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SMILLER

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  1. Terri Just quick question for you if you don't mind. We use Ortho for our gel panels and Immucor for our tube, and both manufacturer's inserts say to test panels with weak antibodies. What do your inserts say?
  2. If I read you right, Colleen, you are saying that you check mode-to-mode once a day and at a recent JCAHO inspection, you had no trouble. This would be in spite of the pertinent standard that seems to say that each mode needs to be QC'd at least every 8 hours with at least two different levels every 24 hours. When we had trouble was not at our last inspection but at the one before that 3 1/2 years ago. At that time, we had no QC at all for the open mode. That inspector was the one who pointed out that we were not in compliance. We started doing mode-to-mode, but only once a day like you. The inspector we had last year didn't really go into it, and of course, we didn't specifically ask him if it was OK to do a mode-to-mode just once a day to QC the open mode. But we have an inspection coming up and our Hematology manager decided to play it safe. Now of course, the next inspector will probably not ask about it at all!
  3. I have wondered about this before (but never investigated it until now), thinking that it was impractical and/or unecessary as far as regs go but... Looking at the product insert for our gel AB panels, it says under "CONTROL OF ERROR" "For quality assurance, 0.8% RESOLVE Panel A should be tested periodically with weak antibodies." Now I am not sure about FDA regs, but I would think that JCAHO would be upset if they knew any test system was not being QC'd per manufacturer's recommendation. Having said that, I think I can kinda see where this is all going. We test screening cells every day. But how can we be absolutely sure that the panel cells we are using for rule-outs actually have detectable AG on them? I agree with some of the ideas here that a comprehensive QC of a panel is impractical. But a documented check at a certian point - say a week or 10 days before the panel expiration date - that consists of one or two weaker antigens known to deteriorate would satisfy any inspector. (That is, if an inspector even makes a point of it, which has never happened at my Lab that I know of.) Does this make any sense? I guess I am struggling to find a middle ground here.
  4. I agree about the time saving aspect, less hands-on but still takes about 1/2 hour to complete a screen. A few non-specific cold specimens may cause you to repeat in tube. Other than that, the results are very consistant and easy to read once your techs get over the learning curve. We found that once our techs grew more comfortable with reading iffy gels, we go less and less to a tube screen for confirmation. Also note that since a gel XM is only the AHG phase, you will also still have to do an IS in tube for crossmatches.
  5. I guess the on-going problems with the-powers-that-be that we have is that TPTB tend to agree to demands made by OR docs or whomever before they listen to the rest of us that have to take care of the patients. Can you pull up all of the data that led to the OR fridge removal from 10 years ago and summarize it for them? Also you will have to offer them something else to help placate whatever OR and administration people have been spending time on trying to get the OR fridge back. Why do they think they need a fridge? Do they not like the TAT in getting coolers into and out of BB? Do they need to get their orders into BB sooner? Try to think of something you can change that will show them that you are willing to enhance the current process.
  6. Almost everyone uses forward and reverse. But come to think of it, it isn't descriptive at all. Something like Direct ABO and Indirect ABO would make more sense.
  7. I guess another thing here is that a CLL may at some point progress to a ALL or lymphoma, so we want to scope the lymphs just to make sure there are no clefted or pro forms. We do manual diffs for leukemias, lymphomas, MMs, etc. once per patient stay anyway, but we never bother about the smudge cells other than report them as a morphology comment. In the article i was referring to, they wanted to see if thier manual count (done with the albumin treatment) correlated with the analyzer diff--which it did. The idea being that they did not have to do the relatively laborous manual diff for uncomplicated CLL CBCs.
  8. In general, we also would wait till the next day to down-tag units. Some exceptions are for our post-open-heart unit patients, where we keep them xmatched for 48 hours, and for any patient with an allo-antibody who may need blood (surgical, GI bleed, etc.) where we usually would have two crossmatched as long as they are in the hospital.
  9. Assuming the patient may need to be transfused, we always repeat the Type AND Screen when a specimen outdates (or when we run out of specimen for some reason before it outdates). Merely repeating the ABO/Rh would not guarentee that it is from the right patient, as chances are not so bad that any two patients are either A Pos or O pos anyway. And its at least possible that a patient may have developed a detectable allo-Ab after three days, especially if they have been transfused. Having said all that (for what it is worth), if a patient has NOT been transfused (or pregnant) within the last three months, and the initial screen was negative, we will extend the outdate on the original specimen up to 5 days as long as the patient remains BB-armbanded in the hospital. So in these cases, we just keep using the original specimen for any crossmatches.
  10. "Our analyzers (Abbott Saphires) do not require a mode to mode since the pathways are the same." That's what we thought also up to a few inspections ago. We are using BC LHs, which also have a "common pathway" from the blood segmantation valve into the rest of the analyzer - (as do all analyzers I think). But the fact is the sample first comes from either needle-peircing assembly or a manual sample probe mounted on the BSV. Our inspector says these two modes are different enough to require separate QC. Hence the need for QC every 8 hours on both shifts.
