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SMILLER

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Everything posted by SMILLER

  1. SMILLER
    We have been using Roche strips and analyzer for some time, and there is nothing in the manufacturer's instruction that would make us want to use an Ictotest as a confirmatory. Years ago we used a Bayer strip/analyzer that gave false positives for bilirubin depending on the color of the urine (the Roche strips have a color compensation pad). We used Ictotests for confirmation then. I would agree that if your manufacturer does not recommend confirmatory testing you do not need to do it.
  2. SMILLER
    I kinda go along with what Jay and others have said about marking unit IDs on tubes for unit typing verification. (I admit I only do it when there is an inspector around). The only problem would be that if one tube out of a batch turns out with an unexpected reaction, you would have to redo the whole batch. But if you are careful with keeping everything in order, this would not happen very often. We do encourage students to label everything.
  3. SMILLER
    Just wondering what other labs use for carbon monoxide reference ranges? Cannot seem to find anything on the web that cites a study. The CDC uses <2 for nonsmokers and <10 for smokers specifically to r/o exposure to CO.
  4. SMILLER
    Thanks all for your comments. The link to the article I referenced is: http://findarticles.com/p/articles/mi_qa3890/is_201107/ai_n58121039/?tag=content;col1
  5. SMILLER
    We have been using a Beckman-Coulter Access for some time. No particular problems that I know of. Cals are once/month. We also use it for BNPs and some other non-STAT tests. Maintenance is minor and little downtime for repairs.
  6. SMILLER
    The study I cited above seems pretty definitive. If a bubble is not present, you are going to miss weaker positives.
  7. SMILLER
    Is anyone else aware of the possible reaction variability caused by different pipetting techniques when using gel? There was an article in Vol 24 no 3 (summer 2011) of Clinical Laboratory Science that seems to say that it is a really bad idea to NOT have an air bubble over the gel during incubation. Weaker positives (up to 1+) are often missed if the incubation mixture of plasma and cells is touching the gel. Currently, I do not think our procedure (Ortho) says much about it one way or the other.
  8. SMILLER
    We run a weak D negative control daily, ending with a tube coombs, so i would think we would be covered. Except I am pretty sure that we do not record our lot numbers of saline anyway. Probably should go read what it says on our saline cubes. Never been an issue with inspectors as far as I know.
  9. SMILLER
    We do not remove segments for later possible use until the unit is issued for transfusion. Those are saved refrigerated, sorted by day by day, for one week.
  10. SMILLER
    Steve Not a big percentage. We do have quite a long list based on certian flags, combination of results and diagnosis that direct the tech to perform a smear review or manual differential. Many abnormal CBCs that would normally be reviewed, if they correlate with a recent one, do not get another review. The idea being that those additional morphology comments are already present on the chart.
  11. SMILLER
    Regarding inspections, we are more worried about the FDA than otherwise. Has anyone actually looked at thier manufacturer's recommendations, or we all just assuming that they have "left it open for interpretation"? We are using Ortho for gel and Immucor for tube AB ID, and both inserts say that the Panels "should be tested periodically with weak antibodies". I doesn't seem reasonable to interpret this as meaning that no QC need be done at all.
  12. SMILLER
    Auntie- Ya, I know what you mean! We have problems with certian techs holding automated results (sometimes critical and/or STAT) while they wait to see the smear on a low platelet count or whatnot. We even get an occasional unecessary redraw based on something they do not like on the auto CBC!
  13. SMILLER
    Does anyone still grade morphology when reporting out a smear review for a CBC? We stopped years ago, the idea being that a particular morphology is either significantly apparent or it is not--so we report only if present in significant amounts on the scope. Likewise we do not report redundant morphologies that can be inferred from automatic CBC results, such as hypochromia, microcytosis, anisocytosis, etc.
  14. SMILLER
    Google: Complete Blood Count Wiki There is a short paragraph on hematology analyzer principles.
  15. SMILLER
    We too have recently let Le-a screening go the wau of Lu-a and other clinically insignificant antibodies. We only keep them in mind as a reason for unexpected reactions while IDing other antibodies. Our reference lab does not normally stock any kind of typing sera for Le-a, so we could not get screened units even if we wanted to.
  16. SMILLER
    Here's a short article I Googled: http://findarticles.com/p/articles/mi_m3230/is_2_39/ai_n27166542/
  17. SMILLER
    OK, thanks Auntie. I agree with the importance of delta checks, just thought the idea of being an adequate check for BB specimen reliability seemed odd considering all of the other methods available to ensure proper patient ID and whatnot. But I think I misread your point. I guess I thought I was in the Blood Bank forum!
  18. SMILLER
    Seems like the only thing you could correlate a PFA to is another PFA, which we do once a year when we have to use a loaner from Dade when our PFA is sent in for routine maintenance. In that case we run a few patients and verify that the QC is good.
  19. SMILLER
    "It is also our *ONLY* way of identifying for sure that the blood bank sample has been taken from the correct patient" Really? I am guessing that your hospital armbands are not always reliable or cut off or something? If its so bad you may want to look into using your own blood bank armbands for positive ID of patients from when the T&S is drawn to when the unit is hung. I am not sure why you would want to rely on delta checks as a "sure" way to detect patient ID errors. (Maybe I am misreading what you are saying?)
  20. SMILLER
    Same here. We would only repeat if a delta check or some other indicator suggested that the result may be in error (just as for any result).
  21. SMILLER
    This article may be of use : http://ajcp.ascpjournals.org/content/134/3/420.full
  22. SMILLER
    Awesome! Once they get this validated, we won't have to worry so much about our darn freezers and refrigerators breaking down any more! Its such a bother to have to transfer product from one to another when this happens! In the future we'll be able to just throw them in a cupboard!
  23. SMILLER
    For various body fluid cell counts (not manual diffs on CBCs) we used to do the "counts within 10% of two sides of a hemocytometer rule". But recently we have been buying a commercial control (it even has Ca pyrophosphate and Uric Acid crystals in it!). With that, the rule is that if a tech does a manual count, he has to have run one control within 8 hours.
  24. SMILLER
    I think if my boss or his boss or his boss found out I was posting stuff like this on a public forum, even anonymously, I would be in real trouble!
  25. SMILLER
    We aslo went overboard on a number of things like this when we first started with gel, and then backed off a bit policy-wise. But I think you have an administrative problem. I would think you would have to ultimately have to have your pathologist decide what Lab policy is, especially for a high-visability area like the blood bank. Having said that, you probably do not want to go over your manager's head. I am guessing that neither your manager or pathologist will appreciate going outside the chain of authority on a policy issue. I would suggest that somehow you need to take time to get your manager to at least understand your point of view, and then casually suggest you talk it over with your pathologist. Good luck.
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