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April 2024 Challenge

cthherbal

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Everything posted by cthherbal

  1. cthherbal
    That's correct, Mabel.
  2. cthherbal
    Could the child have been exposed elsewhere (transfused Rh+ in an emergency perhaps at another hospital)?
  3. cthherbal
    We worked it up as if it were a possible delayed. The only suspicious finding was the new antibody that had appeared to develop. We ID'd anti-Jka and had a few cells with extra reactivity. Did not appear to be an anti-Jk3. Reference lab ID'd anti-JKa and HLA antibodies. DAT and eluate (on post-transfusion sample) were both negative. We had changed screening cells between old/new samples but even when we repeated the old sample with new screening cell the Ab screen was negative. Crossmatch on unit (Jka neg) still compatible with both samples. Will have to store this in my memory banks for when it happens again. Thanks everyone for sharing your thoughts!
  4. cthherbal
    An interesting case: 1st time patient: A neg, negative screen. Transfused 1unit leukoreduced RBCs 2/4. On 2/17 a new sample, screen positive: Jka and HLA identified by reference lab. Re-crossed original unit with new specimen (unit was Jka neg and it was still compatible). We repeated original screen: still negative. 30" incubation: still negative. Could this be a immune response causing a resurgence of previously ID'd antibodies? (That were unknown to us) I can't think of any other reason. -Colleen
  5. cthherbal
    I agree with others that 2 identifiers [we use name and DOB (or Med Rec#)] should be there. Name could be John or Jane Doe, and a fake DOB or assigned MR# (if not known). Even though not official, these things identify that blood to that patient even if the patient is eventually ID'd and the two accounts gets merged into one.
  6. cthherbal
    I believe the package insert says if given IV: 1mL per 15 to 60 seconds. So they could give all 3 vials over 3 minutes total.
  7. cthherbal
    We do the same as Mabel. All generalists here in BB and then confusion ensues (do we give A1 neg units, etc.) So for the rare instance this occurs, we give Group O RBCs.
  8. cthherbal
    You could send one of her specimens to a immunohematology reference lab for molecular testing. They could tell you if she was a partial D or D variant.
  9. cthherbal
    We also require QC records and competency records of "outsourced" cell salvage personnel. We keep the competency records on file and review the QC Quarterly at our Transfusion Committee meeting. My understanding is even though it's contracted out, there should still be a policy defining the process and the Med Dir of the hospital Transfusion Service is involved with that policy development.
  10. cthherbal
    Interesting. Thanks for sharing, Terri. Colleen Hinrichsen, MT(ASCP) SBB
  11. cthherbal
    We do the same.
  12. cthherbal
    Currently we do not have a computer system. I started sequestering antibody patient records from our files. Perhaps now I need to do the same for special needs patients as well. We have someone doing our record validation prior to go live. We are going with SoftBank.
  13. cthherbal
    We require 2 separate blood draws on any new patient prior to issuing type specific. We use Blood Bank arm bands. The original type and screen (large tube) has the band # label on it. The 2nd sample is a small tube and the phlebotomist writes the original band # from the patint's wrist on the tube. If emergency blood is needed prior to us testing 2nd confirmation sample, we would issue Group O RBCs.
  14. cthherbal
    Thanks everyone. We are struggling with this. Blood Bank is not computerized (yet) but it's coming. We are a 200 bed community hospital. We are banking on the patient history being correct and up to date on patient's card in the file drawer. When blood orders are placed in the HIS they are required to answer if patient has SCD or is a transplant recipient/candidate (Yes/No responses). These orders print in Blood Bank. Yes/No responses are incorrect (sometimes) possibly leading to patient getting incorrect products if we don't catch it. We are working on better solutions.
  15. cthherbal
    What does everyone do relating to providing blood products for special needs patients (ex. Sickle Cell or Transplant)? Is it physician order driven or is there a process in the Blood Bank so that the patient will receive the correct products? I appreciate any feedback... Thanks!
  16. cthherbal
    So far our transfusion service does no Point of Issue testing of apheresis platelets. How are folks changing practice without adding this test? Here is a link to the bulletin: http://www.aabb.org/resources/publications/bulletins/Pages/ab12-04.aspx
  17. cthherbal
    I had problems trying to validate the 1-6 Indcators too, Kathy. They would start turning pink when we put them on the bag. When I called the company they said put them on while blood is still in frige. That seemed to work. If you keep blood out (even in coolers) for mort then 4 hours, you could get data loggers (some of them are very simple and cheap). They look like flashlights but monitor temp continuously so then you plug it in to your computer (it has a USB connection) and you see a nice graph. This is to avoid a nonconformance by AABB that require temperature monitoring at least once every 4 hours. We keep our coolers out for max of four hours and take the temperature of units returned, regardless of what the temperature indicator says. So I haven't used data loggers but have seen them and they are neat. I think someone said in this post that coolers are exempt from the temperature monitoring. I'd like to see the reference on this as I also was not aware...
  18. cthherbal
    Our system works pretty well, although not 100%. We require the nurse at the end of the transfusion to return the form to BB in person. We then check for completeness, reactions, and sign off if all is well, and give chart copy back to the nurse. If there are any errors, we do not sign off but BB supervisor (me) goes directly to the nursing director or charge nurse for clarification or correction of a problem. For example, we had 4 missing forms for the month of November and a team of nurses then is responsible to go hunting. The slips usually end up on the patient's chart but 2-3 times a year it's entirely missing and we incident report those. Eventually we aim to go to bedside (paperless) transfusions with our upcoming software transition-can't wait (we are currently still on paper in BB and have about 5K transfusions per year).
  19. cthherbal
    Hi, Becky. We use Hollister system also but not for uncrossed units because they are not crossmatched. We set up 2 O neg for emerg release with paperwork attached. If there is a need, everything is ready to go. All we need is patient name, MR# and we issue. Once a week (or after use), we change out the 2 O negs to fresher units. This process works well for us (community hospital) and mimics the process in my previous trauma center experience,
  20. cthherbal
    I am thankful our power is back on but sad for so many of the other NJ residents still in the dark and with home damages. Worst storm I've seen in my lifetime, and we are 25 miles inland from the coast. I hope the Jersey Shore can be revived. It's our livelihood.
  21. cthherbal
    Panel C comes as a two-panel kit, 1-treated and 1-untreated (same donor cells are used in both panels)
  22. cthherbal
    Yes. We do this test still, albeit rarely.
  23. cthherbal
    Ok with me to remove. Thanks, Cliff.
  24. cthherbal
    Hi, Antti, and welcome. I have friends from Tampere, Finland. I hope to get there someday for a visit.
  25. cthherbal
    I have it in my procedure similar to what you supervisor is saying. We only recommend the blood warmer if the Ab is demonstrating at 37. We require a physician order to use the blood warmer. The order can come from the pathologist if the cold Ab is detected in BB only. The only other time a Blood Warmer is used in our facility is for a Massive Transfusion or in the OR.
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