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SMILLER

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  1. Like
    SMILLER got a reaction from ssnowy787 in Urine Microscopic QC   
    WE do not do it although I believe we had something at one time that allowed for urine micro RBC and WBC counts, which is hardly comprehensive for this type of QC if you have to do it.  But anyway, for years now, we have not done any regular "micro" QC for routine urinalysis.  But I would double-check with CAP if I were you (we are JCAHO accredited).  It should be in your QC standards somewhere.
    Scott
  2. Like
    SMILLER got a reaction from donellda in Christmas.   
    And Happy Boxing Day!
    Scott
  3. Like
    SMILLER got a reaction from Ensis01 in Antisera   
    My inclination is that since this is not in the package insert, this is violating the package insert and shouldn't be done prior to use for in date antisera.
     
    I think you are right with that.  Is this written up in your procedures as well?  I would make a few changes.  Lab practices that are done "just because" should be looked at very closely!
     
    Scott
  4. Like
    SMILLER got a reaction from jojo808 in Daily QC for ABO Reagents   
    I don't think that is correct about dumbing down to manufacturer's recommendations.  I believe the regs read that at a minimum, manufacturer's requirements for things like QC be followed.  CLIA/JCAHO/CAP regulations are often much more strict than what a particular manufacturer may suggest for their product. 
    If you choose to not run a pos and neg control, you better have a better reason than, "the manufacturer said it was OK."
    Scott
  5. Haha
    SMILLER got a reaction from Arno in Just for fun   
    LOL!  We would send it to our reference lab!  We have other things to do here...
    Scott
  6. Like
    SMILLER got a reaction from jalomahe in Just for fun   
    LOL!  We would send it to our reference lab!  We have other things to do here...
    Scott
  7. Like
    SMILLER got a reaction from cthherbal in Antibody Titers Gel vs. Tube   
    On p. 563 of AABB Tech Manual 18th edition, it only mentions that titer methods other than "saline AHG 60 minute incubation" in tube may result in higher titers and "should be validated with clinical findings" (see Malcolm's post, above).  So it does not seem to say one cannot use gel or other methods, just that you need to document validation.
    I have always been a bit uncomfortable with identifying an antibody with gel (for a prenatal), then doing the titers in tube.  But then again, I guess it is the comparison of the series of tube titers that they are looking at.
    Scott
  8. Like
    SMILLER got a reaction from Henrique in Antibody Titers Gel vs. Tube   
    "Do you want it to be faster and more hands-off or more exact?"  They really said that?  Yikes!
    Scott
  9. Like
    SMILLER got a reaction from David Saikin in Antibody Titers Gel vs. Tube   
    "Do you want it to be faster and more hands-off or more exact?"  They really said that?  Yikes!
    Scott
  10. Like
    SMILLER got a reaction from AuntiS in Antibody Titers Gel vs. Tube   
    On p. 563 of AABB Tech Manual 18th edition, it only mentions that titer methods other than "saline AHG 60 minute incubation" in tube may result in higher titers and "should be validated with clinical findings" (see Malcolm's post, above).  So it does not seem to say one cannot use gel or other methods, just that you need to document validation.
    I have always been a bit uncomfortable with identifying an antibody with gel (for a prenatal), then doing the titers in tube.  But then again, I guess it is the comparison of the series of tube titers that they are looking at.
    Scott
  11. Like
    SMILLER got a reaction from dcubed in Tube holder for reading DAT or IAT under microscope   
    LOL! I knew someone would mention that Malcolm!
    Here we only would use a scope to differentiate rouleaux from a "true" weak reaction when getting very weak macroscopic reverse typings or on an IS crossmatch. I am not sure why anyone would think to use it for a DAT or IAT.
    Scott
  12. Like
    SMILLER got a reaction from jojo808 in Blood Requests after a Transfusion Reaction Workup   
    If the DAT is negative, I would think that a post screen would be unecessary, as there was no transfusion reaction to begin with, hence nothing to stimulate any particular antibody.  (Theoretically I suppose, any transfusion may result in an "increase in titer", but no one does a screen after every uneventful transfusion.)
     
