Jump to content

hematolgy specimens for use in abs/abid


tkakin

Recommended Posts

Malcolm may say I am being "pedantic" for this (I just love having a new word to use....thanks Malcolm)....but historically, I do not like using specimens from any other dept. Reasons: Possible contamination and the fact that my experience tells me that phlebotomists are much more conscientious when they know they are drawing a specimen for Blood Bank than other Lab Depts. (not to say they are sloppy in other areas....just that there is an increased fear element for the Blood Bank).

That being said, I have "on rare occassion" resorted to doing it (i.e. if the Physician only wants a DAT and understands we are using the specimen Hematology used; or, if more specimen needed for ABID and cannot easily obtain it from patient....but would expect reactions to be consistent with work-up already started).

Brenda Hutson

Link to comment
Share on other sites

Way back when we went to using EDTA tubes in BB, someone online (probably the AABB forums back then) presented the theoretical possibility that the needle on the Hematology analyzer might have some carryover RBCs on it when the BB specimen was run.  If those RBCs happened to have an antigen for which the specimen to be shared with BB had an antibody, it would take very little contamination to adsorb out the antibody making it undetectable in the antibody screen (at least if it was weak).  I now think that there would have to be a lot of unlikely events occurring together for this to happen so where I work now we occasionally use a Hem specimen for an Ab Screen or ID.  I suspect that the Hem needle gets cleaned pretty well between samples on modern analyzers.  One could test this by taking a sample with a weakly reacting antibody and running it through the instrument right after running one positive for the antigen and see if the antibody reacted more weakly.  One of those RhIG anti-D samples would be a good bet.

Link to comment
Share on other sites

Malcolm may say I am being "pedantic" for this (I just love having a new word to use....thanks Malcolm)....but historically, I do not like using specimens from any other dept. Reasons: Possible contamination and the fact that my experience tells me that phlebotomists are much more conscientious when they know they are drawing a specimen for Blood Bank than other Lab Depts. (not to say they are sloppy in other areas....just that there is an increased fear element for the Blood Bank).

That being said, I have "on rare occassion" resorted to doing it (i.e. if the Physician only wants a DAT and understands we are using the specimen Hematology used; or, if more specimen needed for ABID and cannot easily obtain it from patient....but would expect reactions to be consistent with work-up already started).

Brenda Hutson

Brenda, you're not being pedantic at all (but if you do want to get a rise out of Malcolm, just post something like "Anti-Kell rarely shows dosage effect with heterozygous cells..." - and Malcolm, I do the same!). We limit the use of non-BB specimens for the reasons you mention. I'd really like to think so, but I'm not sure our specimens are as special anymore, though. Back in the dark ages when med techs went up on the floors to draw the morning bloodwork, we rarely had specimen issues anywhere in the lab. We knew what tubes to draw, how much to fill them, how to mix them, how to label them, and the possible consequences of bad specimens - because we had to do the testing on them! If there was a problem with a specimen you had to go back up yourself and stick the patient again. I think, in general, we took a step down in quality when phlebotomy teams came on board because, although under the supervision of the lab, they were a step removed from test performance. Now nurses and nurses' aides do much of the blood drawing and we've seen a further reduction in quality. Their interest seems to rapidly wane the moment the inside of the tube gets wet, blood bank specimens included. We won't even talk about procurement and labeling from outreach areas and doctors' offices. Thank god we have the "2 typing rule", BB wristbands and barriers, computer safegaurds and the other departments have delta checks in place. Still, what we catch is only the visible tip of an iceberg of unknown proportions. I'm not saying that every phleb and nurse is careless or negligent, but I'm convinced that the further away from the lab you get, the fuzzier the specimen procurement practices become. The challenge for us and our institutions is to monitor, educate and tighten these up. That's my take (not pedantry but definate soap-boxism).

Link to comment
Share on other sites

 

I have tried in several Institutions to get the Techs. to say Anti-Big K or Anti-K1. I remember at one place that a Tech. yelled out to me in the Lab....Brenda, the patient just has an Anti-Kell. I said "WHAT" Antibody did you say they had? She then corrected herself and we all got a good laugh out of it.

