CM2

We purchased the thermoscientific Hera freeze 13cu ft -86C model 8933 cat# HFU240BA, around $13000 with warranty and 7 day chart recorder. It is used mainly for reagent storage and as a backup method for dump freezing stem cells if our controlled rate fails (stem cells need colder than the standard plasma storage temp of -30ish to maintain viability). The door is opened only maybe a couple times a day. We received it 9/13/12 and by 12/19/13 it had a compressor failure which required factory repair offsite. I got it back 2/10/14. Because we had the 3 yr warranty, it didnt cost us anything, but I am still not real impressed by getting 1 year of service out of something that has such light usage. I would not recommend this particular unit. From talking to our facility HVAC guys, I get the impression a poorer quality of manufacture (less insulation, underpowered compressors, etc) is becoming much more common in the units currently sold. Management always wants to spend the least money, and these cheaper units are a response to that niche. So whatever you get, I would definitely recommend the extra money up front for extended warranty/service contract (compressor rebuild on our last freezer cost $5000) -C

They are switching to win7 in our facility also. One unexpected problem we had was with the default settings of login security. When Win XP was left idle for a period of time, it times out to password lock, previously anyone with a valid network windows account could log in (so multiple users could use the same pc). With Win 7 they changed the way admin accounts are structured, now only a true IS admin can boot someone out once it goes to lock. For added difficulty, there are no longer 'shutdown/log off' options shown on the login screen, and going to screensaver now also forces password lock. This means if someone is logged in and goes home or to break, you have to depower the pc and sit through the extended boot because 'windows was shut down improperly' So besides the major issue of whether your bbis is compatible with win7, you definitely need to proactively request from IS to disable screensaver lockout as well as extend idle time to lockout to infinite. Because they do not generally seem to understand the concept of shared workstations common in the lab environment.

Our medical director is over both transfusion services and HPC lab, so if she is notified they have a suspected transfusion reaction to a product (usually a known mismatched product, marrow is the worst culprit with its huge volume/hct), yes, she requests a limited hemolytic workup to be done in transfusion services. It's more of a monitoring panel for severity than a 'find that the patient was misdrawn/wrong armbanded' type of workup. Identity of recipient during a stem cell transplant is so thoroughly monitored backwards and forwards, and they and donors are drawn so many times for ABO confirmation thats never been the source of the problem. Its more frequently something like donor specific proteins in plasma causing hives, or a stronger than normal expected hemolysis to a mismatched product. It's a whole blood product so really any type of reaction can occur. We do purple top for hemolysis/DAT, chemistry tube is sent for LDH/bilirubin/haptoglobin.. i think also bun/crea, urine is sent for positive blood strip/free rbcs present. If they suspect TRALI/TACO they may also request things like chest films, but that is usually initiated in conjunction with the clinical team at bedside. We pull micro cultures at time of issue for fresh products and have a reserved vial of frozen products if microbial contamination is suspected, so that end is usually already covered. I would be very surprised if your center doesnt do these things, it may be coming through a different pathway than your usual, especially if the blood bank is not the first point of contact to notify of problems.

My short answer would be No, it is not necessary UNLESS you have a conflict between your results and the donor workup documents that come with the product. Here in the US, the NMDP coordinates the majority of our searches. We get paperwork from the collection center that screens the donors which includes donor virals and the blood type they got in testing on the donor. We also get the HLA results performed (here in NJ by the sharing network) which also includes the blood type. So you already have 2 separate sources of a blood type which are done with a high standard of accuracy. So if they say A neg, and I test and get an A neg on immediate spin, why would I spend energy looking for zebras? The worst that is going to happen is the patient will receive Rh neg units unnecessarily. It is also possible for a tiny subset of weak D people to make anti-D anyway, so to our minds it is taking the path of caution. If you work in a region with very limited blood supply this might be a stronger factor to consider. But Im guessing if you have the capability to perform bone marrow transplants, you have a fairly robust transfusion service as they can be pesky to support (HLA immunized patients needing lots of platelets comes to mind). A few thoughts. Its great you do the antibody screen, I was suprised to learn the NMDP does not require these to be done on donors, and we had one case where a transplanted patient who was rh Pos suddenly acquired an anti-D, which caused a bit of confusion. We never knew if it was because the transplanted T cells from Rh neg donor decided they didnt like the recipients Rh pos remaining circulating cells, or whether the donor was already immunized from a pregnancy/rhogam greater than a year ago (thats the time frame on donor questionnaire) and already had circulating anti-D in the plasma which was also infused with product. (gel method is so darn sensitive) In any event it did not cause any harmful sequelae/DTR or anything. My other thought is, you can probably save yourself the crossmatch, unless you are at one of the unlucky institutions that still has not instituted electronic crossmatch (patients with a negative antibody screen receive ABO compatible units without a physical crossmatch of serum and donor cells). The hct on products we receive is 4-8% which usually translates to around 20-40 mls of rbcs. Much less than a unit of blood.. if electronic crossmatch is safe for 250mls, why not 20-40? We have a cap of 10mls of mismatched rbc allowed per day. If we have a patient with antibodies or a major ABO mismatch we prefer to go the conservative route and break up infusions either into sessions 4 hours apart, or over 2 days, with hemolysis workups in between issuing the next piece to be sure some crazy hemolytic cascade hasnt started. With this amount of rbcs and good kidney hydration, its a pretty self limiting reaction.. once those rbcs are gone, no more is coming in. At least not until the recipient immune system finally dies out and the new one is established and starts making rbcs..and the new immune system doesnt fight itself.

