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SMILLER last won the day on May 31

SMILLER had the most liked content!



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    Has been around for a while
  • 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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    Criteria for Pathology Review

    Is your pathologist in charge of all of the labs in question? If so, it should be relatively simple (depending on the initial cooperation of the pathologist/director) to come up with criteria. Once he or she signs off on a set of standards, it will be your job, as a coordinator, to get all the techs on board with it. Start by sitting down with your pathologist and find out what they feel should be submitted. Then write up a preliminary policy. Keep in mind that it needs to be comprehensive but straight-forward enough so as not to boggle the techs at the various facilities that will have to follow it. (Ours only takes a few pages -- we also have it boiled down to a single-page "cheat sheet" that is posted in Hema areas.) Then take it back to the pathologist for final approval/revision. Follow up with the associates. If some of the techs are under other managers, make sure you get buy-in from them before you start education. Scott

    Transfusion of Visibly Bloody Units

    I suppose depending on how the unit was held by the courier, a leaky segment could indeed be the culprit. Scott

    TRM.41350 Compatibilty Label/Tag

    We are using Mediware's HCLL in the BB. In general, ER will know through field triage what is coming so that they can use the registration system and give us a name/MR before the patient arrives. It takes about 10 minutes to order and print tags for a "initial resuscitation" cooler of 2 O neg RBCs and 2 AB FFPs. We are a level 2 trauma center so it is important that a patient can be registered before they arrive. Like many facilities, we always have at least two AB thawed units of AB plasma on hand along with a 5-pack of plts, in addition to the O neg RBCs. Scott

    Thawing Plasma

    We have a back-up procedure to use warm tap water - monitored by a thermometer. And we have found that the larger units of plasma do indeed take 35 minutes or longer to thaw. Scott

    Transfusion of Visibly Bloody Units

    Whatever the cause, I do not think the unit should have been hung in that condition. I would think that, at the least, the RN hanging the unit would have checked with the BB or a supervisor first. Scott

    TRM.41350 Compatibilty Label/Tag

    I think you need to follow the advice in the CAP response. How does your ER ID patients when they come through the door? They should already have downtime procedures for patient ID (as well as a John Doe ID procedure). I believe our registration system assigns a new MR (Medical Record) number if there is no other admission on the system. For John (or Jane) Doe names, we simply use a system that reflects the year and "Doe" number (Doe2018-14, John). So our two identifiers are at the minimum the name and MR number. Practically, we require a birth date for history purposes as well as date/time, etc. I would think that you may want to start with ER and find out what they are doing down there for ID on these types of patients. In the US, you MUST h ave two Identifiers for everything. Scott
  7. If I am reading this correctly, it seems as though you have a number of chronic problems there, In the US, I would think your lab would be in violation of a number of standards. Who are you regulated by? Those are your MINIMAL guidelines. In addition to following those standards to the letter, your facility will need to address some other things, like--why are you seeing WBIT and specimen mislabeling issues? Your problems seem to go way deeper than whether or not the work is checked after it is finished. Scott
  8. Regulatory requirements are pretty strict. I would think that if you are following those, what you are doing is safe (and you have given us very limited information) . Scott

    ORTHO gel cards

    It may be seen as modifying Ortho's method, which means you would a have to have a great deal of data to validate it. On the other hand, if you can get Ortho to state that it is equivalent to their centrifuges (which may actually be made by Diamed!), then it seems like it would be OK. Scott

    Therapeutic Phlebotomy - H and H limits

    We do therapuetic phlebotomies here at our hospital from time to time. For patients with polycythemia, we check the H&H just before the procedure. (For hematochromatosis, we also check ferritin.) The patient is then processed or deferred based on those results. I would say in both cases, if a phlebotomy is indicated by the lab tests, that is still going to be valid for some time, maybe even weeks. i don't think blood counts are not likely to drop by themselves in polycythemia, and likewise iron levels are not going to drop. You need to have you administrator establish a clear policy in any case.. Scott
  11. Sorry Malcolm, I was distracted by a problem that I was having with a computer crossmatch whilst posting last... Scott
  12. Same in the US. 4 hours from when it leaves monitored storage. Pretty sure that is clear from the regs. Scott
  13. So in that case, the point of the article seems valid. Perhaps enzyme-treated panels (and screens?) should be run routinely by transfusion services (hospitals), not just on those "problem specimens" sent to reference labs. It might be treasonable to run on patients known to be negative for things like Kell or Kidd antigens, and to have been transfused in the past? Scott
  14. So it makes me think about delayed hemolytic transfusion reactions. If these "enzyme-ID'd-only" antibodies are due to a low titre, can we say that they are insignificant? If a Jka antigen negative person has been exposed to Jka, and has a titre so low that it cannot be picked up with a regular gel screen, does that mean a DHT is unlikely? Or, in spite of the initial low titre, can those nasty memory B-cells crank out enough anti-Jka in the hours or days to come to cause a DHT? Thanks, Scott
  15. The AABB Circular of Information for the Transfusion of Blood Components requires blood products to be transfused within 4 hrs. We do monitor this is and write up cases where the 4 hour limit is exceeded. Scott Scott

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