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slsmith

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Everything posted by slsmith

  1. Great answer and explanation Malcolm
  2. No it does not as least with the Ortho kit (alba-science). The fetal screen is looking for D+ cells not anti-D.
  3. The OR has never said they could not scan the armband .
  4. We do the type and screen as soon as we get the sample which almost comes immediately after the patient arrives as other labs are drawn at the same time too. Not so worried about the screen part but would like the ABORH especially if it is a female of child bearing age and she is RH pos so you don't use up the O neg supply
  5. O neg less than 5 day old irradiated leukoreduced red cell that is hemoglobin S negative and washed. 1) The wash cell is transferred to a component bag and segment is made from the transfer tubing to get a hct. 2) The bag is weighed to get the volume(not exact science but gm=ml.) 3) weight of red cell x hct of red cell= final volume x desired hct. 4) the difference between the weight of red cell and final volume is the volume of the AB plasma is added.
  6. We send blood around the system all the time and once one site has performed the retype after receiving it from the blood supplier the second does not have to. We share a computer system , Medical Director but all have different CLIA numbers. This never has been a problem with the accrediting agencies AABB and CAP, nor with the FDA.
  7. We transfuse neonates all the time. If it is emergent as in the baby has just been born or being born we send a less than 5 day old O neg irradiated red cell(always on hand) in a cooler under wet ice, with a filter syringe and a high risk form for the doctor to sign(at some point).
  8. I don't think this is an AABB rule else we would be adhering to it. What we give is O= or O+ red cells less than 5 days old if large volume(>60 ml) or less than 28 days for smaller amounts. Once in a while we have received an request for an A, B or AB because that is what the baby types and that is what Daddy or other donor is and the family wants Direct Donor. We then do a crossmatch on the baby through IgG to detect incompatibility due to Mom's antibody (A,B AB).
  9. The policy at my hospital is ABORH and DAT's are ordered on babies based on the mother being RH negative.
  10. The Trauma patients are assigned MR# when they arrive and banded. Usually the request is for what we call a R-Pack(resuscitation) which includes 6 O red cells, 4 A liquid plasma and a platelet pheresis. Either a OR runner or ED Tech comes to pick up the blood product bringing a ADT label which has the patient's MR# , Doe name, and generic dob. The blood is issued in millennium documenting location, reason, transporter's employee number. The same log for issuing regular old blood products is use which has the patient's identifier, the two Techs issuing(reader and listener), the transporter's number(or full name) and the number of each product that is issued. There is also a refrigerator between the 2 trauma bays that has 4 O+ red cells and 2 liquid plasmas. The nurses have to scan their badges(employee id) and enter the Patient's MR# to get access. There is a huge computer screen in the BB that shows that the refrigerator has been opened and we can see what got removed, who removed it and who it went to. However, I don't recommend this feature it is a pain in the behind ):
  11. We don't honor phenotypically matched blood on a newborn unless the baby has a positive antibody screen due to the mother's antibody. The product that is set up for the baby is fresh ( less than 5 days old), O =/O+(depending on the babies type), irradiated (same day), leukoreduced(comes that way from supplier) and hemoglobin S negative.
  12. Until we have two blood types( original and confirm) O positive blood is issued for Men 18 yrs old or greater and females 50 yrs old or greater.
  13. We use it during a computer downtime when the transfusion is needed before the computers come back up. Then once the computers come back up the units are retroactivity computer xm/dispensed
  14. We use a electronic huddle report via the email system. The shift charge is responsible for writing it and they gather the information by going through the departments to see how the day went, inquire about any issues and asked for pertinent information to be passed on. Most everyone is good about reading this report especially since there is usually some kind of interesting bit of intel to be passed on that induces a chuckle. Also there is 1/2 hr to 1 hr overlap and Techs are good about communicating any issues. Great team work at my site..
  15. We use Ortho Anti-D and their insert says agglutination is interpreted as positive. It also states one drop of Anti-D is used. But our procedure is add 1 drop of Anti-D and if the reaction is negative we add another drop of Anti-D and if the agglutination is 1+ or less the interpretation is negative. We do not send for genomics testing unless the physician requests, which has happened in the past when the patient had a history of Rh positive from another institution. Never have we been cited from CAP or AABB which are the accreditation agencies we use. Who is HFAP anyway?
  16. It had probably been like 10 years or so since there was a "real" exchange, before that 2 times a year??? But since EH is a training hospital for both MT's and MLT's and it seems like we are always training a new employee a product for the exchange is prepared several times a year
  17. The neonatal units we have on hand are less than 5 days old with only one being irradiated ahead of time(for emergency neonatal resusit.) Once aliquoted in a bag it keeps the neonatal outdate which is 28 dates from the draw date but the user has to be started within 21 days from the draw date. If it is a large volume transfusion though ( >60 ml) the red cell has to be less than 5 days old. When I refer to neonatal outdate it is when the products is not longer used for neonates, it could still be used for an adult if the volume is adequate enough. So far have not had an issue with high K levels
  18. Interesting question....maybe we should be but not we don't
  19. We do a "select " panel which is confirming the antibody is still demonstrating , one cell only not the three when the antibody was discovered. And then another cells to rule out the possibilities. Sometimes it is the whole panel and sometimes maybe 5 cells if your lucky.
  20. Yes in the scenario our BB calls it Anti-M and make a note for ourselves(not chartable) that it is showing dosage. We also perform an pre-warm to determine if it is significant.
  21. Legacy is on the BPAM system which started a couple years ago which is based on a matching system. The blood being dispensed has the order scanned using the MR#, the accession # and the unit number. When the unit is to be transfused, the transfusionist scans the Patient's arm band and the unit to be transfused and there some computer field they are in and if everything is okay they can move on and if not it is a hard stop. There is an emergency over ride for cases where emergent uncrossed blood is sent that is another story
  22. I wouldn't trust a nurse in performing ABORH testing, they have a hard enough time with other point of care tests.
  23. Yes we charge for the antigen testing whether or not it is positive. or negative
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