    Scott
  13. Like
    SMILLER got a reaction from AMcCord in Blood Bank staff   
    Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages,
    We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB.  The only real "dedicated"  techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area).  On second and third shift, virtually all of the techs work BB in addition to the main lab area.
    Whether one has BB with all dedicated staff or no, the key is to have adequate training and competency, along with extensive references, including having good P&Ps available.  This is true for all areas of the Lab (and in health care in general!).  It requires a sharp and dedicated management model and staff.
    Scott
     
  14. Like
    SMILLER got a reaction from tcoyle in Changing FFP (with 24hr exp) to thawed FFP with 5 day exp   
    We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
     
    Scott
  15. Like
    We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
     
    Scott
  16. Like
    SMILLER got a reaction from AMcCord in Flying Squad Blood   
    We do not really need it here -- probably too many problems to deal with extra-departmentally anyway. 
    In general, we can get uncrossed product to our ER or OR in an emergency situation within a few minutes.
    Scott
  17. Like
    SMILLER got a reaction from BldBnker in Confused about dosage   
    From the My Two Cents Dept...
    I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
    Scott
  18. Like
    SMILLER got a reaction from tcoyle in Confused about dosage   
    From the My Two Cents Dept...
    I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
    Scott
  19. Like
    SMILLER got a reaction from Baby Banker in Confused about dosage   
    Just to add a bit to what David has already explained.  I tend to think of dosage as relating to the amount of antigens present on the RBCs that you are using to ID the patient's antibody, and if the reagent RBC has lots of antigens of the type in question, then the reaction will be stronger.  This is really important for a patient whose antibodies are just developing--you want to use a reagent RBC with the strongest expression possible, and these are the homozygous cells.
    For example, at our hospital, we use the 3 by 3 method for antibody ID (for each type of significant antibody, if the antibody is present, we want to rule in with 3 positive RBCs, and to rule out all the other antibodies, we want to have 3 negative reactions for those.)  So for antigens that "show dosage", we want at least one of those three rule out RBCs to be homozygous.
    Scott
  20. Like
    SMILLER got a reaction from mrmic in Confused about dosage   
    From the My Two Cents Dept...
    I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
    Scott
  21. Like
    SMILLER got a reaction from John C. Staley in Confused about dosage   
    From the My Two Cents Dept...
    I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
    Scott
  22. Like
    SMILLER reacted to Neil Blumberg in The COVID-19 challenge   
    For platelets you can cut the dose in half with no worsening of clinical outcomes. Randomized trial in NEJM called the PLADO (platelet dose) study some years ago (Sherrill Slichter was the senior author).  Most platelets do little or no good, so this is actually a good idea for patients and helps with inventory in times of shortage.  Try to give ABO identical as the increment is higher, the duration of increment is longer and the patients bleed less.
  23. Like
    SMILLER got a reaction from Texas Lynn in ARC Packing Slips? Keep? Trash? HELP!   
    More likely the slips must be hung onto at least until after your blood provider gets their payment.  If there is any dispute over what you are charged and/or paying for, then you have their packing slip to refer to as a sort of "receipt".  Doesn't seem like you would need to hang onto them forever.  May be a billing department requirement.
    Scott
  24. Thanks
    SMILLER got a reaction from bldbnkr in Blood Shortage   
    We are a smaller level 2 trauma center here.  For example, we normally would want to keep our O pos inventory at 20.  Today we ordered 15, they sent 2.  This is the worst I've seen it in working 30 years here.
    Scott
  25. Like
    SMILLER reacted to Ensis01 in Rouleaux interference   
    My experience is that interference from rouleaux and cold autoantibodies in Gel is not unusual but this may depend on your patient population. 
    As rouleaux is not an antibody an AHG crossmatch is not required. If you IS crossmatch you must (in my opinion) saline replace so you show any agglutination is interference and can therefore enter a negative/compatible/non-reactive result into your LISS, probably with a comment.

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