Karrieb61

Eddible, any chance of getting a copy of your flow chart? it might save me some time since I am working on building one now. Thanks

Hello again, First of all, no I wasn't referring to babies since we don't transfuse babies here for starts and our current policy says that if the DAT is positive, we "consult the physician" which we haven't had to do, maybe never. I was talking about adult positive DATs. I did a ton of research on this, partly to improve my old knowledge since I was out of technical blood banking for years prior to coming to my current job, and partly to get a consensus before making any changes here. For now, we are doing DATS on the Echo, complement, when required, by tube of course. We aren't doing eluates anymore, and I have written the procedure to send out an eluate if the patient was transfused up to 3 months ago and the DAT was positive. We've done that twice maybe and they found nothing new that we didn't pick up in the ABID on the Echo. I am now routinely talking with the Reference Lab we work with - if our Echo DAT is positive at 1+ or 2+, its very likely that a tube DAT will be negative completely, including microscopically. Therefore our Ref Lab wouldn't bother with an eluate if they start with repeating the DAT by tube and it's negative. So things will remain confusing to a point since we will probably always see at least slightly pos DATs with the Echo that will be negative elsewhere. Finally, micro DATs- I was going to dump them but a local Transfusion MD for whom I have great respect says that micro DATs may be valuable. So for now, I'm not changing any of our micro reading SOPs. More on those later on. I personally think that micro readings are value less because we all interpret these differently and way too many techs will call sticky cells 'weak pos" to avoid thinking that they are missing something important. We only have one dedicated blood banker and the other techs aren't in there often enough to gain a ton of confidence when these sticky situations develop.

Me too, screen for all three and do the usual full crossmatches. You have only your own behind to kick if anything at all goes wrong with the transfusion whether immediate or delayed.

Thanks L106. I used to be a vendor for a medical device company and I learned a lot about how vendors are trained to respond to customers. So I have at least a little bit of a sixth sense when they give me answers that don't make sense. I know that when they receive enough consistent complaints, they have hardware and software groups that are supposed to investigate the problems in detail and consider changes to the SW or HW. So its very important that we all stay on top of problems we see and report them!!

I am just discovering this thread now and am so glad that I'm not alone. Yesterday, Immucor told me that my currently funky screening and panel results on a specific patient were due to the patient, not the instrument or reagents and I told them that their answer was unacceptable and that I knew other people were reporting similar problems. I just heard a long quiet pause after that. We were doing very well with the Echo, started using it full time in October then suddenly about 2-ish weeks ago, we are seeing a huge uptick in what I have to now think are false positives. Our only back-up is the tube and I hate thinking that I have to tell the techs that they must use that when we have problems on the Echo (at least sometimes). I am actively working on a workflow/troubleshooting thing for the techs and am anticipating a lot of flack from the older techs who have been waiting for the instrument to "fail" since they don't like change. I can deal with that OK but I sure wish that Immucor would at least admit they have a problem they are dealing with, offer to send new lots, something. Today I plan to call them and ask for replacement screening strips and ABID strips. The controls may look lovely but more and more results are not.

Thanks mrdth5, I am actively working on the workflow diagram now as it turns out. In this particular case that still worries me, it was not a cold antibody at all. Still have no idea what is going on but the patient did get two Echo xmatched units that were compatible with no repercussions.

2 cents well taken Jayinsat and my fear is that what we are seeing sometimes at least are truly false positives. I dont' recall reading the term false pos before this related to Echo use but now I am paying attention to it. I called Immucor on this and they did mention reactions to reagents so maybe Anna's comment is the "truth". Our only backup is tube LISS. A couple of times we have used outdated Echo panels with varied results. I guess I am just frustrated since the techs, particularly the part-time 2nd and third shift techs are confused and call me looking for the definitive answers I don't have. If Immucor is insisting that the antibodies that we see on Echo are indeed developing antibodies that I want all Echo compatible crossmatch RBCs to go out at least and not use tube as the xmatch method. Otherwise, well I don't know. Unfortunately, we have had several of these events over the last 3 weeks. I may call Tech Services for a genuine service call on this.

Thanks Malcolm but wouldn't a cold show up in the immediate tube spin? I may have someone play with it today and see what happens if we run a cold screen from the frig but I would think it would have come up during the IS phase.

Hi to all Echo users- I have an email into Immucor but am not assuming that I'll get the answer I need: had an adult female patient on Friday, history of one rbc transfused back in November at our hospital, patient says she has not been transfused elsewhere. Patient is on no meds except aspirin. ABS at that time was neg. This past Friday her Echo results were 4+ for all 3 screening cells, 3-4+ on all Capture ID cells and the DAT on Echo was 1+. Tech repeated using the tube and got NEGATIVES for everything except a weak micro DAT reading. Repeat sample from patient had exact same results. I had the techs release only units that were Echo negative and we got about 20% of the tested units compatible that way. Local reference lab admits that they would have stopped with the first tube screening if it was negative and couldn't offer me any suggestions. Have any of you seen this much of a discrepancy between tube and Echo? I've seen lots of tube=neg, Echo= 1+, sometimes 2+ but never this. Comments?

Computer? What's that????

I just had a great laugh at Dr Pepper's comments about related Rhode Islanders. I've worked here off and on for years, crossing through Customs from Massachusetts and cannot believe how often everyone knows of or is related to everyone else. Mind blowing. Don't worry Malcolm, we can introduce you to basically everyone in the State doing Blood Banking over a pint or two. Or three. Maybe four. Better pre-tape your lecture just in case you need a back-up the next day.

