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Dansket

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  1. Like
    Dansket got a reaction from AMcCord in positive dat w cord blood   
    An important aspect of this conundrum to remember is that physicians do not treat newborns just because of a positive DAT, they treat infants who are anemic or hyperbilirubinemic regardless of the DAT results.
  2. Like
    Dansket got a reaction from Malcolm Needs in positive dat w cord blood   
    An important aspect of this conundrum to remember is that physicians do not treat newborns just because of a positive DAT, they treat infants who are anemic or hyperbilirubinemic regardless of the DAT results.
  3. Like
    Dansket reacted to tbostock in Specimen Expiration   
    3rd day at midnight, with day of draw being day zero.
  4. Like
    Dansket got a reaction from AMcCord in Performing Antibody Screens As Part of RhIG Workups   
    Over the decades since Rh Immune Globulin became available and a standard for care in 1968, the guiding principle changed from 'looking for reasons not to give', i.e. withholding the injection versus currently 'looking for reasons to give'.  Initially, the injection vial was packaged with a crossmatch vial that required a test tube crossmatch with the patient's rbcs.  This was a safety step to address the concern of giving such a large volume (at that time I think it was 5ml in the US) of anti-D to an Rh positive individual.
    Much later, it was determined that a second injection was required around 28 wks to prevent sensitization of women who might be hyper-responders. 
    Those safety concerns have been addressed with low volume (0.7ml), low protein formulations.  Crossmatching is no longer required.
    Performing an antibody screen with a workup is consistent with the original philosophy of 'looking for reasons to withhold the injection'.
  5. Like
    Dansket got a reaction from Malcolm Needs in BloodBankTalk:Antibody/Antigen Reaction   
    I just answered this question.


    My Score PASS  
  6. Like
    Dansket got a reaction from Mabel Adams in Non cellular component transfusion and historical ABO/Rh   
    Does your investigation-of-an-adverse-reaction-to-blood-transfusion-protocol for non-cellular blood components require testing the pretransfusion blood sample?
    I think this standard could stand an infusion of clarity.  I read it as 'Patient samples for all transfusions and a segment from any red-cell-containing component shall be stored at refrigerated temperatures for at least 7 days after transfusion.'
    Maybe someone can get clarification from the AABB as to their intent for 5.11.4.
  7. Like
    Dansket got a reaction from Mabel Adams in Emergency Release Blood   
    1. See AABB Standard 5.27 Urgent Requirement for Blood and Blood components, page 43 in the 30th edition.
    2.  No, if completed type on armbanded sample is not group O, we continue to issue Group O until completion of the 2nd confirmatory type.
  8. Like
    Dansket got a reaction from Marianne in Typenex Bands: Should They Stay or Should they Go?   
    You might consider offering an alternative to the Typenex bands that would satisfy both sides by offering an electronic system that mimics the rationale for the Typenex system. The current Typenex system is based the use of bar coded blood sample container labels that can only be sourced from the patient identification band.  An electronic mimic of Typenex can be used for identification and labeling of all laboratory specimen containers.
  9. Like
    Dansket got a reaction from Byfaith in Hemolysed samples for pretransfusion testing?   
    At the beginning of the testing process, ProVue warns the user with a disclaimer displayed onscreen that hemolysis, icterus and turbidity (wbcs, lipemia) may interfere with reading of a sample.  ProVue takes an image of the gel well and does a gray-scale analysis. The presence of turbidity, hemolysis and icterus would darken the image and prevent analysis due to lack of contrast. 
    Byfaith was asking if her current criteria is too restrictive and for options for sample rejection criteria when using automated gel testing.  My suggestion was to let the machine determine sample acceptability.  Using a visual color chart comparision process that was probably developed for manual tube testing ignores the machine's capability to do sample rejection that is more consistent and appropriate for the machine.
  10. Like
    Dansket got a reaction from Patty in Cord Blood Gel DAT QC   
    I think you need to demonstrate in Day of Use/Daily QC that the Anti-IgG Gel card reacts properly with positive and negative control, not only in the Indirect Antiglobulin Test (indirect agglutination with 37C incubation), but also in the Direct Antiglobulin Test (direct agglutination without incubation).
  11. Like
    Dansket got a reaction from SMILLER in Hemolysed samples for pretransfusion testing?   
    At the beginning of the testing process, ProVue warns the user with a disclaimer displayed onscreen that hemolysis, icterus and turbidity (wbcs, lipemia) may interfere with reading of a sample.  ProVue takes an image of the gel well and does a gray-scale analysis. The presence of turbidity, hemolysis and icterus would darken the image and prevent analysis due to lack of contrast. 
