Auntie-D
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Posts posted by Auntie-D
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I've been fighting this battle for years and haven't made a dent yet. They cite patient confidentiality??!!!!??!!! most often. I am, however, the original squeaky wheel needing greased, and some year, in a galaxy far, far away, I may yet wear them down!
As to the delay of surgery, the surgeon will call and tell me to "just keep trying to find something" or "it's not my problem". Love the last one and so does anesthesia! We feel like magicians sometimes...nothing up my left sleeve, but look what I just pulled out of my hat!
Patient confidentiality? Yet they send you samples with the patient's names on lol...
As far as providing blood cover if they have a positive antibody screen - we have our policy written that if an antibody is identified we need 72 hours to provide blood (covers us for shipping from elsewhere). Just tell them that the blood isn't ready yet when they ask and they'll soon come round... I insist that for elective surgeries phenotyped blood must be given - none of the xm compatible nonsense. If the patient isn't yet cut, they can wait!
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None of any of my colleagues (who have worked in places that EI) have had any reports of transfusion reactions due to DAT postive donor units.
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This is precisely our process as well.
Us too. If something is going to go wrong during delivery it is ususally going to go seriously wrong. My biggest blood issues during my career have been for a AAA and ruptured placenta - 43 units was the most during labour... Having the group and screen already done meant that the blood could just go out EI - if we'd had a fresh sample it would have delayed things unecessarily.
As the midwives keep remining us - it's two lives that are at stake...
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We are manual and do work as it comes in. With my supervisors (lab, I am BB super) belief it does not matter if QC is done 32 hrs after 8 hrs of work as long as it is recorded somewhere on that calendar day. To over rule her I need some type of regulation.
I'm in the UK so not much help there... It's hard convincing people but it is just good practice to do a QC after a period of inactivity. I'll see what our MHRA state...
Edit - it just states 'must be robustly controlled'...
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I wish I had access to the OR list. I "do not need to know". All those surprises (antibodies, etc) keep the blood flowing in the morning!
Keep asking - make them think that you are going to make their job easier (which you are). We get our theatre list for the next week on a Friday morning to allow us to order enough blood to cover any surgeries. I argued that it would seriously benefit me running the transfusion service and cut down wastage - and it has...
Keep at them - they'll give in eventually
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Is there a TJC or AABB or CAP regulation that Daily QC must be done prior to any portents being done once 24 hrs from last QC has been done? I have tried to standardize the time we do QC to be sure we have done QC within 24 hrs but some oldtimers ,including my supervisor , say anytime that day. Which could mean variables from 24-32 hours between QC.
As long as no samples are processed before the QCs are done then there shouldn't be a probelm. My SOP states that they QCs need to be done before the first batch of the day - if that first batch is at 3pm then the QC is done at 3pm. But then we're still manual... It would be good practice to do the QC first thing in the morning to allow any analyser problems to be resolved.
If any of my staff were running samples after a prolonged period of inactivity I would be displeased...
In my last job when we were using Diamed analysers we used to do a weak positive control for each batch that went on the analyser - not QCing the reagents but the technique, as you would do for manual. I did think that this was bordering on OTT though...
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Even if they do have a weak "real" anti-D, give them the RhIg anyway. There is no easy way to prove if it is primary or secondary sensitization until well after delivery. I wish I could get my ob docs to stop ordering absc for the RhIg workup . . . isn't needed. Just give the stuff to the ladies who require it. I have never had a f/u on any perinatal anti-D's. As Denny puts it - we have screened them at 16 and 28 weeks . . . they don't need another one. Itf they have something else clinically significant it will get dealt with if it impacts the child. You don't still do minor crossmatches . . . do you?
The whole point of antinatal screening is to pick it up *before* it impacts the child. A term G&S is covering the mother for the next pregancy - allowing problems to be identified before they happen - allowing the mother to be counselled before she gets preganant, rather than upon having a hydrops foetus and miscarrying before the 16 week screen. With modern advances a mother carrying immune D can have a foetus screened at 10-12 weeks and decide whether to advance with the pregnancy or not.
Antenatal screening cannot be compared to crossmatching - if blood is needed they can have it in 10 minutes if need-be. If an immune D is missed it can impact a whole family for life. If you have presumed passives that aren't being followed up your clinicians need educating to the potential impact. It isn't difficult to recall a woman with presumed passive at 3 or 6 months post delivery - she'll be vising for follow-ups anyway. In the grand scheme of things sticking an extra tube on the analyser isn't much when we're talking about preventing suffering from HDFN. If proper follow-up was done the 0.3% that are still happening might be reduced further.
There is a lot of talk of comparing BTS now with pharmacology terms in deaths/or serious morbidity per million. 0.3% is still 3,000 affected babies per million Rh Neg mothers and 450 per million of all groups. If this was in pharmacology, where off the top of my head I think the cutoff is 5 per million, it wouldn't be accepted.