Orders are placed and resulted in the computer, slips print at nursing station when we result ready. We will call OR's if we get TS while they are in the room, esp if we've issued emergency release already. Very few other calls. No pneumatic tube. We didnt want to validate its a safe way to transport blood for one. And its hard enough to be sure the units are hung in a timely fashion when they are picked up by hand. Our old super was afraid we'd have a real problem with things ending up sitting in the delivery station. Its also hard enough to unjam/clean the system when a urine cup comes open, 250ml blood would be a nightmare. Nurse, CCT or unit clerk are all ok. Must be employee (no volunteers) with badge and we request they have been given at least an inservice on what they are looking at. In the old days we did have one unit that would send the housekeeping staff on short staffed days... Computer ordered units should be finalized as complete by the nurse on their end, which takes care of the majority of billing. Softbank has usage reporting for our end. Paperwork wise, we retain the printed orders we use to issue from as well as the pickup slips and the returned completed transfusion hangtags. And of course copies of any emergency release/downtime/OR manual orders. -c

Hello All, We are starting to look at new database software for our HPC Lab to replace our current Microsoft Access database. I went to the CTTXPO in oct and have to say mediware's transtem and stemsoft's stemlab look the closest to filling our needs. Does anyone have experience using either of these from the stem cell lab side? Pros/cons about your system? Other suggestions? We want something that stores the data locally, not web/cloud based. We are a moderate sized processing lab handling maybe 200 products/yr, mainly apheresis HPC, occasional marrow/cords. Feel free to respond in private message if you want to give feedback in a nonpublic forum Thanks! -C

One easy workaround for printing tags ahead of time to "save" special units for someone (besides handwritten scraps of paper tucked in the holder), is to have a regular laser/paper printer also set up which you can print to. You can just send the tag there instead, have all the info on the paper about when xm done, who its for, etc, but theres no holes or 3 part paper or unit sticker, so it cant be mistaken for a ready to issue tag. Its a quick way to see physically which units are on hold for someone and cue the door/issue person to investigate if say a crossmatched platelet near expiration might be able to be freed.

To freeze cells and store cells usually requires different equipment. I only know about freezing stem cells, which requires a controlled rate freezer that drops the temp gradually to -80, at which point the cells are transferred into the long term storage freezer at -190 ish. For controlled rate freezing we use a Cryomed model 1010 (ancient) purchased from Custom Biogenics systems http://www.custombiogenics.com/ I dont know whether this would be appropriate for freezing rbcs, Im sure a blood supplier reader is out there and will chime in For long term LN2 storage, we use the Chart MVE 819 with TEC 3000 controller http://www.northeastcryo.com/pdfs/10934034.pdf Dont know where you are located but we purchased ours from northeast services in south plainfield NJ, which also provides service (great company) http://www.northeastcryo.com/ It holds a very stable temp for a long time (approx 2 days between fills) on a full charge. We run with btw 4-6 inches LN2 which keeps temps around -190 continuously. The controller unit tracks LN2 levels, and when you drop below whatever level youve set it opens the fill valve automatically, until your target level is reached, at which point it shuts the valve. All you need is an external supply tank, although it is possible to run a permanent piped system for supply. Which model you buy is going to depend on the number of products you anticipate storing. Most companies that sell these support a variety of racking systems and which one you choose will affect the total number of bags that can be stored. Id strongly suggest something with built in temp/Ln2 level monitoring and alarms that can be wired to a remote monitoring system. We needed an external chart recorder to maintain a record of our continuous temps since our Isensix monitoring system does not have its own temp probe for LN2, it only says yes/no you are in alarm state. Other monitoring systems may offer this capability.

