Frequently calling "cold autos"

[Deny Morlino]

If the correct treatment is given, in the long-run, it may actually be cheaper for the insurance people.

Malcolm I agree with your logic 100%. It makes much more sense to "spend a little up front" to minimize the cost in the long run. The sad thing is that the insurance system does not usually allow that sort of logic to prevail. An example: my daughter went to see the family physician. He requested an MRI of her head. After calling the insurance precertification group, I discover that an x-ray must be performed first. This did not show what the physician was looking for. Precertification again for an MRI and this time a CAT scan was what they insisted upon. The result still did not give a clear result to the physician. The third time of precertifying an MRI was approved and wouldn't you know the result was useful to the physician. Moral of the story I guess is even though we know what the better practice probably would be, we are at the mercy of the insurance precertification system.

[Barbarakym]

And my question was and still is: How does one working in a regular hospital lab when a cold antibody needs to be sent to reference lab. What parameter in our regular flow chart should trigger that response? Remembering what equipment we have. Reg 37 heat block, and non heated/cold centrifuges. On doing plain old TS and finding what looks like a cold as it's reacting at RT and clinically dig AB ruled out then what triggers upping the ante? We often get 4-5 colds a week. Maybe more.

[Malcolm Needs ☆]

I would think that the only thing that would trigger it is, then, a request from the doctor looking after the patient for a more thorough investigation. In the mean time, you would just have to cross-match at 37oC and, if the blood is compatible, issue the blood. Under such circumstances, however, if the requirement for transfusion becomes frequent (or becomes more frequent), I would be jumping up and down flagging this up to the doctor looking after the patient, and the doctor in charge of the Blood Bank.

[Deny Morlino]

Agreed. I often confer with a physician and our blood bank director on issues. I am in the department most frequently and usually in the best position to "put the pieces together". Getting reimbursed is another sore subject all together.

[Barbarakym]

Malcolm this helps. I frequently pull 'visit reports' on big users. Want to see if plt refractory. Or delayed Trans rexn. Or? L

[Barbarakym]

Hit send by accident. Looking to see if Tx is helping. Sometimes pt have a bleed they don't want to fix for valid or not reason. Sometimes not sure. So what outside of suspected bleed would be symptoms to do further workup? Getting 2 units every day or two and staying even or less so on HH? Or less. Or more? Specimen Hemolyzed or icteric I look for already. Any other tips for triggers to suggest ref lab workup?