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Auntie-D

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Posts posted by Auntie-D

    Gel testing anyone?

    in Immunohematology Reference Laboratories

    Posted

    In the UK the primary mode is gel. I'm finding it a bit weird following this thread - I've been qualified 12 years and have never used anything other than gel for primary identification. The only problem I have found it that Ortho doesn't seem to pick up anti-Cw (but who cares ;)). Diamed (BioRad) seems much more sensitive all around. We can send IDs away to our reference lab (who use Ortho) and what we scored as a 2/3 will come back as 0.5! There have been 4 occasions in 2 years that we have identified an antibody with Diamed and Ortho hasn't picked it up. And we only do about 30 groups a week!

    Anti-f

    in Transfusion Services

    Posted

    Oweee Rh-fan - red and big ack! Jeez...

    Yes I know it's either/or was just double checking... hit , instead of /

    Everyone else - thanks for the help :)

    Malcolm - I know it's only ever reported as extremely mild but this guy has that much wrong with him that he could probably do without a transfusion reaction on top of it all - no matter how mild ;) He's a 'frequent flier' and we like to do our best for him :) He's a nice chap :)

    Anti-f

    in Transfusion Services

    Posted

    We have a patient that is on repeat transfusion and has had phenotyped (just CDEK) for over 20 years without developing an antibody. He has just been on holiday and has had his top-up in a well known teaching hospital who, despite being provided with full clinical information, EIed the patient unphenotyped blood! The patient has now come back home with an anti-f! We are a remote and rural lab and do not hold huge stocks of blood so now have to manage this patient.

    For routine top-ups he is now going to have to have two visits - a pre-sample t be sent away and then com in again for his transfusion. Logistically, this is going to create so much more work and also impact the patient's lifestyle as multiple appointments will cause problems at work :( My question is though, if he is to go into crisis at any point (bearing in mind that the nearest blood centre is 3 hours away), am I right in thinking the c-, e- blood will be negative for the f-antigen and thus suitable?

    Platelets D+ve can be destroyed by Rhogam injection

    in Transfusion Services

    Posted · Edited by Auntie-D

    In our trust we do not restrict D- patients to D- platelets. There is very little evidence that there are enough red cells contaminating platelets to illicit and immune response. Platelets contain no Rh antigens so cannot illicit an immune response by themselves.

    This is a paper her covering one hospital's study. http://www.ncbi.nlm.nih.gov/pubmed/19856725

    If you have any concerns and wish to be on the 'safe side', 500iu of will cover up to 4mls of blood - it is highly unlikely that the platelets are going to be contaminated with any more than this.

    And don't worry, giving D+ platelets wouldn't make the woman sterile...

    Edit - the sample applies to cryo and FFP.

    Unused plasma and cryp

    in Billing

    Posted

    I don't think you can bill for those. It might be called "fraud"!

    I disagree. If you purchase a cucumber and it goes past expiry before you eat it, you still have to pay for it. You can't just return it and say 'I didn't use this so I want a refund'. Why should transfused products be any different.

    The only exception I can see to this is if you have thawed units and they have been used on someone else. If someone has requested a thawing and the units have been wasted - they should pay.

    Newly promoted, overwhelmed.

    in Introductions

    Posted

    The first thing I did was ask everything what bugs them and how can I help - I found there were lots of ideas bobbing around that my predecessor had vetoed. Really good ideas! Involving people with the decisions and shaping their lab how they actually wanted it really helped me settle in.

    It was just little things like doing a workflow analysis to help the day flow more easily - samples moving round the lab in a circuit rather than back-and-forth. I also took the pressure off a bit - my predecessor was a stickler for turn-around-times and insisted every sample be processed as and when it arrived in the lab. I suggested that 3 batches a day was enough - 10am for the ward round things meant that the first hour was free for getting organised, then 2pm and 4pm. Anything non-urgent arriving after 4pm now waits until the next day. I've also said that preops need only be done once a day so if the 10 o'clock samples are all pre-ops for 3 weeks away then the 10am batch doesn't go on and waits until the next batch. This also frees up time for people to take time to do Continued Professional Development and the like. Changing the workload like this hasn't made it any more difficult at 10, 2 and 4 but it has made it a lot easier between times. Of course there's always the odd urgent crozzie to contend with but my staff are much happier knowing that they don't have to break their backs.

    Oh and I've also introduced a radio!!

