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May 2024 Challenge

kirkaw

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Everything posted by kirkaw

  1. kirkaw
    How often does your blood bank supervisor or medical director review tissue records or do they? What is the requirement for checking the temps on storage devices for temperature? Our tissues are kept in a monitored freezer in the OR where the OR staff checks the temp daily. Our blood bank supervisor reviews these records, but that's as much review as is happening right now. I am wondering of the blood bank needs to be more involved. I am interested in what other hospitals are doing. Thanks.
  2. kirkaw
    John, Our contract is up for renewal with our blood supplier and although we have gotten the price per red cell down $12 from what we are currently paying, our CFO is pushing for more. I think we are getting a great price, but she is insistent that we do 'market research' to see what others are paying. Thanks for the information you were able to provide. Regards, Amelia
  3. kirkaw
    Greetings! Is anyone willing to share what they pay their blood supplier for a unit of red cells? I am also curious to know the size of your hospital. Thanks!
  4. kirkaw
  5. kirkaw
    We have a statement on our Emergency blood release form that states, 'The risk of delaying the transfusion outweighs the risk of transfusing the blood without complete testing. I accept responsibility for the administration of this blood.' We had a Joint Commission inspector tell us that the second statement is not true; that 'the FDA says that the transfusion service medical director is responsible for the administration of blood products.' I cannot find that documented anywhere and I have looked in the CFR, AABB Standards and the Technical Manual. Can anyone substantiate that the transfusion service medical director is the 'responsible party' for (all) blood administration and point me to where it is stated? Thanks!
  6. kirkaw
    For those of you that do not do the antibody screen, did you do one prenatally or have access to the prenatal records to determine that the mom is not alloimmunized?
  7. kirkaw
    Our rule is that the RhIg be administered within 72 hours of delivery but we do not have a policy regarding the timing of the specimen collection. Typically, it is done with AM collections the morning following delivery. Also, we do a fetal screen first and only perform the K-B stain if the screen is positive. What is the rationale behind the 1 hour post-delivery collection?
  8. kirkaw
    Thanks for the link and explanation, Scott. That helped a lot!
  9. kirkaw
    Scott, I could not find the guidance you mentioned. Is it referring to a 2nd specimen for testing when employing the electronic crossmatch or the use of a 2nd specimen for any person who does not have a historical record in the BB/TS, regardless of transfusion orders? Thanks, Amelia
  10. kirkaw
    To take this one step further, with regards to Mabel's post, I am curious if the folks that allow 3 cells with heterozygous expression to rule out, do you use this logic for all antibodies or just to rule out anti-K. I was never taught that it was OK to rule out using cells with heterozygous expression if you could find a cell of homozygous expression. Anti-K is frequently an example of this as is anti-E in the presence of anti-D and anti-C. The previous blood bank supervisor in our blood bank allowed rule outs using 3 cells of heterozygous expression but I prefer not to, except in the aforementioned cases.
  11. kirkaw
    We had a patient this week with a history of WAIHA. The patient had not been transfused since 2005. We sent the current specimen to the Reference Lab and they provided phenotypically matched red cells for Rh, Kidd, Duffy, Ss and K. Tube IAT crossmatches (no enhancement) were 3+. In this situation, would your institution require a conditional release to be signed by the attending physician? Thanks, Amelia
  12. kirkaw
    Terri, can you tell me what the regulatory requirement is that prohibits the release of blood products until after the med director has signed off on a transfusion reaction? My medical director insists that if there is no serologic evidence of hemolytic transfusion reaction, that he not be called in the middle of the night to sign off on a transfusion reaction. Also, is it in your nursing policy that they draw a blood specimen when a transfusion reaction is reported? Our nursing staff looks for direction from the transfusion service on that; I thought it was 'standard practice' for a blood specimen to be drawn when a transfusion reaction is called. Thanks!
  13. kirkaw
    Adding onto this conversation with a slightly different spin. We had a patient with positive gel antibody screen, whose gel panel showed a perfect anti-K pattern with a positive control. The patient was transfused 3 months ago. The patient is B+. A DAT was performed and found to be negative. On a subsequent day, 2, B+, K- units were crossmatched in gel and found to be incompatible with 1+ reactions. 2 more O+, K- units were crossmatched in gel and were clean as a whistle! What gives? Should I have done an eluate?
