SMILLER

i doubt very much that the writer of Luke was referring only to males (see 1b, below)... Definition of man (according to Miriam-Webster) plural men 1a (1) : an individual human; especially : an adult male human (2) : a man belonging to a particular category (as by birth, residence, membership, or occupation) —usually used in combination b : the human race : humankind

...and on the earth, Peace, and goodwill toward men

May we all be blessed! Scott

That system sounds pretty good to me. I would try to do weekly every 7 days though. If an inspector sees that most of a particular scheduled maintenance is run on the day of the week (or month) that it is supposed to be run, I do not think they will get upset about a few that is a day or two off. As far as gaps, you may want to schedule monthly maintenance somewhere in the middle of the month so it looks better if you are off a day once in a while. Scott

We have found that restrictions on taking blood transfusions varies from patient to patient. Whenever we have a JW patient, we will consult with the patient'e RN and/or physician. A good resource in the US is The Jehovah's Witness Hospital Liaison Committee, https://www.jw.org/en/medical-library/hospital-liaison-committee-hlc-contacts/united-states/ Scott

I am not familiar with ISO 15189 standards--at a minimum you obviously have to follow them, along with manufacturer's requirements--but it seems to me... ...like you are being advised to validate a particular analyzer by comparing it to another exactly the same, which presumably was compared to another exactly the same, which was... With any new method, you must show correlation with a previous method, in this case, your manual method. Comparing it to an analyzer at another facility seems rather pointless. (The exception being if the other facility is part of your system, and you use the same procedures and reference ranges). You should also be doing a reference range study to validate your reference range, especially if there is significant variance in the correlation. It has been our experience that automated methods correlate pretty well with the old manual ESRs. Scott

You may want to call Ortho and ask if they have heard of issues with those lot numbers. Scott

Similar to David, above. Also, when an order is put in on our hospital system, for uncrossed products, the doc is also documenting authorization. Scott

I agree that it is possible that the "reactive" lymphs may be lymphoma cells. If the patient is middle-aged or older it could also be an early CLL. They should probably see a hematologist. Scott

If I am not mistaken, it appears we have an enhanced string of lights to pop this year! Pretty Cool! Scott

We have had the same experience with our Jane/Jon Doe system. When patients are triaged in the field, our ER sets up the Doe and MR so that they are ID'd positively when they arrive. Blood Bank always has warning, so often we can set up and have properly labeled units down there in a cooler when they arrive. Additional policies regarding cooler sets for MTPs had to be set up a few years ago so we could establish our level 2 trauma designation. We have had no avoidable delays due to any of this. Scott

If I am not mistaken, when a Bloodsafe unit is used, the system automatically records who the unit is being released to, as opposed to simply taking a unit out of a cooler or refrigerator. For look-back and other purposes, identification information must be reliably retrievable afterwards as well. Scott

Same here. Although almost all of our physician documentation for things like this is through the EHR. Otherwise, we would get a signature on a paper form, hopefully at some point while the patient is under the physician's care.

The AABB standard (2.1.3) also seems to be a general competency requirement for testing personnel. When you got your final inspection report from AABB, was this citation still on it? Scott

i do not think anyone issues blood based on a previous admission's history. People are not always who they say they are. Scott

I do not see anyone here defending the idea that you need to know, with absolute certainty, where each human blood product goes and who ends up with the transfusion. Every transfusion is a transplant. Do we really need to review why we cannot issue products willy-nilly no matter how 'universal donor' they are? There are several suggestions here already for policies to ID John/Jane Does and the units they receive. It takes consultation and cooperation between multiple departments; and yes, its going to take some work. Once implemented, an appropriate system will satisfy regulators without any loss to patient care. (Blaming regulations that may be "inconvenient" when pointing out our deficiencies does little to help our patients.) Scott

Did they happen to cite a specific standard? Just curious. Thanks, Scott

Did you try a hemocytometer? It seems like a count of less than 100 / ul would be doable on one. See: http://www.vivo.colostate.edu/hbooks/pathphys/reprod/semeneval/hemacytometer.html (you can find anything on the internet!) Scott

In general, our procedures require a specimen up to 48 hours old, as long as it is stored refrigerated. Usually specimen testing is begun soon after the specimen reaches the blood bank, where they are left at room temp while that is completed. Scott

From you to our pathologist's ear, Malcolm! Scott

Right. But please look at AABB standard 5.8.4. As I mentioned above, the donor processing facility can only label a unit as tested negative (far a particular antigen) if that has been done on two separate occasions. In that case, or if the unit in question was tested by the donor facility, the donor facility could indeed label the unit as "negative for RBC antigens". Otherwise, it would have to be tested, either by the donor facility or when it reaches your blood bank. After all, every donation by a donor is typed twice for ABO before a patient gets it. Scott

Vel, as always, I appreciate your response, Malcolm. Scott

Ja. Here, if the anti-Le a shows up on an inpatient, we set up 2 AHG crossmatched units, because that is what we do for all atypical antibody patients. But if it does not show up in the antibody screen, we have to order confirmed Le a units from our blood supplier and XM those! It's so 20th century... Scott

Isn't it possible, for a new antibody, to have both IgM and undetectable IgG produced at the same time, or even IgM without IgG, at least at first conversion? Scott

I would say that since they mention "a label or tag", that they are thinking that a label would be something that is stuck to the unit, and between the labeled unit and the transfusion tag all that required info would be there. Scott