Auntie-D
Content Type
Store
Profiles
Forums
Blogs
Events
Frequently Asked Questions
Gallery
Downloads
Glossary
Links Directory
Questions
Jobs
Vendors
Posts posted by Auntie-D
-
-
+/- 1o for me too...
-
Don't worry about multiple barcodes - most scanners allow for the use of multiple barcodes
Double sided scanning - now that's another matter altogether... -
All of the gel cards we use are IgG/C3d, mainly because they are the same cost the same as soley IgG ones and we do that few that they would expire - so we use them for everything. We do seem to pick up a few antibodies that our reference lab who use IgG only Ortho cards don't seem to find. If the antibodies are C3d reacting that would explain it... It has been a bug-bear of mine for a while - they describe us as 'oversensitive'.
Does anyone know if anti-c is more reactive with C3d? We have a patient who has Anti-c but the titres are too low for our reference lab to pick up - we get 3+ though...
-
I bet it's an anti-Cw
That's the usual one that comes out better manually... -
Ahh, I thought you meant you were forcing the alarms to alarm every week... my bad.
We do challenge ours every week, just to make sure we catch enough personnel. Having the alarm going off routinely and people following a procedure that they are comfortable means that when things do go wrong, product isn't wasted.
For example we have a lady - lets call her Janet. She works on the reception and routinely would ignore our alarm challenge as she perceived it as 'just a test'. After ignoring 3 consecutive challenges I spoke with her and explained the reason why we are challenging the alarms and the importance of relocating the blood within 30 minutes. Coincidentally when our flying squad fridge broke she was the one on in the night and phoned someone straight away. 15 minutes later they had returned to the lab which gave them 15 minutes to move the stock to a working fridge.
Every time my boss challenges my weekly challenges I point out how useful it is as a learning exercise for people.
Of course it sounds like your system is far superior to ours - our's is just terrible to be honest. I am tendering for a new system and hope to go with one that has remote dialing to the on-call person. Would make things so much easier lol
-
I sort of agree with you, and sort of don't (it's the old saying, "I used to be indecisive, but now I'm not so sure!"), but, although I agree that 2 months is far too long, a cracking anamnestic delayed haemolytic transfusion reaction due to a reappearing anti-Jka (for example) would not necessarily show up straight away, and it may be nice to know if the units were Jk(a+), or, at least, incompatible post-transfusion cross-match?
But is it going to affect patient management?
-
Challenge the alarms weekly? I would do it weekly if the mfg of the alarm system or fridge said to, or if CAP or AABB said to, but otherwise, that seems like overkill to me. Have you found that the alarm check fails periodically - frequently enough that weekly is warranted? I'm just surprised. Ours have never failed....
We're not checking the alarms themselves weekly per se - more that procedure is followed when the alarm goes off. In the UK this is a requirement.
And yes issues are discovered regularly where people reset the alarm in out main alarms board (outwith the lab) without notifying the laboratory. The alarms indeed do go off in the laboratory but periodically some poor chap in estates is sent on a wild goose chase...
Just out of interest, is your lab staffed 24/7? If it is then you are fine but if the alarm goes off in the middle of the night and noone is notified then wasted blood still has the potential to be used...(at least until the temps are next checked)
-
have gone digging through the bags when a patient developed a new antibody and was able to find the segments she got 2 months earlier and they were positive for the antigen that she developed an antibody to!
That isn't unexpected though. It is however generating unnecessary work - this doesn't provide and direct benefit to the patient or affect patient management, all it does is satifies our own curiosity...
I still don't understand the general rational behind keeping the pigtails - if there is a suspected transfusion reaction the bag will come back anyway for culture - hey presto! Tag lines without doing any work at all
-
Just a thinking sideways thought here - if the subsequent sample was normal, could the post transfusion sample have been from a different patient? What were the chemistry delta checks like on the other parameters in which there shouldn't have been intra-sample variability?
-
If you are in US and AABB accredited :
AABB std 5.12 Serologic Confirmation of Donor Blood ABO/Rh (including autologous units)
Before transfusion, the ABO group of each Whole Blood and Red Blood Cell component and the Rh type of such units labeled as Rh negative shall be confirmed by a serologic test from an integrally attached segment. Confirmatory testing for weak D is not required.
Ahh... In England packs are guaranteed and in Scotland they are prepared to the same standard, though not guaranteed. We just do an immediate spin, tube crossmatch to guarantee ABO compatibility.
Still don't understand what a 'dry lab' is though...
