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gilmanch

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    Senior Technologist Blood Bank

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  1. Does anyone have a policy to not require a second draw/specimen when your patient is blood type O? At my previous employer, we did not reytpe O patients, b/c only going to give that patient O blood and if 1st draw was wrong and patient was A, that truly A person can have O blood. D did not matter. I was thinking about having this here at my current place. I wonder if other places do this, and may be if they do they take in consideration D typing if woman, to get 2nd type on O pos woman under 45.
  2. Does anyone have an opinion on Immucor's Gamma-Quin CDP solution?
  3. I am investigating the CDP method today. Technical Manual has the procedure, 17th edtion method 2-20 is what I am looking at. In the notes, #6 it states "in addition to its use for removal of autoantibodies, this method can be used for removal of Bg (HLA) related antigens from red cells. Appropriate Bg controls should be used." What is the appropriate Bg controls???
  4. I am about ready to implement blood bank armbands here. So happy to have this finally happen! I have a lot of patients that get drawn the day before as out patients for transfusion the next day so this will put me at ease since they have nothing on them at the time of draw. And help with my preop. The only thing that is up in the air with management is banding the preop patients at the time of the draw and having them wear the band until surgery date. I feel that this is the safest, but also feel that I will have a hard time getting this one approved, along with patietnt satisfaction. What is everyones thoughts on this one? I can have pleb give the band to the patient and they have to return with band, or have band placed on chart so when they return it gets placed on patient then. I am also extending our expiration date/time of specimens during this change, but have not picked one yet. Thinking 28 days (just so is a nice 4 weeks, easier to see on calender in my mind) if the patient has not received blood products or not been pregnant in last 3 months. It looks like my preop blood work is being drawn 3 weeks before at this time. What is everyone's expiration date for No patients? I need to make sure the questions are being asked, so that is the next tasks in all this.
  5. I am signed up for this review. I also bought the books Specialist in Blood Banking: question bank and study guide and another book that I dont have the title of handy right now, but is from the AABB website, yellow cover
  6. Malcolm: I can perform titers here. So would this be a good procedure? 1. if all common ruled out and not pregnant give XM compat 2. if pregnant do titer. if titer = (insert number here) monitor titer with draw in 2-weeks if titer = (insert number here) send to ref lab OR 1. if all common ruled out and not pregnant give XM compat 2. if prenant send to ref lab OR 1. if all common ruled out and not pregnant give XM compat 2. if prenant have the dad drawn I feel that, even thou sounds very simple and helpful, our staff/resources should not be testing the dad with the mom due to the fact that ABO could play a role and having to adsorb/neutralize. I have techs that have never peformed and question would be the understanding of what is going on when doing that. I could write procedure to do ABO on dad first. if compat blood types do xm with mom. if not compat send to ARC. I am then also at what is that telling me when doing the XM with mom and dad. if it is positive then it is more likely an antibody to a low prev antigen and if negative then more likely the HLA?? Where would I go from there? Still send to the ARC? Thoughts again, b/c it is always appreciated!
  7. What is your procedure for a random cell that is reacting and not accoutanted for? Our testing capablity is limited with simple ABID. I am still trying to figure out a happy balance for us for sending things and not sending things to a reference lab. I know at where I used to work we didnt sent a lot of those one random cells for further investigation. Would just assume low incidence or HLA(if postitive on the extended) and be done giving IgG XM. But I did not know what I know now and knowing what I know now...makes things harder sometimes!! haha Is it more important with the pregnancy patients. How about with patients who have been transfused ever? Talking with red cross they would confirm the HLA by treating with something that destoys the antigen to show no more reactivity So wondering if write the procedure say: 1. any unexplanable cell and patient pregnant and or transfused hx must go to reference lab even if all commonly encountered are ruled out 2. any unexplanable cell and pt not pregnant or transfused and all commonly encoutered are ruled out give IgG xm Thoughts, ideas appreciated, thank you!!
  8. I have a similar situation/question: What is the best practice for RHIG and patients who come into the ER pregnant and as a vaginal bleed? We do not offer the Kleihauer Betke at my hospital, only the fetal bleed screen. If any fetal bleed screen is positive we send to another hospital for the Kleihauer. This is practice for our postnatal cases. I am concerned about the ER patients and not giving them enough RHIG because right now, no fetal bleed or Kleihauer is being done to see how much of a bleed. So far in my studies I have found early in the pregnancy, the baby is so small, the blood volume of the growing baby is not over what 1 vial of RHIG can cover. But at a certain point, the baby is now big enough and the blood volume, if all of its blood volume was released into the mother’s circulation, the 1 vial of RHIG would not cover it. I think it might be 13 weeks (and by sarara26's post I feel little better about that number) that you should begin to worry about 1 vial not covering it, but not 100% sure. At my previous employer, any ER *** bleed we did TS and KB and gave RHIG based on that. Should I suggest we do the fetal bleed on any ER *** bleed and send out if positive? Or if the mom is 13 weeks and over, must send out for KB? Any suggestions would be appreciated, thanks!
