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Everything posted by janet
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Does your facility change Blood infusion tubing/filters after a set number of units or specific time period?
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We require a blood type for this admission for plasma only. Platelets we require a group on file. We don't keep a big supply of platelets so usually whatever we have is what the patient gets....often ABO incompatible.
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Our L&D has always collected cords into EDTA and plain clot. We have always done our DAT's from the EDTA and though it often has clots there has been no adverse effect on our results. Since we have gone to EDTA for all our blood bank testing we thought there was no need for the clotted sample anymore but they do still draw it in case viral testing is determined to be needed later.
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Is this free?
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We've been using the gel for 4 years now, cold agglutinins have a distinct appearance-almost like a dual cell (my theory is that some antibody attached to the cells while at room temp., then as the suspensions warm on incubation agglutination stops or comes off. So you get some reacting near the top of the gel 3+ appearance but a cell button at the bottom.) We will prewarm using the Ortho method but sometimes if it is a strong cold agglutinin it only helps a bit (since there's no way to warm the MTS centrifuge during the 15 minute spin!!) To clear it up completely we go to the full prewarm tube method where we wash with warm saline, etc....never letting it cool down from 37C. We have had a few anti-M's reacting in a line across the side of the gel (almost like the card wasn't seated right in the centrifuge!!) Other than the Anti-M's we rarely get Lewis's and I only recall two Anti-P1's in the four years.
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Our reference lab is unable to autoabsorb after the patient is transfused. How are others who do autoabsorptions capable of doing this? Do you use donor cells phenotypically matched to the patient's? That is my reasoning for giving phenotypically matched....if you haven't stimulated them, they can't make it!
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We have the same scenerio.....we are transfusing phenotypically matched (or as close to as possible) so we are assured no antibodies are produced. We do the full work up every 3 days (more when the patient is not in a crisis episode and not requiring daily transfusions). I have asked the same question, 'why am I doing all this work when he still reacts with everything'. It just makes me feel better to know if something happens I went throught the motions and found nothing was different.
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By Cliff's reply I would assume that if you think the patient is hemolyzing (I guess you would know if hgb did not rise, icterus, etc???) the phenotypically matched units the lab should forget trying to avoid making allo-antibodies and give units that won't "feed the fire" anymore?? I have read much literature supporting phenotypically matched units in auto-antibody cases but I guess this kind of goes against all we try to do when we identify an antibody (give antigen negative units). Without the ability to do auto-absorbtions after transfusing how could you know you won't make matters worse causing the patient to make allo-antibodies? How would you know which route to go??? Look for those signs of hemolysis then go for the antigen negative units?
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What about the literature that supports giving phenotypically matched.....does anyone else agree with this philosophy?