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Posts posted by drwajiha
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On 2/18/2016 at 3:56 PM, David Saikin said:
My transfusion form is electronic - I review for completeness. When we had a paper form compliance would wax and wane from 50% (when we would become hard-nosed about it) up to 95%. Currently we are running greater than 95% compliance. Nursing Admin makes certain that their staff completes all missing data.
dear Davidi want to know how do you ensure the identity of staff identifying the patient and staff extracting the sample from the patient.also what about the authorized person to order the blood products.how do you manage these things electronicallyregards,drwajiha -
On 2/12/2016 at 10:46 AM, Malcolm Needs said:
It would be nice to have the ability to perform tube testing for those rare cases of which you speak, but my only worry is, as they are rare, would you be able to guarantee competency when called upon to perform these tests.
It is slightly different for me, working in a Reference Laboratory, as, although such cases are rare within each of our hospitals, almost all of them pass through my laboratory, and so keeping up competency is extremely easy.
Tube testing in the wrong hands can be fraught with danger.
Dear Malcolm, This means that i should take it as that it is better that I remove the tube testing from the routine procedure used by the technical staff and define it to be used in rare cases as non conformance by senior member or by me only. (actually in problematic cases I prefer to repeat the testing myself before interpretation of the test. a bit crazy !!! but better to be fussy and crazy than putting patient into problem)
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Hello Everyone,
I am in the process of revising the policies and procedures.
Since past 3-4 years we are using gel cards and doing antibody screening and identification using BioRad gel cards and the corresponding cells.
I am not using the tube method for doing antibody identification .
I have tube method panel cells but I prefer using extended panel Plus 6 and papainized RBCs Panel to solve the problem.
I want advice that shall i continue having tube test for rare unresolved cases or shall I remove it .
regards, wajiha
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Biotest cell 3 are antibody screening cells .
if you are using them as QC cells because you know their antigram is appreciated but still if you are conscious about maintaining your QC lab journal archive in Tango it is better to use the reagent specified for this purpose
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We run Rh + K on our donors using Tango ( before using Optimo now replaced by Tango infinity).
The commercial QC set by BioRad is run every day at the start of the day and it covers ABO blood grouping as well as Rh + K.
CHECK WITH YOUR SUPPLIER.
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Dear Fellow Blood Bankers,
I want to know once FFP is thawed , what expiry time is given to the blood product and how it is documented.
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Thanks to everyone for responding to my queries.
Dr Pepper you are absolutely right we still have paper system .
There are too many documentations in our facility and i am to be blamed for it.
- Step 1 component preparation section: we record the unit number in component preparation section and document the components prepared from it. If the unit is not fit to process it is also documented. This is documentation is carried out by component preparation section staff.
- Step 2 Process of release blood products in circulation:There is another logbook which is used to record all serological tests of the donor and result of blood group confirmation. When blood components are released into circulation this process is recorded in this logbook with date and signature of two senior staff members releasing the product into circulation.any product discarded is also recorded in this logbook.
- Step 3 cross match :We do serological cross match. The patient's data and the product used for x-match is recorded in this log book. This documentation is done and signed by the technical staff working on the immunohematology bench
- Step 4 Issuing blood product to the clinical unit: The staff coming to collect the blood product checks all the data related to patient and blood product and record it in a separate logbook of issuing blood product to the clinical unit with date,time and signature.
- Step 5 Expired / Wasted Blood products: a separate logbook for documenting these.
My Problem: during one of the accreditation visits the inspector wanted to see the unit traceability record for each unit on a separate sheet assigned only for that unit. I tried to design a protocol but was not able to achieve consistency. I need help. Thanks
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Hello Everyone,
I would be much obliged if someone could share their protocol of maintaining unit traceabilty record.
I want to know how people are documenting it and the policy governing the process.
i have been working on it since two years and tried different experiments but I have not been able to strike a simple protocol which would be easy for all technical staff (including the weak ones) to follow.
Thanks
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I will forward the links as requested drwajiha as soon as I can, but I am on compassionate leave at the moment because my Mother-in-Law died on Thursday and my Sister-in-law died on Friday, so I am at home and do not not have access to all of my collection of reprints at present, which are at work.
Dear Malclm, Sorry to hear about the tradegy. But knowing this has made me to respect you more. Inspite of your problems you spent time to answer my thread and give me advice. It is truly very nice of you.
Best regards, drwajiha
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Why would you crossmatch with enzyme??? Never did and will never do it....
We do not do enzyme unless it is absolutely necessary....[ I know Malcolm will not agree and other Ref. lab also will not agree. I believe in ref. lab they run enzyme panel on every specimen?)
There are more serious issues we can and should worry about.
I have explained earlier that at our facility we are using complete crossmatch gel card (by DiaMed / BioRad).
This card has two phases of crossmatch:
- AHG
- Enzyme phase.
I am getting positive result in enzyme phase only. NOT that I am doing crossmatch using only enzyme phase.
In reply to the other queries and comments by Malcolm Needs and Abdul Hameed i would like to say that at our facility we do serological crossmatch and my explanation given above might answer your queries that how and why so many units were tried .
If antibody screening was positive and Antibody Identification was conclusive, there would have been no problem.
I brought up this problem in front of you because all of you are knowledgeable.
May be people are using these cards for a long time and they could give me information about any interferences encoutered or any similar experiences or advise me to check my working or about my course of action to be taken now.
Again thanking you all for your time and interest in this thread.
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Well done for doing all that work, but you actually did more than you needed to do.
