Karrieb61

Thanks Dansket, we don't have Ortho Gel but its nice to know what's out there

ElinF, does this mean that Ortho sells a specific product to test all the cells in your gel panel? If there is no standard for this, are you doing it only because you feel better if you do or have a medical director who requires you to? Just curious. We end up performing QC of sorts of specific panel cells when we do antigen typing of patients and donors using specific panel cells as our pos or neg control. We do several of these a month on various panel cells with various antigens. Seems to me that if an inspector asked about this, we would have proof of doing a "periodic" check of the cells per the manufacturers insert (which is not a requirement anyway).

I'm not sure what you mean by "tube ABOs for our crossmatch patients" but: where are you reporting your results? Are you saying that the clerical errors are handwritten errors on a paper log sheet (like we have )? What exactly was the error- a wrong type written down that did not match the documented test results? Did you give out or crossmatch the wrong type blood? Please let me/us know where the errors are occurring and then I can probably make a suggestion or two since we deal with potential clerical errors daily here in our small Blood Bank. Secondly, on your second and third shift, is there one person for the entire lab or is there a second person who is trained in Blood Bank? We require two people on all three shifts to have Blood Bank training so that potential issues can be addressed. I am guessing that during the root cause analysis that you must be planning, a corrective action may be to require a check of all tech work during the same shift before blood products can be issued. So while we have only one person floating in and out of the Blood Bank on second and third shift, we require two trained techs to double check at least blood types and medical record numbers before blood products go out the door. More details if you can please!

Anyone else? Thanks

OK, maybe never mind on this. I should have trolled through this site first and just found a discussion from 2009 that addresses this. However , maybe someone knows of a newer standard that requires a weekly check on panel cells (as random as it may be?)

I am taking a poll- what do you do to QC current (not expired) panels? We have a procedure currently that calls for one panel cell to be checked against an IgG sebsutuve antisera and one panel cell to be checked against an IgM sensitive antisera weekly as a check for "deterioration of the panel". Curious as to what you do. Thanks

Thanks Auntie-D. In this case, I can tell that the MD (one of the few here) is questioning a delayed hemolytic transfusion reaction based on all the other tests that were ordered but nothing has been said to the Lab at all - but that's another whole story. I really would like to work out a "do this when this happens" algorithm or at least have some specific statements in the SOPs for the benefit of the part-timers which is why I am beating this to death. I know that the tech is looking at a couple of 'clean" crossmatches which show him that there are no antigens that the current donor units have that are causing an incompatibility with the patient today but it seems to me that the patient may be developing a new antibody that isn't showing up in the plasma quite yet? It would be great to avoid another delayed hemolytic transfusion reaction if this is the case.

Oh brother, back to the Eluate question again for me also. Current case: patient with historical Anti K, transfused 2 units of RBCs in October that were K neg only. Then we found an Anti E last month (early November) . RBC Units were then screened for both antigens before transfusion last month. Now the patient, in house again today, has a classic Anti K and Anti E in the serum still and has a 2+ DAT on the Echo (solid phase), micro pos DAT in tube, complements neg. The tech doing the workup thinks that the DAT is due to E sensitized red cells from the transfusion in October (assume those units were antigen E pos) and doesn't think an eluate is worthwhile. So after I changed our Eluate and DAT procedures to send out an eluate when: a) recent transfusion (under 3 months) with a pos DAT or when a Trans RX is suspected, now I am getting push back from a tech. I know lots of people don't bother with eluates after a couple of weeks but I decided to go with the most extended timeframe which is the 3 months. I need consistency here due to the large number of techs who are crosstrained in the BB but aren't in there often enough to have enough experience with such situations. Am I back to square one and maybe need to change the policy to shorten it up to ""pos DAT within 2 weeks, one month???" AARRRGGGG. Thanks

Sounds like some people are in the bad habit of just plain articulating something incorrectly. I bet its been done for years ("we've always done it this way"). We do something similar to what rrcc1974 is doing- we note "historical (or previous) Anti-X do full crossmatches with X-neg units. "

Well we have a bed count of around 140 and recently bought an Immucor Galileo Echo (solid phase) which is designed for smaller labs. What may be more important to know is what is your daily volume of types, screens, antibody Ids etc within the Blood Bank. We have no outreach so we see samples one or two at a time only on all three shifts. So the Echo works well for us but can take several samples at one time. I have heard that the Ortho Diagnostics Provue is only appropriate for very large labs and there were two of them at a lab I worked for that transfused about 3000 units per month. Personally, if you are short on staff, I would avoid the manual Ortho gel as you still need someone to sit there to do the incubation etc manually. Hope this helps.

Its not Santa??

I don't try to explain that craziness as I just ignore it. I call Christmas National Gift Giving Day since the spirit of that day seems to be about glutton also IMHO. Boy, are we way off topic

Yup, major glutton day for us Americans. After the turkey we fall asleep so there is no time to do PLT. Plus if we did, our family members would call as Geeks

Oh goodness, how does one measure competency. That's another whole story

Oh boy. Thanks, I am so glad I ask these questions to all of you. I am about to take a few days of vacation and will take care of this when I return. These responses are probably why I can't even find a procedure in AABB tech manual on how to do this anyway. Vacation, take me away!!!

