ionmaster 4060R years ago that helped tremendously.  With the gloves, the synthetic coats, vinyl chairs and the dry southwest air - you can imagine what our problems were.  The StaicMasters Ionmaster comes from NRD, INC http://www.nrdstaticcontrol.com/  - look at the 4065 or 4067 now.  They are a little expensive to start and require a yearly recharge of ionizing strips (check prices so you don't get surprised), but when they are turned on and blowing over the bench - forget about static.  They may recommend something else by now for bench applications.  If our little fans ever quit, I will ask about something different from them.
Thanks again.  I love this site.
 
 
 
 

I don't think gel testing eluates has been a problem for us either, although in the past there have been isolated incidents where the results were questionable that we have attributed to technique and have cleared up with retraining/competency observations.
 
You know step 9, where it says to mix well and centrifuge to remove any precipitate or cellular debris, then transfer to a clean labeled tube? We do that step several times. Since we've been doing that there are very few problems with weird reactions.

Following this thread to review with greater detail when I get back from vacation. I'll also post some of my own fun ones!

Am I being obtuse? What are you using the scope for?

Am I being obtuse? What are you using the scope for?

Am I being obtuse? What are you using the scope for?

Do these labels go on the back of the unit?  We still have dot matrix unit labels and "unit ready" slips.  We send the unit ready slip when the unit is crossmatched and the nurses tube it back when they are ready for the unit to be sent by tube.  Everyone but ER and OR use TAR.  ER and OR are still paper holdouts!

Great post and exactly my point. Blood bank needs to ensure that our requirements are met but it's a nursing documentation/workflow issue.

Bear in mind also:
if testing was performed without documented QC, and that testing was used as pretransfusion/compatibility testing for a unit of blood that was issued from your department, it requires a mandatory report to the FDA as a biological product deviation.

Yes, our reference lab also provides an itemized list with CPT codes.  I review all antibody workups the next day I work and charge for things like antigen typing and DATs if autocontrol is positive, since we don't do any elutions or other fancy stuff!

Our reference lab provides an itemized invoice of testing performed and the associated CPT codes. We have "charge only" tests that we add to the requisition of the original test request based on the invoice. We do a similar process for in-house antibody identifications. All workups are reviewed the next business day, we note the different tests/method counts at the bottom of the AB ID worksheet, and add the appropriate charge only tests to the requisition based on the actual tests performed.

AABB 5.11.4
CAP TRM.41800
You've never encountered a delayed transfusion reaction?

You need to do positive/negative controls for anti-IgG cards for every day of use. This can be direct or indirect.
 
If you perform DATs in gel, you also need a positive/negative control for the diluent for every day of use.

I can see your point @mpmiola, if the box is validated to keep the blood product at the appropriate temperature for thirty minutes, it stands to reason that it should be acceptable to use for transport to patient care area for immediate transfusion, or during a brief pause (up to 30 min) at the patient's bedside while the nurses prepare for the transfusion.
On the other hand, what mechanism prevents this box from being used to store blood at the patient's bedside for longer than 30 minutes?

So much fun and stress relieving, thanks  Merry Christmas to all. My very first post on this forum.

Made my day today to see the lights, popped a few bulbs for good measure. Merry Christmas to all and thank you for great discussions!!!!!

Thanks! The only Christmas lights to be seen in Saudi Arabia! I will not smash them!

Congrats on your go live! We had a bumpy start and a possessed analyzer, but it's much better now. I really like the analyzer and I really like our TAS and FSE. They do feel like an immature company in that they are newer in the US and seemed to struggle with supporting their staff as they've grown, BUT they seem to hear us and resolve our issues. We've been working with them a long time and I've seen dramatic improvements and growth, I don't think other hospitals or systems would experience the same rockiness.
We had a few learning curves too. I'm happy to share, if it helps anyone else avoid some of our self-induced problems.
1. People kept throwing away the service racks when emptied-not understanding they were service racks. The Erytra would dump the cards ok in the service rack space, but when it went to get one, it couldn't find them. 
2. If it freezes on you, DON'T hard reboot by pushing the start button. Use a mouse to right click, click global settings-not to use the global settings but to access the windows start menu and shut it down that way.
3. You'll save yourself a lot of headaches if you turn it off every night instead of letting it go to sleep for 20 minutes for your daily maintenance.
4. GENTLY shut the doors. We had to slam our Provue shut-so gentle touches have been difficult. Not being gentle can cause reagent splashing and possibly even splashing in gel cards too.
5. Don't let the Wash bottles get too low. We'll easily go through a full wash A container/day. Staff would get busy and not realize it would get super low or empty and start to cause issues. I ordered back up bottles and always have one ready to go on so they swap them when needed and clean and refill the container at their leisure.
6. Make sure your staff knows if there is a red triangle that they need to investigate and resolve the issue, not modify or accept. We allow some hemolysis as long as the gel card isn't more hemolyzed than the original sample. ANY other red triangle means there an issue and the test MUST be repeated.
 
I'm sure there lots more that I'm not thinking of at the moment. If you have any questions, I'm happy to answer and share our experiences.

Anytime I suspect weird interactions with reagent cells, I recommend grabbing a few units from the shelf and seeing what those results look like.

So we went LIVE with our Erytra this week.  We had a couple of hardware issues along the way (though nothing major).  One change I made (and this was just a personal decision) to prophylactically prevent 1 type of issue, is that we changed the double-layer racks to single layer (so when we take them out of the box....we have saved empty racks after use so we place the top layer in a 2nd rack).  We do that because in training, they emphasize how you have to make sure the cards are patted down; that a corner doesn't pull back up, like maybe from your glove sticking; that the drawers must be closed very carefully or it could jar the cards.  Well,  you can "teach" your staff all of those things, but you KNOW it is going to happen (some heavy-handed tech. is going to come along and just slam the door shut.....then you are in trouble  ).  So by making single-layer racks, we hope to decrease gripper vs. card issues.  Our workload is not so high that we needed the 2nd layer....even filling the Erytra with single-layer card racks in every space, is more than we would use in 24 hours. One thing to be careful with if you do that though is that when you are handling the cards, do it gently so as not to cause splashing within the wells; otherwise, you create another problem.  Another change we made is that it was initially connected to a drain.  After training (and learning to do decontamination), we decided to have it switched to reagent waste bottles.  Again, our workload is such that we would not even fill 1 of those bottles in 24 hours much less 2; so we cut down on the tedious decontamination process.
You also learn some things the hard way.....like if you remove a solution bottle to add more solution, don't close the drawer!  If you do and the analyzer is priming (or wants it for something else), it will disable the probes.  So leave the drawer open during the process.  There were several things like that we learned by making the mistake.  The more we use it, the more we learn (there is a lot to learn with the touchscreen).
But we still really like it.  There are some software changes we would like so they are adding them to a new version coming out next year.  Also, they definitely need to "beef up" their panels (and they know that).
All in all.....a good purchase.  My only outstanding concern is some missed weak antibodies (which we will continue to watch for.....for now, every questionable antibody screen will be repeated by Tube PeG).
Brenda Hutson, MT(ASCP)SBB

To minimize the number of steps required to issue blood, we retain donor tubing segments as part of the ABO/Rh confirmation process on receipt of donor units from the donor center.  I dislike trying to find the end of the donor tubing that is tightly rubber-banded together under any circumstance and certainly not when a nurse is standing beside me!

Exactly what I needed, another distraction at work!