Sandy Jo
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Everything posted by Sandy Jo
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That is great! I think I am a retired SBB, but not quite certain. Still maintaining my licenses but no longer working. Hmmm... just in case.
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Providing antibody information to patients
Sandy Jo replied to adiescast's topic in Transfusion Services
Here is another generic template we use with Avery Business card stock... genericANTIBODY CARD TEMPLATE-BLOOD BANK.doc -
Basically there is a bias with the selected samples. I would not be picking a patient with a SPD (Solid Phase Dependent) antibody to compare with manual tube methods. We pull samples that have already been run on the Echo and repeat them in tube testing. I also include a "disclaimer" of sorts in the SOP by stating that the methods may not compare 100% due to the sensitivity and specificity of each test method. The goal is not to achieve perfect correlation, but to document comparable results given the difference in sensitivities, specificities and general limitations between the methods. As we all know and love - no one method will always detect all clinically significant antibodies!
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That is the quantity we use in other areas of the lab and it is also the quantity used in other facilities in our division. We are standardizing many of the processes so that is what I am using. Sandy
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Quick! Does anyone have a form they are willing to share (or post in the Library) for method comparison of Blood Bank assays? I would like to include a minimum of 10 patient samples and correlate between Solid Phase (Echo) and tube testing for ABO/Rh and Antibody Screen. Thanks so much! Sandy
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For our Helmer Cellwasher I obtained a letter from the company verifying that the RelyOn Disinfectant tabs we use for the Immucor Galileo Echo is acceptable for the cellwaher as well. That also allows use to use the tabs up before they expire. Win-win!
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I am interested in more input from those that use Echo for automation: We currently use API for our proficiency testing and have had questionable or inconclusive results several times over the past several years. We are considering going back to CAP. It just isn't worth the cost savings if you have to waste Tech time and/or risk failure due to sample issues beyond your control. Are there many others using API that are seeing results such as this and/or have switched back to CAP because of it? Thanks! Sandy
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Do you have a flowchart or algorithm to share?
Sandy Jo replied to Karrieb61's topic in Transfusion Services
If you have a flowchart or something visual for one or more procedures (AB ID, DATs, eluates, ABO discrepencies, etc) and would like to share these, please send me a PM. I would dearly love some examples as well. I am a working BB Supervisor and with loss of several staff members in the lab I find myself covering BB as well as helping to cover Chemistry as well. Unfortunately the "off bench" tasks get left behind. If anyone can send some examples please PM me. It would be so VERY MUCH appreciated! Sandy -
We result the positive antibody screen on the Echo and then perform an antibody panel on the Echo. We add an IAT using manual tube method. If all cells are positive in Capture, with negative results in tubes, we result it as a Solid Phase Dependent antibody and use full coombs crossmatch. I have concerns with techs calling results "junk." I have seen what looks like a WAA show up in the more sensitive methods, like the Echo, and later have found a specific alloantibody. IMO we should be performing a full coombs crossmatch (just in case) whenever a method gives positive results for an antibody screen, not just ignoring the results. Obviously we all know with increased sensitivity there is decreased specificity. But I would not want to be responsible for treating something as insignificant and having a delayed hemolytic reaction come back to bite us!
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Thermco...Tempcheck...Laser thermometer device, etc., What are pro's, con's, recommendations from actual users of these devices? I am trying to research and not finding a lot of user reviews. I have a big concern over anything that is too complicated or lacks consistency. We are a small facility with a lot of generalists. I want to adapt a process to check temps on returned products, but I also want to avoid loss of product for a device that has questionable accuracy. Thanks for input!
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I also like to have a textbook on hand for the generalists that get crosstrained to work in the Transfusion Service. Actually it is good for anyone to go back and review and helps with questions for competencies. I recommend Denise Harmening "Modern Blood Banking and Transfusion Practices."
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Our Medical Director is looking for some examples of a form letter to use when blood product usage is not in compliance with our established criteria. Does anyone have some standard form letters for this topic that they would be willing to share with me? Also - for the moderators - what is the best way to give an email or fax number for contacts to send me the requested information?