    Byfaith was asking if her current criteria is too restrictive and for options for sample rejection criteria when using automated gel testing.  My suggestion was to let the machine determine sample acceptability.  Using a visual color chart comparision process that was probably developed for manual tube testing ignores the machine's capability to do sample rejection that is more consistent and appropriate for the machine.
  12. Like
    Dansket got a reaction from David Saikin in Cord Blood Gel DAT QC   
    I think you need to demonstrate in Day of Use/Daily QC that the Anti-IgG Gel card reacts properly with positive and negative control, not only in the Indirect Antiglobulin Test (indirect agglutination with 37C incubation), but also in the Direct Antiglobulin Test (direct agglutination without incubation).
  13. Like
    Dansket reacted to BankerGirl in Nursing Order   
    This is how we treat it.  I have no way of verifying that there wasn't a verbal order from the physician to transfuse.  We do have the physician order to transfuse on their checklist as well, and there have been nurses who just checked it and went about their transfusion without an order.  I have to explain several times a year that it is the Dr.'s responsibility to order what he wants, Lab's job is to prepare what the Dr. orders, and the RN's responsibility to carry out the physician's orders.  Not always popular, but we can't babysit everyone.
  14. Like
    Dansket got a reaction from ANORRIS in Cord Blood Gel DAT QC   
    I think you need to demonstrate in Day of Use/Daily QC that the Anti-IgG Gel card reacts properly with positive and negative control, not only in the Indirect Antiglobulin Test (indirect agglutination with 37C incubation), but also in the Direct Antiglobulin Test (direct agglutination without incubation).
  15. Like
    Dansket got a reaction from Linz in QC for ABO in Gel   
    I'll assume you are doing Gel testing manually. I think you are wise to convert routine ABO/Rh and Antibody screen from tube testing to Gel testing.
    To QC the antibody screen test using Surgiscreen and Anti-IgG Gel card, you need a positive and negative control cell for each screen cell vial.  This can be accomplished in one (1) Anti-IgG Gel card.
    To QC the A/B/D Monoclonal and Reverse Grouping card, you will need to test each reagent in the gel card with positive an negative controls (this will require a minimum of two cards). You can QC the two (2) Buffered Gel columns with anti-A + A1 cells, anti-A + B cells, anti-B + A1 cells, and anti-B + B cells using the same two A/B/D Monoclonal and Reverse Grouping cards.
    You could use the A/B/D Gel card to confirm all donor unit types or you could use the A/B Gel card for non-group O Rh positive units, the Anti-A,B Gel card for all group O Rh positive units, and use the A/B/D Gel card for all units labeled Rh Negative.  All these cards would require Day of Use QC.
    You could use the A/B/D Monoclonal and Reverse Grouping Gel card or the A/B/D Monoclonal Grouping card for Cord Blood testing.  These cards will not detect all weak D's. You will have to run Weak D testing on all Cord Bloods initially classified as Rh Negative.
    There are other options based on your workload.
  16. Like
    Dansket got a reaction from AMcCord in Non cellular component transfusion and historical ABO/Rh   
    30th edition of the AABB Standard 5.11.4 states, "Patient samples and a segment from any red-cell-containing component(s) shall be stored at refrigerated temperatures for at least 7 days after transfusion."  Bold-face type is my emphasis.
  17. Like
    Dansket reacted to AMcCord in Doctor forgot to order DAT on O+ baby with O- mom. How does your lab deal with this?   
    We are Epic/Harvest/SafeTrace.
    Our cord blood specimen labels include the mother's name and MR# as well as baby name and MR#. Our facility is also using a naming convention for babies that includes mother's first name (Last Name, Mother'sFirstNameBaby's Sex - example: Jones, BeckyBoy). The names are awkward to look at, but do help connect mother/baby.
  18. Like
    Dansket got a reaction from Townsend in Non cellular component transfusion and historical ABO/Rh   
    You are correct.  However, in a facility with a very low volume of transfusion <1000 units annually, we elected to standardize the criteria for collection of pretransfusion blood samples, i.e., collecting a blood sample within 3 days of the intended date of transfusion for both red cell and non-red cell transfusions.
  19. Like
    Dansket got a reaction from Teristella in Lot Qual of Commercially Prepared RBC reagent controls on the ProVue   
    We use Alba-QC-Chek for Daily and Day of Use QC on ProVue. We put new lot of Alba-QC-Chek into use on Mondays.  If inspector asks for evidence of lot to lot comparision, we would show them Sunday's QC test results on old lot of Alba-QC-Chek and Monday's QC test results on new lot of Alba-QC-Chek.   It is extremely rare for Daily QC to fail on ProVue.
