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Posts posted by BldBnker4
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This is my first post so I hope I don't break any rules! We are looking for a document control system for all our policies, procedures, etc for the entire lab. We have looked at a couple and they all seem fairly similar. Any suggestions?
Thanks!
We use PolicyTech. It started out with just the lab but is so well liked that now it is used for the entire hospital (nursing policies/procedures etc). It was a pain to get all of the policies/procedures loaded in the beginning, but it is Word compatible. It also is linked to our email and alerts us to any documents that require review/reading. Very well organized.
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Sorry, but YEP!!!!!!!!!!!!!!!!!!!!!!!
We have had a few weird antibodies here too.....nothing as exciting as an Anti-Lan or a "Bat." Our claim to fame is the multiples that require us to get blood from rare-donor sources. We have one regular patient that has an Anti-M along with an Anti-U! She is a dialysis patient...gets blood quite regularly! We also have sickle-cell patients with 6 or 7 antibodies that make life exciting (and a bit expensive) too! We have one patient with multiples and an Anti-Chido. And yes....I too am a nerd! A lab-rat nerd! That is what makes us Blood Bankers, right?!
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We have the Tango, and have not seen the problems that you describe above. We use it for all tests, and run different specimens/units and tests all day long. It's only slower when you try to run 1 sample at a time, but this would be the same for any analyzer that only has one centrifuge on board. And there is no carry over issue; the manufacturer has resolved that and I validated that very well to prove there is no carryover. You can absolutely troubleshoot the instrument, although service has to be called in a few circumstances. And they have manufactured QC reagents for antibody screen, not blood type yet (coming soon though). You are correct on the size; it is larger than the Echo or Provue. If space is a concern, the Tango might not be the best option. But I have had it for over a year and am still very pleased with it, and so happy I don't see all of those false positives from other analyzers.
What we are seeing isn't so much "false positives" as it is weakly positive DAT's and strong cold antibodies. We think finding these is useful. We have seen some of the weak positive DAT's become strongly positive DAT's (escpecially in our oncology patients). If the patient has the strong cold antibody, we then know to use warm techniques, if necessary. Rarely, do we have a patient that there is no explanation. These tend to be the oncology patients and maybe it is some of the medications that they are receiving. What I like about the Echo is that we can run T/S's, Weak D's, and antibody id's all at the same time. We also run crossmatches on the Echo. We have also detected weak Anti-Jka's, Anti-Jkb's and Anti-E's on the Echo that are negative when tested manually. We think those are is very significant! Must be the red cell stroma!
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We are seeing a lot of positives (all screening cells positive) on our Echo, that when done by alternative method are negative. I'm also thinking about taking the ID panels off of our standing order as 90% of the time we land up doing a back up method due to the cost.
We have had some of those reactions too. We discovered that some of those patients have weak positive DAT's. We take them to the bench and do a DAT and a cold screen. Some patients with strong cold autoantibodies cause a complement reaction with the indicator cells. If either of the above are positive, we do a manual screen and result that. The Echo isn't perfect but we recently looked at a Tango (as we were considering switching too) and found that the Cons outweighed the Pros. It can't run multiple types of tests at the same time and is slower. It has carry-over of specimen issues and is bigger. You can't access the instrument internally to trouble-shoot and there are no manufacturered QC reagents. (?) Just sayin'!
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So sorry to hear of your loss, Malcolm! Glad you and your family are all okay! Hope you find new lodgings soon and that your insurance company pays well!
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The Blood Bank Assistants are CLIA qualified. There is no charge for this bedside type. It is documented on the Transfusion Slip. We do not "switch" types at this facility (unless we experience blood shortages). Even then, it states on the slip that the patient's type and the unit type are "compatible," not the same. Like I said, we are FDA inspected, AABB inspected and CAP inspected and it has flown with all of them. On the mishaps that occurred, I can not speak to what was reported as I was not the supervisor then.
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I'm curious. How many times in the 40 years this practice has been in place has an ABO incompatible transfusion been prevented?
Don't know how many in all of the 40 years that we have prevented an HTR (haven't been here all those years!), but I can say for the last 20 years or so.....I can think of 5 or 6 times we discovered that the patient in the bed was a different type than the blood set up. Mislabled samples are usually the culprit.
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Sorry, I should have asked.........Are your pre-transfusion samples for Blood Bank drawn by lab staff (BB assistants?) or by nurses/physicians?
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Pre-transfusion samples are collected by nursing staff and phlebotomists.
