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Generic

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Everything posted by Generic

  1. I think the main concern with regards to transfusing out of type platelets is the antibodies in the donor unit potentially causing a hemolytic transfusion reaction in the recipient. At our hospital we do try to give type & rh specific platelets whenever possible. Our guidelines are that neonates get AB or type specific. Patients <5 years old get type specific due to small body size. Adults get type specific if available. We transfuse 10-14 apheresed platelets a day on weekdays, fewer on the weekends; in the last 25 years or so we've only had one hemolytic reaction due to a platelet transfusion...a B patient received an O platelet. I can't remember off the top of my head what the titer of the platelet ended up being though...
  2. The only radiation badge we have in our blood bank is the one attached to the wall between our two irradiators. I've no idea if there are any plans to remove it. To be honest, since my station is the closest one to the irradiators, it makes me feel better seeing it there lol
  3. At our hospital, we do it all the time when performing select cells, etc. The Provue is built to allow cards that have unused wells to be used again after an incubation/centrifugation cycle...this would imply that Ortho doesn't see a problem with it.
  4. At our hospital we rarely use samples from other parts of the lab (really, we will only take them from hematology). The rest of the lab used to not be as stringent on correct labeling as we in the blood bank are, although that has changed recently. I think that our lab has a form the nurse has to fill out with the reason the sample needs to be transferred from hematology to blood bank, but I've never seen it. We don't allow other parts of the lab to use our samples, the reasoning behind this as it was told to me is that if something happened and we were taken to court, we could run into legal issues if the sample was taken out of the blood bank. My main gripe about accepting samples from hematology is that the barcode labels they use in the main lab are huge and cover up the entire patient label. I prefer to be able to see that it is correctly labeled myself, and it is nearly impossible to peel the barcode label off and not destroy the underlying patient label. The processing area is always really busy, and there have been instances where the wrong barcode label has been put on a sample...
  5. Testing in the gel is much more sensitive than the tube. IME, a reaction as strong as 2+ in the gel can still show up as negative in the tube...
  6. We test our eluates in gel, the same way we do our antibody IDs. The only suggestion I can think of is that it's really important to get as much of the "junk" out of the eluate as possible before you pipette into the cards. It can cause a mixed field or weak to 1+ look if you accidentally suck some up, same as in the tube I'm sure.
  7. 1. At our hospital, the nurses draw the vast majority of the blood bank samples. Only very occasionally do we get one drawn by the phlebotomists. Blood bank tests can't be ordered by the floor, so no draw order gets sent to phlebotomy. All our samples have to have the 2 identifiers, date, and initials of the person drawing or the sample gets written up and thrown away and a new correctly labeled sample requested. Either the rest of the lab didn't have the same requirements as blood bank or they weren't as strictly enforced (I've always been fuzzy on the exact situation), but our new lab director has been very strict about the blood bank labeling policy applying lab-wide (and adding time of draw too). That has greatly reduced the number of mislabeled samples we get... 2. We don't use armbands... 3. We require a confirmatory sample on all patients with no prior history. We only perform a forward type on these samples and the patient isn't charged for the test. If they can't get a 2nd sample, we require that an emergency release be signed before we issue any blood products. Nursing grumbles about this from time to time, but oh well...we almost always get the sample and very rarely have to issue under an emergency release. 4. Although we do rarely get the wrong patient information on a sample, this has always been caught with the second sample. It of course gets written up and sent to nursing to deal with, I don't know how hard they come down on them in those situations though...
  8. I believe Shands at the University of Florida had one of these machines because of a very long walk (approaching 10 minutes) between the OR and blood bank due to construction. If I remember correctly, the machine was only stocked with O's and was only for use in emergent situations. If it was actually only used in those situations, I have no idea.
  9. The expiration date for our spiked transfer bags is 24 hours, the syringes we pull from the bag have a 4 hour expiration.