Union Station gets my vote. Trinity serves stale nacho chips

As a quick follow-up, we are extra quiet today and I am taking cards of patients who if still alive are at least 100 years old and I am putting them in a separate card file calling them "Pts approx. 100 years old, problem patients, mostly dead" Haha,, only kidding about the mostly dead but I am holding those cards of problem patients who are about 100 years or older off to the side permanently. Really, does any accrediting group really expect you to maintain a "current" file on someone who would be 110 years old now? I am being sassy and bold and taking them out of the current hard copy file.

Wait, where are you getting those wicked good size pints around Providence? I've been going to the wrong bars it seems. Hopefully these giant pint size beers are in the same bar as the ones they serve the 12 ounce glasses of wine?

I plan to take him out for a pint after his presentation. Are we lucky in Rhode Island or what?????

Malcolm rules

R1R2- you mean some people actually have LIS records of their patients???? We have absolutely minimal data going back only about 6-7 years. I would never bother to update whatever new LIS we might get someday to enter people who are 110 years old per our old workcards. Sko681, I thought we had to keep these records of problem patients indefinitely? I'll have to go dig out the Standards book. Thanks all.

We do pull the cards when we receive notification that the patient died while in the hospital but that's it. I am talking about very, very old cards on very, very old former patients. If I had the time and access to SS info I would do that but I don't so I still don't know what to do other than stash these really ancient cards into a shoe box.

So you don't pick an age like 102 or something? I have no idea how I would access SS numbers at work as we have a very firewalled computer system and accessing the outside world is difficult. For the most part, I am looking at records of patients who haven't been in our Blood Bank in maybe 20 years and would be well over 100 if still alive. I also don't imagine our Medical Records dept would be happy to help me locate SS #s from records of theirs that are probably archived.

Thanks mollyredone. Anyone else?

Another poll, thanks for putting up with me and my polls: we still have paper card records on patients with some kind of clinical history that may affect transfusion since AABB requires us to keep these records "indefinitely". I can't find anything that tells me how indefinite indefinite is in terms of the patient's age. We are clearing out old cards and have some from people who are 114 according to their birthdate. I assume you are determining your own cut-off birthdate, if so, what is it? I am toying with tossing cards on patient who would be in excess of 102 years of age. What do you think/do? Needless to say, if we have any old cards with missing dates of births or no medical record numbers, I instruct people to toss those anyway but these have only been found on cards where the patients still are =/- 100 years of age. Thanks.

Unfortunately, in our little hospital, the medical director has no blood bank background and our part-time Pathologist has no blood bank background. We just redid the trans reac SOP and decided that we wouldn't be the ones to "call" a delayed hemolytic reaction (with or without evident hemolysis) and that our Pathologist would have to call the patient's physician so they could discuss the situation, lab results etc and decide what to call "it". But I guarantee that our Pathologist in reality will make no such call. I did, BTW, rewrite the existing SOP to include all the usual criteria used to suspect a delayed TX RX but again, who makes the decision to fill out a form declaring a formal work-up and says its a "delayed hemolytic reaction"? I have a call into the AABB to clarify Std 7.4.3 which does not say WHO suspects or detects a delayed trans reaction. I am probably over thinking and over-worrying this but I don't want to be confronted with an assessor who asks to see the records of any suspected or detected tx rx. We will never have one to show if we wait for the MD to call it. I would hate to be considered out of compliance with the Standard.

I would like to revisit this and hope some of you will respond. I looked at the Regulations and the AABB standard says "if a delayed TXRX is suspected or detected....well my question is- suspected by whom? I don't think we are the ones responsible for deciding that a patient has or has not had a suspected delayed TXRX. We are a small lab like Sophie1210 and to test every potential donor segment and maybe sending the patient sample to our Reference lab for an eluate (under specific circumstances) because WE think a reaction has occurred seems to be valuable only academically and I doubt its legal to charge the patient if the patient's physician has not ordered the tests. I am looking at this post because I just rewrote our previously unclear SOP on TX RXs and decided with our part-time pathologist (with no blood bank background) that we would perform a delayed workup only if ordered by the physician. That never happens basically. We have two oncologists who will order the usual chem and heme tests after a transfusion which implies that they are wondering about a delayed reaction (based primarily on continued low H&H) but there never is any conversation with the Blood Bank about their suspicions regarding a delayed TXRx. So bottom line is- who is supposed to make the call to order an official workup? I want to meet AABB Standard 7.4.3 but don't feel its appropriate for us to order and charge for additional tests if the order is supposed to come from the physician. What we do now is the usual antibody ID on any patient with a positive screen, we send out an eluate to the Reference Lab when it meets our criteria (new or stronger pos DAT, transfusion within 3 months etc) and we charge for those tests but I don't want to see the techs pull out old segments, find that a donor unit is positive for the antigen that has now (possibly) caused the new antibody to form, and start declaring that the patient has had a delayed TXRX. Really, if a new antibody is identified, then we will obviously screen future donor units for that antibody and it does go into our LIS/HIS for the physician to review- what would be the point of the Blood Bank going any further without an official MD order?

Everett, I don't think there is an established guideline for this at all. I think, based on previous inspections I did years ago, that you would want a Blood Bank to show awareness of the need to audit and a written program that says what you audit with a general statement of "several from each floor per year" something like that. You don't want to have to meet your own requirement of X number of live audits per year if you can't reasonably make them happen but you should have a general statement about doing them throughout the year on all floors that transfuse on first shift, whatever. Very vague I know but I think that good intent is the key here with some records to show the inspector/assessor periodically.

How wonderful, I bet your daughter will appreciate this. I have a hard cardboard little house, painted green with little shutters that my grandfather made maybe 70 or more years ago. You put an electric candle inside and when its lit up, you can swear that the elves are in there (when I was 5-6 years old, I was completely convinced of that). I hope that one of my two kids will want this little house someday as its just not Christmas for us until that house is lit up. Blessings all!