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Auntie-D

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Posts posted by Auntie-D

    Emergency Blood Release Form

    in Transfusion Services

    Posted · Edited by Auntie-D

    We approach it a different way - the compatability sheets accompanying the units have, in big bold writing "These units have been issued uncrossmatched and the physician prescribing the blood takes all responsibility for any possible adverse reactions.". The forms have to be signed when the blood is transfused for traceability. We have considered extending the concessionary release form to cover the flying squad but in all honesty - who are we to delay the provision of blood in an emergency situation? That's a clinical decision... If the clinician deems that the patient is bleeding too much to wait for a full crossmatch (or EI) then my view is 'just give them the blood'. The physician is prescribing the units and taking responsibility.

     

    What we do however do is fully audit all Massive Haemorrhage initiations and use of flying squad - any that are deemed 'inappropriate' use result in a one to one training session on the implications. In the past two years we have only had one and that was in 'death week' and due to a panicking medic thinking better safe than sorry.

     

    ETA - this is in the UK

    Anti-D Testing Mystery

    in Transfusion Services

    Posted

    I think you're confused here auntie-D.  I think we have established that there were no foetal cells - so just one population of red cells (maternal).  Are you mixing this post up with another one??

     

    Yep I sure am!

     

    OP - Anti-D can go away (rare but it happens). We have a patient who is male and has a recently developed anti-D that is no longer expressed. It is more likely that the scenarios to have happened that others have mentioned.

    Anti-D Testing Mystery

    in Transfusion Services

    Posted

    I always label my tubes as: A, B, D, C, α, β along with the patient initials on each tube.  I always pipette 2 drops of plasma into each of the reverse type tubes first, then I remove the pack cells and make my cell suspension.  I then pipette 1 drop of each Anti-Sera into each test tube and then pipette the 1 drop of each reverse cell into each tube as labeled.  I then pipette my cells suspension 1 drop into each A, B, D, and C test tubes - then in the centrifuge for 15 secs.  

     

    Just for future reference - it is considered good practice to do the forward and reverse groups off different 'spins'. We have an SOP that we use whole blood for the forward group (and half the diluent), then spin and use the spun plasma for the reverse group. If there was a discrepancy on the forward group then the sample is now spun and ready to go for a second check.

     

    I find, doing it this way also saves that crucial 5 minutes as you don't have to wait for the sample to spin to get a provisional group.

    Anti-D Testing Mystery

    in Transfusion Services

    Posted

    Your post has just made me think Phil (not a common practice - me thinking I mean, not your posts making me think!).

     

    Foetal red cells cells are 22% larger than adult red cells.  They would,therefore, settle in the sample quicker than would adult red cells (although not a lot quicker).

     

    If the red cells were taken from the top of the sample after it has settled, and the sample was not mixed, then these red cells are more likely to have been derived from the mother than the foetus.

     

    Could this also be a contributory factor among a plethora of other contributory factors I wonder, or am talking complete garbage???!!!!!!!!!!!

     

    Malcolm you are right - the same reason you are more likely to get a positive DCT on the analyser because it takes the cells from the bottom. All our analyser weak pos ones are repeated manually and are usually negative.

     

    Here's a zebra for you? Could the baby sample that was tested have been from the wrong baby, and the baby was in fact rh neg? The rh neg foetal cells would persist...

    Pondering (in the UK)

    in Transfusion Services

    Posted

    With the national shortage (absence) of 250iu and 500iu units of anti-D, is anyone collecting data of the number of babies with iatrogenic HDN due to overdose of prophylaxis? Could this happen? Could for example, a 13 week old foetus be exanguinated by the mother being given Rhopylac? We have been giving Rhophylac 1500iu for all gestation and some women have multiple doses.

     

    I daren't ask in the lab in case someone laughs at me. I have been distinctly uneasy in issuing myultiple lots of Rhophylac for ladies under 20 weeks :(

    Blood Bank Staff as runners

    in Transfusion Services

    Posted

    Our current procedure says we only check out blood to a licensed RN, LPN, Paramedic, or Perfusionist.

    Is that a hospital decision ? Can I change that?

     

    I've worked in a lab where the porters were allowed to collect blood (lab's own porters) as long as they were fully competency assessed. In our current lab our Lab Assistants do some running.

    QC Monitoring SD month to month

    in General Information

    Posted · Edited by Auntie-D

    When we had the Advia it would produce a report I think once a week or every so many patient samples.. I think it was called Neut X and Neut Y.  I think coulter has something similar Xbar B or something like that.  

     

    It's the moving averages on the advia and does all basic parameters - usually it is set to compare the last 30 results. Any deviation from the mean is flagged - great fun when you put a rack of oncology samples on ;)

     

    Ours is set for

     

    RBC

    MCV

    MCH

    MCHC

    WBC cor - the correction between the perox and baso cell counts

    Hb cor -  the correction between the measured and the calculated Hb

    MHC cor - the correction between the MCH and CHCM

     

    The cut off is a values of below 0.95 or above 1.05 (5%) but people seem to accept anything between 0.8 and 1.2 *sighs*

     

    Not sure why there is no platelet moving average though...

