bbbirder

I can't help with the Emergency Issue/EXM thing, but couldn't you just enter NP for your reactions and then an interpretation of "P" for presumed compatible? That is what we do if we transfuse Emergency Issued Group O blood and never get a patient specimen (due to the patient dying or something). Linda

We had a discussion about this in the past, and as I recall, it isn't absolute that it is a pharmacist is in charge of it or must review it, rather that it was a qualified, licensed practitioner. A patholgoist meets those requirements. I wish I could quote the actual regulation, but I can't find it now. Linda

We no longer stock any group O FFP/FP24, instead with thaw A's for the group patients. We don't have much wastage, but this has helped to reduce waste even more.

We have been having a discussion about when a Kleihauer-Betke stain (or even flow cytometry for fetal cells) becomes a worthwhile test to perform. We already do not perform a fetal screen (rosette test) at less than 20 weeks gestation, and only give one vial of RhIG (300mcg), assuming that the fetal blood volume is less than 30 mls prior to 20 weeks. However, in the case of trauma to the mother, the doctors often want a KB stain. I have not been able to find any reference that states it is of no value to do before XX weeks gestation. I assume there is one, where even if the fetus was exsanguinated, you would be unlikely to detect it in the mother's blood. Any thoughts? Thanks, Linda

Has anyone used Immucor's "HPC" (Human Platelet Concentrate) product? I am considering using it, but would really like to use it on specimens on our Echo analyzer that have reactions in solid phase but are negative in gel or tube. I think some of these are HLA related, just based on how they react and the patient characteristics. However, the product insert says to use it on serum (because it can cause some clot formation in plasma specimens) and we almost never have serum readily available on these patients. And, it indicates using it in tube... but if the tube testing is negative, there is no point. Thanks for any insight into this. Linda

Could you elaborate on the UDI product? Thanks, Linda

Merry Christmas to everyone, from someone working this day! Linda

Like Brenda, our nurses must signe off that there is an order. This is the responsibilty of both nurses doing the bedside ID checks. Linda

I agree with John, generalists are a challenge. But I am really proud of the generalists we have. I really try to keep on top of problems every day. And tell people what they did 'wrong' every time, don't let it go. If you let it go, they get the impression it is ok. For minor, annoying things, reminders. After 2, then I get more serious with notes into their performance evaluation file, then comes counselings. This gets there attention, if nothing else does. If it is serious, then counseling right away. Annoyances: Forgot to add the stir balls to the indicator cells on the Echo analyzer. More annoying: Can't figure out my panel because I pulled the wrong antigram! (Echo panel) Linda

We dispense all RhIG (Rhophyllac) from BB. The NDC is attached somehow in BAR. We are Meditech Magic. I can get details for this if you need it. Linda

At our facility, it is nursing's responsibility to confirm the order. In fact 2 nurses are required to confirm the order (due an error in the distant past when blood was given without an order). Monitoring is done by Quality Care Management (a nurse is the auditor). I would not want BB to be responsible for this. Linda

No, I really meant Rh-positive. Our Massive Transfusion Protocol (greater than 4 units per hour with continued bleeding), calls for switching to Rh positive blood on all males and females greater than 50 yoa. We will also switch Rh negative females of childbearing age if needed. We are 2+ hours from our supplier and can't afford to use all our O negs on one patient. We have never had to do this, but we will if we need to. Linda

We do vitals pre, 15 min and hourly AND then 1 hour post. The Outpatients (who are usually return customers) are encouraged to stay and given written instructions on what to watch for when they leave. Many of these outpatients do not stay (I doubt the nurse really twists their arms), if they leave prior to the one hour check, the nurse documents that the patient declined to stay.

Ditto to the last 3 responses. The nurses performing the transfusion are responsible for verifying the physician order. Linda

We have an Echo and get these antibodies from time to time as well. We have gel and tube available to us, and test with those, and due a full XM. Most patients who are positive with all cells on the Echo but neg in gel and tube seem to have some sort of autoimmune disease, at least the ones I have looked at. I don't think we'd benefit from sending these to our reference lab, since they only do tube testing. If our tube is negative, I assume their tube test will also be negative. Has anyone used Immucor's "Human Platelet ... something..." product (sorry I forgot the exact name) to neutralize Bg-HLA related antibodies? And, if you have used it, do you run specimens treated with it on the Echo? Linda

We have the Immucor ECHO and love it. Phone service and field service are both great. It picks up many more Jk's than gel or tube. It does seem to pick up more 'warm autos' than gel. We have our manual gel stations as back up and for alternate testing. Unlike the Provue (at least when I saw the Provue) you can add specimens without waiting for the analyzer to allow it. Linda

We use coolers for ED, OR, & Dialysis. But the procedure says it can go to other areas (such as ICU) at the BB techs discretion. If it is still out at 4 hours (which never really happens) we need to check temp and re-ice if needed.