    Transfusion Reaction?

    in Case Studies

    Posted

    I have a culture started on the unit. After some checking I found that she is 28 weeks pregnant, and having issues, but I don't know exactly what issues. I did a D-Dimer and it is 4060 ng/mL - our upper range is 400 ng/mL. Protime and Ptt are within normal limits and the platelet count is 248,000.

    D-dimers are raised in pregnancy anyway so this has no significance unless you are querying DIC (but it's too low to point to that anyway).

    Critical values

    in General Information

    Posted

    "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?)

    Hospital policy is to use the wristbands in the case of an unconcious patient and verbal confimation for a concious patient. A delta check would pick up a failure in procedure. And if a delta check was ignored and a patient was transfused the wrong blood the legal people would be pulling their hair out. Delta checks are our final check to verify the validity of a sample.

    I've just this minute used the delta check and identified a drip arm sample on a patient with a Na of 118 - all the other results were low too compared with the previous sample. I've just validated the repeat sample and all the parameters are now normal. Reporting borderline calcium, sodium and the like could have resulted a patient being treated in an adverse manner.

    I LOVE the delta check :)

    Storage vs. Shipping/ Validation

    in Education / Quality

    Posted

    If the unit is to be transfused this is complete overkill.

    Since 90+% of the times we use a cooler the products are going off-site, generally for 6-8 hrs, what recording temps at the transfusion site allows is for us to return the units to inventory if they aren't transfused. Frequently patients don't show for their appointment, or for one reason or another they can't receive all of the units that were requested. By recording temps when the products are packed, on arrival and several times throughout the day we can safely return the units to stock. The assessors like it as well!

    Ah makes sense for off site shipping :)

    Transfusion Reaction?

    in Case Studies

    Posted

    Could be, but I would have thought that she would have been systemically very ill, and almost certainly would have required IV antibiotics.

    Just covering all bases ;) Our medics are notoriously bad for not providing relevant information. Sample today ?LRTI but failed to mention that they were on chemotherapy which would have gone a long way to explaining the Hb of 70, neutrophil count of 0.5 and platelet count of 28. It would have also saved us a phonecall - the GP was completely unconcerned as those were the results they were expecting...

    Storage vs. Shipping/ Validation

    in Education / Quality

    Posted

    We send a thermometer with each cooler. The temp is read and recorded at the time of issue, at the time each unit is taken out of the cooler and if any units are returned the temp is documented at this time as well. I like to think that we are 'validating' the cooler each time they are used.

    Nursing also records a visual inspection and date/time of use for each unit used.

    Also at issue we check and record a 'visual inspection' of the cooler.

    If the unit is to be transfused this is complete overkill. In the UK if the unit is going to be transfused to that patient then it can be out of temperature for 4 hours - it just cannot be put back in the fridge. A lot of hospitals have not taken this up yet as it is harder to track the time out of the fridge for 4 hours than 30 minutes.

    But we need to make things easier for them in an emergency, not harder. To validate the box ever time it is used makes more paperwork for them and more for yourself too. Once every 6 months, with the temeperature actually challenged is sufficient.

    We do a 6 monthly check winter check where we leave the box in a bike locker with a data logger in - this is challenging extremes of low temperature. We do this as our blood is transported by van and it takes about 6 hours to reach us. We also do a high temperature validation in the summer where we leave the box on our hot windowsill. In both cases we also use a data logger to record the ambient temperature to ensure there was indeed a challenge.

    IMO it's no use challenging the boxes to room temperature - they need to be challenged for the worst case scenario.

    Critical values

    in General Information

    Posted · Edited by Auntie-D

    Delta checks are invaluable! There are many instances in my career where a crossmatch has been requested (significant number of units) and a review of the chemistry deltas has show that it was a drip arm sample. It is also our *ONLY* way of identifying for sure that the blood bank sample has been taken from the correct patient - and I have requested repeats on crossmatch samples due to erroneous deltas, and had different blood groups on the two samples. There are chemistry parameters that do not vary much with time and are invaluable to us. There is a huge amount of literature about delta checks and the need to make use of this tool! Chemistry is where good blood bank procedures begin...

    In my lab we check the chemistry deltas for all crossmatch requests - it's not a difficult or time consuming thing to do - the computer does it for us - it's up to us to make use of it...

    Edit - I'm doing my November CPD talk on chemistry delta checks and their impact on blood bank. If anyone wants a copy of my notes and references email me on leanne.kaut@nhs.net.

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