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SMILLER

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Posts posted by SMILLER

    Antigen Typing Charges

    in Transfusion Services

    Posted

    The patient who currently needs the screening done gets charged for however many antigens are tested.  Pos or neg, transfused or no, does not matter.  I would think that the charge code would be the same regardless of what the antigen typing results would be.

    Scott

    Transfusion Reaction Criteria

    in Transfusion Services

    Posted

    7 hours ago, jojo808 said:

    Hi all,

    I am trying to overhaul our policy for transfusion reactions as recommended by our last CAP inspector. We were basically culturing all reactions except urticaria and the inspector said we were wasting time and energy and I agree but I need more assurance for the definite criteria so I want to know what are your criteria for culture and gram stain for blood products that are in question. I've looked online and found some use only temperature increase while others use temp increase with or without other symptoms What my research has found is the following: Most call febrile reactions bet 38-40C, or an increase in temp bet 1-2C from the baseline (pre-transfusion). The ones that use other symptoms use tachycardia and/or hypotension.

    Just want a poll for several things:

    1. At what temp do you call it a Febrile reaction?

    2. Do you also use temp increase from the baseline? If so what is?

    3. Do you use other criteria with Temp increase for culture? If so what are they?

    4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?)

    5. Same with Hypotension, any numerical definition?

    I know there are threads on this but I don't want to sort through it all. Please, I would love as much input as possible. Add any advice or other pertinent information is greatly appreciated. Thank you all in advance. 

    1.  Febrile 1-2 C.

    2.  Measured from the baseline, which is just before the transfusion starts.

    3.  Cultures are done only when directed by a pathologist or other physician.

    4. and 5.  These are nursing calls.

    Rotating departments

    in Education / Quality

    Posted

    We are a 220 bed trauma 2 hospital.  We do  not have the luxury of having a large number of specialists for each area.  We have many generalists here, especially on evenings and nights.  In general, we do a 4-5 week training period for the BB area, and try to make sure they are rotated through BB on a regular basis.  First shift BBers are available at all times by phone.  We ahve few problems.

    Scott

    Gel card with 1+ reactions showing negative after spinning a second time

    in Immunohematology Reference Laboratories

    Posted

    2 hours ago, Patty said:

    I have noticed that if my gel reactions start to look hazy after centrifugation that the card I keep as a balance card may be getting extremely dried out.  After I replace it with a new card my reactions are clearly negative.  Could it be a problem with the balance of your centrifuge or it may not be level?   

    We sometimes get the weak reactions that are absent after a second spin but they are mostly from OB patient's post midterm RHIG.  We do not use a readings after a second spin.

    Thanks for the tip!  We have not had any particular problems but we will refresh the balance card!

    Scott

    manual cell count control

    in General Information

    Posted

    21 hours ago, dtreadway said:

    Yes!  There are guidelines that correlate the cell count with the cellularity of the cytospin.

     

    I would think that it would have to be arbitrary to the point of uselessness, but what do I know?

    In any event, we are not CAP certified but have been inspected by JCAHO forever.  I am pretty sure you will need cell-count QC like mentioned above.  You can always check your inspection standards when you get a copy!

    Scott

    manual cell count control

    in General Information

    Posted

    We do indeed run wet controls when we do cell counts on the hemacytometer.  We use Streck Cell-chex.  JCAHO noted that we needed to do this a few inspections ago.  Once every 8 hours when testing patients.

    (Not sure what you mean  by a procedural control vis a vis manual cell counts...)

    Scott

    ESR analyzer for small lab

    in General Information

    Posted

    I appreciate the point about someone not being around when the alarm goes off! 

    Just one more note, the sedi-mat uses the same Polymedco tubes used for a manual test.  So if you get that or another auto ESR that uses standard tubes, you would have your back-up available STAT.

    Scott

    inconclusive antibody ID

    in Transfusion Services

    Posted

    On 1/8/2019 at 3:11 AM, jojo808 said:

    Even if the antibody screen is subsequently negative? Our night shift tech initially did a panel because one of the screening cells on this patient looked 'suspicious' A panel (Ortho panel A) was tested and there was one cell out of that panel that was a 1+. He then did panel B, which was completely non reactive. Of course all common clinically significant alloantibodies were ruled out. Now if this patient continuous to come back with negative screens ... you know I'm trying to find a reason why we can stop doing this without being irresponsible. 

    So Smiller how would you prove it was an artifact? And Dansket what does your lab do if screens are now negative? Again trying to find an out. 

    Thanks everyone in advance!

    By artifact I mean gel interference/mixed field/cold agglutinates that go away with a redraw or alternate method such as tube, proving that it was specimen or technique related and not otherwise.

    The thing is, if you have even one stubborn positive cell, it could be a sign of a developing atypical antibody that might be significant down the line (if the patient is given blood from a donor with that particular antigen).  Granted -- I would think it's extremely unlikely that the patient would ever have a problem with a transfusion just because of a limited situation like this.

    But I know of at least one big university hospital that will NOT bother with future AHG crossmatches in situations like these.

    Scott

    ESR analyzer for small lab

    in General Information

    Posted

    We have been using a Polymedco sedi-mat for a few years and have had little trouble with it, other than getting used to its simple menu.

    With only 10-15 ESRs a month I have to wonder why you don't just use the old-fashioned 1 hour manual test.  You need it as back-up anyway if I am not mistaken.

    Scott

     

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