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Posts posted by kirkaw
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Hi,
Supposing you have a quad pack where one piece was taken off for a baby but the rest of the unit is intact and has not been entered (hence the original unit outdate can be maintained), would you give the remainder of the unit to another (adult) patient once the unit is too old to give to an infant? Are there any standards governing this?
Thanks!
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That's a great question, but yes, I am sure the neurosurgeon understands the difference between a pheresis unit and a 6-pack.
As a follow-up, I enlisted the help of 2 other physicians on the transfusion committee and hopefully, we will be setting up a meeting soon, to discuss parameters of needs and what we can reasonably provide.
Thanks All, for the input.
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I need some help. We have a new neurosurgeon who is insisting that we keep 5 platelet pheresis products on-hand at all times for potential brain bleeds. To give you some background, we are a 350 bed hospital withOUT a trauma designation and who does not do solid organ transplant. Our platelet usage has been reduced by half in the past 2 years as blood loss during surgical procedures has been curtailed. I have been working very hard to cut down on platelet waste. In 2014, there were months when we wasted 8-12 units of platelets/month. We are about 3 hours from our blood supplier.
If there is anyone out there willing to share their protocol for patients with brain bleeds? I would be MOST appreciative! It would be especially nice if your hospital was similar in size to ours and/or has the challenge of being greater than 60 miles from your blood supplier.
Thanks in advance!
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AABB standard 5.27.5 (29th ed) states that 'the records shall contain a signed statement from the requesting physician indicating that the clinical situation was sufficiently urgent to require release of blood before completion of compatibility testing....' And I either read in a JC standard or heard at the AABB conference, that that standard is firm regarding the signature; it cannot be a PA or FNP.
As for the timing, I too, have to chase down a physycian. However, our policy is that the MD can sign after the fact. Much like the scenario already stated, the requesting physician may be too busy attending the patient, to sign the emergency release paper. I generally like to have this accomplished by the end of the shift on which the emergency occured. However, I have had to chase that physician down on Monday morning when the emergency was on Sat. night.
Not ideal, but better late than never.The other recourse you have, if you truly feel like your physicians are abusing the grace period is take this to your transfusion committee. They would be the ones to enforce the signing in a reasonable timefreame.
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Hi,
For those that have a wet ice machine in your blood bank, do you have a log that indicates a cleaning schedule? I heard that Joint Commission cited a hospital for not having such a log. It was not clear if this ice machine was in the blood bank or in the kitchen!
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I digress, but in response to David's post, I had a resident bring a specimen for culture to the Microbiology department, where I was working part-time as a student, and he asked if he should wait for the results.
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Pammy, I am getting a quote for the Hettich EBA 280. Is that what you have? The spec sheet the sales rep sent me says it spins at 5000 rpm and I didn't know if that was accceptable for serologic testing. I am happy to know that this speed is adjustable.
How have these worked for you now that you've had them a few months?
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I beileve K-Centra is relatively 'mainstream' now and stocked in many hospital pharmacies. However, most docs are reticent to use it due to cost. We had a patient yesterday get 5 units of group AB plasma to correct an INR of 2.5 (pt. was on anticoagulation therapy due to A Fib) so that he could have hip surgery.
I thought this would be the perfect situation for K-Centra.
How are your docs using or not using K-Centra? Do they seem concerned about the cost?
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I would not repeat the panel in either case unless the C negative, AHG crossmatched units were incompatible OR the antibody screen showed additional reactivity or increased strength.
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Assuming that the serofuges in question refer to ones used for pre-transfusion testing of patient specimens, I would not report this to the FDA. FDA reportable events are ones that may have affected the safety, purity or potency of a distributed blood product. This applies both to transfused products and products that were in control of the BB/TS at the time of the deviation. I do not think your situation applies. Granted, the safety, purity or potency of the product may have been affected if you mistyped a patient due to improper centrifugation, but I think that's a stretch.
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We require an ABO/Rh on the current admission for transfusion of plasma products.
Also of note, we do not perform a blood group/type on a 2nd specimen prior to transfusion for new patients. We rely on the crossmatch to provide that check. However, only patients who have had 2 indepedent determinations of blood group and type qualify for electronic crossmatch.
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We do the same as goodchild and pbaker.
I am also interested to know how many people do a post-partum type and screen in addition to a fetal screen before issuing post-partum RhIg (this assumes that the baby is Rh pos.
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OK, forget about Lua or Lewis antibodies or whatever. I am not interested in that. Think of this as aphilisophical question regarding the trustworthyness of using a 2 or 3 cell screen in the following situation:
Hypothetically: If for some unspecified reason, you have positive cells from a panel and a negative screen, do you do rule outs for significant antigens? In other words, does the negative screen suffice, in a case where you know there are equivocal reactions with panel cells, to not have to worry about any rule-outs?
Scott
I think yes, you trust the negative antibody screen. This is what we do every day. When we get a negative antibody screen, we don't run cells positive for low frequency antigens just in case, even though we don't know if the patient has been transfused and may have an antibody titer that has fallen to undetectable levels. That is what the Coombs crossmatch is for. If you get an incompatible crossmatch, you would do more investigation to find out why
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Hi All,
I am curious about the medical oversight of your blood bank. If you have the time and inclination, please take this little survey.
