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Posts posted by cthherbal
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We only QC the new lot with the new controls that come with the kit. I don't think there is any requirement to do this crosschecking with controls from the old kit. In any case CAP TRM.31350 states "If there are multiple components of a reagent kit, the laboratory uses componenets of reagent kits only within the kit lot unless otherwise specified by the manufacturer."
Bill
I think I agree, Bill. From what I recall, CAP is more concerned with PATIENT results with old, new lots (no significant variation in result with either lot). I remember it being a pain with urine dipsticks doing lot to lot comparisons. If we don't get Fetalscreen tests for several days or a week, the samples are no longer "stable". Plus we hardly see positive fetal screens (maybe 2 a year). Thanks everyone for the input.
Colleen Hinrichsen, MT (ASCP) SBB
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Do I meet the CAP requirement of QC-ing a new test kit (example: Fetalscreen) at the same time as a patient on 1st day of use? Do I have to check the old lot of QC (pos/neg) with the new anti-D reagent in the kit and vice versa?
I am thinking of when I worked in hematology and we ran a pos/neg patient with old and new kits (ex: Sed rate, FDP). But at my current facility we don't get very many Fetalscreens so I don't think I could accomplish this, as long as we are not combining kits of different lots?
Any input is appreciated...
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Thanks everyone. We are staying with the Provue for now...
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Wow. I can't believe you posted this. We had the same exact thing last week. Eluted anti-A1 from A neg patient. We were also getting incompatible crossmatches on a sample drawn 4 days later. Assumed patient had developed anti-A1. Pre-transfusion (of 2 B neg SDPs) sample patient type was A1 pos (4+). We assumed the anti-A1 was from a high titer in the SDPs of anti-A1 (both platelets from same donor). I found out that pt also received IVIG same day as platelets. So although still a passive anti-A1, probably from IVIG!! Thank you. Always something new to share on this site! Oh I should add O crossmatches were compatible, so that's what we are giving.
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Thanks so much for sharing, Terri.
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pbaker: We are hoping to start something similar as well. Reducing critical Hgb call value from 8 to 7 we think will help the "trigger" physicians use to order blood. Spoke to some other hospitals in our region and we are catching up to what they've already been doing for years. One hospital saved over 1 million in blood costs in 18 months by just making this one change. We are getting some resistance from our docs but we hope to push this through our transfusion committee but also the Medical Quality Council.
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I agree with the others. I dropped my individual membership because I am the AABB institutional contact as well.
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bmarotto: Our hospital also uses SCM and we get all the printouts in BB. Believe it or not, our blood bank is still "manual" but we are in progress of bringing SoftBank live this year. How is your experience with SoftBank?
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We had a real incident a few weeks back where there was a terrible school bus accident. 17 children were injured, 1 unfortunately died. We are not a trauma center, but received 10 patients in our pediatric ED. Luckily none of the kids needed blood but we were on the alert just in case.
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To streamline our process, I have the Tranfusion Medicine Med Dir review/sign all changes, then it goes to Lab Med Dir (CLIA) for 2nd signature. Seems to be working well.
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We are in the process of transitioning our factor concentrates from Blood Bank to Pharmacy. Do any of your hospitals require a blood consent for factor products, or is it handled like a medication?
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We have been noticing it sporadically as well. All have repeated normal in tube. I better keep a closer eye on it.
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We use Streck red spirit, works well. It does require an MSDS.
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The instrument manual should contain all this information for closed mode and open mode sampling. It should be in section about specimen requirement and preperation. Who told you that "mixing studies" are necessary?
There is a section in the manual that comes with the instrument. I believe it's a CAP requirement. You are essentially showing that whether the specimen is auto mixed by instrument, rocker mixed, or hand-mixed, the results are the same (statistically).
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We had an interesting case today. Patient is B pos with a neg Ab screen. ABO discrepancy in reverse (B cells 1+). Initial testing on Provue (gel). Repeated in tube, no discrepancy and Ab screen neg all 3 phases. Did 4 degree incubation, all 3 SCs pos with neg auto control. Two group O cord cells neg at 4 degrees. So I'm calling it an anti-I but all the other anti-I's I've seen we're auto anti-I's. Any other thoughts?
I should have mentioned that patient had similar results last visit.
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We use 10 day prior to surgery for PAT patients. Sample expires 3 days from surgery. I have also worked at a hospital that used 30 days because they validated storage- that the same type and screen results were obtained day of draw as 30 days later.
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Thank you so much tcoyle for posting this. I am glad others feel the same way as me when it comes to event reporting. Many
issues have been identified and fixed but it seems there is always something- in our line of work you can never sit
on your laurels. I wish other areas of the hospital were as good as the lab in Root Cause Analyses, or if they could respect the level of regulatory rules we have to deal with.
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Thanks everyone for your thoughts. It could just be my perception because I have used Galileos in the past, and I don't
remember having nearly as many HLAs as I see now detected in Provue/gel. Yes I have seen the CAP reports and I'm not so
much concerned with performance of one over the other.
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We currently have a Provue and are considering switching to the Echo. I am looking to hear your thoughts if
anyone has already made the switch. Any additional comments on why you would or wouldn't switch.
Our main reason for considering a switch is reagent cost.
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At a large University Trauma center where I worked we verified our cooler validation temps annually.
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Brenda: Were you able to find an answer from the FDA? We are struggling with revising this procedure at my facility. We are not FDA registered and have probably done 2 WB exchange transfusions in 15 years. I would like to validate a procedure where the neonatologist can use separate products (charter med makes a 2 or 3 syringe/filter set) that would run into one line. As long as the calculated volume was correct (we give entire bag of RBC and FFP), and neonatologist determines how much of each to run, product goes through a blood warmer and an infusion pump, into one infusion line into baby. In theory it sounds like it would work, but I'm not sure if its breaking rules with the FDA to do this. Of course we would fully develop the procedure in conjunction with the neonatologist who would actually be performing the transfusion.
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I have used the Biohits before. They were easy to use but if dropped a few times, did need some repair.
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We use Rhophylac (patients and nurses love the IV capability) and pharmacy profiles each order electronically just like any other drug for possibility of interactions or contraindications. Our orders are linked in the HIS in that Pharmacy and lab see their orders separately but they are a part of the same order set.
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I am curious what other hospitals do for RhIG. Do you require a separate physician order for the injection itself or just give it out due to the result of a positive Fetalscreen or RhIG testing workup?
transfusion medicine automated survey
in Accrediting Agencies
Posted
Same with us. Only test what you normally do with automation. If you call CAP they will tell you the same.