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Hey Regina - how's it going? We generally give type O units. We also perform an AHG crossmatch, although perhaps not required, it helps maintain consistency when you have generalists rotating into Blood Bank. Sandy
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For our confirmatory hgb (for out-patients or someone that does not have a CBC or H&H done at our facility) we DO charge for just a hgb. We sent it through an approval committee (MEC) at the hospital and require at least a hgb - it is on record and considered a reflex test for the out-patients so the lab has approval to order it, and charge for it. In essence, if we transfused the patient and sent them into circulatory overload, we would be liable, not the outside lab. We do not accept the results of outside labs for this protocol. But I am still wondering about billing issues with confirmatory blood types, especially from other HCA facilities. Sandy BB Supervisor MT SBB
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Just wondering with all the interest in performing retypes on samples - if you can bill for this testing? We retype a specimen (quick forward Anti-A, Anti-B, Anti-D) each time the sample (previously T&S'd) is pulled out to add more crossmatches. Does anyone know if it is acceptable practice to bill for this testing? CPT codes? Also, if we were to adopt a protocol to require a repeat ABO/Rh on another lab sample drawn at a different time, would we be able to perform a billable ABO/Rh. What CPT codes? It seems as if the testing is performed, it should be billable. Although I do understand re-imbursement is a whole different ballgame! Thanks for the response, Sandy
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For the location that is routinely thawing Cryo for 20 minutes. Be aware that the FDA and product circular state to thaw Cryo no more than 15 minutes. Refer to 12 CFR 606.122.
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We actually use a blood pick-up form that serves as the first step of the utilization review. Blood Bank staff and myself (supervisor) review records first, then outliers go to medical director. Could fax form if anyone is interested. I may also have it on computer to email, but I would have to check at work.
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For our revco freezer we take the container holding the probe out of the freezer (door will close OK on the probe wires) and set it off that way without leaving the door open. Otherwise (door open) it would drop to unacceptable temperature levels for the products.
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We save the company QC data from the box of Safe-T-Vues and keep as a record of QC for it. So far have never had anyone (inspector) ask to see it.
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At a facility where I used to work we had issues with both of theirs. The parts were replaced and they were fine afterwards. It was some sort of mechanism that made the lid stay locked shut. We have one of them at our facility and have not had a problem. It is newer (about 2 years old) so perhaps the problem has been solved by the company.
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Perhaps you could suggest to them to look into bacterially testing the random platelets. Our supplier in Florida (Florida Blood Service in St. Pete) has designed a method to effectively test random platelets using culturing. I am not sure if FBS is marketing the process or procedure, but it may be worthwhile for your supplier to investigate!
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Our general acceptable review criteria is </= 8.0 g/dl hgb and/or </= 25% hct. For patients with CAD, SOB, and/or cardiac ischemia we use hgb </= 10.0 and/or hct </= 30%. For pre-op patients it is hgb </= 9.0 and/or hct </= 27%. Remember, you have to be prepared for the additional work and action needed if you lower the values. You want to maintain a reasonable review for utilization needs, but you have to use care in assessing the local standard of care provided by your physicians. There are publications put out by AABB such as "Guidelines for Blood Utilization Review," that may help you.
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We use the pick up slip (called Blood Order/Review Form) as a part of utilization review. It contains the indications for the transfusion and I review it initially (as supervisor) and if I detect any out of our justifiable conditions, it would go on to the pathologist for further review. As it stands I don't keep the "justified" slips more than tow months. I only keep the "unjustified" and the additional review/action taken with those cases. Even though I use if for different reasons (review) I am not aware of any need to keep the form longer once they have actually been reviewed and are deemed "acceptable." Do others agree?
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Speaking of armbands, does anyone know a specific brand that holds up to water (shower or bath) for our pre-op patients? We allow pre-op specimen collection of up to 7 days in advance of surgery if negative history, but have had issues with illegibility. We had been using Hollister, but had switched to Precision Dynamics due to contract needs.
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Regarding 100% leukoreduction I think the study info I have read has been supportive of the product, so I agree it is a better product in general for all patients. We currently provide leukoreduced for patients in which it is specifically requested, but our supplier is going to convert to 100% leukoreduced in the future (after ISBT). This will solve the issue for us, since we won't be able to supply non-leukoreduced blood. It also solves billing issues, as that is the only product we will be able to obtain.
