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Dansket

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  1. Like
    Dansket got a reaction from mpmiola in temp of returned units stored in continuously monitored coolers   
    There is an article titled "Debunking the 30-Minute Rule" in the May 2010 edition of the AABB News.  The 30-minute rule ignores the laws of thermodynamics and is unacceptable today.  The temperature must be taken on all units returned unused to determine if the unit can be re-issued for transfusion. 
     
    You didn't mention the pneumatic tube transit time.  It is likely the reason why units are exceeding 10C as Deny Morlino mentioned.
  2. Like
    Dansket got a reaction from maristelgp in Type specific vs O red cells for unconfirmed patients   
    The science is very basic!  When you issue non-group O red blood cells in an non-emergent situation, there is a real possibility of transfusing ABO incompatible red blood cells to a patient, i.e., there is risk associated with this practice. What is the Lab Managers compelling reason to do this?
     
    When you issue group O red blood cells in an non-emergent situation, there is no possiblity of an transfusing ABO incompatible red blood cells to a patient.  There is no risk here!
     
    Our policy requires that group O red blood cells be issued uncrossmatched unless all tests required by routine pretransfusion compatibility testing have been completed.  There is no ambiguity for staff to address with this approach.
  3. Like
    Dansket got a reaction from Yanxia in DAT on newborns   
    Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge.  Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn.  Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT?  How many newborns were ABO incompatible with mom?  How many were ABO compatible?  How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? 
     
    I did this on 1350 newborns of whom 26 were treated with phototherapy.  There was no correlation between ABO, Rh and DAT results.  13 newborns were treated who had a negative DAT. 
     
    My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia.  Bilirubin levels do!
  4. Like
    Dansket got a reaction from AMcCord in DAT on newborns   
    Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge.  Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn.  Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT?  How many newborns were ABO incompatible with mom?  How many were ABO compatible?  How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? 
     
    I did this on 1350 newborns of whom 26 were treated with phototherapy.  There was no correlation between ABO, Rh and DAT results.  13 newborns were treated who had a negative DAT. 
     
    My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia.  Bilirubin levels do!
  5. Like
    Dansket got a reaction from Sandy L in DAT on newborns   
    Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge.  Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn.  Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT?  How many newborns were ABO incompatible with mom?  How many were ABO compatible?  How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? 
     
    I did this on 1350 newborns of whom 26 were treated with phototherapy.  There was no correlation between ABO, Rh and DAT results.  13 newborns were treated who had a negative DAT. 
     
    My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia.  Bilirubin levels do!
  6. Like
    Dansket got a reaction from Malcolm Needs in DAT on newborns   
    Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge.  Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn.  Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT?  How many newborns were ABO incompatible with mom?  How many were ABO compatible?  How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? 
     
    I did this on 1350 newborns of whom 26 were treated with phototherapy.  There was no correlation between ABO, Rh and DAT results.  13 newborns were treated who had a negative DAT. 
     
    My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia.  Bilirubin levels do!
  7. Like
    Dansket got a reaction from BrianD in Sequestration and cost reduction   
    Is your department a separate cost center? Are you being held directly responsible or is the Clinical Laboratory Administrator?
    Look at the numbers of units returned to the donor center as a percentage of units received. If it is high, you need to re-think your inventory control as each unit returned is a unit you spent time/money confirming.
    How do you confirm your donor units? Can your testing requirements be reduced?
    Are you doing IgG crossmatches on all patients or just those with positive screen or history of clinically significant antibody? Electronic?
    Are you doing a 3-cell screen versus 2-cell antibody screen?
    Does your hospital host mobile blood donations? We negotiated a price reduction on rbc units if we met mutually agreed donation goals.
    Do you have more than one blood supplier?
    Have you optimized your reagent red cell shipments with your usage? Do you monitor them monthly?
    Have you optimized your gel card shipments with your usage?
    Do you make your own ProVue controls or purchase them?
    Do you use both tube and gel methodologies? If so, you must purchase proficiency surveys accordingly. I purchase JAT only and no longer do J.
    Just some thoughts, hope they help.
    Dan
  8. Like
    Dansket got a reaction from Lbiggs in Type specific vs O red cells for unconfirmed patients   
    The science is very basic!  When you issue non-group O red blood cells in an non-emergent situation, there is a real possibility of transfusing ABO incompatible red blood cells to a patient, i.e., there is risk associated with this practice. What is the Lab Managers compelling reason to do this?
     
