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Johnv

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Everything posted by Johnv

  1. I concur! This was a great symposium. The SBB program I attended sent us to Ann Arbor in 97' and I arranged to go back nearly every year up to 2013 or 2014. We came away with new ideas and confidence in our job. Plus, the Weber Inn was a great place to stay. On the down side listening to John Judd talk about warm beer was not fun. Beer should be drunk ice cold.
  2. In Cerner after UNXM units are issued, the Blood Bank tech orders the a UNXM test with the release statement attached. It goes right to the physician's inbox for their electronic signature. It's not perfect because although the physician is suppose to approve immediately after the trauma, in some case you still have to hunt them down to sign. It has the advantage of allowing the ordering physician to complete the approval signature where ever they are or where you find them, ie. on the beach in an exotic south seas island.
  3. Has there been any new literature on this issue? We continue to see examples of reactive screens in Ortho gel, but negative when 3% screen cells are diluted to 0.8% with MTS diluent and run in gel.
  4. We use a certified alarmed thermometer that will alarm, separate from the refrigerator alarm and the wireless, set for 2.5 to 5.5. This is checked during quarterly alarm testing.
  5. Not sure about just one answer - We had a labeled Rh negative RBC from the ARC that retyped as Rh positive. Upon investigation, it was found the Immucor anti-D reagent we use for retyping had anti-Crawford while the ARC automated process for D typing used an Ortho reagent which was from a different clone. Not very unlikely but certainly more than one answer.
  6. The Blood Bank has ultralow freezers for the storage of tissue and frozen plasma. At our hospital we have been approached as a possible overflow storage location for the Covid-19 vaccine. Is there a FDA regulatory rule against the storage of human vaccines with blood products? I believe in the past we have stored RhIG (Rhogam) with the RBC inventory, although due to the temperature requirement (2-8C vs 1-6C for blood) we currently have a separate reagent storage refrigerator. The storage of Rhogam with blood has never resulted in a citation from CAP, Joint Commission or our State Department of Health. thanks.
  7. I have to agree with you too. The BBGuy was one of my professors during graduate studies and SBB training - way back when...
  8. Thanks Dr. Blumberg. I have passed your comments to the physician
  9. In regards to Neil Blumberg's comment about using ABO identical plasma: can I assume that ABO compatible plasma acceptable? ie. Transfusing A plasma to an O patient? thanks. John V
  10. We decontaminate our coolers daily because they go into the OR. If a cooler came back from an isolation room, we would decontaminate (wipe down with a bleach wipe). Units returned are also rare because it is difficult to have the RN staff to return blood in a timely manner to ensure it is still 10C or less. Consequently this is not an issue. It would be interesting to hear the lessons learned on this subject from the Medical Centers in NYC.
  11. A number of years ago the President made a visit to our area. His advance team visited our hospital and the blood bank. They asked if we were AABB accredited which we regrettably answered no. We are accredited by the Joint Commission Consequently our blood bank was told we could not provide blood product in the event of a medical emergency!
  12. We had a recent example where the patient has anti-A1 but the A cell well on the Ortho ABD gel card was clearly negative on the Vision. It was discovered when two A positive units were crossmatch at initial spin and they were +4! Two O Pos units were crossmatched and they were negative or compatible at immediate spin. Testing in tubes with Immucor A cell gave +2 A cell at initial spin. When testing the patient cells with A1 lectin the result was negative and repeating the reverse with A2 cells the result was negative. In addition, a cold panel indicated a cold antibody was present. The Ab Screen was negative and we crossmatched the units to AHG and they were negative. Has anyone else seen this situation?
  13. We recently received a blood bank plasma freezer thermometer 20C to -90C in a bottle filled with sand instead of glycerol or ethylene glycol. Has anyone had experience with blood product freezer thermometers whose measuring bulb is immersed in sand?
  14. You use a less sensitive assay method to reduce interference with cold and warm auto antibodies that you have shown or proven are not clinically significant, with the idea that a clinically significant allo antibody like Kell, if present, will shine through. It's a balancing act.
