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SMILLER

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SMILLER last won the day on May 25

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About SMILLER

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  • Birthday 08/10/1958

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    Medical Laboratory Scientist
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    Saginaw, MI, USA
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    Generalist, mid-sized level 2 trauma center

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  1. We use the Ortho confidence system with manual gel. We have found that a dilution of 5 drops of Ortho diluent plus 5 drops of 22% albumin plus 50 ul of confidence sera works pretty well to produce 2+ to 3+ reactions. Scott
  2. From our experience, both negative and positive reactions should give a reasonable clearly delineated button after 15 seconds or so. (If you spin patients for 2 minutes, I would think that you would end up with a lot of "snotty" false positives!) Is your centrifuge running at the correct centrifugal force? Is it vibrating too much? You may want to try the process with another centrifuge just to see if there is something wrong with what you are working with in the Blood Bank. Scott
  3. We allow other areas to change BB armbands. We have a form for that that is returned to the BB so we can make the proper adjustments to the specimen ID, tags, computer, etc. Scott
  4. Signature each admission. After discussion, this is usually done by a hematologist. (It is really not that big of a deal "bureaucratically" for us. Perhaps large medical centers have more turf issues with this type of thing.) Scott
  5. With a few exceptions, only Lab phlebots draw BB specimens here. And we have our own BB armbanding system. Scott
  6. Of course. There is no link between a previous admission and a current one that is reliable enough to allow for transfusion of any product without at least confirming the ABO/Rh. We have even had a few patients who have been admitted with a friend or relative's ID in order to piggy-back on insurance! Scott
  7. I do not think there is any way to always avoid WBIT. If a particular error in patient or specimen ID can be made once, it can be repeated. What a second specimen does is verify that the two specimens are the same ABO/Rh--which is good enough to avoid an ABO acute hemolytic transfusion reaction. Using a BB armband P&P properly will assure you that the blood you are testing and the patient it is being tested are the same--even if the patient ID is wrong. Scott
  8. We do not test a different specimen. Currently regulators in the US only require a second ABO test (in order to release "electronic crossmatched" units). We test the same specimen twice, unless we have a previous record. However, we DO use a BB armband specific for BB specimen draws and transfusions. The phlebotomist applies it and it must be used when ordering, issuing and transfusing blood products. Scott
  9. Malcolm, if you have a minute, I am interested in any observations you have regarding the National Whole Blood Summit 2019 thread.

    Thanks, Scott

    1. Malcolm Needs

      Malcolm Needs

      I'll have to read it Scott.  It has largely passed me by.  It may have to be tomorrow now though.

    2. Malcolm Needs

      Malcolm Needs

      I've had a look at it, but not a detailed look.

      I think I understand Dr Neil Blumberg's argument vis-a-vis ABO immune complexes being lethal, BUT, basically, I think here we are talking, largely, about giving blood to get people to the hospital before they die, and then giving them the best we can/idealised treatment, rather than trying to give them idealised treatment at the "roadside" (or wherever the life-threatening injury takes place), in order to keep them alive long enough to get to hospital; and there is a big difference between the two.  Certainly, it has been shown that there is a big difference between the way a blunt trauma injury is treated than a sharp trauma injury is treated and, as a consequence, the 1:1:1 red cell/plasma/platelet ratio (or near to that ratio) is not necessarily the best for all incidents.

      To a certain extent, I am very glad that 1) I am not a clinician, and so the decision will never be mine (particularly as statistics is a branch of mathematics that is even worse than most other branches of mathematics in what I can either understand or do!), and 2) that I am retired.

      The whole thing reminds me of the arguments concerning the use of clotted samples, which were used universally, when it was thought that detecting haemolysis and complement activation was essential, as opposed to the use of EDTA anti-coagulated samples.  There was a huge kick-back against the use of EDTA because antibodies may be missed, but, eventually, the statisticians got involved, and showed us we were talking nonsense, which then allowed us to introduce automation and, as a consequence, transfusion with minimal human intervention (hence fewer mistakes, particularly as machines do not get tired).  However, that does not mean that transfusions are without dangers - particularly in cases involving, for example, anti-Vel and anti-Jka.

      It seems to me that, at the moment, "you pays yer money and you takes yer choice!".

      As I say, I instinctively have sympathy for Dr Neil Blumberg's viewpoint, but I feel that we still need more evidence.  Meanwhile, I know for a fact that the HEMS in the UK are delivering more live patients to a hospital alive, using packed red cells and tranexamic acid, and these patients are surviving and staying in hospital for shorter periods, and using fewer blood components during their stay than before we used anything - when patients died on the spot.

      I have no idea what is best, but there is no doubt that we are doing better than we were.  Dr Neil Blumberg would not have so many patients to determine his statistics (and he may well be correct - don't get me wrong) if it were not for the fact that many more patients are getting to the hospital alive these days.

    3. SMILLER

      SMILLER

      Thanks Malcolm.  You may want to post your thoughts on that thread.  I would be interested on how Dr. Blumberg and others would respond.

      Scott

  10. Agree! I am optimistic that as the data gets discussed more at various conferences and seminars, that we can move on to improvements on the supply side for those facilities who do not have the luxury of running their own donation service. Scott
  11. We are a trauma-2 hospital in a reasonably populated area in mid-state Michigan. Our hospital has 270 beds, and is busy with a number of neuro and CA patients, along with an open-heart program. There are two other hospitals nearby who are also busy, but not nearly as busy as a big medical center like U of M in Ann Arbor. So we have these utilization issues. I wonder how many other hospitals have the same limitations. We already have problems (like in December) of obtaining any platelets at times, much less ABO matched. We normally only keep one 5-pack on hand for traumas, and we take what we can get, with the only exception being for females of child-bearing years. Citations are not going to fix this no matter how good an idea it may be. Scott
  12. We still do this once and a while for autologous WB units. But if you have to enter the unit to split it, then that cuts the outdate down to 24 hrs. You would have to be sure to have satellite packs for WB units. As far as the "salvage plasma", you can simply fractionate it and use it for gamma globulin! Scott
  13. I don't think so. It's not like charging for a antibody ID after getting a positive screen. It would be more like repeating a charge for, say, a potassium because the analyzer failed on running it the first time. So I would say no, you cannot bill again. Scott
  14. From Neil's post above: "ABO type platelets and so-called "universal donor" AB plasma for all patients is highly toxic due to formation of ABO immune complexes in every patient we give this cocktail to" Is there any data on this? What ABO immune complexes are being formed from the transfusion of O pRBCs and AB plasma (which is the typical way to treat bleeding trauma patients)? Interesting concepts though, even though some of the "data" in these articles is a mixture of speculative opinion and retrospective study results from rather small cohorts. It will be interesting to see how this progresses! Scott
  15. We had situations like you describe a few years back. Now checking the Blood Bank (and hospital) armbands are part of the "time-out" check-off before the patient is strapped to the table. The ID info on the bands are recorded so it is available at all times during the procedure. Scott
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