Our massive transfusion protocol simply says that for OB hemorrhage, Cryo and PLT use may be greater. And we try to avoid using Rh positive units on females less than 50 years of age.

Our blood center is 2 hours away, and like others have said, our biggest problem product is Platelets. We keep some on hand, but sometimes run out and need to get shipments off schedule. Another product difficulty is when you need to order those 'rare' antigen typed units. How many to get is always a game. Another impact is your ability to ID complex antibodies. We rarely send anything to our reference lab, just because of the time and logistics. So, even though we have all generalists, we are pretty good at ABID.

We do pH testing on the PBS because the manufacturer requires it for our Echo analyzer. I don't know if that is why others do it or not.

We are next to hematology, so we borrow some of their urinalysis controls to QC pH paper. However, most of the time we QC the saline on a blood gas analyzer. They run QC regularly anyway.

Many have mentioned what they did to study (Transfusion, Technical Manual, Issitt, Daniels, Last Chance Review, etc.) and I want to add some additional items about what I did to study. 1) I found Malcolm's educational powerpoints on blood group systems on this web page to be very helpful. (Thank you so much for sharing.) 2) I read lots of abstracts and some articles in the journal "Blood" (many of them are open content, all are after one year). Particularly about coagulation disorders and treatments and hemolytic anemias. 3) The web page "Blood Bank Guy" has lectures and quizzes and this helped me. 4) I am a visual learner. I would do searches and look for Google Images (it is amazing what is out there, like pretty cartoons of Platelet glycoproteins, Complement cascade, red cell antigen structures) and then print them out and (literally!) cut and paste them into a study notebook. Then I'd add my notes. 5) practice the "Blood Bank Math" problems <repeat> Linda Frederick

I questioned this also. I took my exam in July of this year and passed!!!! (Hip-hip-hooray, especially for someone with such an aged brain.) When I read this in the materials and saw conflicting things in other reviews so I though, I will just do what we always do and add a dose.There was a question about RhIG dosing on the exam. I don't remember the deails. I don't know if I missed that question or not, but I did manage to pass! Linda Frederick

The NHSBT (Malcom?) for using red cells from donors negative for the offending PLT antigen to reduce the risk of post-transfusion purpura (see below). It would seem to me that if red cells from such donors are not readily available, washed red cells is a legitimate alternative. We have had 3 patients with PTP at our 'small' hospital over the years (a high number I think, plus we have more cases of NIAT than I would expect), and each has come back with a recommendation from a 'big city' hematologist to get washed RBCs. Each of these patients was found to have a PLT antibody and all were 60+ years-of-age women who reported later that there had been a problem with one or more of her infants years ago. As I understand it, the risk of PTP is greater when the PLT antibody declines and then rebounds, but I don't know of any studies that say when this could be a problem. http://hospital.blood.co.uk/library/pdf/INF272_1_3.pdf 5.2 Transfusion advice Patients including pregnant women and mothers with HPA antibodies are at risk of post transfusion purpura (PTP) and should be transfused with HPA compatible red cells and platelets if these are readily available and will not result in the delay of an urgent transfusion. 5.2.1 Antibody card and information sheet The NHSBT H&I Reference laboratory will issue an HPA antibody card for patients with HPA antibodies in case they require further transfusions in the future. An information leaflet will be provided for women with pregnancies affected by NAIT. 5.2.2 For the mother Red cell concentrates obtained from donors negative for the relevant HPA antigen should be made available at delivery if the risk of transfusion is high. This should be discussed with the Obstetrician. Linda Frederick

I agree with Mabel 100%. How is this an infection risk? It would be a mess, and unsightly, but not an infection risk. Aren't tested donor blood products also exempt from some DOT regulations?