     

    Neut x/y is the average point of your perox scatter plot - it gives you an idea of the shape of the scatter without having to look at the plot.

    CAP today article about RHD genotyping

    in Education / Quality

    Posted

     don't understand why we have been trying to approach RhD as simply positive or negative.  

     

    But it is either positive or negative reactivity-wise, it is only degree of reaction that cause an issue. If a patient is clearly Rh negative in gel then I can't see the need in the expenditure - a 2+ reaction, yes, but a clear-cut 0?

    Peer Review of Transfusion Practice

    in Transfusion Services

    Posted

    I'd be less concerned about the numbers transfused - at the end of the day that is a clinical decision and who are we to disagree with their medical judgement. I am more concerned with the timings - routine topups ordered and transfused out of hours, 'urgent' crossmatches ordered out of hours but not used, routine topups ordered out of hours etc.

     

    We also operate the policy of 'don't give two without review' - we electronically issue so this isn't an issue for us timewise. Our hospital transfuses to clinical need - for example a patient today was transfused only one unit, enough to alleviate his symptoms, with a Hb of 43. Previously the hospital would have ordered (and transfused) at least 4 units - on appearance not numerically excessive as it would still only, in theory, have raised to Hb to 80, but in this case it it would have exceeded clinical need.

     

    I think the laboratory assessing need is wrong - we are not dealing with the patient at that moment in time. We can educate them as to what is appropriate use, but at the end of the day they are the ones responsible for the patient.

    Questions about FFP

    in Transfusion Services

    Posted

     

     

    1.       Basic info about what FFP is, what it is used for.

     

    Surely as a consultant you should know what FFP is - I'm sorry if this comes across as rude but this actually quite frightens me a bit that you asking such basic stuff on a forum!

     

    2.       Where do hospitals get their FFP from?

     

    In the UK they come from the donor centre who separates the whole blood into its relevant components

     

    3.       I’ve seen that FFP is mainly used in trauma centers/surgery units, are there any other departments in hospitals that are active in thawing and using the product?

     

    Departments themselves don't thaw the products, this is done by the laboratory under strict regulation. Other departments who regularly use FFP are maternity units (during massive haemorrhage cases), liver units and also a lot is used for premature babies to correct their frequent coagulopathies.

     

    4.       About how many thawing systems are in place in each department that uses them?

     

    This depends on how many beds the hospital has and the level of the trauma centre. We are a 380 bed hospital with specialist maternity and NICU for the area as well as the main A&E and we have two, each capable of thawing 4 units (or 2 each on fast thaw). 

     

    5.       What are some of the major thawer brands used? I’ve seen people list Helmer, Cytotherm, Boekel, Plasmatherm, Sahara-III, and the ArkBio microwave as some of their favorite thawing systems.  What are some pros/cons for the thawing system you use?

     

    We use the Sahara III - it is a dry system so less messy and also records the temperature of the units and notifies you when it is free from ice. We have used waterbath types that are messy if the bags burst and the microwave ones make human scrambled egg when the bags burst.

     

    6.       What are the sizes of the bags used in the thawers? (Are there standard sizes or do they vary a lot?)

     

    The FFP packs are usually around 250ml. It varies dependent on the haematocrit of the donor.

     

    7.       Last question! Are there any needs regarding FFP thawing systems? (eg. Quantity a machine can thaw, size, issues regarding frequency of use, or any other issues you have with your current thawing system you wish could be improved on.)

     

    The Sahara III is perfect for our needs

     

     


    1.  To correct prolonged Coag times due to Coumadin overdose.

     

    This isn't quite correct - the primary mode for reversal of overdose of an asymptomatic patient is vitamin K. Complete reversal can be achieved in 4 hours (though in practice I have found complete reversal is achievable in less than 2 if sufficient dose is given). For a patient that is currently bleeding, or due to undergo emergency (no planned) surgery, the mode of reversal should be PCC. FFP is notoriously unreliable for reversal (especially for significantly raised INRs) and usually results in incomplete reversal. You also run the risk of TOCO due to the volumes needed, and also delay due to the time taken to transfuse the units safely. PCC is a small volume and dose is adjusted based on INR and weight - for an INR of >8 you are talking of 4+ units of FFP and still running the risk of incomplete reversal - Vitamin K would have worked quicker...

    QC Monitoring SD month to month

    in General Information

    Posted · Edited by Auntie-D

    [This is intended to be humorous] People from the UK need to add u's or e's to everything, even proper names!

     

    OMG the mustached one will be unhappy I have added a U to his name.

     

    And pst - we don't add them, they were always there. It's lazy ass Americans dropping the letters ;) Mind you nothing is as bad as the Southern English teeage 'innit' for lazy talk. 

     

    ETA - yes there is! 'Bae' grrrrr

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