SMILLER

Can someone give us a reference for the AABB bulliten in question? Thanks, Scott

We do not routinely do RBC counts for any fluids other than CSF. Scott

Sounds like the nurse practitioner is in trouble for that one case if I read it correctly. But such a mix up must occur only rarely. We give our docs 24 hrs, but make every effort to get the release signed ASAP after the patient is stablized. Scott

We dont have a problem with that either, at least for BB. (if you can get the specimen before Hema gets it, you could always pour off a aliquot for them) We frown on using previously "pierced" specimens for any kind of molecular diagnostics tests tho. scott

I agree with the others. The rise in temp in this situation may indeed have nothing to do with a trasfusion reaction, but you certainly cannot say for sure that it does not! For minor temp increases, a quick DAT that comes out negative is usually enough here to allow the transfusion to continue with a Drs. permission. But if there is any indication of a real reaction to the transfusion (eg big increase in temp, pos DAT, whatever) the transfusion CANNOT be started, no matter what the Dr. wants to do. If there is a hassle on this (it has happened) we get ahold of our pathologist ASAP and have them talk it out. Scott Scott

Holy cow Malcolm! I am glad you are all OK! Scott

I would say that considering the importance of a cold-reacting antibody, the significance of a RT or 4C reaction is not what is important. It is whether or not it may be reacting at 37C or AHG. If you cannot rule out the latter (by getting a negative result somehow), then you cannot say that it will not react in vivo. Scott

Pretty sure that most state regs would say they can go down into any sanitary system--sink drain or toilet. That's what we do with ours. We do not make housekeeping do this. They are to stay away from biohazard stuff in our hospital. Scott

I would try to have your Biomed people talk to Hettick customer service. They should be able to figure it out between them. Otherwise, let your salesman know that you want to return the centrifuge if it is not resolved. As far as the settings: You want to match the RCF to whatever was used on your last centrifuge, assuming that worked well for you. If your rotor diamater is different, you will have to change the RPMs to get to that. Scott

I think the intent of that type of standard is to ensure that the same person does not due QC day after day. I agree that you should be OK with once/day QC that is not performed by everyone who works in an area. Chemistry is another area where this would apply. Scott

It seems like the odds are not too bad that any two people would have the same ABO/Rh. We do do a ABO/Rh, but only to help verify a misdraw for a write-up. This si becuase if the typings are the same, it does NOT necessarily mean that they are the same patient! If the two CBCs match (or the Chem profiles) then we would consider it the same patient. Scott

Yikes! This IS the internet, isnt it! Scott

I believe that this is the original article: Gulati GL, Asselta A, Chen C. Using a vortex to disaggregate platelet clumps. Laboratory Medicine. 1997;28:665-667. Good luck finding it on the internet tho, I think its too old. Having said that, if anyone has doubts about the appriateness of the method, don't waste time in philisophical arguments here, just go and test it out in your own lab yourself. We have been using it for years. RBC, WBC, etc. counts before and after are the same. Some notes: Always get a redraw with an additional citrate (in case its an EDTA-clumper) if possible. Of course the problem here comes when a patient is an outreach case or whatever and it is not practical to get a redraw. Vortex a small amount for at least minute or two. Make a smear and rerun it. If the post-vortex smear still shows clumps (about 1/2 the time in our experience) you will have to report an estimate anyway. Otherwise, take the platlelet count from the vortexed run and use that for the platelet count. Do not use any other results from the vortexed specimen. Having said all that, remember that if the draw was rough enough to clump platelets, some of the other results may be comprimised also, even though they are not flagged on the analyzer. So careful review is always necessary just like with any suspect specimen. Always best to get a redraw! But this method does work in some cases. Scott

Since indices normally change very little, we would suspect a mislabeled specimen and follow up. If the last result was recent that is. Scott

Yeah, Likewine's about not overanswering a question from the inspector is kind of a classic. Most of us have a tendency to over explain things when dealing with co-workers in healthcare. But you do not want to volunteer too much info to an inspector if you can help it! Scott

We came across a journal article on this years ago. We do try this on specimens that show clumped platlelets on the slide. I would say it works about half the time for "regular" clumpers. It does NOT work for EDTA clumpers. If you know you have a patient that is an EDTA clumper, draw a citrate as has been suggested. And of course, if there are clots in the tube, you have to get a redraw. Anyway, to do it properly, you need to aliquot a small amount like 1/2 to 1 ml, and vortex it for 2 to 3 minutes. This is a long time to stand at the vortexer feeling your hand going numb, but if you want to work, you do need to do it longer than a few seconds. Then you make a smear with the vortexed specimen AND run it. If there are no clumps on the slide, you can report the platelelet count off the vtxd specimen. Scott

We are just about to start using this new analyzer and I wonder if anyone has any observations on how it fairs on a day-to-day basis. So far (after training by the Abbott rep) we do not anticipate too many problems. Any users out there? Thanks, Scott

LOL! I knew someone would mention that Malcolm! Here we only would use a scope to differentiate rouleaux from a "true" weak reaction when getting very weak macroscopic reverse typings or on an IS crossmatch. I am not sure why anyone would think to use it for a DAT or IAT. Scott

kathy I can only echo the nice comments made here. Its natural you are feeling a bit jumpy. If you have been working for a while, as a tech you have already gone through a number of inspections. And inspections reflect on and impact everyone in your organization, not just the management. You must already be aware from those previous inspections that things usually go better than one expects. As management, the only difference will be that you will have more of an active role in the inspection and whatever follow up is necessary. On my first inspection as a manager, I found that as I became engaged in the process, any nervousness i had anticipated seemed to be less and less of a problem for me. So on the next inspection, you should be even more at ease! (or at least, relatively less uneasy!) regards, Scott

We have always just put a bit on a slide. Not sure the advantage of using a special reader to look into the tube. Not sure there is such a thing. Scott

Yeah, and then there is the ongoing headache question of QC for Antibody ID panels... Scott

We do them in the Lab. The same associates (techs and phlebots) that do our auto-donors do the therapuetic phlebotomies. Scott

I agree with all here. Yikes! And, Yikes! again! Have someone from Risk Management go with you to that transfusion committee meeting. Scott