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SMILLER

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Everything posted by SMILLER

  1. SMILLER
    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
  2. SMILLER
    There is no requirement that I know of that requires a physician to enter all orders at all times. But the amount of orders entered by a particular physician does affect compensation for the hospital (in the US anyway). So insisting that a doc enter all orders for an emergent situation like a MTP is a dangerous bit of overkill. To make it easier for our docs, we have an order set that includes a "heads up" order to the BB for things like an MTP. We follow our established protocol in BB when that happens, and keep on it until the MTP is called off. These orders are entered typically before the patienet arrives at the hospital in the case of ER. Scott
  3. SMILLER
    Agree with John, above. Scott
  4. SMILLER
    History is part of the workup--it doesn't matter if the info is from my own system or another hospital's--I would try to get those concession/declaration forms signed after a consult with the attending. Scott
  5. SMILLER
    You should be able to find a number of journal articles online, for instance, this one: https://academic.oup.com/ajcp/article/138/suppl_1/A195/1772848 , just by doing a google search. Ideally of course, your quality target should be 0 errors. But practically,I think what you will want to do is establish where you are now and show how, month after month, you are improving on that. Like all projects of this sort, you will end up having to drill down on your data to identify areas that you can improve. Scott
  6. SMILLER
    Well, it may seem subjective to YOU... The particular problem we had was with a few panel cells on a new panel coming up only slightly hazy--not even a weak 1+. (These are R1R1 cells that should be clearly positive with our usual QC anti-sera which contains anti-D and ant-e. So that is what is under investigation.) Ortho said that we should be seeing a definite 1+ at the least. We are used to seeing 2+ or 3+ with these gel panel cells. Scott
  7. SMILLER
    Actually, I was talking to an Ortho tech the other day in regards to another issue, and asked them about their QC for gel panels. They said they test each antigen on each cell to make sure that they get a decent reaction (pos or neg depending). Did not ask what they used for QC anti-sera though. sCOTT
  8. SMILLER
    Yeah, I wondered about that hetero/homozygous D thing as well... I will also mention that according to Ortho, Panel cells are all tested with specific antisera for each antigen for appropriate reaction strength before being released for shipping. Scott
  9. SMILLER
    I am not sure what the various regulatory inspectors would say, or exactly what standards they would cite. I do think that any facility that is going to do transfusions would want a armbanding procedure that established an unbroken chain of identification from the initial T&S draw, through processing and testing, to the transfusion. As can be seen by the various responses here, this can be accomplished in a number of ways. Scott
  10. SMILLER
    Is there anything special about the Ror phenotype? On a recent prenatal antibody work-up, we noticed that along with all the weak reactions for the D pos panel cells (gel), the cells with the Ror phenotype were completely negative. (The patient was given a dose of anti-Rh two months ago.) Is the D antigen more weakly expressed on these cells for some reason? Thanks, Scott
  11. SMILLER
    We make a copy of the patient's photo ID at the time of draw. The BB armband is attached to that copy, along with the BB number written upon it. If the patient does not have a photo ID, they can either wear the band or have the T&S draw done at time of the procedure. Scott
  12. SMILLER
    Indeed. RBC product can be issued as long as it is before the AB screen expires, even if it only a few minutes. Products cannot be infused after they expire, no matter when they are issued. Scott
  13. SMILLER
    Both. In the first case, we have the patient drawn for the T&S (either here at the hospital, or at our outpatient facility), and then the testing is done here. When the patient comes back, we usually send the units to our outpatient facility, as that is where we do almost all outpatient transfusions. In the second case, a specimen for a T&S is sent with the proper documentation (as I mentioned above), as part of pre-admission testing for a procedure at our hospital. Note that all of this is dependent on being able to create a BB armband with proper documentation at the time of draw, and have it all delivered to our BB with the specimen. If that cannot be done for some reason, we would armband, draw and test the day of the procedure. Scott
  14. SMILLER
    We do it for hospitals and some other facilities in our group. These may be patients with pre-op work done at another hospital for a procedure here, or a T&S and XM done ahead of a patient coming in the next day for a transfusion. We use a BB armband for all of our patients who might be transfused. For outpatients, this is made out and attached to a copy of their photo ID along with the order and a questionnaire regarding previous hospitalizations, recent transfusions, etc, and sent to the BB. When the patient arrives for their transfusion or procedure, the paperwork is checked and the BB armband applied. We do not transfuse patients without a BB armband. Scott
  15. SMILLER
    I would think that one can only use this method to rule out if the patient is a secretor. Scott
  16. SMILLER
    It may have something to do with the EDTA equilibriating with the specimen. We will get false high Baso counts when a specimen is run about 10-20 minutes after it is drawn. Do your PLT histograms look normal when this happens with the platelets? Could also be a background issue. Anyway, suggest you call Coulter and ask for advice. Scott
  17. SMILLER
    Oh God, yes. Those of us working in hospitals have to contend with non-Lab draws every day. Part of our pre-analytical responsibilities is to check for stuff like this before processing specimens. Scott
  18. SMILLER
    The problem would be with hemolyzed samples due to a hard draw. (We see this quite often in our EDTA specimens.) In which case, it would not matter whether it's serum or plasma, it could be a problem down the line as far as interpretation of tests go. Scott
  19. SMILLER
    Just remember that one cannot be sure what sort of conditions the unit was kept under while away from the blood bank, whether it was away for 5, 15 or 30 minutes. So a particular unit may or may not be OK to put back into stock, regardless of any validation one has done with units sitting out on the BB bench at a normal room temp. This is where those little blood safe stickers come in. Scott
  20. SMILLER
    After reviewing a few journal articles, we recommend that in most non-acute cases, the hemoglobin one measures 30 minutes after a transfusion of RBCs is going to be accurate enough. Obviously, the necessity of "real-time" lab values are important if the patient is a more acute case and the physician is trying to keep ahead of the situation. Scott
  21. SMILLER
    We read the collector's initials off the tube. On the BB system, the initials are the codes used to ID the full name of the collector. Scott
  22. SMILLER
    I think the only regulatory violation here would be if a unit was returned and there was no documentation that the temp was acceptable if it went back into inventory. Like some have mentioned, a unit at room temp for only 10 or 15 minutes is going to be warmer than 10 C. You can set your acceptable "return limit time" to whatever you choose, just don't forget to check the temp if you are going to re-stock it. (There are other considerations for units released in a cooler.) I think the concept of a return time limit is more to encourage the transfusing RNs to not come for the unit until they are set up to hang it. Scott
  23. SMILLER
    Agree with all above. (And I believe there are many older threads here that exhaustively cover this sort of thing regarding units out of monitored storage. ) In general, there are two things that are clear to me: a unit must be transfused within 4 hours of release from monitored storage, and that a unit returned to the blood bank for storage must be documented as being at an acceptable temp. Scott
  24. SMILLER
    Right. So leukoreduction helps prevent those pesky febrile transfusion reactions, and irradiation helps prevent GVHD. They are not the same thing, after all! Scott
  25. SMILLER
    Leukoreduction, by no means that I know of, can get rid off ALL WBCs in a blood product. So if you are worried about Graft-Versus-Host Disease in an immunocomprimised patient, you do not want to rely on leukoreduction alone. The residual donor WBCs may "engraft" into the host recipient's system, and attack the recipient as a foreign threat. So to avoid GVHD, you must kill all of the WBCs in the donor blood product. This is accomplished with radiation. Scott
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