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OkayestSBB

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Posts posted by OkayestSBB

    Air Ambulance Transfusion

    in Transfusion Services

    Posted

    On 8/28/2022 at 4:50 PM, Mabel Adams said:

    We have a contract to provide blood to our air ambulances, but they charge the patient if they transfuse it (well, it's wrapped into their total charges for the flight, but we don't charge the patient).  If the patient comes to us, we do the XM like we would for our own UNXM units but if the patient is transported elsewhere, we maintain final disposition of the unit in our computer but don't do the XM (yes, we give the patient a fake account in the BB computer using a specific format).  It is just easier for us to maintain the record of the unit's final disposition for if there is a market withdrawal etc.  We would notify the air transport company to do the patient or next of kin notifications if that were ever needed. It hasn't happened yet so it isn't a big problem.

    Thank you for sharing this Mabel! Sounds like your facility is in a similar boat as ours.   By chance, are the units you provide ever returned to you if not used, prior to expiration? And do you ever accept them back into inventory for transfusion, or do you just discard them? 

    Air Ambulance Transfusion

    in Transfusion Services

    Posted

    1 hour ago, jayinsat said:

    As far as I have been able to ascertain, unless your facility provides the units to the air ambulance, you have no responsibility for their crossmatching or transfusion. Those records should be kept by the donor services that provide them. Our ambulances and helicopters carry low titer O pos whole blood provided by our local blood supplier. When they are given en route, the EMS is supposed to give the record of transfusion to the Emergency Department staff, and that staff is supposed to forward one copy of it to us in the blood bank, along with the bag, so we know the patient received the unit (as it may interfere with blood typing). That, however, rarely happens. It is not until we have an ABO discrepancy (mixed field in the front group) that we begin to realize what happened. 

    For your responsibility, it is the same as if a patient were given uncrossmatched blood at a remote hospital and then transferred to your hospital. The responsibility of the crossmatch and transfusion is on the prior facility.

    We do provide the units to the air ambulance.  Patients transfused with those units can either get transferred to our facility, or another trauma center in the area.  We keep segments aside of the units we give out and if they come to us we crossmatch but there is talk of removing that from the SOP.  We feel uncomfortable with that because we cant find much information other than the FDA wants traceability and trackability of the unit.   I feel like this situation is a black hole for units, not much information in the regulations/standards. 

    Air Ambulance Transfusion

    in Transfusion Services

    Posted

    Hi All, I'm curious if anyone knows or can point me in the right direction regarding air ambulances and the responsibilities associated when units are transfused in-flight.    Do those units need to be retroactively crossmatched by the facility receiving the patient? Or is there an exemption of some sort in these scenarios?  Any info, documentation standards etc is greatly appreciated! 

    Lexmark 2400 series

    in Transfusion Services

    Posted

    Hi all, this might be a long shot but does anyone have experience with Lexmark 2400 series?  Our current issue is with printing component tags using Cerner Millennium.   All of a sudden our printer has started to print a blank after each tag, and gets offset, it’s like the printer thinks the tag is longer than it should be.  Our IS no longer services these kinds of printers 🙄 and the manual is unhelpful.  Any ideas? Please 🙏🏻 And thank you 

    A1 lectin QC

    in Transfusion Services

    Posted

    On 9/18/2021 at 4:26 AM, Malcolm Needs said:

    I attach a hybrid of my lectures on the differences between the A1 and the A2 ABO type, together with a very few slides from my lecture on lectins, and I hope that this will serve to be of some use to you.

    It is hugely important to remember that many lectins, including Dolichos biflorus, are not specific unless they are diluted to ensure that they only react as desired.  For example, this particular lectin (Dol b) will react quite strongly with A2 red cells unless suitably diluted so that it only reacts with A1 red cells.  It is because of this that group B red cells are totally unsuitable to be used as the negative control for the Dol b lectin, and the same applies for group O and other group A subtypes.  Group B red cells will not tell you whether or not your grouping reagent is "specific" for the A1 antigen, or will still react with the A2 antigen.  In addition, the lectin will also react with red cells expressing the rare polyagglutination antigens Cad and Tn, and so, in the true meaning of the word, it is not "specific" anyway.

    What is the difference between A1 and A2.pptx 512.68 kB · 2 downloads

    Thanks Malcom! I know A1 lectins need to be diluted properly but didn’t think it all the way through to that’s why A2 cells are a necessary negative control. 