    When you issue group O red blood cells in an non-emergent situation, there is no possiblity of an transfusing ABO incompatible red blood cells to a patient.  There is no risk here!
     
    Our policy requires that group O red blood cells be issued uncrossmatched unless all tests required by routine pretransfusion compatibility testing have been completed.  There is no ambiguity for staff to address with this approach.
  9. Like
    Dansket got a reaction from silverblood in Blood Bank ID Bands   
    I can appreciate John's and cimergen's stance on this issue.  But there is a distinct advantage to a secondary blood band system and that it is designed to prevent WBIT; doing a blood type on a specimen collected from a different venipuncture is designed to detect WBIT.  So choose wisely..or do both!
  10. Like
    Dansket got a reaction from MOBB in Eluates on babies with positive DATs   
    For those who routinely do eluates, what evidence/data have you to support such a policy?  Whether an eluate is positive or negative, when have eluate results changed the physician's decision to do or not to do?
  11. Like
    Dansket got a reaction from Yanxia in Need opinions...Giving Ag neg units vs. antibody "rule-out"   
    I must disagree to some degree with almost every response (except Mabel's first statement).  Well thought policies and training should prevail, not an opinion in the heat of the moment.  I certainly do not think that the cost of doing business should enter into the decision whether or not to follow the antibody identification protocol.  Tom didn't mention the urgency for blood transfusion in this situation, so I don't know if the patient's conditions supported his actions.
     
    We don't re-identify historical antibody for transfusion recipients unless incompatible crossmatches are detected with antigen-negative donor units or antigen-negative screen cells are agglutinated.  Just this one change in policy would save thousands of $$$ annually in Tom's facility and take cost out of the decision equation.   Requiring that this patient receive Kell-negative blood is also an unnecessary cost incurred by such decisions.
     
    Regardless, I do agree that the specimen should have been sent to an IRL to confirm Tom's conclusions.
     
    As a new BBK supervisor, please consider updating the antibody identification protocol to allow rule out of anti-K with a single heterozygous panel cell (as Mabel said) and communicate this to all your staff. 
     
    Dan...
  12. Like
    Dansket got a reaction from Eagle01 in AABB Standards 5.15 Crossmatch   
    The following reference may be pertinent to your question:
    2010 Ask the FDA and CLIA Transcript



    Ask the FDA and CMS/CLIA
    October 11, 2010
    AABB 2010 Annual Meeting
    Baltimore, Maryland

    FDA

    Jay Epstein - Director, Office of Blood Research & Review, CBER
    Ellen Lazarus - Director, Division of Human Tissues in the Office of Cells, Tissue and Gene Therapy, CBER
    Hira Nakhasi - Director, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research & Review, CBER
    Paul Mied - Deputy Director, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research & Review, CBER
    Judy Ciaraldi - Consumer Safety Officer, Division of Blood Applications, Office of Blood Research & Review, CBER
    Lore Fields - Consumer Safety Officer, Blood & Plasma Branch, Division of Blood Applications, Office of Blood Research & Review, CBER
    Sharon O'Callaghan - Program Surveillance Branch, Office of Compliance & Biologics Quality, CBER

    CMS

    Penelope Meyers - Division of Laboratory Services, Survey & Certification Group, Center for Medicaid & State Operations at CMS

    Moderator

    M. Allene Carr-Greer, Director, Regulatory Affairs, AABB


    Question 4: We perform all routine testing using gel technology. We also perform electronic crossmatches. For patients in whom clinically significant antibodies have been identified, is it sufficient to perform only a gel antiglobulin crossmatch? Does this satisfy the CLIA requirement to perform a test to detect ABO incompatibility?