  9. I have been following this a little due the the fact that I came from a place that did Ortho Gel ABO to a place that we only do tube ABO. I was going to switch us to gel and started validating the cards, but had a couple that would give me negative in the tube and then positive (3 or 4+ would never question if it was weak) in the gel card. I did the weak D in the tube and that was positive. This got me questioning and learning more about all this. I still dont quite understand thou!! At this point, with everything going on molecularly and the articles out there, I am just going to keep us at tube. We do not do the weak D normally. I called a hosptial close by to us to see if they had these patients on file, they use gel. One they did and they call that patient D positive. I was not able to send this for molecular testing due to my vito by management. I did however have 4 different manufacturer anti-D (collected from friends )and all tube with those were D negative. I have wrote Ortho asking for a little explanation: They also refered me to an article I attached. "Based on the monoclonal anti-D present in ID-MTS Gel and the handful of studies reported in the literature, the following seems to describe this reagent’s reactivity with uncommon Rh phenotypes: Category VI partial D does not reactWeak D Type 2 is very reactive, may be 2+s in ID-MTS Gel vs neg, +/-, or 1+w in tube, depending on reagent anti-D used and other variables of traditional tube testing. I’ve not seen sufficient data for any further characterizations of this reagent. However, there are ample studies to suggest that any currently licensed anti-D reagent in the U.S. can give strong reactivity (≥ 2+) with some very rare partial D phenotypes that are at risk of immunization to the missing epitopes. One anti-D reagent may even react up to 4+ with a low incidence antigen that is not a part of D. This is certainly a current hot topic. As molecular testing becomes more refined, we should be able to better understand and predict the behavior of the various reagent antisera, but for now, our knowledge is somewhat limited." When I was working at U of Michigan, we decided to treat patients that reacted 1+ or less with anti-D by direct agglutination as though they were Rh Negative. This was strictly tube testing back then. Our concerns were not just that weak reactivity tends to increase the statistical potential for a partial D, but also because of concerns about fibrin, rouleaux, spontaneous agglutination from autoantibodies, overreading, under shaking, etc. Gel certainly lessens some of these concerns, but it still may be prudent to be conservative and treat such patients as Rh Negative for the purposes of transfusion or Rh IG therapy." http://www.aabb.org/annual-meeting/attend/2014/Pages/Using-Molecular-Methods-to-Resolve-Weak-D-Phenotypes.aspx this link had some good info Can anyone chime in on this? Do we need more standardiation of method(s)? Are the gel D positive results acceptable for the new recommened guidelines? Is the tube is too weak? My mind has went around and around on this!! Immunohematoloty Vol 21 No 4 - Judd Westhoff 11-4-2005.pdf
  10. Milesd3, what analyzer do you have? something I now have my techs doing is using the analyzer for comparison. They must match the anaylzer somewhat, (i use the same criteria as the man diff) and if they do not, repeat the diff. If they get the samething, then I want them to look at the flags and scatter plots to see if what they are getting make sense. if not, remake the smear b/c something could be off on smear (prep or stain) if the flags ans scatter plot match what could be the variance then they can release it. We have an Advia, and most of our unmatched man diff compared to the auto diff is if the patient is myleoperoxidase deficient, will mess with the diff, give us more monos then what is really on the smear.
  11. Hi, I think a good monitoring of your analyzer's performance is looking at your analytes SD from month to month, and it should stay constant. If it changes that could be a sign there is a problem. My question is what is a criteria is used to say there was a change and needs investigation? 10%, 20%, 30% differenence? Or it doubled? What is a good guideline to watch for? Thank you!
  12. This is something I have been working on also. Few things I have implemented: 1. Prodedure that is detailed about what we call for morphology and cell identifcation (we were having variance in bands vs. segs.) 2. Techs signed up for the Media Lab 3. Each morning I or my lead tech pull 3 slides (one each shift) and perform a diff to check results reported. criteria I use is need to agree 10% if results over 30 and need to agree 50% if results under 30. I got this idea and criteria from another lab's supervisor. Since then I have seen other things that need to be standardized more 4. This article has information that I am going to use one day to help standardize us a little more further MORPHOLOGY PAPER.pdf
  13. I do not have this implemented at my hospital yet...but another hospital I visited to check out their blood bank module has a really great idea. On the unit tag, they have one side the patient and unit information, and the other side a quick reference guide for the steps to follow if they think the patient is having a reaction. I like this idea a lot, is right there readily available.
  14. Hello everyone, I have a question for what other places do to fullfill the CAP Hem 25870 stating: If commercially assayed controls are used for CBC instruments, control values correspond to the methodology and target values (mean and QC ranges) are verified or established by the laboratory. Note: most commercial controls have expected recovery ranges for each parameter, provided by the manufacturer. The mean of such ranges may not be the exact target value in a given laboratory. Each laboratory must assign its own initial target value, based on initial analysis of the material; this target value should fall within the recovery range supplied by the manufacturer, but need not exactly match the package insert mean. The lab must establish specific recovery ranges that accommodate known changes in product attributes, assuming the calibration has not changes. Do you guys tighten the ranges? Make your SD smaller so the range is smaller? The package insert range is usually quite wide and if it is tighter problems from trends and shifts can be seen sooner. I have tightned ours, but it seems it maybe too much? Thanks for the help!
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