    A1 lectin QC

    in Transfusion Services

    Posted

    Hey all, 

    I was wondering how you all QC your Anti-A1 lectin, particularly if you use commercial A2 red cells as your negative control. Background: We do not QC Anti-A1 lectin daily only as needed, we use commercial A1 red cells as our pos control, A2 as our neg.  However, we then QC our A2 cells (bc they are not included in the QC of our daily rack QC) which I find to be unneccesary and wasteful.  Why would you QC your QC? You are accessing the functionality of Anti-A1 not the A2 cells, right? Why not just use B cells if they have to be QC'd. Just curious if I am missing something.  I am really wanting to get rid of this practice if possible, and I am currently going through CAP and AABB standards for clarity.

    Thanks :) 

    Chido / Rodgers Identification

    in Immunohematology Reference Laboratories

    Posted

    In my experience with HTLA like antibodies you usually have a feeling to go that route by the way they shake off, they are generally weaker reactions and sometimes hard to reproduce.  As Malcom has stated, I have heard strong Ch/Rg antibodies that need to be diluted out to neutralize.  I personally like to do a titer, and I find that antibodies to Ch/Rg usually like gel.  But that's when they place nice... 

    Hope that was helpful

    DATs on Cords in Gel

    in Transfusion Services

    Posted

    Thank you Malcom, that was a good explanation.  Its funny that you said the human eye is not always accurate because one of the blood bankers told me they eyeball it, and I said the same exact thing that you said. How do you eyeball a 0.8% suspension?!  :disbelief:

    DATs on Cords in Gel

    in Transfusion Services

    Posted

    Thanks everyone! Im actually relieved bc I can just tell them not to wash and it'll be an easy fix.

    We do use that calculation to make the 0.8% from packed cells, the problem is that people are washing the cord blood four times in the cell washer and it doesn't leave enough red cells to get 10 microliters of true packed cells.

     

    Anorris, page 377 last paragraph.   

    DATs on Cords in Gel

    in Transfusion Services

    Posted

    Hi All, 

    Quick question for the gel users.  We use gel as one of our back ups to our ECHO, I personally have never performed DATs in gel.  At my current facility they perform only cord blood DATs in gel. I've noticed that when the techs prepare the 0.8% cell suspension they are WAY off when compared to commercially made Ortho cells (the cell button after spinning is like 1/2 the size it should be).  In our procedure manual someone hand wrote in to wash the cells four times, when I grabbed the technical manual it states that the advantage to column technology is that you do not need to wash for anti-globulin tests.

     

    I've been so ingrained to wash for DATs, I find it hard to believe you wouldn't for gel.

     

    So to wash or not to wash? That's my question.

     

    Thanks!

    Stryker Units

    in Transfusion Services

    Posted

    Does anyone have any info or experience on transfusion services being involved with auto-transfusions of shed blood (Stryker)?  How do you get involved or monitor?  Do you work up adverse reactions etc?

     

    Any info (or being pointed in the right direction) would be greatly appreciated.

     

    Thanks!!

    Freezer out of Temp

    in Transfusion Services

    Posted

    Thanks for all the input.  As of now our inventory is Quarantined with a small stock of new frozen product for emergencies.  

    I had sent a few suspicious looking products back to the supplier to look at, and they aggreed and put them through their review process.  So we are waiting to speak with them

    I cant imagine that being at -10 for 2 hours would thaw the product that much, but I want to be sure.

    Thankfully no one was transfused with any frozen product within that time period or after.

    Freezer out of Temp

    in Transfusion Services

    Posted

    Thanks all for your input.

    According to my blood supplier, I should be ok with a visual inspection of the units so long as they didnt look like they thawed.  Nothing was said of a FDA Biologically deviation report so I will def be looking into that. 

    Freezer out of Temp

    in Transfusion Services

    Posted

    I came in this morning and noticed a huge spike on our -30 freezer temp chart from the evening prior.  The Freezer was at -12 for about 2 hours.  We have FFP and Cryo in there.  Does this mean I have to discard my entire inventory? Im having a hard time finding an answer via the technical manual

     

    Any advice/input is appreciated!

    Weak backtypes on Echo- why?

    in Equipment

    Posted

    Yes, we get this all the time, mostly with our B Cells too.  Whats frustrating is when you repeat in tube and its 2+ or greater!  One thing I thought about was I believe Immucor recommends to refrigerate the A1 and B red cells occasionally to keep the expiration on the bottle, otherwise they are only good for like 5-7 days at continuous RT (not 100% about the 5-7 days, it may be 3).  Another explanation I got from Immucor is the analyzer shakes the strips a certain amount of times but it will stop when the monoclonal control is negative. When you read your tubes you generally do one at a time so you wouldn't notice the difference between the monoclonal and B cells.  Therefore if you were to shake the tubes together you'd be more likely to get results like the ECHO. 

    I don't think I explained their reasoning very well.  Or maybe they didn't explain well to me. Or it maybe its just bologna, and they can add bad lots of B cells to their bad lots of ready screen strips/indicator cells.

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