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Everything posted by TreeMoss
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BBK Product Dictionary -- page 3 -- UNIT SCREEN (about 1/3 of the way down the page on the left) -- look up the documentation (Shift+F8). "Order Screens are customer-defined queries created in the MIS Dictionaries." When we built our inspection statement, we made it so it would only accept "Y" as an answer -- thus the required inspection.
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Our Massive Transfusion Protocol states that blood bank/lab staff will place orders for subsequent products needed. Other than that, we have a "Written verification of Verbal Order" sheet that we complete and send to the patient location for the physician to sign. This is used in those circumstances where the nurses are too busy to order so blood bank puts in the orders. For Emergency Issue products, we have the physician sign a release for the use of the emergency products.
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We also get orders for cord workups on the babies of all O Positive and Rh negative moms -- and nothing on those moms who have been sensitized. It would be nice to only get orders on those infants who have symptoms of HDN.
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The AABB Technical Manual states that antibody titers should not be performed using gel technology, so we revised our procedure to go back to tube method.
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can wash change the strength of the reaction
TreeMoss replied to jwnola's topic in Transfusion Services
I suspect because anti-A, anti-B, and anti-A,B are usually cold-reacting. That would be similar to washing with cold saline if you were working with a cold autoantibody in preparation to performing a cold auto-absorption, I think. -
can wash change the strength of the reaction
TreeMoss replied to jwnola's topic in Transfusion Services
The AABB Technical Manual says to wash cells once and make a 3-5% suspension. Then to wash one drop of cells (for each the DAT and DAT Control) a total of 3 more times prior to adding the AHG and spinning. Our AHG requires two drops. I have also read that the cord cells should be washed in cold saline to prevent eluting of the antibody while washing the cells. We did this years ago but somehow got away from that practice. -
If the mother is a possible miscarriage of 12 weeks or less, we do a blood type or go by the patient's history. If she is Rh negative by history, or if she types as Rh negative on a current specimen, she is a candidate for 1 - 300 mcg dose of RhIG. No further workup is needed. A patient who is 13+ weeks pregnant and bleeding would have the ABO/Rh, antibody screen, and fetal bleed screen tested prior to administration of the RhIG.
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One thing our reference lab mentioned was transfusing antigen-matched blood so you know no new antibodies will be formed. In that situation, I don't think we would need to continue sending specimens to the reference lab every time the patient came in for transfusion. Anne
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Immucor's is 2-10 minute RT, spin and read.
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This is also what we do and it works well for us.
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Meditech Issuing Products questions
TreeMoss replied to richj's topic in Computer Systems / Software / ISBT128
We change the location to where the blood product is being issued if not to the patient floor. We have validated the blood coolers for 24 hours, so we indicate on the issue screen that the blood was issued in the cooler and then we just return to prior status when the blood cooler is returned to us. -
We are a level II trauma center located 3 hours from one blood center and 4 hours from another. We normally stock 4 PLTPH units, and we can sometimes get some from the hospital one hour away.
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We do not use cord blood specimens for any crossmatching purposes because the cord blood specimens are labeled with mom's armband label and are not always labeled at the time they are collected. When any Packed Cell is ordered, the computer automatically orders a type and screen with the crossmatch. We have the NICU draw us 1 ml of blood in EDTA, and we do the type and screen (in gel). If the screen is negative, we can result on that specimen until the baby is 4 months of age. We do not do any crossmatches on the baby unless the antibody screen is positive, and in that situation, a new specimen is needed every 7 days until the antibody screen is negative and a crossmatch is performed. If we need to test using the mom's plasma, we would enter results and add a result comment that the antibody screen was performed on mom's plasma.
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Unfortunately, we get antibody ID and titer referral specimens from a reference laboratory, so we don't know for sure if these anti-D's are from RhIG or not. I think the docs may just be covering certain parts of their bodies! We have asked the reference lab to provide that information to us, but they don't contact the physicians' offices.
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We first started thinking about this when we had a patient with positive reactions in all 3 screening cells and all panel cells, but the auto control and two packed cells were negative in gel. How could units be compatible when all screening and panel cells were positive? We then diluted up our Immucor cells to test in gel, and amazingly, there were no reactions. We do report ours as an antibody to the preservative in the Ortho cells. We've seen several times that these patients are on Sulfa drugs, and we wonder if there is a connection there.
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We absolutely love working with the ARC in our region (Idaho). The Reference Lab folks are pleasant to work with and will do whatever is requested of them. We have a courier system that delivers routine overnight shipments, and, if needed, the ARC will have someone drive units up to us. We are 3.5 hours away from one blood center and 4 hours from the other. They supply packed cells, FFP, Cryo, Pooled Cryo, Platelet Pheresis. We do not have a need to receive single platelet packs. Before we got our sterile connection device, they would also send units with aliquot bags attached. Due to CAP question TRM.30882, I built a Supplier Selection Criteria form where we compare blood suppliers based on such questions as: 1. Are all blood products available? 2. What transportation is available: How many times a day for product arrival? What emergency transportation is available? 3. Are reference lab services offered? 4. Are expired or short-dated products credited? 5. What is the turn-around-time for providing products? 6. What are the client service hours, and is an 800 number provided? 7. Are they open 7 days a week? 8. What are the billing options? 9. Who pays for blood transportation? 10. Do I have communications from the account manager? Because of our distance from the blood centers, we send and receive products to/from other area hospitals. The empty blood boxes are stored on our loading dock, and the courier returns them to the blood center once a week. As for the ice, we have a cooler to store the ice bags for use in individual blood coolers used for patients in ED, OR, or wherever we need to send more than one unit at a time for a patient.. We don't have an ice machine in the lab, so this saves a trek down the hall. ARC also offers Education events (SUCCESS). I would encourage anyone to go with the American Red Cross.