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I'm doing the same at the mo. If you send me your email address I'll send you what we have so far
I'm sure others will offer too
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A bank holiday Friday zebra is an even worse one...
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Malcolm - I've been following this research too. I'm so glad they have increased the 'shelf life' as a result of these studies - though it still hasn't reached Scotland yet (evidence based medicine-what's that?)...
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Antenatal testing is normally performed around the 16th week of gestation here as part of a prenatal profile. If the patient is rh negative a RhIg workup is repeated at week 28. This includes an antibody screen. If the patient is determined to be a c-section delivery, a type and screen is performed prior to surgery. Other than these instances, a screen is not routinely performed. I do not see how the safety of the patient is compromised in these scenarios. It is a comfortable balance of safety and cost containment that works for our physicians and blood bank. OK off my soap box now
A woman is far more likely to bleed from a vaginal delivery than through a CS - I don't see your argument...
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Good to hear that. Looking forward to more than one player in the column agglutination arena.
What I should have said is tha Biorad have bought out Diamed...
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...but the 30 minutes takes into account multiple removals from the fridge which is why we sould adhere to it, regardless of whether the unit reaches 10 or not (8oC in the UK). There is even talk here of extending the regulations so that the unit is only allowed to be out of the friedge for 30 minutes in total, regardsless of how many times is has had to be crossmatched.
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Biorad is due to enter that market in 2012 I believe. Ortho's lock on "gel" in the United States expires this year I believe. Will be interesting to see how this all plays out.
Diamed in the UK now uses Biorad for their reagents. I've been suitable happy with them.
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Seems like quite a bit of medical non-necessity. Part of our job is cost containment, and this is a perfect example of unnecessary waste in my opinion.
I view it as very necessary as part of the antenatal screening process - not ever weak antibody seen is prophylactic D... And if testing isn't even done then there is no way of identifying the problem until the woman has another pregnancy or needs a transfusion. And by that time the titre could be too low to identify. The NHS in the UK is budget strapped but is still able to put safety before cost.
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I agree with Shelby - for your initial QC you are QCing the reagents, card and cells so only need to use the one method.
The analyser should be QC'd daily (does not need to be separatate to the initial daily QC) and for manual technique you should have a weak positive and negative control with *each batch* to control the technique and make sure the reagents/cards/cells are behaving as expected. This is a completely separate issue to controlling the reagents - both need to be done.
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Barbarakym - I'm glad I'm not the only one who thinks Ortho gives nonsense results. I'm a Diamed girl through and through
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I'm curious, how many of these surprising positive antibody screens are attributed to the antenatal RhIG injection at 28 weeks and therefore are of no concern for following pregnancies?
In my past life the only routine testing on admission for OB patients was an Rh type. Everything else was on an "as ordered" basis.
None when we're talking about Rh Pos women... For Rh Neg women it is important to identify whether any anti-D is showing is passive or immune. Our women have 1500iu/ml prophylaxis at 28 weeks and as a result should not have any anti-D showing up at delivery (check the curves for one shot of 1500 vs 2 shots - 2 shots covers past pregnancy, 1500 doesn't). If anti-D is showing then followup must be carried out - too many assumptions are made that D is prophy and if no testing is done, you don't even have assumption. Prophylaxis is a great help but it is not a coverall and does not elimnate the need for G&S at delivery. Prophylaxis will cover the *majority* of bleeds but not necessarily all of them.
Incidentally most of the antibodies I have identifed seem to be either K or C. No, it isn't going the affect the woman immediately but to have an antibody identifed in readiness for the next pregnancy (or trauma) is not a bad thing.
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Surely this is what external QA is for? I don't see what purpose QCing the person does - competency testing and adequate QA performance should be sufficient.
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Of course we do a fetal screen on a postpartum specimen but we can often get away with using the CBC tube which is routinely drawn the morning after delivery.
Our babies rarely get bled - all testing is done on cord blood. Poor things have had enough trauma without uneccessarily stabbing them too
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We're tied to Fischer
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We do one on admission as the final part of the antenatal screening. If the patient is Rh D Neg then we hold back on it until the patient has delevered(or the maternity team start to flap) and just process a post-natal sample ready for prophylaxis +/-Kleihauer. It's surprising the number of antibody screens that are negative at 28 weeks but positive at delivery... Nice to be prepared for the next pregnancy, or emergency admission
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What's an OB?
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Have asked the mods to anonymise further - can't edit my own thread...
TJC Reg Regarding Ortho Manual Gel Daily QC
in Accrediting Agencies
Posted
For manual testing every batch means every time you do a set of G&S - be this 10 patients or just one. Manual method should always be QC'd each time. Not 8 or 24 hours. Batch testing is completely different than reagent testing which can be done every 24 hours. I don't know about over the pond but in the UK our guidelines state that each day reagents must be controlled and each batch of samples must have a positive and negative control.