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carolynn

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About carolynn

  • Birthday 10/07/1970

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  1. Thank you all for your responses! If I had a "do-over" I definitely would have called the floor. I still feel pretty awful about it, so hopefully I will be quicker on my feet next time. A QA failure from our LIS would have been very helpful. On another note, do you all do extended crossmatches on patients who have received Rhogam (history of, or current passively acquired anti-D)?
  2. I issued a unit of O neg blood to a patient with an (active, not RhIg) anti-D. About 10 minutes later, I discovered that the tech who crossmatched the blood only did IS, not extended. First I started the extended. Then I called my supplier and made sure the that all Rh neg units are tested for weak D. My crossmatch was finished in about 17 minutes. (negative). In retrospect, I think that I should have called the floor and the transfusion stopped. I debated it, but didn't want to raise any alarms with the unlikelyhood of a positive crossmatch. PS, I had no supervisor or pathologist in house to consult. By the time I got off the phone with my supplier, the crossmatch was almost finished. My question, should I have called the floor?
  3. Brenda, I think you are right about Case#1 not being about failure to follow SOP. The reason being that it was presented as part of a study (Case 7... see Mabel's post) to see what percentage of CLSs surveyed knew what was considered reportable. In my opinion, the study would be meaningless if the cases presented were dependent on individual institutions' SOPs. This is the abstract from the study: [h=1]Knowledge of food and drug administration reportable deviations [/h] Rebecca Lam, Barbara J. Bryant BACKGROUND: As early as 2001, the Food and Drug Administration (FDA) required blood centers and hospital transfusion services to report events associated with testing, storage, or distribution of blood products that deviated from current good manufacturing practices or affected the safety, purity, or potency of the product. Between 2004 and 2009, an average of only 8.6% of hospitals reported blood product deviations. STUDY DESIGN AND METHODS: Case scenarios designed to evaluate knowledge of FDA reportable deviations were developed and sent for evaluation to the Center for Biologics Evaluation and Research (CBER) and FDA division directors for FDA reportable deviations. A final survey containing eight cases was launched in a web-based online survey tool and sent to blood bank medical technologists. Additional information was queried regarding job title/responsibilities and the size of the blood center and/or transfusion service. RESULTS: There were 176 respondents to the survey. Only 5.7% (10/176) answered all questions correctly. Analysis by job title and place of employment revealed no correlation to the number of correct responses. More importance was attached to deviations involving quality control, blood bank identification, unit specifications, and antibody identification. Less importance was attached to deviations involving phlebotomist's initials, failure to issue units in the computer, and using a recent sample from a previous hospitalization. CONCLUSION: This study revealed that blood bankers did not have clear understanding of what constituted an FDA reportable occurrence. Size or type of blood establishment or individual job title was not associated with more knowledge of FDA reportable deviations. "Less importance was attached to deviations involving...using a recent sample from a previous hospitalization." Is there a regulation that states that a patient's blood bank specimen must be from the same admit? That may explain how pre-ops and outpatients can be banded and go home. Case #2(8 in the study) is pretty scary to me, because I can imagine the former me (before reading the study and joining this group) failing to interview the patient and send out the specimen for an elution. Thanks everyone for all your responses!
  4. In the July, 2011 issue of Transfusion, was the study entitled "Knowledge of food and drug administration reportable deviations". A bunch of scenarios were presented, all of which were reportable, I think. Two cases I didn't understand why they were FDA reportable. I am a generalist, so I don't know the FDA regs in depth. But I do understand the gist: if a specimen/product isn't fully tested or properly labeled per SOP, and the product is issued, (even if it's returned), then the case is reportable. So what's the deal with these two: Case 1: A patient is discharged from a hospital, but returns to the ER (same hospital) the next day wearing a blood bank armband. The specimen/band are from the previous admission and are not expired. A crossmatch was ordered, and the CLS used the old specimen to add on 2 units RBC. (Based on this, I have had 2 patients rebanded: First, an oncology patient who was banded Friday for a transfusion on Monday, but who came into the ER over the weekend. Second, an ER patient who left AMA, but who came back to the ER the next day wearing the same band. I don't know if this was necessary or not!) Case 2: (part of my copy got cut off, so I am missing the end) A patient's antibody screen was negative. The doctor ordered a DAT, which was positive. The CLS did not request a transfusion history because he thought all was fine with the negative screen. The patient had, in fact, been transfused at another hospital a few days earlier. An elution was not ordered by the doctor or the CLS. (This is where my copy ends. I think what happened next is that the patient was transfused.) Can anyone explain why these are reportable? Sorry about missing info on case 2. I don't have access to the article and am going off of a powerpoint I found off the internet. Thanks!
  5. The anti D reagent was Ortho Bioclone (Murine Monoclonal Polyclonal Blend). One of the limitations of the procedure was if the cells were DAT positive, a weaker reaction could occur due to reduced available antigen sites or steric hindrance. We didn't do DAT testing, too bad.
  6. Thank you, Malcolm. The people on this sight are sooo smart, and I have learned so much from them! The patient has some kind of lung cancer, no bone marrow or stem cell transplants. The reagent was a polyclonal (both IgM and IgG)...we use it for weak D testing on our cord bloods. The reason I refrigerated it was a quickie experiment to see if I could reproduce the previous results, thinking that the prior testing may have been done with cold reagents or cold specimen. I don't know if the insert says it is suitable for cold (probably not), but I will definitely check!
  7. Hello (1st post ) We had a chemo patient come in a few months ago for a type and screen (no blood transfused) and she typed O pos, with a 3+ Rh (tube, Gamma). She came in again recently for a crossmatch, and now her D is typing 1+ to microscopic. If taken to coombs, it types 2+ to 3+. I incubated it in the refrigerator for a few minutes (perhaps the prior tech used cold sample/reagents?) and it does type stronger, 2+ to 3+. We ended up giving her O neg units. My question is, is that necessary? If the antigen is there, she shouldn't make antibody, should she? If she were a mosaic, would the tube pick it up at all? Also, does anyone know if chemo can affect Rh expression? Thanks a bunch!
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