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Everything posted by SMILLER


    Plasma Purchasing Companies

    You could call your local blood donation center and ask what they do with their extra plasma. Scott

    manual cell count control

    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

    manual cell count control

    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

    manual cell count control

    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

    Exchange Transfusion Product Code

    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

    inconclusive antibody ID

    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

    ESR analyzer for small lab

    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

    inconclusive antibody ID

    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

    inconclusive antibody ID

    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
  10. I just answered this question. My Score PASS  

    ESR analyzer for small lab

    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


    Where's the snow?

    The moment when the glass broke

    And the snow! Snow all over my monitor! Scott

    GEL Testing Question

    No. Scott

    FDA reportable?

    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
  16. 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

    BloodBankTalk: Allergic Reaction

    I just answered this question. My Score FAIL  

    CPK Critical Value??????

    We do not have a critical cut-off for CPK. Earlier this year, however, we did add one for Troponin. Scott
  19. I have read an article from last year about a lab that routinely runs a gel enzyme panel when they get equivocal results (i.e. antibodies of undetermined significance, AUS's, non-specific reactions) on gel screens or panels. About 25% of the time they identified significant allo-antibodies that otherwise would have been missed as they would have been ruled-out on the regular panels. Does anyone else do this? https://academic.oup.com/labmed/article/48/1/24/2666003 Thanks, Scott

    Training new employees

    All of our associates who train for BB, except for the coordinator, are generalists here. We are a trauma 2 250-bed hospital with no peds. Our training typically takes 3-5 weeks, depending on previous experience. Scott

    Direct antiglobulin test

    And its at least possible that the speck in question was, indeed, an artifact, and the anti-Jka that was discovered was just very weak, and a coincidence. Scott


    Whew! I was starting to think there were none left after I broke them all last year! Happy Holidays All! Scott
  23. Has anyone else ever noted these? These crystals appear with Wright-Giemsa stain as greenish aggregates in neutrophils. They are often associated with severe necotizing liver disease. Here is one reference but there are others on the net: https://www.ascls.org/communication/ascls-today/320-ascls-today-volume-32-number-4/431-a-case-of-blue-green-neutrophil-inclusions In the articles I've looked at, they may only appear in 1-2% of cases, so they are easy to miss. There are a few good images on the internet if you look for them. I was wondering if anyone else who is aware of these things, routinely reports them if they are noted. Thanks, Scott

    MCV and hyperglycemia

    This is a new one for me (after 30 years!) An ER patient presented recently with a MCV of 107 and low MCH, MCHC. This patient was in house at our hospital just last week, with all normal indices. Called the RN in ER who commented that she is expected to have a very high glucose. Googled it and sure enough, hit a few articles like this; https://www.ncbi.nlm.nih.gov/pubmed/7259094 The patient had a glucose over 1400 g/dl. My question is this: for those of you who are aware of this phenomenon, do you attempt a correction and report that out? Apparently this is a in vitro pj=henomenon related to hyperosmolality when the blood sits in the EDTA tube before processing on the ananlyzer. The "cure" is to do a saline replacement and let it sit a bit. Thanks, Scott
  25. We start with O Negs but after 4 - 6 units, we would switch to O pos for those patients in question in order to have the remaining O Negs on hand for women of childbearing age, should one show up. Note also that our nearby blood supplier can have more RBCs to us within about 45 minutes. We are a level 2 trauma center. Scott

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