  10. The segs we pull when we are processing in units we put in a small bag labeled with the date received, then put those bags in our reagent refrigerator (where we happen to have a few empty shelves). Every month we put all those "daily" bags in a larger "month" bag that goes on another shelf in that fridge. The segs that we've pulled for our emergency issue units we just keep at room temperature with the rest of the emergency issue paperwork near the door.
  11. At our hospital when we report a transfusion reaction to the pathologist on call, we just have to ask them if it is okay to transfuse any more requested products.
  12. Something similar happened at my workplace...a student rotating through the blood bank asked a coworker if her blood type was possible. She was certain her father was AB+ (he was frequently in the hospital), while she herself was O=. My coworker was stunned but managed to get out that blood types could be complicated and anything was possible.
  13. Here at our 700+ bed hospital, the pharmacy handles all factors, RhIG, and albumin. We'll occasionally have a doctor call about them, and we're more than happy to transfer the call to the pharmacy
  14. We also have two provues and our stat turn around time is 75 minutes, starting from when the specimen is received in the blood bank. We generally don't have any problem staying within that time limit and often result out in under 65. If there is a situation in which a T&S is needed superstat, I'll perform one manually in the gel. You can get the gel cards pipetted while the sample is centrifuging to cut the time down. If the provue hasn't been used in awhile (not sure how often that happens during day shift, but it happens occasionally at night) I'll have it prime while I'm centrifuging the sample so it doesn't have to prime before it starts pipetting. That'll save about 5 minutes.
  15. Like butlermom, we get another sample and repeat the ABO/Rh. You should definitely retype the samples at least...we recently had a patient with a warm auto come into the ER near shift change. The evening shift tech called to the ER for additional samples to finish the workup and left it for the night shift tech...the new samples came and the night shift tech was working on the elution before she remembered to retype - original sample was O+, new samples were A+. They were all correctly labeled...someone in the ER got in trouble over that one lol...
  16. Yep, we run it as an AHG crossmatch. We'll stick on the K+ and K= controls followed by the samples we want to test and just run them as a batch anytime we want to K a group of samples, as it generally isn't more than once every few days. We validate every test we perform on the Provue...I don't know how many samples they used during the validation though, it was done before I started at this job.
  17. We use the Ortho anti-Kell on our Provue and it works great
  18. According to the FDA you cannot exceed 5000 cGy. You can irradiate a product more than once as long as you note each irradiation and the cumulative dose is no more than 5000 cGy. I had a similar question several months ago.
  19. I don't have any experience with the ECHO, however occasionally something similar happens with the Provue. Depending on the reaction, it'll either be an antibody against a preservative in the 0.8% cells or an antibody against something in the gel cards. We repeat the original screen in the tube or using 3% cells diluted to 0.8%, depending on the situation. If the repeated screen comes back negative, we result the antibody as an unidentified, with a comment saying something along the lines of "probable antibody to preservative in 0.8% cells" or "probable antibody to gel - perform all testing in tube." In these cases we'll perform all crossmatches through AHG.
  20. You may already have answered this, but how long did you incubate the gel cards? Maybe a 30 minute incubation would be enough to get a weak positive reaction from it? Sometimes things come up and you can't get the cards in the centrifuge right at 15...just a guess?
  21. I'd just point out here that without a second sample, you wouldn't necessarily know you were giving Rh pos blood to an Rh neg baby in the first place To be frank, we only get a few 2nd samples a year that are discrepant (although that definitely doesn't mean that the same, correct patient was drawn both times). However when you have a major discrepancy - a type O patient having a type A initial sample, as happened in our pediatric ER several months ago - it makes all involved VERY happy you have the policy in place. That being said, I can't speak to the logistics of implementation at my hospital as the policy began before my time.
