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Johnv

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  1. Johnv
    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.
  2. Johnv
    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.
  3. Johnv
    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.
  4. Johnv
    I stand corrected. I'd better adjust up the lower alarm settings on our refrigerator storing Rhogam too.
  5. Johnv
    Did you have any actual temperatures below 2C? It is certainly a good quality idea to have an alarm on a refrigerator that maintains reagents and medications such as Rhogam or RhIg Immunoglobulin (obviously it's required for storing red cells or plasma) and also maybe a written procedure on what to do if the temp is observed to fall below 2C. However I'm not aware of a regulation that requires medication refrigerators to have an alarm system. As long as you can show you are recording the temp once per day and the temps are staying in range (2-8C), I don't understand the basis of CAP/AABB surveyor's objection? John V
  6. Johnv
    Are you referring to this article by Dr. Judd and others? Rh discrepancies caused by variable reactivity of partial and weak D types with different serologic techniquesGregory A. Denomme, Louann R. Dake, Daniel Vilensky, Lily Ramyar, W. John JuddArticle first published online: 7 DEC 2007 DOI: 10.1111/j.1537-2995.2007.01551.x
  7. Johnv
    We started using the Provue in 2013. Currently when testing prenatal and maternal patients to determine if a patient is a candidate for RhIg immune globulin or Rhogam, we perform tube and weak D testing. Considering the AABB Std that weak D testing is not required, we looked at dropping it all together (except cords and neonatal testing), The Provue ABD gel card package insert says it will detect nearly all forms of D antigen so we are considering using the Provue result exclusively. A quick survey of other labs with Provues in our area shows most are still using weak D testing to various degrees. If you use a Provue, did you drop weak D testing? Or do you only perform weak D if there is a +1 or +2 reaction in gel as some facilities are doing? thanks.
  8. Johnv
    The Lead Blood Bank Technologist
  9. Johnv
    Another tell-tale sign of a Blood banker-can't give up old Techical Manuals or at least you want to make sure they have a good retirement home! I must admit I still have my 2nd and 3rd Edition (the red cover and blue cover) from my first blood bank assignment after lab school. Our Director issued every tech their own personal copy. I'm sure this is a common story.
  10. Johnv
    What a coincidence that just this morning our Transfusion Committee had a discussion on how important was the end of the year C/T ratio average, then the issue appears on bbtalk! We average 1.29, but our transfusions are mostly oncology and in-house medical. Post-op transfusions tend to be from ortho and gyn procedures. I see the Tech Manual doesn't state an optimum value any longer. My thoughts are that 1.29 is pretty modest value and that if we had individual providers crossmatching but not transfusing, it would be reflected in our monthly C/T stats. I found an article on C/T values but it is somewhat dated (not that older research is any less valuable today-I definitely don't want to imply that, as others in this blog have done to their peril!) I was just wondering what the BB community-who read this blog-feels about total C/T and if it should continue to be a quality marker. The article reference was Clin Lab Haematol. 1983;5(4):379-85. thanks. John V
  11. Johnv
    I would also like to simply say "YES" . The FDA always gives a "dump truck load" of explanation when answering a question. A patient-product compatiblity program that prevents an ABO incompatible RBC from being crossmatched and issued when performing an electronic crossmatch, is acceptable in place of a saline phase crossmatch.
  12. Johnv
    We use Golden Hour coolers. They keep the blood 1-6 C for up to 8 hours or more (we only validated to 8 hours). They work great.
  13. Johnv
    Recommending a blood warmer when a cold antibody is present seems to make sense. Since the blood bank tech is observing agglutination at roomtemp or warmer (if it is interfering with the gel screen), why wouldn't you want to recommend a blood warmer? Granted, these antibodies are rarely significant, but I'm not aware of any disadvantages to using a blood warmer (that is if used correctly). Again, the operative is "recommend". Requiring a blood warmer would take a Doctor's or pathologist's order.
  14. Johnv
    If the dinner is Saturday, unfortunately I won't be able to make it. I might be able to drop in later if my prior engagement is over-for a fine mug of COLD beer. thanks. John V
  15. Johnv
    It would be great to attend, however not sure I would make it in time. Let us know the time and place and maybe I'll might be able to show up. If there is no room, I'll hang out at the bar and try to overhear the great stories and good times you all are having.
  16. Johnv
    We have Cerner and had IT Dept build an Access db that reads all new patient file updates (antibodies, blood types, comments, etc) from Cerner and adds them to the hard drive on a PC in Blood Bank (and a backup file on the network). It auto updates 4 times a day. When we have a computer outage, we can use this PC in local mode and inquiry on blood bank history. It works great. We check it once per month and never had a problem unless the PC itself fails. No paper although we use tons of paper in other areas.
  17. Johnv
    Has anyone with Cerner converted to the enhanced version of PTC Export? PTC Export uses an ACCESS database to display patient blood type and antibody history when the main computer system is down. If so, how did you overcome the problem of special characters <, >, &, ', " in your legacy database whe you converted? We understand if these symbols are not cleaned out of your database, they will freeze the program.
  18. Johnv
    Our ER Docs want us to switch to the mini dose too, but fortunately our objections were not overruled. They said we were over-dosing 1st trimester patients. We countered by showing the cost is not much different between the two doses and the greatly increase possibility of a dosing error, ie. incorrectly using a 50 mcg dose on a post-partum or near term patient. We cited the Technical Manual which specifically discusses this possible error when both doses levels are available for issue and administration.
  19. Johnv
    Small convex hand-held makeup mirrors are $1 at the Dollar Store and are exactly (and I mean exactly!) the same.
  20. Johnv
    It is probably best to look at the decision to remove or not remove the antibody history in terms of risk. There was evidence, however suspect, that the patient had an anti-K. If you remove the requirement of transfusing K antigen negative blood and by a very unlikely chance the patient had a transfusion reaction due to anti-K (or any harm even remotely attributable to the transfusion), then you have to convincingly explain why this was a safe or better decision for the care of the patient to your hospital QA, administrators and/or lawyers, who may only know one thing about blood-it's red!
  21. Johnv
    You can make your own thermometer too. Glycerol is cheap ($70 for 500mls) and can be purchased through most Lab supply companies. Make up a 10% glycerol solution in a glass/plastic bottle with a holed stopper for the thermometer or an unused blood bag (but blood bag won't last as long and is hard to keep from leaking). Your thermometer still needs to be NIST certified (in the US).
  22. Johnv
    Six (6) hours to transfuse sounds like it was intended for the thawed, FFP and FFP/post 24hr stored at room temp that has not been entered. If the product was spiked, then the standards require 4 hours to use, but when stored at refrigerated temperatures, it is acceptable for 24 hours. It appears the problem is how the statement in the CFR was written.
  23. Johnv
    This cold weather is causes shipment problems for platelets. We recently received plateletpheresis unit at 18C that was shipped and delivered in less than 24 hours. At a previous blood bank I worked at in Washington DC, we had a policy that 18 or 19C for platelets shipped less than 24 hours was OK as long as the appearance was acceptable (swirling, no clumping, etc). The policy cited a comment in the Tech Man, but I'll be darned if I can find now. I did find the article in Transfusion (Vol 37, Jan 97, PP 5-11). Does anyone else have a policy to accept colder than 20C platelets and is there an AABB reference?
  24. Johnv
    Consider attending an SBB program. There maybe a tuition requirement depending on the program but what you would gain is well worth it. NIH has a very competitive program as well as a number of other major institutions. The clinical component and research-based investigations are critical for your training. The goal is to develop the person into a valuable colleague on the Transfusion Medicine team.
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