-
I don't understand what you mean by 'dry lab' testing reagent QC.
And what do you mean by unit retype? You mean confirming the unit's group? If so there isn't actually a requirement to do that if an immediate spin, tube crossmatch is done...
-
I think what John means Mabel is by using the DAT card available from DiaMed/Bio-Rad in Europe, you perform an "auto" IAT in the DAT card, using the columns that contain monospecific anti-IgG, anti-IgA, anti-IgM, anti-C3c, anti-C3d and a negative control.
Is that correct John?
That's what we did the last place I worked...
-
It seems if you use automation designed for the 6 well card, it would not handle the 8 well card, right?
No, the Griffols have their own machine I assume. The OP said the lab is small so I assume manual gel would be done...
-
I have a question about this that was brought to mind after attending a session at AABB. Why do we need to record the daily temp of refrigerators if there is either a continuous chart or an electronic monitoring system? We currently have a probe that is connected to the chart, a different probe that is connected to the digital readout on the refrigerator, and 2 different thermometers in different places from which we record the temp daily. It seems like overkill. Couldn't I just calibrate the probes annually to my NIST, verify that the chart is working everyday, temperature map every so often and get rid of the other 2 thermometers and daily recording?
Yes
But you still need to check daily that the system is behaving as expected and challenge the alarms weekly... -
(International disclaimer: In the US we put the quote marks outside the period whereas I understand the Brits would put them inside.)
Yeah, I never did understand that corruption...
-
My Bio Rad rep said probably early 2013. Be careful in comparing Ortho's European products because they market the BioVue there that they don't sell in the US. It uses glass beads in its columns. There is another gel card maker in Europe-Grifols, but I haven't heard that they plan to enter the US market nor do I know much about them.
Griffols seems good thy do 8 well cards rather than 6 well so you can do two 3 cell screens with a pos and neg control without having to open another. The Grouping cards have two Ds and also K which I think is fab. When our annual contract is due I'm going to seriously look into them as the technology is identical but you just get more
-
My notes on the matter before assembling the SOP
-
Diamed who have recently been bought out by Biorad are trying to crack the US market. The technology is similar
There is quite a bit about it in the other gel thread, including the difference between US and ortho technology -
Thanks to all who are sharing their great procedures!
Agreed
-
I label everything - it's at very least good practice... And agree with what Malcolm says about manslaughter.
In England units are guaranteed, in Scotland not. But I don't know of any labs in Scotland that check the groups of they bags unless the EI - your immediate spin should guarantee ABO incompatibility.
As for tube groups - I only actually label with the details of the patient not the reagent as - blue = A, yellow = B and no colour = D. The controls all get labelled with a C to distinguish them.
-
Oh just to add we are currently using Thermomax which if far from ideal but are switching to Comark soon. I've used Comark before and have found it to be great.
-
We check minimum and maximum daily but don't record as it is stored in the database. We don't have a seperate thermometer - the whole point of continuos monitoring is to eliminate this. The temperature is mapped every 6 months and there is an air and core probe.
-
How very topical!! We've just had a crossmatch request on a repeatedly transfused patient. After the second to last transfusion I added haematinics on myself and found that the ferritin was 1650. I discussed with the medics that this should possibly be investigated and that transferrin might be a good place to start. Well they transfused anyway and didn't investigate. The ferritin today is 6500 and they are have requested a further 2 unit xm. I point blank refused to do it until they discussed it with the consultant haematologist. I'm organising a talk for the junior docs now on transfusion of chronic anaemia to go along with my other talk I'm organising on the appropriate use of Anti-D...
-
. I was just wondering how is this bubble accomplished? Is it part of the gel-card manufacturing process?
The well narrows to a column towards the bottom. If the cells/reagent/plasma are pipetted at an angle towards the side of the well, it shouldn't go towards the column.
[ATTACH=CONFIG]572[/ATTACH]
Edit - I still feel that the weak reactions are more to do with improper mixing and prozone than contact with the gel itself (the actual surface are in contact is small).
If the red cells are pipetted and go into the column, when the plasma is added there is no way for it to mix. During incubation the red cells are circulation and fall through the plasma. If the cells are below the plasma already, this can't happen. Think of it as a combination on convection currents, brownian motion and the ESR
. If nether the twain shall meet there won't be a reaction...
Double sided scanning - now that's another matter altogether...
That's the usual one that comes out better manually...
Discrepant Blood Groups - SOP
in Immunohematology Reference Laboratories
Posted
I'm glad I started this thread now - seems to have helped lots of people