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That is very interesting, i had not heard of BB assistants before. Something I shall seriously look into as we grow into a 600 bed hospital very soon. Yes I can see how it would avoid mistakes and leaving blood on the station esp if one has a teaching medical center as well. Good idea. 40 years!
Here I must ask if 4 on days, 2 on evenings, and 1 on MN's are enough? How many transfusions a month do you have? You do have a BMT unit, etc...
What goes on in the OR, ER, and closed units, ICU, PICU etc..?
We transfused 1037 PC's last month along with about 250 other prodcuts. The staffing is adequate. Of course, there are times when they may have to take more than one patient's blood at a time, but they are very efficient and try to combine trips if possible. We are not a level 1 trauma center and no longer do peds (there is a large pediatric facility nearby). We have 2 ICU's and a cardiovascular recovery area. The samples are collected by nurses (if the patient has a line), the Assistant (if it is a fingerstick) and the physician (if it is in the ER sometimes or OR). The documentation of the bedside type is noted on the transfusion slip.
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P.S. We are a pretty large facility. We are licensed as a 600 bed hospital. This system has been in place for over 40 years! It seems to be working for us!
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Pls do tell us the number, the shifts and job description of Blood Bank Assistants. Interesting.
Thank you
They are trained technicans that have phlebotomy experience. We have them on all shifts (4 on days, 2 on evenings, and 1 on MN's). They do not fingerstick on each unit transfused. Once the bedside type is performed and product is hanging, the hanging product bag is used to compare blood types and other identifying information on the "to follow" units. Most of our patients have lines and the sample is drawn from the line. Much less fingersticks than you might think. This process has saved our butts more than once. Literally. We are only as good as the sample we receive. Mislabeled samples can cause HTR's! The cost is minimal considering the risks vs. benefits. These assistants also help in the Blood Bank when they are not on the floor. They answer the phone, perform clerical duties, help with inventory of supplies and blood products. A tech issues the blood to the assistant and we have control over the blood until it is started. If there is an issue, the blood is returned in a timely manner. We never leave blood on the floor unstarted. This helps with time limits on the blood being out of the bank and the two-person of patient identification is also a safety mechanism. The nurses love it because they don't have to leave their patient/floor to physically come to the Blood Bank. We deliver!
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I heard of a bedside blood grouping kit meant for checking the reciepients blood group just prior to starting transfusion. The name of the product is "Serafol" manufactured by SIFIN labs, gmbH. Is this an FDA approved kit. Can it be used for this purpose. Does AABB standards recommend this?
Thanx
We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.
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I see this as the CYA statement you find just about anywhere. I find the use of the words "some" and "may" to be what I fondly refer to as waffle words. Now if they used "most" and "will", that's an entirely different cup of tea. As Malcolm noted, in the real world you probably (my favorite waffle word) have nothing to worry about.
We are constantly detecting passive Anti-D's in our OB patients with our Echo. It made validation challenging when our bench (manual) screens were negative and the Echo was finding the prenatal Thogam Anti-D's! I can't imagine why you are not detecting the passive Anti-D's? We have also been detecting weak Anti-Jka and Anti-Jkb antibodies too. Manual screens are negative. We are seeing these in recently transfused patients....maybe newly formed "baby" antibodies?!
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We have also had this problem. We have noticed that the patients have cold antibodies. We do a "Cold Screen" by setting a manual antibody screen (with no enhancement) along with an autocontrol and "incubating" in the 4 degree C refrigerator for 15 minutes. Spin at 3000 rpm for 15 seconds. Usually they have a 2+ to 4+ reactions. Not sure if the cold antibody is binding complement or interferring with the stroma or "glue" on the testing well. We still go by the "Gold Standard" of the bench. If manual testing is negative then we turn out negative!
ATTENTION ECHO USERS,Over the past couple of years, we have seen the following scenario several times:
*Patient with no antibody history is panreactive with screen and Ready ID panel on the Echo.
*DAT performed on Echo is negative
*LISS screen is negative
*Supervisor made the decision to call this an "atypical warm autoantibody"
Has anyone else experienced this same issue and how was it addressed/what do you call this?
Thanks for any input/feedback that you could provide us
Group O transfusion reaction
in Transfusion Services
Posted
We use O Neg, irradiated, CMV neg, leukocyte-reduced packed cells that have been washed for our premie neonates and all babies in our NICU. This reduces citrate-toxicity, issues with increased K+ and any potential reaction caused by residual plasma. Plasma containing products must ABO compatible ( we prefer to give type AB products but don't always have that available).