1. Is your medical director solely a clinical pathologist or does he/she do anatomic pathology as well?
2. If your medical director also practices anatomic AND clinical pathology, what proportion of his/her time is spent on each?
3. Does you medical director review all your QC?
4. How many beds does your hospital have?
5. About how many red cells does your facility transfuse per month?
Thanks for your time!
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I would love to know this too. My hospital is only 375 beds but we are stretching the truth by saying we are doing peer review of transfusion practices. I (blood bank manager) do a monthly blood utilization report and submit it to my medical director, our VP for Quality and the transfusion committee. If I notice a patient that appears to have been transfused outside of our transfusion guidelines, I submit it to a clinical nurse leader and hospitalist for review and that's what we are calling peer review.
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Mari,
I cannot thank you enough for relaying your experience for our edification. We do disaster drills at our hospital but, IMHO, they never go well. I always feel like I've lost track of something.
It sounds like your hospital is similar in size to ours. Our typical red cell inventory for our 375-bed hospital is 55 O pos and 15 O negs (not counting other groups and types).
I love the idea of having a tech in the ED area during a disaster. I think it would be super helpful to have a 'gate-keeper' for blood products who really understands the critical nature of proper documentation. It would also help to have someone as a resource in the ED who knows the indications for use, for each blood product. Many of our providers seem to get platelets and plasma mixed up and I can only imagine that in a disaster that gets even more confusing.
Great job handling such a difficult situation. My hat is off to you and my heart goes out to you and your community.
Regards,
Amelia
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Mari, I am so sorry for the tragedy that your community had to endure. I'm sure you and your staff behaved heroically. I'm sure most of us have practiced disaster drills/emergency preparedness drills many times hoping never to have to use those plans. Might I inquire how well your emergency preparedness plan worked? Do you have any words of wisdom for revising such a plan given your real life experience?
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I was taught to use 'p' values to establish confidence in determining antibody ID's, using a 7 and 1 or 3 and 2 arrangement. (7 positives and 1 negative or vice versa OR 3 positives and 2 negatives or vice versa).
I require techs to rule out using cells that are homozygous for the expression of the antigen they are trying to rule out, except for K.
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I'd like to know this too. I was visited by a Grifols rep this week. He told me that they manufacture the Ortho Provue and that now, they are going to market it themselves under the name Wadiana.
Wondering how Grifols products and customer service stack up against Ortho.
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Greetings,
This may be just semantics, but I am wondering what you call an antibody that does not have an identified specificity. This could apply to plasma that has demonstrated reactivity in the antibody screen but not the antibody panel or for plasma whose reactivity does not fit a pattern (and all clinically significant antibodies are ruled out).
One of our techs calls these 'HLA antibodies' or 'HTLA antibodies' but I tend to call them nonspecifics. I have heartburn over calling these something that I am not sure they are.
Anyone else have thoughts on this terminology? Does it really matter?
Thanks!
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Where did you see this? What exactly does that mean? My facility is just starting bi-weekly IQCP meetings to start developing our game plan. I am a new supervisor so this is all a little overwhelming to me.
As far as panel cells go: I did get both my panocell 20 and panel A/B package inserts off their respective websites. According to the package inserts you should "periodically" check the panels with weak antibodies, and immucor suggests testing with antibodies that are "likely to deteriorate" like LeA -- Does anyone do this kind of testing at their facility? The hospital I work per diem at said they used to that a long time ago but it wasn't required so they stopped.
Danielle Correll
I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.
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Ok...for those interested, I emailed the AABB accreditation folks about this and was told that the applicable standard is 5.1.8.1 regarding tissue storage. Specifically, Storing the fecal material in the backup freezer would be ok as long as there is segregation from the bone fragments and the storage temperature is suitable.Storing the fecal material in the backup freezer would be ok as long as there is segregation from the bone fragments and the storage temperature is suitable.
So there you have it...
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What do folks know about storage of fecal transplant material? I've been told that we are ordering some and the OR clinical director wants to store it in the back-up freezer for tissue?.
Does anyone know if this is necessarily prohibited? If so, by whom and what is the standard?
Thanks!
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I was asked about the quality control of panel cells by a TJC inspector last year, but it was to verify whether or not we were in compliance with the manufacturers recommendations. I was not asked if we used expired panel cells. I agree with cswickard; we have been doing using expired panel cells for rule-outs for decades.
One of my previous employers, who is a tertiary care medical center did a study to confirm reactivity of antigens on panel cells expired for up to 3 months and deemed these acceptable. They no longer use panel cells more than 3 months out of date.
I think the inspectors who are citing blood banks for using expired cells say it is a violation of the manufacturers package insert. JC standard 05.05.01 addresses reagents in the blood bank and nothing is explicitly stated about the use of out of date cells.
Not ideal, but better late than never.
Give a partial unit?
in Transfusion Services
Posted
I agree with you 100% Malcolm and we ended up trashing the remainder of the unit but I was curious as to what others would have done.