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exlimey last won the day on January 12

exlimey had the most liked content!

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About exlimey

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    Gaithersburg, MD, USA
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    IRL; Reagent Manufacturing

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  1. A very good point, Anna. The same applies to anything done "off-label", regardless of how much validation has been done.

    Scandalous, Scott !!!!!

    I think you're joking, but just in case...... It's a simple C1 x V1 = C2 x V2 calculation. One of the few times when algebra gets applied outside of high school. To do this accurately, you must first know the hematocrit (concentration) of your "packed cells" - this will be used as C2. For this example, let's say the hct is 75%. C1 = desired hematocrit (concentration) - 3%; V1 = desired volume - for this example, let's say we want 100 mL of 3% cells. Using the formula and information above.... 3 x 100 = 75 x V2, which resolves to 3 x 100 ÷ 75 = 4 mL. Ergo: 4 mL of "packed cells" in 100 ml pf PBS will yield ~3% suspension. This process works for low cell concentrations where the added RBC volume is only a small portion of the whole (4 mL added to 100 mL). If you try to make higher concentrations, you have to take the RBC volume into consideration as part of the whole volume.☺

    ANORRIS, I think you might need a few more details in your question before anyone can lend advice.
  5. Cold Agglutinin Panels

    Good call !
  6. Crossmatch Billing

    Well said, John. We've all been in positions where "extra work" was logical because either the original request was wonky or we did it for our own sanity.
  7. Cold Agglutinin Panels

    First step: Is it reacting with autologous cells ? Fairly easy to make that call, IF the patient is untransfused. If the patient is transfused, it gets more difficult, if not impossible. Any reasonably competent IRL should be able to help. If necessary, they would be able to perform adsorptions and/or test rare cells. They may even be able to isolate autologous cells from a transfused patient.
  8. Crossmatch Billing

    I think Scott is saying that there is still a cost associated with each test, regardless of billing. Socialized medicine bean-counters have a very real interest in making things efficient and cost effective. Redundant or unnecessary testing is the target in such situations.
  9. Cold Agglutinin Panels

    The key question: Is it auto or allo ? This may be difficult to prove if the patient has been transfused. If it is an autoantibody, I agree with Malcolm's position - who cares? However, if the autocontrol is nonreactive, you may have to consider other things. Beware anti-Vel and anti-PP1pk (-Tja). These can behave like cold-reactive AUTO antibodies, i.e., demonstrate panagglutination, abolished reactivity by pre-warmed tests, etc. There is at least one case (published by Jill Storry) of an anti-Vel that was "dismissed" as a cold auto (it was rendered nonreactive by pre-warming). The patient was transfused with random cells and had a fatal hemolytic reaction.
  10. Blood Utilization Suyvey

    I would check the regulations VERY carefully. I suspect it would be very difficult to make this kind of thing mandatory, especially if there is some arbitrary cutoff (transfusions/yr). On the other hand, if your boss would LIKE you to participate, it might take some clever moves to convince them to decline. Good luck.
  11. Blood Utilization Suyvey

    A serious finger wagging ????? Twelve lashes with a wet noodle ????? A stern, disapproving look ?????
  12. BB saline

    Perfect ! Throw in a risk of workers' comp. and the argument is won quickly. Nicely played.
  13. Blood Utilization Suyvey

    I agree too. I find it additionally perplexing that that information from these types of surveys usually takes a few years to be compiled and published. Not much use after the fact.
  14. Blood Utilization Suyvey

    Fascinating.....voluntary, but, it appears, strongly encouraged. I wonder in how many institutions this has been translated to "mandatory"? I lean toward R1R2's position - don't do it, especially if it is indeed a "doozy" or a "stinker". We're all busy enough already. Unless the survey organizers (FDA) are going to provide funding for such an exercise......
  15. BB saline

    While it is not impossible, it can be extremely ticklish to extend an expiration date (of anything) beyond that of the manufacturer. You may find that the burden of proof required exceeds the value of the theoretical savings. You also have to remember that the manufacturers of the products put on that expiration date for a valid reason - presumably their testing indicated some deterioration/deficiency over time. Certainly microbial contamination is an issue and culturing may provide useful data. However, and this is a BIG HOWEVER, most BB saline products do not contain preservatives and don't claim sterility after opening. Therefore, you will undoubtedly end up at some point with positive cultures on opened containers. The question then becomes "How much contamination can our test system tolerate ?" - a very difficult question to answer satisfactorily. Perhaps more importantly for BB testing is stable pH and any plan to extend the expiration date of saline should include pH testing.