Lcsmrz
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Everything posted by Lcsmrz
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I've seen Anti-D's in antenatal patients, where the nurse gave the injection, then collected the sample. Some must be absorbed immediately.
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Bones & tissues in the blood bank...
Lcsmrz replied to johnvb's topic in Tissue, stem cells, and bone marrow
While the Blood Bank is certainly comfortable with managing tissue products according to regualtions, there is always the inventory problem -- surgery tends not to communicate surgeon requests well, so the appropriate products aren't always available. Then there is the cost of carrying the inventory and of expired products ... -
We don't pool products, and only thaw FFP and Cryo. All we do is strike the original exp date and add a revised one.
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It's a trade-off between a slightly higher potassium in the unit and an additional donor exposure. We start aliquotting units when they're less than 7 days old, but will use them for one infant until expiration. The amount of extra potassium is small in comparison to the total potassium in a premie.
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We use 6% Alb if a cell control is required -- our package inserts recommend this. Sometimes it's just the comfort level of the BB supervisor; we have to sleep well at night. As a small transfusion service, we don't purchase a BB QC kit either, using available reagents to QC each other. The biggest difficulty is the requirement for 1+ to 3+ reactivity with screen cells. We haven't found one that does that in gel yet, so we make our own dilution daily. These kits are not cheap either, so we found an acceptable alternative.
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Our Oncology practices does their own outpatient transfusions, but we furnish the products and do the crossmatches for them. If they had their own lab, there is no reason that they couldn't do the testing too, with the right expertise and equipment.
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Thanks for verification that what I am trying to accomplish can actually be done. I can only get things to print by using the "reprint" option (issue, issue/transfuse card) and that happens one unit at a time. I want to check the boxes on the Results Verification screen and get all of them when the XMs is done. The "daisy" menu options don't work either. Fragments are correct in the dictionaries. IT can only get collection labels to print on our label printer. For BBK, something hits the printer, but nothing prints, so it's probably in the report config. I'm new to Meditech, and until ISBT128 is done, I have no time to learn reports. The hospital cancelled my trip to Boston for classes. Been working on this on-and-off for months now. No one knows enough about the connection between the application software and the printer -- and Meditech is not being very helpful.
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We have an occasional problem with positive ID of cord bloods -- nurses are "too busy" at delivery to properly label the sample, so it sits around in the room or at the nurse's station until they get a chance. We refuse to use them for crossmatch testing ...
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ISBT 128- labeling help!
Lcsmrz replied to Melissa Willcock's topic in Computer Systems / Software / ISBT128
Mabel: Just our social club. Being new to Meditech, I've gotten some gems from the emailings ... Larry -
We perform an AHG crossmatch with an immune Anti-D, but not with passive Anti-D from RhIg and a negative r-set. We would test them for weak-D, but only as part of the antibody workup.
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With electronic XM, this problem is moot. In my patient population, we see a fair amount of rouleaux, which we confirm microscopically and attempt to disperse first with albumin. Saline replacement is the second step.
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ISBT 128- labeling help!
Lcsmrz replied to Melissa Willcock's topic in Computer Systems / Software / ISBT128
You must be registered with ICCBBA in order to print labels for aliquots and pools. See www. iccbba.com if not already registered with them. Most LIS vendors are using the Digitrax system to print labels for them. I suspect Mysis has an ISBT group already formed to address conversion issues. Jump on their web site to find it. We Meditech users have our own group for ISBT discussions. -
There is alot of wailing and gnashing of teeth about the accuracy of IR themometers for use in Blood Banks. Granted, they're not as accurate as a mercury NIST reference thermometer with 0.01C increments, but they register within 1C of the LiG thermometer I used to verify ...
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I heard from some great sage on this forum that the 30 min rule was determined using whole blood many moons ago. Our experience with additive PRBCs and temp indicators show that 15-20 mins is probably more realistic. In reality, 15 or 30 mins won't matter, since most or our discarded units are returned to us unspiked 1-2 hrs later.
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Since I've been doing inspections for quite a while, I didn't find the CQA exam that difficult. I read the top few recommended references and found them helpful, since the exam covers alot of the the process of auditing, resolving contentious issues, etc.
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In addition to educating techs, physicians and nurses about TRALI, we submit a sample to our blood supplier, using their form and protocol for testing.
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TRM.41350 (label or tag must remain attatched during txn)
Lcsmrz replied to tracylab's topic in Accrediting Agencies
We currently hand-write a tie tag. but we're still trying to get our Meditech system to generate a label using the "Crossmatch Tag" function by checking the Verify screen box. Right now, it can only generate an "Issue/Transfuse Tag" using the reprint function. IT has been working with Meditech on this for at least 6 months. Annoying ... -
Typical knee-jerk reaction, IMHO. I'm betting the numbers really show 7-day plats no worse than 5-day plats.
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We run a cell control with both Anti-IgG and Anti-C3 when doing DAT's, but these are non-reportable results. In our computer system, only interpretations are posted to the EMR, and the rest of the individual test results stay on the BB side.
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I vaguely remember a study in the early 80's showing 25Gy, 30Gy and 35Gy, with the recommendation that 30Gy might be a tad better than 25Gy at getting complete inactivation in all products. But my memory fades me today -- actually, it faded years ago, but I forgot when ...
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I just switched from poly to IgG and C3 separately -- IgG only for babies and both for adults.
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specific gravity of products
Lcsmrz replied to dpflanz's topic in Donor Services and Donor Recruitment
Older references will not have additive solutions included in the table. I don't convert any more. I enter the weight in gms, and the nurses are ecstatic! -
We perform an antibody screen as part of a post-partum RhIg workup, unless a T&S was performed in the same admission. If positive -- and it usually is -- we use the "R Set" to check for antibodies other than passive Anti-D. We found an Anti-Kell once, and the baby was Kell negative -- go figure!
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Looking at your processes is very good for the soul. Common things that we routinely do tend to disappear when the question "why" is asked -- or better yet, "show me the standard or regulation", since I know it doesn't exist. I don't like to accept "cuz that's what we've always done it" or "cuz that's the way we like to do it here" as an answer, but you'll be surprised how often I hear that. Another common one is "cuz we were cited for not doing that", only to find out that the citation was issued in the 70's. I attempted to LEAN a blood bank once, only to have it unLEAN'd by my predecessor, so I was told. Some old blood bankers are pretty set in their ways ... I like the ISO 15189 format much better than others, and still think any TQM-type program is helpful.
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One has to ask the question, "How much is enough?". I can think of several other tests that may have some value, but when you look at the predictive value, it's quite low. And if you transfuse a couple old units, the suggested four tests may be slightly suggestive of hemolysis, so determining a cutoff would be interesting. The clerical check has got to #1, the post DAT #2, and a visual check as #3 to catch those situations where #2 will be falsely negative due to destruction. These rule-out immediate hemolysis, and you can decide after that on clinical findings if additional work is warranted for situations of decreased survival.