  14. kirkaw
    Is anyone using a datalogger device in their coolers? I am wondering if this would qualify as 'continuous monitoring'. Would it matter that the device measures the ambient temperature inside the cooler and is not submerged in liquid that simulates the viscosity of blood? I would appreciate any thoughts....especially if anyone is using or has considered using one of these devices. Thanks, Amelia
  15. kirkaw
    Let me be more direct as to why I'm asking the question. We stock both the 1500IU Rhogam product and the 250IU Rhogam product. The ER uses quite a bit of the smaller dose. Our policy is that the 250 IU product is to be used for Rh- women at less than 12 weeks gestation. Prior to issue of this product, we perform a blood group and type and antibody screen. If a provider, ER or OB orders the larger dose, which is designated for a pregnant woman, at more than 12 weeks gestation, we perform a blood group and type, and antibody screen and the fetal screen (rosette test). Of course if the rosette test is positive, we would do the K-B stain. The questions have come up, A) do we really need to stock the smaller dose of Rhogam and for women greater than 12 weeks who present in the ED, assuming their ER visit is related to a threatened pregnancy, do we need to perform the rosette test or K-B stain to make an assessment for Rhogam administration. When I suggested the K-B stain, the ER docs did not want to wait for it.
  16. kirkaw
    I just got a mailer from Rush University and am planning on checking that program out. I've heard good things about an SBB program through Florida Blood Services, but I am not sure if that program is in existence anymore. I've also heard good things about the one in Indiana.
  17. kirkaw
    AMcCord, We only use complement control cells as check cells for anti-C3b,C3d. We do not use them with panels/antibody screens where the Coombs reagent is polyspecifc AHG or anti-IgG.
  18. kirkaw
    David/R1R2, If a known Rh negative woman presented in the ER with some sort of trauma with a gestational age of 18 weeks, would a K-B stain or rosette test be appropriate? Or both? Thanks, Amelia
  19. kirkaw
    Thanks Kathryn. This helps a lot! -Amelia
  20. kirkaw
    Thanks Terri. I would be interested to know if you still like the Ovation in 6 months. I'm considering ordering 1 of the Ovations as a trial. I think I'll stay clear of the Biohit.
  21. kirkaw
    Thanks Kimster. I may not consider HyperRho based on the information you provided. I use Rhophylac for the 300 microgram dose and was buying a box of 5 MicRhogam but I can't get that anymore so am looking for a new 'mini' Rhogam vendor/manufacturer.
  22. kirkaw
    I am in the market for new pipettes to use with my MTS-gel system. I currently have 2 old Tipmaster pipettes that Ortho sold us with the gel system. I have seen a brochure on the Ovation Vista adjustable pipette. It looks pretty cool and is ergonomically correct, which would be great for one of my techs who has a little bit of arthritis. Is anyone using this? If so, how do you like it? I am also considering the Biohit, but I have seen some bad reviews of this one (breaks down too soon) and it's more expensive than the Ovation and the Tipmaster. Thanks, Amelia
  23. kirkaw
    Kathryn, I am wondering if you got any replies to this and if the move has already taken place, what did you decide to do? We are moving to a renovated space in a couple of months but it is only about 50 feet from where we are now. I was just going to run about 10 previously tested specimens after the move for validation...plus the QC of course. I was not even planning on having a field service engineer on site because I was told that would cost about $4k! Thanks, Amelia
  24. kirkaw
    For blood banks/transfusion services who issue Rhogam, do you know if there is any validation or change process required if I change manufacturers? Has anyone used HyperRho? If so, what do you think of it? Thanks!
  25. kirkaw
    Please pardon my confusion with terminology for 'issue order' or 'blood product order'. Are these terms synonymous with orders to transfuse? No place I have ever worked puts the onus on the transfusion service to verify orders to transfuse. At my current facility, the providers use a physician order entry system (CPOE) to place orders for crossmatch and transfusion. The order to transfuse is a nursing 'sequence' so we, in the transfusion service, do not see that order. It is the responsibility of the nurse to ensure that both the consent and order to transfuse are present before she/he hangs the blood. We comply with all orders for crossmatch. We do not require any additional documentation from the person picking up blood except the 2 patient identifiers (name, DOB and a unique blood band number). I just want to make sure that I am not overlooking a Joint Commission or AABB requirement. Thanks.
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