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Posts posted by mollyredone
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On 7/27/2017 at 4:53 AM, BankerGirl said:
We do the same as CSP0102 unless the physician specifically orders one, usually if the baby is jaundiced the next day.
So how long do you store the cord blood? How long are they good for refrigerated? Do you get cord bloods on all babies? We would like to quit performing ABO and DAT except for O moms and Rh neg moms, but have a sample as above in case the baby is jaundiced.
Thanks!
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3 hours ago, Kathyang said:
We only get bags back for transfusion reactions
Same with us. Then we have the bag if it needs to be cultured. Doesn't work for delayed reactions, but I would question the suitability of culturing a bag from several days ago.
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We don't have bags returned to us. We take off 2 segments when we retype the units and save for a month, 1 week in each bag. It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.
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On 2/23/2018 at 9:01 AM, KKidd said:
The antigen types on our unit labels are not barcoded. CMV negative attribute is, but we cannot read the barcode with Meditech.
We have Meditech Magic and we can scan the barcode for CMV negative and it is accepted.
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2 hours ago, David Saikin said:
sounds like your negative control is really not controlling anything. If you are using antiglobulin reagents then you should be adding them to you negative control and expect a reaction with check cells. If you qc your reagent daily there should be no reason to run a negative control with each test (i.e., you've tested the reagents with a positive and negative system). For my C-3b,-C3d testing I run my A2 cell as the negative control of the antisera; C3 sensitized cells are the pos control, run w the antisera. I do this testing in gel.
David taught me this! We switched to gel for both IgG and complement DAT and use the buffered cards for complement and require QC with every patient test to verify that the anti-sera was actually added, using A2 cells and complement check cells.
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As Eagle Eye said, check into low titer A plasma. We use it for all our massive transfusions and emergency release, in the form of liquid plasma. They have quite a few studies done (including over 8 years at Mayo) with using A instead of AB. And of course stress patient blood bank specimens ASAP. We actually quit carrying O plasma since it was outdating and use A instead. But we have very few "real" MTPs.
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We have a form to fill out and usually have the tech repeat the test and comment on anything that might have caused the problem.
This is a copy of our form.
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5 hours ago, Eagle Eye said:
we do not write on unit. Our staff runs report from LIS and all our antigen negative units are on one shelf (~20 at a time) .
Do you have Meditech? I saw a place I could print a list putting in specific antigen typings, but it prints one page for each antigen and blood type. Kind of tedious.
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On 1/19/2018 at 12:35 PM, Brenda Hutson said:
In my experience, there have been a few occasions through the years where "added" labels (i.e. Antigen Negative; CMV-; Sickle Cell Negative; Unit Number labels on back of bags) get stuck onto a unit that they are stored next to. Obviously, it would be very dangerous to have a unit with an Antigen status that did not belong to that actual unit.
I understand what you're saying. It has happened here as well. But we also document unit status (CMV, HGB S and antigen typing) in our LIS, so it would be caught when the unit was being crossmatched. Do you not do that at your facility?
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Our nurses use TAR. They scan all four barcodes, so they also scan the product code. We try not to crossmatch units that have the same DIN to the same patient.
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19 hours ago, Brenda Hutson said:
This is not an "exciting" question....but just wondering, does anyone out there know of a commercial label for Antigen Typing (to place on the unit) that has a space provided to write the Unit#? We could get some specially made, but that would be expensive; so just curious. I know we had one at a previous place I worked at many years ago, but not sure if they made those themselves?
Brenda, why do you need the unit number on the label? You are attaching the label to the unit, correct? We have red antigen positive labels and green antigen negative labels. We also document in the blood bank module that the unit is P/N for an antigen. That way if there is a label that comes off the unit, we can still see that the unit has been tested and verify it in our antigen testing log. I have found that attaching the label to a little bit of the whole unit label helps it stick on better.
- David Saikin and TreeMoss
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Ditto what AmcCord and Tricore said. The medical director's name is on every result. If he/ she is unconcerned that is a very bad situation!