Hi all, we have an old SOP used for determining if a patient may have a purely cold allo (or two) or auto antibody . The cold panel SOP has no reference to anything ("we've always done it this way") in terms of how long a screen (which actually isn't even in the procedure) and/or subsequent panel should sit in the frig before being read. Can any of you point me towards a useful reference so I can revise this procedure with proper references? Thanks! I am assuming this is actually a useful procedure at times particularly when we are doing a manual screen and panel which reacts strongly at IS. We just moved to the Echo so I'm not sure yet how often we will determine that Echo positive reactions may end up being attributed to a cold allo or auto. We do frequent pre-warms here which sometimes makes me nervous but the cold panel is only used by one tech 99% of the time. I think I might want to get rid of this SOP? Hope this makes sense?

A belated thanks again to all of you. I don't interpret the standard to require me to follow a transfusion although I used to do it often elsewhere. I am ramping up our QA program in the BB to include live audits of patient identification during draws at least. I l already check close to 100% of all returned transfusion admin forms for compliance to signatures, vital sign recordings etc so I think we'll be good come AABB 2015

Sorry its taken me so long to say thanks. I got caught up in getting ready for Echo, plus vacation, and lost sight of this post. For the moment, I revised the existing procedure to say to use washed cord cells of the same type as the adult patient and test the plasma against the cord cells to eliminate Anti I. I threw out the references to Anti H, no idea why that was in there to begin with. I may revisit this procedure soon but for the moment, I am working on DAT, algorithms for ABIDs etc. So much thinking to do that my brain hurts

I put in goals that pertain to new skills, new computer programs, new instruments, etc that will have to be learned that year. I don't bother with CMEs because the state of Rhode Island already dictates that and the techs know what they have to do. No one does any presentations here which would be nice but to meet CME goals, the state only requires attendance at lab programs, or completion of online study programs etc. I haven't put in any "personal development" things like Dr. Pepper but that wouldn't be a bad idea. One of our problems is that all but one tech are crosstrained and only work in the Blood Bank on 2nd and 3rd shift and/or are perdiems or very part-timers and almost never work in the BB. So there isn't much opportunity for them to expand themselves in our little lab.

Happy Monday. To answer Malcolm's question- our Onc who orders all the DATs never gets back to us one way or the other and a delayed serologic or hemolytic reaction is never ordered. Based on the chem and heme tests she always orders at the same time that go directly with a delayed reaction investigation, that was my assumption. But again, never a word from her. Whatever, onward we march

Thanks Goodchild. and I agree with everything here in this post. Interesting (to me) to note that you do so many eluates per year. We average one. I'm trying to move them to our local Reference lab. We have one oncologist who orders DATs on her post trans patients and she is clearly looking for delayed hemolytic reactions based on the chem and heme tests she orders along with it. But once we report out the pos or neg DAT, that's the end of it. In other words, no MD seems to order delayed transfusion work-ups either hemolytic or serologic. I ought to poll people on that one too! For now, I am detailing all of the "investigation" possibilities in our Transfusion Reaction procedure and will include 'at the request of the MD who suspects......." Hope it isn't overkill?

I agree with you completely Galvania which is why I am moving the lab forward away from the scopes. My old boss, a Trans Med specialist told me back about 15 years ago that if it's not visible with the naked eye, it is insignificant. I have to convince our Pathologist who has zero background in Blood Banking that the world won't end if we get rid of the scopes for these types of tests. She oversees one other small hospital who borrows procedures from us so she has no opportunity to be exposed to a more 21st century lab. Onward we march!!!

Thanks Goodchild, I appreciate that! I sent out an email to a number of local East Coast hospitals but for some weird reason no one will comment on doing or not doing microscopic readings which is what I need to know.

Yup, I knew you would say that Malcolm and I should have mentioned the fetal stains, rouleux and all those micro-dependent tests. Goodchild, we rarely get these positive DATs and when we do they are microscopic. I haven't repeated a thing yet but might someday. I want to get rid of micro readings because I know if I repeat them, I will likely call them negative. People love their sticky cells here and lean heavily towards calling sticky cells under the scope as positive readings. 1960s here we are but not for long

I know, I know, microscopic readings-yuck! I am trying to move my little lab away from microscopic readings on everything but have to convince our Pathologist first who has no Blood Bank background. So first I am working on eluates: Bottom line, at what strength of a DAT do you perform an eluate if attempting to find antibodies? I want to change the SOPs here to at least get rid of micro DAT readings leading to eluates. 2+ macro? Please let me know and dear Malcolm, I already know how you feel about micro readings. I need to present a large number of "macro" only reading opinions to our Pathologist who will then agree to dump the micro readings. Thanks!!