  22. All of our samples are drawn by people on the floor. When we receive a sample for a type and match, we perform the type and screen and crossmatch, put a sticker on the blood to let us know we need a second sample, then call the patient's nurse to tell them the blood is ready and we'll need a second sample. They'll generally walk the sample down when they're ready to pick up the blood. We'll perform a quick type and order a "Retype" in the computer, then issue the blood - usually one tech will be issuing while another is performing the quick type, and there is no delay in issuing. Even when, for whatever reason, there is only one tech in the blood bank, the delay to issue is minimal - less than 60 seconds usually. We have no policy regarding who has to draw the 1st and 2nd samples, as long as they properly label them. Some people in the blood bank won't accept two samples received at the same time regardless of the time written on them (sure, sure, they were drawn EXACTLY 5 minutes apart), but some will. When the 2nd sample policy first went into effect there was some push back from nursing, but that has largely disappeared. The areas that transfuse most often - ER, ICUs, and cancer floors - are used to the 2nd sample request and will cut us off with a "Need a 2nd sample?" once they hear our voices. If we come across a nurse who is resistant to drawing the second sample (most will calm down when you tell them you just need a couple drops), informing them we'll need an emergency release signed by the doctor instead will usually get them to send us the sample. OR and outpatients work similarly. In trauma situations in which we don't know the patient's name, everything is issued using an emergency release and an emergency blood sample; once we get a correctly labeled sample to perform a T&S on, we'll use the original sample as the 2nd sample. The second sample is listed in our system as an ABO confirm, so we know it can't be pulled to crossmatch on without a full type and screen being performed on it. Our hospital requires a second sample on all patients, regardless of blood type or component being transfused - all except neonates, who get O= blood and AB plasma products.
  23. We recently had a sickle cell patient come in needing transfusion. She had a previous history of a warm autoantibody, anti-S, and anti-A1. The screen was positive, 3+, 2+, 2+. The panel came back 2+ down the line, except the C+ cells reacting 3+. The autocontrol and DAT were negative. I ran a ficin panel and it showed up 3+ for all cells, except the C+ cells reacting 4+. At this point I called it an anti-C and unidentified, thinking it was an antibody against a high frequency antigen. After shift change another tech performed a titer and got a result of 32, with all tubes reading 1+. She called it an anti-C and HTLA. My supervisor agreed based on the results of the titer. The strength in the gel and the fact that it was enhanced in the ficin panel make me wonder though. What do you think? By the way, the patient received at total of 10 phenotypically matched units over the next 8 days, all reacting 1+ to 2+ incompatible in gel, but had no adverse reactions.
  24. Here's a link to an article about the dropped signature requirement. http://www.healthdatamanagement.com/news/Report-CMS-to-Scrap-Lab-Signature-Requirement-41911-1.html
  25. Thanks for all your replies. With regards to my question on irradiating a unit twice, I didn't mean to imply that it was desirable or somehow more effective. I was thinking along the lines of a unit that didn't have a RadSure sticker placed on it, like dpruden and joanbalone mentioned, or if the label fell off. I was able to find an old memo (http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/OtherRecommendationsforManufacturers/MemorandumtoBloodEstablishments/UCM062815.pdf) on the FDA website that said that if a product is irradiated more than once, each instance should be recorded and the total amount calculated (it did not give a maximum amount of total cGy). From that and the guideline nmartin referred to (http://www.fda.gov/OHRMS/DOCKETS/98fr/981218g2.pdf) it sounds like you can irradiate twice, as long as you don't exceed 5000cGy, like vilma_mt said. I have to admit this surprised me... As far as my second question, I checked the patient's history and she was admitted in early August and has only received platelets and E negative blood since she has been here. None of her other workups showed this result. Just out of curiosity, my coworker did an eluate on a sample drawn a week before the one showing the "auto"-anti-E, and I just did one on a sample drawn yesterday, and both eluates were negative. So I'm assuming either she didn't wash well enough or this is the non-specific uptake referred to in the Elukit instruction sheet. I'd hoped the elution I performed would turn up positive so I could try the saline washes, but no luck...
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