The point is that the blood you are going to transfuse to her, always assuming that she needs blood, is NOT going to be enzyme-treated and will NOT cause a transfusion reaction.
There has been a an awful lot of work done on "enzyme-only" antibodies and, as far as I know, only 3 EVER have proved to be clinically significant (and all 3 of those were specific, rather than non-specific [or pan-reactive]) and so I, for one, would not worry one iota about this lady's "enzyme only" antibody.
Don't worry about it and just transfuse blood that you find compatible by IAT cross-match.
There is NOTHING that you have missed. It may be a rare antibody (in that it is actually an anti-Rh17 or anti-Rh18) but you are never going to be able to prove that, unless you have access to incredibly rare red cells (and what is that going to prove?), so stop worrying and give the lady IAT cross-match compatible blood and sleep with a clear conscience.
Thank you Malcolm Needs, You do not know how much you have relieved me mentally.
I work in a setting where every small thing has medico legal issues. I would be much obliged if you could forward some links to these articles to have as ready reference to show that in such circumstances what course of action I have taken in not unscientific
Thank you again, drwajiha
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Dear fellow blood bankers, Hi!
I need your help and suggestions to solve a problem. I have a patient,G2P1, case of placenta praevia in need of blood.No history of previous blood transfusion. Blood group B Positive.
Cross match done using complete cross match gel cards ( DiaMed /BioRad). 50 units tried all incompatible in enzyme phase only. AHG phase is compatible. Antibody screening using Liss/Coomb's gel cards is giving a negative reaction. DCT is negative. Tried doing crossmatch using samples from her sisters and brother but same incompatible result in enzyme phase. blood group of her siblings are O negative and O positive.
I need urgent help/ suggestions to solve this problem.
Is there any interference? or rare antibody ? or anything I missed ?
Thanks
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Dear Mabel,
We check all the negative reactions microscopically for verification .
But I want to know why you started this thread because there must be a strong scientific point which you want to make us realize.
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· Temperature: A ≥1˚ C rise, or ≥ 2˚ F rise, in temperature above 37˚ C or 98.6˚ F
· Hypertension (blood pressure increase of ≥ 50 mmHg)
· Hypotension (blood pressure decrease of ≥ 30 mmHg)
· Respiratory Distress with Hypotension
· Bronchospasm
clarify that are you talking about systolic BP
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1) If this is an acquired B antigen the it can be identified / differentiated from true B antigen by using acidified anti-B.
2) Bone marrow transplant induced blood group changes usually give chimerism.
3) Have you done DCT ?
4 ) Try using O and auto control as part of panel of cells used in reverse typing. (O cells with known absence of M antigen will exclude interference form Anti-M)
5) Check if the patient has elevated levels of globulins.
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thanks David and Aafrin for responding but actually I wanted to see the form or format in which the other facilities are maintaining their record. I can post to you people my own form so that you can correct me.
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respected fellows,
I need urgent help and feedback about how everyone is keeping unit traceability record in their facility and what are the essential criteria to be included and what is not allowed by accreditation bodies.In our facility all record keeping is in form of hard copy. I have designed the form and revised it too but during the past two visits, the inspector's expression were as if he has some reservations although he did not reject it completely.
Thank you.
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we have a protocol in our hospital that in such cases the least compatible unit is arranged and all the reactions and their interpretation are written on the x-match request- Blood bank work up section with recheck done by pathologists.
instructions to transfuse under strict clinical observation after the treating doctor signs the note by blood bank as acknowledgement that he is aware of the risk associated .
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A very pleasant surprise to see beating hearts raining when I opened the forum page. The person responsible deserves a lot of appreciation for the idea and its execution. Thanks a lot from all the people of this forum.
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immediate spin crossmatch is done in only in case of emergency when you do not have time to do a complete compatibility testing and the objective is to rule out ABO incompatibility. Practically a lot of time is saved doing it in tube instead of using gel card. Kindly anyone will explain the logic / scientific reasoning of using gel card under these circumstances. I would be much obliged.
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Helmer. easy maintenance, loud alarm which draws immediate attention from technician.
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Hi umeshkumar,
Our hospital has a clear policy regarding this issue. The blood transfusion request or blood group request must have :
patient's three names on the request and sample tube.
medical record number
name and signature of the patient identifier and person who extracted sample on the request and sample tube.
date and time of extraction on sample tube
if these criteria are not fulfilled the sample is rejected.
Monthly a transfusion / blood group request monitoring report is generated and submitted to nursing director's office with copies of deficient reports.
Departmental incident report is generated for any technologist who processes any request which should have been rejected.
This has resulted in solving the problem in our hospital .
we in blood bank are dependent on the ward staff to collect from correctly identified patient. Deficiently labelled sample indicates a careless attitude of the collecting staff so we do not allow the nursing staff to come and do any changes in data under routine circumstances. Under emergency if it needs to be done the nursing staff is required to write that they take the responsibility of correctly identifying the patient . Since blood bank is a medico-legal record. nobody likes to give in writing their mistake rather they try to rectify it.
I hope this will help you have ideas to solve your problem according to your circumstances.
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dear friends,
Hi, I am interested to get views from the senior people about using complete cross match cards by BioRad (Diamed). Can these replace the saline phase and albumin phase of serological cross match completely? Can any one post their policy and procedures using these cards or similar methodology cards to give information how to use these cards effectively.
Thank you
look back event
in Donor Services and Donor Recruitment
Posted
dear Auntie -D , No I am referring to haemovigilance and look back event initiated by donor or patient