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SMILLER last won the day on August 18

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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    Repeat Antibody Investigations

    Right, good point. The previously ID'd antibody does NOT need to be "reproved" (even if it is not showing up you will be screening units for it anyway). But any newly developed (i.e. de novo - Spanish for "not vocal" BTW) must be ruled out each time. Assuming they do not exist because a screen panel of 2 or 3 cells "matches' previous screen results just isn't adequate as far as appropriate "additional testing" that "must be performed". Scott
  2. We have three "uncrossmatched" orders: uncrossed RBCs (which would include an indication of quantity), an "initial reforestation cooler" (of 2 unxm'd RBCs and 2 AB plasmas), and an order that initiates a Massive Transfusion Protocol. The MTP order stands until it is cancelled--we keep sending sets until then. Once a clean T&S is done, the MTP sets will be crossmatched product if at all possible. Scott

    ABO Retype

    I think that originally in the US, (before a senator's wife endured a tragedy after a false-positive pap smear was reported by a 50-paps-per-hour histology aide causing the birth of CLIA) labs were sort of self-regulated compared to today. CAP and JCAHO for labs in general, AABB for blood banks, FDA for certian services, etc. So that the AABBs standards were, and still are, thought by many as de rigueur for any inspection organization as far as Immunohematology goes. But that doesn't mean they copy or follow AABB standards precisely -- US federal CLIA standard requirements are not as comprehensive as AABB (or CAP standards for that matter). Scott

    ABO Retype

    Right. My sense is that the standards for a particular inspection agency, like JCAHO or CAP, are specific for that agency, and those are what your facility is inspected by. Having said that, I believe that when a Blood Bank area is inspected (in the US at least), the particular agency's standards are based on AABB guidelines. (Likewise ALL agencies must follow, at a minimum, CLIA legislative requirements for all areas of the clinical lab.) Scott
  5. This is pretty much exactly what we do and neither the FDA or JCAHO inspectors have a problem with it. Scott

    Repeat Antibody Investigations

    If I am reading these responses correctly, I would suggest that it is at least possible that there could be a weak developing allo-anitbody that would easily be obscured by a 'mere" 2 or 3 cell screening (that has positivity that matches the previous sscreen). In which case, just because a new positive screen re4activity matches the previous one, one cannot rule out other newer significant antibodies, as you may be able to do with a full antibody ID workup involving panels. Getting back to the original posts, we would attempt to have the patient phenotyped to start with. Then for transfusions, we would only give those phenotypically-matched units. As long as we keep this up, we can be reasonably certain that no new antibodies are going to sneak in (as long as we are the only facility transfusing the patient!). This is the approach we try to take for particular patients with multiple antibodies, warm autos, Daralex patients etc. Scott

    2 cell verses 3 cell screen

    I do not think that it's really that hard to get consistent results from tech to tech with tube testing. But it requires adequate training and oversight, just as you need for automated testing, in order to provide appropriate patient care. Interesting note above about platelet-poor-plasma and gel though. Scott
  8. Reverse ABO typing, and IS crossmatch. Scott
  9. We have had this done from time to time. Like David's facility, above, the surgery department has a procedure that leaves the blood bank out of it. Scott

    High MCHC

    Not a bad idea! There are a few other things that could be gone over as well, like why one has to do a smear review when you have a high neutrophil or RDW. I believe our Hema manager actually included questions like this on our last annual competency. They try to ask about stuff that associates are slipping on. Scott

    High MCHC

    The problem we have here from time to time, is that we will have something like an obvious iron-deficiency anemia where the MCV, MCH, MCHC are all low, as you would expect. But when certain techs (who should know better) see that H&H check fail flag, they immediately incubate the specimen at 37, thinking this will correct "something". It is a waste of time, of course. So that with many pathological conditions, the H&H "rule of three" is supposed to fail, and further manipulation to "correct" the H&H fail flag is not indicated. Scott

    High MCHC

    OK. But I would say that results for MCH and MCHC are different because they are measuring two different things. And I am not so sure that using the "rule of three" or "H&H check fail" to check results is very useful when we can just look to the indices for troubleshooting. For example: I see the MCH as the Mean Cell Hemoglobin, that is: the total amount of hemoglobin in the cell (NOT the concentration of Hgb). So for high MCVs, the MCH will tend to be high, and for low MCVs, the MCH will tend to be low. The MCHC, on the other hand, is the Mean Cell Hemoglobin Concentration. Cell size, by itself, does not matter here. However, consider an iron-deficiency anemia where not only are the cells small (low MCV and MCH) but the concentration of Hgb is also low, which will result in a low MCHC. However, the concentration of Hgb can only be so high (no more than 36 or 37), as it is physically impossible to have a higher density of Hgb beyond that. (Again, the MCV or MHC is not the issue here.) This is why when one has a very high MCHC you have to try to resolve it. Too much lipemia skews hemoglobinometer results upward, resulting in a higher Hgb and no change to the RBC or MCV. Cold agglutinins skew the RBC count downward, with no change in Hgb. In either case, if you do the calculations for MCHC, you get a impossibly high result. Scott

    body fluid

    Generally just CSFs for RBC counts. But a physician here can order a "miscellaneous body fluid cell count" that would include RBC, WBC and diff (no reference ranges, and since the counts are done on a hemacytometer, we can go down to zero.) Scott

    Gold Medal.

    What? You don't already have one? Just kidding... CONGRATS! IT MAKES US ALL HERE VERY HAPPY! WE KNOW THAT THEY APPRECIATE YOU OVER THERE! (here too!) Scott

    Separate Blood Bank Armbands

    We use them. No plans to drop them. There are just too many problems relying on the chart-label armbands for patient ID. Scott

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