As a student I initially thought saline replacement meant you did not use patient serum in the testing. This was very confusing to me in how it was supposed to yield meaningful (or any kind) of results... LOL

Just curious if this might not have been started as a response to not being able to physically quarantine new incoming units from 'ready to use' units (as in, separate fridge or shelf). Thats about the only thing I can think of that having a visual cue might be good for.

I perform all my product typing in tube, forward and reverse. After you have done them a while your eye just gets used to filtering out the white clumps that sometimes form vs red cell agglutination. You have to stop expecting them to be 3+ or better like blood and instead accept tinier clumps. There is a fine granularity to rbc agglutination that doesnt shake away the same way the white cells do. You are not truly typing the patient, just trying to make sure products collected at the same time werent cross labeled in some way. If I had a real question about what ABO/Rh the donor really was, I would go to the peripheral blood sample collected pre/post procedure and compare to historical typing done on the pre-collection screening. This way you could do Du, gel, A1 lectin, whatever you need to clarify confusing results. The HLA results often have subgroup information on them, at least from Sharing Network out here in NJ.

I think what you have to check for isensix quarterlies depends on how far you have gone in the alarm response settings of isensix. Basic setting is alarm condition on the website which have to be manually reviewed and cleared with a comment through the website. Does the website show alarm condition when they are triggered? Next level is having a flasher/audible alarm set up - if you have one of those youd have to check it actually goes off and hopefully its in a place that Is staffed - do those personnel know how to respond? Highest level of response is enabling the remote calling feature of isensix where if alarms are not cleared in a set amount of time, it starts calling or texting whatever numbers you have put in. Do those go through in the timeframes you have set, to the right numbers, specifiying the correct equipment? We do both the equipment alarms and remote activation alarms (the hospital operator for us) bc our feeling is the equipment alarming is a part of normal functioning of the equipment. Isensix does have outages (most notably during generator tests for us) and we'd never feel comfortable imagining our freezers sitting there happily warming up and not saying anything about it We posted a sign on our lab door saying "alarm after hours/on weekends? call pager xxx-xxxx!" which at least gives passerby a chance to let you know if it's been going on a while. We have not gone live with using isensix solely for alarms and instead have a wierd chimera of using the operator for notification and the web system for nice documentation and temperature trend review.

We've had a great lab committee, and every year they come up with a few new things. The basic idea is they acquire a few prizes from pathologist and vendor donation. We may even have a small budget for prizes, we had a ton last year. They set up some contests and activities available to every shift, and every thing you participate in earns you a lotto ticket for the prize drawings at the end of the week. Some of the contests are factual quizzes, like, how many manual diffs do we do a year, how many beans are in this jar. Some of them are dressup participation (depends on your corporate culture) - wear jeans, wear all your laboratory related buttons and pins, wear a silly shirt. The more popular quizzes were match this baby picture to grown tech, match this child to tech parent, match this pet to tech owner. One of the most memorable events was the scrubs fashion show where people dressed in their favorite scrubs and got to do their best catwalk while someone announced what they were wearing. As far as outreach to the rest of the hospital, likewine is right. Serve food and youll have all the interest you could want. (Why are people at work so hungry?) One thing we have done at our hospital is every department prepares a posterboard describing what it is exactly they do, and we get to display them for a day in the hospital atrium (big inside center courtyard area with lots of foot traffic). With candy bowls in front of the posters.

We bought the standalone Hematrax and use it exclusively fulltime without interface to our BBIS (we use softscapes softbank module). Im not sure how you would create an ISBT label downtime without the standalone program. If you are used to your BBIS choosing the correct product code for you, its going to be a big adjustment during downtime using the standalone. The module does allow you to search product codes but due to complexity (of ISBT, not bad hematrax design) we found it very unwieldy. What we did was actually create manual tables we bound together in sheet covers at the terminals most often used to make labels. The tables broke down products into platelets, rbcs, plasma etc and basically one column was what 5 digit code is on the product now before you change it VS heres the 5 digit code for after you irradiated it, split it, etc. Then you can just go straight to the 'make full face/half face label' menu and print exactly what you need. It was a pain to make but as a part time blood banker, its a godsend compared to having to search through the elaborate combinations of anticoagulant, volume collected, leukoreduced/not leukoreduced, product type etc.

[/quote=Malcolm Needs;43626]If you don't bring it up, who is going to give you the answer????????????????!!!!!!!!!!!!!!!!!!!!!!!!!!/QUOTE] Im terribly afraid the answer will be from a regulatory agency that says "We'll be sure to address that in the next issue of standards" and then I'd be marked for death by anyone in the real world who has to ship or receive products.