SMILLER

I am using My Activity Streams to see postings (like usual) and looking at Last Three Days, and for today, there are 16 of these for 16 different posters. About the same for yesterday. Thanks, Scott

Yes, you reference-lab people know all the tricks! I am, indeed, interested in what transfusion service labs like hospitals are doing, though. Scott

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

Is there a way to get rid of these individual postings? Can't they be grouped under one topic? Today I have page after page of the same heading from different posters. It's kind of ridiculous. Thanks, Scott

That's a good point. Each Lab would have to use specific policies to ensure "that the temp is OK". Here we use those Timestrip tabs, which we have validated for RBCs and thawed plasma. But obviously if a unit of plasma goes out that is still warm from the thawer, the tabs are useless. We have a log for all products sent out in coolers to OR, ER, etc. If product is returned, return temp and inspection is documented there. Scott

Lately we have been doing this primarily for Daratumumab patients. Scott

As with packed cells, as long as the cooler is validated, and you document that the temp is OK when it is returned, I can see no reason you cannot accept plasma back. In the US, you just want to ensure that any AABB recomendations for storage are met, then write up your new policy. Scott

I am not familiar with using volume reduced platelets, but if the unit is not entered in any way, i do not see why the expiration would change. But this is a question for AABB. Scott

1. We do not test a second sample. See std. 5.14.5 c). 2. We are using a 10 day period. If the OR date is beyond that, we do not draw the T&S at the time pre-admit work is done.

And back in the day (last century) we had to deal with CAP workloading, more recently LEAN. etc. Anyway, one does have to find out how to deal with whatever the latest "big wig" administrative push is (something they got at their latest seminar). Like has been suggested above, information is power. Find out as much as you can about the new process. You will also want to be clear on what your immediate management expects out of all of this so you know what to focus on. Scott

The corporatisation of Healthcare in the US has naturally led to administrators who are more and more likely to trust other corporation's advice on how to justify business changes. This is bad business and bad for the patients. It seems like health care administrators who seek out advice on direction from those who are actually taking care of the patients are few and far between. Scott

Now wonder we are struggling here! We need to start charging (for transfusions) by mL! Scott

I think most would agree that using up 10uL of reagent RBCs is not excessive. That is less than 1/2 drop. You would have trouble measuring out anything less. Scott

Yes, that is exactly what we do once we make sure that they are, indeed, on the OR schedule for that morning, and they have NOT been transfused since the screen was done. An appropriate comment is attached to the change. Scott

And don't you be doin' no computer crossmatches with those homozygous RBCs neither! Scott

Someone reminded me that saline is used to keep the line open until it is certain that there is not going to be any need for it --- like in the case of a delayed transfusion reaction. (Although I do find the theory that the last few mls of blood are in reality Super Cells more intriguing.) Scott

It may be good practice for some other reason, but I would think that, at the most, there would only be a few mls of blood left in the line. It does not seem worth the trouble. Scott

Here, if the units do not have to be in a monitored cooler, they just transport them by hand. Scott

This particular alarm is a little thing from Supco, its a TA-6. We have a separate chart recorder. Scott

I think so. One thing you could do is call a hospital in the state you are moving to and see if they have any suggestions. Scott

Good point about some antigen typing antisera not appropriate for gel QC. For our QC, we do indeed use a kit that is appropriate for gel. We dilute down the anti-sera from the Ortho Confidence QC system (same one that we use for ABO reagent QC), which has anti-D and anti-c IgG. Scott

Over the years we have tightened our monitoring of temps in the BB to include requirements from various regulators. For example, we store room temp tissue for OR and have been recording temps from a thermometer there, but just recently we added an alarm to the side of the cupboard where it is stored. In general, we check all alarms and temps for the various refrigerators, platelet rotators, freezers, etc. and record them once a day, documenting that the charts match the readings match the thermometers. All of our freezers and refrigerators are also monitored automatically by a computer system in engineering as a back-up. Also, everything is checked quarterly against calibrated thermometers. Scott

It looks to me that there are 12 states in the US with licensure requirements, including Florida, California and New York. You will want to check the state government website for more information for the state you wish to move to. As for certification, which is required for any clinical lab science position in the US, check out the ASCP website as Cliff suggested. You will have to take a national certifying exam. You can google that also, here is one resource: https://study.com/articles/ASCP_Certification_Requirements_and_Information.html Scott

There is a paragraph here: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajh.10062 in a journal article from 2002 that mentions a few drugs that can cause auto-immune hemolysis. There are probably others out there. Scott

The rule in many cases in the US seems to be, if there is a control available, you should be using it. We used to do cell counts without controls, then the manufacturers came up with "body fluid" controls, now they are required, even for manual counts! I don't know how many hemocytometers I have had to recalibrate because of those damn controls! Scott