  11. We also only handle Rh immunoglobulin--pharmacy does everything else. Now if we can only get someone else to handle all of the darn bone, tissue and valves we have to keep track of!
  12. Thanks Steve: No, I tend to agree with you. In fact, as far as I know we've never had a doc call us and question why the manual diff doesn't exactly match the auto diff. In fact, since we only report an absolute diff from the analyzers, I doubt this will ever happen!
  13. According to JCAHO and others, Hematology analyzers must have at least one level of control run every 8 hours, with at least 2 levels run every 24. If you are using both open and closed modes on an analyzer, this means that you have to use twice as much commercial QC material as you would if you only used one mode. One way around spending twice as much for commercial controls is to use a patient control. Does anyone do this? We are currently reviewing our policies for using patient controls and we are wondering if and how other labs are doing it. We now run a random normal patient 3 times in the closed mode, and make sure the variance is low enough for each parameter. We then run it 3 times in the open mode. The mean open mode results must be within a pre-established range of the closed mode results in order to say that the open mode is in control. (Commercial QC is also run in the Closed mode) We have been doing this only once a day, however, and now are thinking we should have been doing it every 8 hours to be compliant with what I mentioned above in the first paragraph. Anyone else use a patient-control protocol?
  14. When numerous smudge cells are seen on a slide: In order to do an accurate manual diff does anyone routinely make another slide for the diff by adding albumin to the specimen in order to eliminate smudging? I just came across this technique in a article, but we have never done this. When we add the comment "smudge cells present" to the manual diff, I guess we assume that if there is any significant variance between the automated and manual count due to smudge cells, that the doc will understand that the smudge cells would account for it.
  15. Regarding repeating a ABO/Rh on a stored specimen before doing a later XM: I have never heard of such a thing before now. (I suppose I can see some reason in it if it is part of an electronic crossmatch policy, but we do not do those here, so I cannot really say). Like most labs (I think), our specimens are barcoded by the BB computer system and additionally have armband codes on them that match the computer record as well as the patient's armband. Not sure how this could get mixed up. When a tech pulls a specimen out of the fridge to add a XM, the assumption is that the T&S tech did their job correctly--both in lableing and testing.
  16. If it interfers with reading the results, then we go to tube. If the tube screen is positive, we would do a tube panel to ID it.
  17. Assuming you have the antigens covered that show dosage, I am not sure that there is much of an advantage by adding one more screening cell. If an unexpected antibody is present, chances are that one extra cell is not going to take care of all of your rule-outs anyway. That said, we do use a 3-cell screen, but we also use a 3 rule-outs / rule-ins rule, including a homozygous where appropriate.
  18. Seems like a good idea! If we ever get a request like that, that's how I am going to do it!
  19. This one looks pretty good: http://faculty.washington.edu/calvoc/DocumentsLabM419/ZLabProcedures/MXST.doc Of course, you would modify as necessary for use in your Lab. For example, in our procedure here, we do not do a mixing study for a particular PT or APTT unless one or both is elevated above the normal reference range for that test.
  20. We had an experience with this regarding QC for our coag analyzers a few inspections ago. We are a JACHO certified Lab. We were cited for not running QC every 8 hours for Coag. We ran them 3 times a day, but not exactly at 8 hours. There were a few 6 and 9 or 10 hour gaps. The regs just say every 8 hours. The inspector said they should be within 1/2 hour of every 8 to be in compliance. We did not argue the point. Not sure what the regs say about automated UA analyzers, but if they or the manufacturer say every 8, i think you need to try to get people to run them as close as possible to that.
  21. Does anyone have any experience with implementing TEGs? We have a trauma doc that would like to see them being put into use here at our mid-sized L2 trauma hospital. I know that some places that use them have gone back and forth a bit over how they are used and whether they are run out of the Lab or ER/OR. Supposedly if used appropriately, there is less waste of blood products for traumas and some surgeries when compared to relying on more routine coagulation testing. Has anyone documented a cost benefit? Thanks, Scott
  22. Thanks for the standard reference, Gerald. The requirement reads "full name". By this I believe the intent is to not use nicknames or initials for a first name, etc. If that is correct, then it seems like a "full" first and last name would satisfy the requirement. (Otherwise, an initial for the second name would not be considered "full" either!) We routinely have to correct for Admitting adding a middle initial (or removing one). We DO NOT redraw/retest a patient for this. Only if a pre-existing middle initial is changed. We have never been cited for this and we have recently gone through a very thorough FDA inspection.
  23. We allow MLTs to do virtually anything a CLS can do. We do require a CLS to check a MLT's antibody workup, however. We only have used assistants in BB to help with paperwork. We do not allow them to do any testing, including issuing of blood or thawing of plasma.
  24. I agree with most here. We do not worry about the addition of a middle initial when one was absent in the first place.
  25. Interesting case. Regarding the question of whether to "correct" the patient record or not: I would agree with those who caution against it. Without definitive proof as to whether the original ID of anti-K was accurate or not, I do not think you want to change the record. I think you are stuck with it.
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