    MS. MEYERS: For this question, before I start, I would like to just make the comment that the answers that I will be giving to the questions today are based on the CLIA regulations. However, I would like to remind the audience that many laboratories choose to obtain their CLIA certification through a CMS-approved accreditation organization, of which there are six. One of which is AABB. These laboratories must follow all the requirements of their chosen accreditation organization which may be more stringent than the CLIA requirements.

    Now back to the question. Actually, these CLIA requirements for crossmatching are based on the FDA requirements for crossmatching, and FDA and CMS have collaborated in preparing the answer to this question. The simple answer is that the IgG gel card does not fulfill the requirement to demonstrate ABO incompatibility. There are two issues involved here. First, the labeling clearly indicates that the IgG gel card is for direct and indirect antiglobulin tests. In other words, detection of cell-bound IgG antibodies. While the limitation section of the package insert states that some IgM antibodies may react, this limitation should not be interpreted to mean that the card is capable of detecting all IgM antibodies, particularly ABO antibodies. Secondly, the IgG gel card is a low ionic test system and there have been reports that ABO incompatibilities, due to IgM antibodies, can be missed when the antibodies are weak and the test is low ionic strength. While we acknowledge that there is continuing debate on this topic, but with the knowledge of these reports and in the absence of data from the reagent manufacturer to support the use of a low ionic strength system for detection of ABO incompatibility due to IgM antibodies, we believe it is not appropriate for users to omit some kind of test to detect these incompatibilities. And for eligible patients, an electronic crossmatch would fulfill the requirements. An immediate spin crossmatch, of course, is an acceptable method for all patients.

    MODERATOR: Thank you, Penny. Can I ask, because I could not hear everything that you just said, but did you respond to the part about sufficient to perform only the gel antiglobulin crossmatch, that first part?

    MS. MEYERS: No, it is not sufficient to perform only the gel antiglobulin crossmatch because that does not fulfill the requirement to detect ABO incompatibilities.
    PANEL MEMBERS:
  13. Like
    Dansket got a reaction from Mabel Adams in Resolving Abo Discrepancy In Mts Gel   
    I presented a poster at the 1997 AABB convention regarding  26 ABO Reverse Grouping discrepancies detected in Gel when testing over 3500 patient blood samples.  An immediate-spin tube test (reverse grouping) resolved 19/26 discrepancies due to patient's anti-A/anti-B not detected in gel.  The immediate-spin tube test was 3-4+.  Expected anti-A or anti-B was not detected in gel or tube for 3 blood samples and remained unresolved even with extended RT incubation and cold incubation.
     
    We also found that unexpected agglutination in the ABO reverse grouping test was sometimes resolved by centrifuging the blood sample for a total of 9 minutes (three times for 3 minutes) in a STAT-Spin express centrifuge (4400g) and then retesting in Gel.
  14. Like
    Dansket got a reaction from Deny Morlino in Resolving Abo Discrepancy In Mts Gel   
    I presented a poster at the 1997 AABB convention regarding  26 ABO Reverse Grouping discrepancies detected in Gel when testing over 3500 patient blood samples.  An immediate-spin tube test (reverse grouping) resolved 19/26 discrepancies due to patient's anti-A/anti-B not detected in gel.  The immediate-spin tube test was 3-4+.  Expected anti-A or anti-B was not detected in gel or tube for 3 blood samples and remained unresolved even with extended RT incubation and cold incubation.
     
    We also found that unexpected agglutination in the ABO reverse grouping test was sometimes resolved by centrifuging the blood sample for a total of 9 minutes (three times for 3 minutes) in a STAT-Spin express centrifuge (4400g) and then retesting in Gel.
  15. Like
    Dansket got a reaction from DAWNA1983 in Plasma transfusion and ABO history   
    Type a new specimen for each admission
  16. Like
    Dansket got a reaction from EDibble in Antibody Screen At Delivery   
    As there is no bullet-proof system for determining whether anti-D detected at delivery is due to passive or active immunization, we discontinued antibody screens as part of our Postpartum Rh Immune Globlulin Protocol. Has the physician indicated what he would do if "the RHIG did not work"?
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