  20. Like
    Dansket reacted to Neil Blumberg in High Risk transfusion form   
    I think these bureaucratic methods corrode the trust and collegiality felt by our bedside practice colleagues.  High risk patients require discussion between the medical staff of the transfusion service and the ordering provider, and a note in the medical record documenting the decision making. Signing forms is a another tip of the hat to bureaucracy and legalese that should have no role in the provision of medical care.  A joint responsibility for such decisions and documentation is far more humane and in the interests of good patient care.  Neither the FDA nor regulatory agencies require such divisive practices and we should abandon them for better patient care and documentation of shared decision making. I realize some of you do not have knowledgeable and enthusiastic physician support, but this responsibility needs to be taken by the transfusion service medical director, who is paid to do so, however reluctant and happy to dump this on medical technologists.  Just saying.
  21. Like
    Dansket reacted to pbaker in Non cellular component transfusion and historical ABO/Rh   
    We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.
  22. Like
    Dansket got a reaction from mpmiola in 2nd ABO   
    Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube).
    You need to gather some data to show how many patients would be impacted by collecting a second blood sample. 
    Ask these questions, "How many patient admits annually?", "How many patient admits required blood bank testing?" (at my facility the calculated percentage was 11%), "How many patient samples type as Group O?" (at my facility the calculated percentage was 55% and we don't draw a second blood sample on these patients), "Of the non-Group O patients, how many had an independently collected blood sample in Hematology that could be used for the second ABO blood sample" (in our facility that was calculated to be 16%).  
    So for every 1000 patients admitted annually, 100 (I'm using 10% for sake of simple calculations) would require blood bank testing of whom 45 (100-55) would be non-group O, 7 (45 x 0.16) would have a blood sample in hematology, leaving  38 (45 - 7) or 3.8% (38/1000) patients requiring a second sample to be collected.  
    Using this kind of data will give you a much better grasp of the impact of routine performance of a second ABO determination on all patients for whom a Type and Screen or a Type and Crossmatch is ordered.
  23. Like
    Dansket got a reaction from bowerj1 in 2nd ABO   
    Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube).
    You need to gather some data to show how many patients would be impacted by collecting a second blood sample. 
    Ask these questions, "How many patient admits annually?", "How many patient admits required blood bank testing?" (at my facility the calculated percentage was 11%), "How many patient samples type as Group O?" (at my facility the calculated percentage was 55% and we don't draw a second blood sample on these patients), "Of the non-Group O patients, how many had an independently collected blood sample in Hematology that could be used for the second ABO blood sample" (in our facility that was calculated to be 16%).  
    So for every 1000 patients admitted annually, 100 (I'm using 10% for sake of simple calculations) would require blood bank testing of whom 45 (100-55) would be non-group O, 7 (45 x 0.16) would have a blood sample in hematology, leaving  38 (45 - 7) or 3.8% (38/1000) patients requiring a second sample to be collected.  
    Using this kind of data will give you a much better grasp of the impact of routine performance of a second ABO determination on all patients for whom a Type and Screen or a Type and Crossmatch is ordered.
  24. Like
    Dansket got a reaction from SMILLER in 2nd ABO   
    Your post suggests that patients who initially type group O should be tested a second time for not only ABO, but also Rh and Antibody Screen.  I assume you would include the same testing (ABO, Rh and Antibody Screen) for non-Group O patients. I disagree.
    Does anyone (US and UK) in this forum repeat the Antibody screen on the same sample or a newly collected blood sample?  Repeat the Rh?
    The concept of a second ABO typing did not emerge until after the "Computer Crossmatch" became an alternative method (to the serological crossmatch) approved by the FDA in the late 1990’s.  Repeat testing of the same sample or a newly collected blood sample for Rh and Antibody screen was not required by the FDA, AABB or the CAP.
    A second ABO typing is intended to be a serological alternative to the Immediate-spin Crossmatch to confirm the patient's ABO determination when a "Computer Crossmatch" is done. This creates a process that is similar to that done for donor units, i.e., blood type determination by donor center and blood type confirmation by the Transfusion Service. 
    In the absence of a "Computer Crossmatch", a serological Immediate-spin Crossmatch is required to detect ABO incompatibility between donor and recipient and most patients are transfused based on a single ABO determination without any repeat testing for Rh or Antibody Screen.  
  25. Like
    Dansket got a reaction from Patty in Red Cell Storage Position   
    We discontinued storing RBC units upright in holders years ago.  You can observe "hemolysis or other changes in appearance" regardless of storage position, flat or upright.
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