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SMILLER

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Everything posted by SMILLER

  1. The problem is not just that the unit is or is not within particular temperature range before being put back into use, but rather the unit has not been monitored while not in the care of the blood bank. A unit sent to, say. OR in a cooler, may have been "checked" when it got into the theater -- and left for a time on the counter (maybe next to an incubator!) -- returned in the cooler on ice you will never know if it was kept at a proper temp all that time. And how do you really "validate" a unit's potential for a "detrimental" effect? Transfuse various units left on a counter for different times and see which patients have a bad outcome? Scott
  2. Right, and I would not even go so far as to say that a CAP or JCAHO inspection is equivalent (as far as how stringent it is) compared to an AABB injspection. Just that any CLIA accredited agencies are going to be using standards that are derived from AABB guidelines. In fact, the FDA does some extra stuff beyond AABB for things like tissue tracking. Scott
  3. In the US, all accrediting agencies must satisfy CLIA, and Blood Bank regs are based on AABB standards. So AABB standards are already in use by JCAHO, CAP, etc. Scott
  4. If one is doing a DAT in order to determine the status of a possible acute transfusion reaction, then the presence of antibodies on donor cells is the concern. There may be some use in incubation here to enhance uptake, but I have never heard of it being part of anyone's transfusion work-up procedure. Scott
  5. We haven't for some time. It always was a crappy test for so many reasons. For general platelet function, we have a PFA-100 , and for P2Y12 (e.g. Plavix) and aspirin, we use a Verify Now (Accriva). Scott
  6. The patient who currently needs the screening done gets charged for however many antigens are tested. Pos or neg, transfused or no, does not matter. I would think that the charge code would be the same regardless of what the antigen typing results would be. Scott
  7. 1. Febrile 1-2 C. 2. Measured from the baseline, which is just before the transfusion starts. 3. Cultures are done only when directed by a pathologist or other physician. 4. and 5. These are nursing calls.
  8. We are a 220 bed trauma 2 hospital. We do not have the luxury of having a large number of specialists for each area. We have many generalists here, especially on evenings and nights. In general, we do a 4-5 week training period for the BB area, and try to make sure they are rotated through BB on a regular basis. First shift BBers are available at all times by phone. We ahve few problems. Scott
  9. Thanks for the tip! We have not had any particular problems but we will refresh the balance card! Scott
  10. You could call your local blood donation center and ask what they do with their extra plasma. Scott
  11. I would think that it would have to be arbitrary to the point of uselessness, but what do I know? In any event, we are not CAP certified but have been inspected by JCAHO forever. I am pretty sure you will need cell-count QC like mentioned above. You can always check your inspection standards when you get a copy! Scott
  12. Really? So if there are cells on the slide and cells on the hemacytometer then you are good for QC? Those CAP dudes are far-out! Crazy Man! Scott
  13. We do indeed run wet controls when we do cell counts on the hemacytometer. We use Streck Cell-chex. JCAHO noted that we needed to do this a few inspections ago. Once every 8 hours when testing patients. (Not sure what you mean by a procedural control vis a vis manual cell counts...) Scott
  14. Welcome Steve! This web site: http://medical.oneblood.org/biologics/distribution/search-and-view-isbt-product-codes.stml among others, seems to at the least have a listing of the codes available. It looks like you want code E0272? You may want to call AABB just to make sure if that is the source that your inspectors use for standards. Scortt
  15. Oh no, I get it. We do not dismiss things like this here out of hand either! But I know of other Labs where they have different policies regarding follow-up testing for cases like these. (I suppose they would say that when they hear the sound of horses hooves they don't bother looking for aardvarks, pigeons or spyrogyra...) Scott
  16. I appreciate the point about someone not being around when the alarm goes off! Just one more note, the sedi-mat uses the same Polymedco tubes used for a manual test. So if you get that or another auto ESR that uses standard tubes, you would have your back-up available STAT. Scott
  17. By artifact I mean gel interference/mixed field/cold agglutinates that go away with a redraw or alternate method such as tube, proving that it was specimen or technique related and not otherwise. The thing is, if you have even one stubborn positive cell, it could be a sign of a developing atypical antibody that might be significant down the line (if the patient is given blood from a donor with that particular antigen). Granted -- I would think it's extremely unlikely that the patient would ever have a problem with a transfusion just because of a limited situation like this. But I know of at least one big university hospital that will NOT bother with future AHG crossmatches in situations like these. Scott
  18. Agree with those who say that as long as it cannot be ruled as an artifact at some point, one must do a AHG crossmatch for the life of the patient. Scott
  19. We have been using a Polymedco sedi-mat for a few years and have had little trouble with it, other than getting used to its simple menu. With only 10-15 ESRs a month I have to wonder why you don't just use the old-fashioned 1 hour manual test. You need it as back-up anyway if I am not mistaken. Scott
  20. And the snow! Snow all over my monitor! Scott
  21. Yes, I would think so, as a unit was released from blood bank that was not compatible based on your own P&Ps. But you should check with the FDA! Scott
  22. If I am not mistaken, for a massive transfusion, a D neg patient who receives D pos blood is unlikely to develop an anti-D, (but I appreciate the concern!). In any case, each facility has to decide how it will reserve O neg units for those trauma patients that must have them. Scott
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