  15. You can add canned unit comments printed on the tag. Attributes can also be automatically included when the product name is printed on the tag. It is user defined. Or you can place a sticker on the unit or tag, ie. "Irradiated".
  16. I would say - not reportable to the FDA but definitely needs to be documented with an occurrence and the steps reviewed for opportunities to improve the process. Not reportable to the FDA because the unit was designated and acceptable for transfusion to the patient. I assume the review process of inspecting the unit, documenting when it was issued, when the TX was started, any adverse events associated with transfusions, completion of the TX within the required time limit, etc was correct and documented. If the incorrect selection of unit 2 instead of unit 1 in the computer led to issuing an unsuitable unit, definitely reportable to the FDA or your State agency if they assume that role. The same thing happens frequently when a unit is issued but not saved in the computer (the saved button is not clicked) so it is not issued but stays allocated, to be corrected when the transfusion documents are accounted.
  17. A closed system room temp product expires in 6 hours. An open system room temp blood product expires in 4 hours. In most cases the blood product, ie RBC unit, doesn't become an open system until it is spiked. If your policy is to start the transfusion within 30 to 60 minutes from issue, then you would still comply with the regulations if the total time of the transfusion, from spike to completion is no longer than 4 hours. The 4 hour time limit is easier to comply when the RN is keeping track of the time it starts until completion, not when it is issued since that time is likely only documented in the blood bank computer. John Van Patten, MT(ASCP)SBB
  18. Mallinckrodt manufactures Glycerol USP. I think we ordered directly from the company a couple years ago but I would guess one of the lab supply companies can get it too.
  19. Does anyone know a reference that specifies standard times to collect blood samples after the transfusion of RBCs to determine Total Iron, TIBC, ferritin, hemoglobin, hematocrit, etc?
  20. What a great question to present to "Ask the FDA" at AABB in Orlando. Unfortunately the meeting is months away. Why is this different than the other tests conducted under an IND, such as WNV?
  21. Many years ago while in the SBB program, our training institution told us it was very (very!) important to ensure the room temp and below reactive antibody is not clinically significant by ruling out one of the few significant allo antibodies that react in this phase, specifically Vel. They told us of a recent case (recent back then) of how this was not done and the consequences was fatal to their patient. Was this just a "bedtime boggyman" story to scare the student blood bankers or is it important to perform cold screens to establish a clinically significant allo antibody is not present?
  22. We recently adopted the below guidelines to manage massive hemorrhage with OB patients. California Maternal Quality Care Collaborative guidelines. The guidelines lay out stages of increasing severity and the blood products to tx at each stage. The Blood Bank supports our providers by ensuring RBCs, thawed plasma and at least 2 plateletpheresis are continuously available. There are recommended transfusion ratios but as others have said, the different reasons for the massive hemorrhage dictate different responses. I agree that the guidelines promulgated by the military for hemorrage during combat casualty care are unique for that specific circumstance and maynot work when applied to civilian settings.
  23. Another method to concentrate 0.8% to 3% is to use the MTS pipet set to deliver 0.5uL. Pipet 6 - 0.5uL parts of the 0.8% in a glass test tube. Centrifuge for 30-60 seconds. Decant all of the supernatent. Add 2 drops (maybe 1 depending on how "fat" the drop) of saline until it is 2-5% by appearance. We only concentrate 0.8% cells when using expired panel cells for antibody ruleouts and it is necessary to verify the antigen expression is acceptable. The panel cell must be 3% when testing one drop with an antisera to the specific antigen desired. Our acceptible minimum agglutination is +2 for the cell to be used to ruleout an antibody.
  24. We use Cerner Millenium. Although it is not perfect, once you learn the tasks it does the job. We have clinics that use Epic and are now developing an interface so providers can order blood products. This is not completed so I can not say one way or another how well it works. I have used Mysis, Meditech, and DBSS (the military blood system) in the past and so far, Cerner seems to work out the best. I hope that helps.
  25. I stand corrected. I'd better adjust up the lower alarm settings on our refrigerator storing Rhogam too.
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