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About Kathy

  • Birthday 02/18/1969

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    Chief tech - blood bank

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  1. The patient stated that he has NOT been transfused anywhere in the past 3 months.
  2. Thank you. Our transfusion director has spoken with the patient's physician and requested a peripheral smear, but I don't see any mention in the chart about suspicion of relapse. The patient is an outpatient with cGVHD who comes in for photopheresis.
  3. Is there anything I can do to resolve this? Would adsorption and elution be helpful?
  4. Thanks for the input. Very good information. The patient's physician is investigating a possible relapse. The suggestion that the patient may have been transfused elsewhere is a good one, but it wouldn't explain the strongly positive D typing, which is that of the patient's donor. A relapse would involve both the ABO and the Rh types, would it not?
  5. We have a patient who is now typing as A positive (2+ with gel and tube in the forward A type, no mixed field, 4+ with anti-D, no mixed field). This patient was originally A negative and had a bone marrow transplant in 2010 from a type O Positive donor. The patient fully converted to a type O Pos forward type as of 2015, but never made anti-A (this happens, I understand, so I'm not concerned about it). I would maybe think the patient was relapsing to his prior A blood type, but that does not explain the D+ typing. I would expect to see mixed field reactions if the patient was relapsing as well. I did run his cells against the plasma of three type B patients, and the result was negative. I typed his cells with 5 different anti-A antisera from 4 different manufacturers, three of which gave positive results and two were negative. I did not test with A1 lectin. Any idea what is going on here?
  6. What is the prevailing thought regarding the quality of platelet products stored with bubbles or foam? I found two articles that concluded that "storage with air bubbles/foam causes considerable enhancement of disintegration of platelets".
  7. We definitely see the specks as well. We got the 'upgrade' a few weeks ago. It's great that we can now put half used IgG cards back on the instrument and we can change QC results, but we are having worse problems than ever with the instrument not knowing what to call things or calling them 1+ when they are really negative. We have verified the 1+ reactions as negative with manual gel testing.
  8. You can't change a QC result because that's how the Ortho people programmed the instrument. You are allowed to change patient reaction results. The software update will allow users to change the QC result.
  9. This does not answer the original question, since we are interfaced with Softbank, but I am going to warn you to the potential problems that are in store for you: We have had two of these instruments up and running since August. Here are the problems we have: 1. QC is a pain. Half the time it does not pass because the instrument can't interpret the image. You can't change the result, so you have to rerun the QC. Sometimes you have to rerun it multiple times. It can take half the day just to get the QC to work and there have been times that the QC has timed out on both instruments and we have had to resort to manual testing. Not good for a busy hospital like ours. There is a software update in the works that will allow techs to manually interpret the image, but I feel this is a bandaid on a bigger problem, which is the sensitivity of the instrument to artifacts (see below). 2. The instrument is extremely sensitive, so even dust will cause it not to be able to interpret images. Techs manually have to change the grade. 3. After centrifugation of the cards, we will sometimes see streaks of cells up both sides of the well, but not in the center. The instrument will interpret this as positive, but we have learned through experience that if we repeat with manual gel testing, it will be a nice negative result. We never saw this happen with the ProVue and I wonder if it is a problem with the centrifuge. Perhaps if it used a balance card, we wouldn't have this problem. It's just my theory. 4. You can't put partially used cards back on the instrument. It causes a lot of waste. Also having to repeat QC so many times is wasteful. 5. Aside from the above problems, we love the instrument.
  10. Thanks. I need to make 0.2M DTT, but I need to make the PBS first. I ended up ordering this PBS with pH 7.3: http://www.lonza.com/products-services/bio-research/cell-culture-products/reagents/buffered-saline/pbs-without-ca-mg-or-phenol-red.aspx and this DTT: http://www.gelifesciences.com/webapp/wcs/stores/servlet/ProductDisplay?categoryId=11093&catalogId=10101&productId=22063&storeId=11787&langId=-1 One of my coworkers found an SOP that calls for adding 1 g of DTT to 32 ml PBS. When the chemicals arrive I will try that and check the pH. Unfortunately, we don't have a high-accuracy scale for weighing dry chemicals, so I needed to order the everything as much pre-measured as possible. Stay tuned....
  11. Does anyone have a recipe for making the DTT solution for treating RBCs? The AABB Technical Manual says to "prepare 0.2M DTT by disolving 1 g of DTT powder in 32 ml of phosphate buffered saline (PBS), pH 8.0". I cannot find a source of PBS with a pH of 8.0. Do I need to buy phosphate buffer with a pH of 8.0, add it to saline, and then add the DTT powder?
  12. I spent 24 years working in 2 pediatric hospitals with level 3 NICUs and can count on one hand the number of times I or any of my colleagues did the procedure. I doubt there is any hospital that does a lot of them. For competency, you can save up expired RBCs and FFP so that you can do a direct observation. Make sure their final product has the target hematocrit. I would also make a thorough written quiz for assessment of problem solving skills.
  13. There are no cost effective disposable temperature monitors for platelets that you can stick on the units that I am aware of. I know that Berlinger makes something that you could have custom made for the 20-24 degree range...cheapest would be about $10 each (Q-Tag, I think), so a bit pricey. I think the best option is to validate coolers for platelets - you can beef up a standard cooler with Styrofoam, room temp gel packs, etc. and then use a temperature datalogger in the cooler - preferably with an alarm. I like the Traceable Memory-Loc ones because you can transfer the temp data on USB if needed. I want the platelets back ASAP... CAP says something about not being agitated for up to 24 hours is acceptable, so you will want to define how long it is OK to be out of the blood bank in your SOP.
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