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We also use glass tubes in blood bank.
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We send our Warm Auto / Cold Auto specimens to the reference lab to determine if there are any underlying allo-antibodies. We give least incompatible units using the in vivo crossmatch procedure -- antigen-negative units, if applicable.
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We find the heat elution to be less time consuming, and the results are good, so we use that for the cord elutions since we do more of those. Yes, we could just utilize the acid elution method but find that what we're doing works for us.
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Immucor FMH RapidScreen ABO incompatibility
TreeMoss replied to labguru's topic in Transfusion Services
We also currently do the Kleihauer-Betke stain on moms with weak D positive babies to determine whether they need more than one 300 mcg dose of RhIG. We also let them know that they may return to the lab in 6 months, if they would like, to have the blood type of the baby rechecked. No one has taken us up on that offer yet, but we would like to have a verification of the baby's blood type, if possible.- 15 replies
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- weak d
- abo incompatibility
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Immucor FMH RapidScreen ABO incompatibility
TreeMoss replied to labguru's topic in Transfusion Services
Has anyone ever used the FMH RapidScreen test on cord blood to determine the Rh of a baby in this scenario? Our reference lab suggested that as a possibility, but I've not been able to find any references for this procedure. If the FMH RapidScreen is negative on cord blood, that should indicate that the baby is Rh negative with a positive DAT. If the FMH RapidScreen is positive, that should indicate that the baby is Rh positive. Positive DAT does not affect the FMH RapidScreen test. Curious to know your thoughts.- 15 replies
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- weak d
- abo incompatibility
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We also store all cord blood specimens in the blood bank. We routinely get orders for cord workups (ABO/Rh, DAT) on babies of O Positive and all Rh negative mothers. I have tried to push the issue that just because the mom is O Positive it doesn't mean the baby is at risk. Is the cord workup medically indicated if the baby does not have jaundice? Anyway, whenever we get a positive DAT that we think is ABO, we do a heat elution. For other antibodies, we use an acid elution (Immucor Elu-Kit II). We work up all positive DATs on babies.
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Additional blood request for type & screen
TreeMoss replied to Kandahlawi's topic in Transfusion Services
AABB Standards indicate the blood bank specimen is good until midnight on day 3 after collection with day 0 being the day of collection. Your specimen is good for crossmatching units until midnight on the expiration date, and the crossmatched units are also good for the same time period. -
If a reaction gets reported, we work it up. We let the pathologist decide if it was a significant reaction. anne
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Transfusion Administration Records (TAR)
TreeMoss replied to ADawson's topic in Computer Systems / Software / ISBT128
We use TAR -- although we call it BCTA (Bar Code-enabled Transfusion Administration). Do you use an additional form of identification (Typenex bracelet)? We use MobiLab and patient wristbands, so we do not have to have an extra wristband for specimen identification. We scan in the patient account number barcode to print the specimen labels -- Love MobiLab because the labels include collection date, time, and collector ID. No handwriting is needed on these labels. We use the Medical Record number for our "wristband" number -- so it remains the same every time the patient is admitted. MobiLab makes it possible for us to use an EDTA specimen from hematology morning pickup if a patient needs a new type and screen instead of having to draw the patient a second time. If so are you using it for all products? This is used for all products for the patient. Pharmacy issues RhIG and factor concentrates. We had to transfer all "lot number" products to Pharmacy when we went up on BCTA, so we only have PCs, FFP, Cryo, and PLTPH. If required for all products do you use a different one for each product? No. What form of identification or requisition do you require at the time of issue? BCTA has a pre-transfusion checklist that the nurses print off and bring to the Blood Bank. This checklist also has a copy of the patient wristband, so we can scan in the Medical Record number when issuing products to the patient. (This is another plus for patient safety.) In urgent situations, they simply bring a patient identification label from the chart or handwritten patient number and MR#. We require two identifiers when blood products are issued. What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside? BCTA requires Patient wristband to be scanned and then unit Donor Identification Number, product, and blood type barcodes. If all of those check correctly, the blood product can be administered. In urgent situations or during computer downtime, two nurses are required to check the unit and patient information. BCTA is being used everywhere except in emergencies and in the ED (working to get it used here in non-emergent situations). The nurses on the floors love this because they don't have to find a second nurse to check the unit with. What other issues have you encountered? None. As I said, we really love BCTA here. anne