- BBK710 and Malcolm Needs
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That's an awful situation! I have had to retrain several techs who made mistakes. How long do you usually train them? I would document everything he does wrong. Does your procedure state that you have to put your results in immediately? Ours does, since that is what CAP requires. What's worse is that your higher ups aren't alarmed by your observations. If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.
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We have Meditech Magic and I believe only "Super Techs" or supervisors can edit the BB specimen expiration. It's under Requisitions, LIS menu, and 29 "edit BBK specimen expiration. I don't do it often because we are a small hospital, but if the patient has been admitted for surgery and hasn't been transfused/pregnant in 3 months, and then needs blood, I will extend it for a couple of days. I have to admit I haven't tried it with EXM though. I'll have to try that.
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We don't usually crossmatch before antigen typing, but we charge for every antigen typing, positive or negative. Use judgment-don't antigen type 10 units to find one K-negative unit. We also charge if there are multiple antibodies-3 antibodies, 2 units is 6 antigen typing charges (at least).
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On 12/26/2017 at 6:02 AM, JLF said:
So if the patient needs an extended/Coombs crossmatch, how is the ABO incompatibility being demonstrated? Is the LIS validated to combine an electronic crossmatch with an extended/Coombs crossmatch (this is usually no), does the antiglobulin test detect ABO incompatibility (this is usually no), or do you need to do an immediate spin crossmatch?
Our computer system is validated to detect ABO incompatibility before we do any kind of crossmatch. If I pull out an A Pos PRBC for an O Pos patient and scan the unit, Meditech will tell me the unit is not ABO compatible whether I am performing an electronic crossmatch, immediate spin crossmatch, or an AHG crossmatch.
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We also allow phone orders for emergency release and get the paper signed afterwards. The only time we insist on a signature before issuing is if we know there is a problem with the patient, known antibody and no screened units, etc. We feel this is important enough to have the paper already signed so the doc can't say, Oh we didn't know there was a problem... That form is called the High Risk Transfusion form.
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We are inspected by CAP. Everywhere else in the lab QC, surveys, competency etc. only need to be kept for two years, but it is 5 years for blood bank.
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Thanks! I wrote my EXM procedure so I listed criteria where the EXM is eligible (as well as a flowchart for tech use) and then listed all the computer system alerts that pop up if the criteria is not met.
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49 minutes ago, Malcolm Needs said:
2) (Tongue very firmly inserted into cheek) how would sending down a med tech to the ER help, if you keep your platelets on ice?............................SORRY.
Oh You!! ER did return some platelets on ice not too long ago, with the whole massive transfusion pack of 4 PRBCs, and 2 FFP! Obviously not needed!
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We do all DATs in gel. We do baby DATs by washing the cells, spinning to concentrate, taking 10 ul in 1 ml of MTS buffer, adding 50 ul to an MTS IgG card and spinning. We do complement DAT by the same method, using a buffered gel card, 50 ul of 0.8% washed cells. We always run a positive and negative control, since we want to make sure we have added the 25 ul of anti-C3b, C3d to the card. Otherwise everything will be negative!
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When we had our shooting here two years ago, we just handed out emergency release OP and ON PRBCs to the ER. There was no documentation regarding these units, and we still don't know which patients received which units. They did not ask for blood for a certain patient, just that they needed units. One doctor charted that he gave a unit of platelets to a patient-we didn't issue any platelets.... To comment on Carolyn's post, if we have another mass casualty, we will send a med tech down to the ER with the products in boxes with ice, and the tech will coordinate with the nursing supervisor to make sure when we hand out a unit that a sticker gets put on that patient's chart.
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2 hours ago, Kathyang said:
When we order antigen testing, we don't re-test the unit. We do order historically tested units from our blood supplier and then we test it.
That's what we do as well. If the unit comes from the supplier with an antigen test result on a separate tag, we do not retype it. We also get a historical database from our supplier to test our own units.
In Vivo Hemolysis
in Transfusion Services
Posted
I even have that section bookmarked in our book. It can help explain a lot of reasons for a DAT to be positive.