You are correct that Nurse draws are "scary....."fortunately, there aren't many of those here (and most of them have to be witnessed by a phlebotomist who then places the label on the tubes). The phlebotomists may not have the same regard for specimen integrity as a Tech. would....but they do have "scared into them," the repercussions of drawing the wrong patient or mislabeling a specimen when it comes to the Blood Bank.....and where I have worked, they are written up "big time" for that.

Questions for you as you talk about your checks and balances:

1. Is the 2nd type you speak of; performed on the same specimen; or on a 2nd blood draw? Because if on the same specimen, that will not detect an error in the blood draw itself (as I am sure you know). It is that way here right now.....but after I finish my "current" project (new Irradiator); electronic crossmatch and a 2nd blood draw will be my next. I know the regulatory agencies have been moving towards that for years and I have worked places that do that.

2. The Blood Bank armband you speak of....is it just one of the typenex (or whichever brand)that is a manual process? Not saying that has "no" benefit; but unfortunately, most places where I have worked that use them (including my current one), do not use them 100% as intended (i.e. must be placed on every patient, at time of draw; while phlebotomist still in the presence of the patient)? Here, the armbands for pre-op patients are placed in a labeled envelope and placed on the patient when they come in for surgery. At another place I worked at, they would not place them on patients being drawn; not only for pre-op, but upcoming outpatient transfusions. Said the patients did not want to wear an armband around outside of the Hospital and they refused. To me, that is a "broken cycle" and is almost useless. Or does the patient have a locking Hospital band with a barcode on it which must be scanned for everything? And cool thing they were just starting to look at where I just came from.....palm scanning (no, not palm reading...that is for another Post). One of my Managers had that done in their ER.

Thanks

Brenda

Brenda, you're not being pedantic at all (but if you do want to get a rise out of Malcolm, just post something like "Anti-Kell rarely shows dosage effect with heterozygous cells..." - and Malcolm, I do the same!). We limit the use of non-BB specimens for the reasons you mention. I'd really like to think so, but I'm not sure our specimens are as special anymore, though. Back in the dark ages when med techs went up on the floors to draw the morning bloodwork, we rarely had specimen issues anywhere in the lab. We knew what tubes to draw, how much to fill them, how to mix them, how to label them, and the possible consequences of bad specimens - because we had to do the testing on them! If there was a problem with a specimen you had to go back up yourself and stick the patient again. I think, in general, we took a step down in quality when phlebotomy teams came on board because, although under the supervision of the lab, they were a step removed from test performance. Now nurses and nurses' aides do much of the blood drawing and we've seen a further reduction in quality. Their interest seems to rapidly wane the moment the inside of the tube gets wet, blood bank specimens included. We won't even talk about procurement and labeling from outreach areas and doctors' offices. Thank god we have the "2 typing rule", BB wristbands and barriers, computer safegaurds and the other departments have delta checks in place. Still, what we catch is only the visible tip of an iceberg of unknown proportions. I'm not saying that every phleb and nurse is careless or negligent, but I'm convinced that the further away from the lab you get, the fuzzier the specimen procurement practices become. The challenge for us and our institutions is to monitor, educate and tighten these up. That's my take (not pedantry but definate soap-boxism).

 

 

Nope....we're just being pedantic! Ha Ha

Brenda

I'm concious that I may just have made a rod for my own back here!!!!!!!!!!!!

 
Link to comment
Share on other sites

Brenda, (1) yes it's from 2 different draw times. I've always been surprised that for years typing the same spec twice was considered an acceptable way of "reducing" mis-ID risk. (2) I was just listing some of the options we have now that were not available many years ago, even though the application (like your Typenex bands) might fall short of ideal. And people always find ingenious ways of getting around the most well-intended and thought-out systems.  Like drawing an ER patient for several tubes, but not labeling all of them right away. The blood bank calls for a second draw to confirm the original type, so you grab one of the unlabeled tubes from that first draw, print up a label and slap it on and presto, it looks like it just came out of the guy's arm. I guess my point was that a tech would never do that, a phleb probably not, but a nurse...? Phil

Link to comment
Share on other sites

"He's got a Kell" "A WHAT!?"  ;|

 

Anyway, way down on the screen on this, I forgot the subject!  Oh ... using Hemo specimens for BB tests.

 

Aside from the 'pendantics' (is that a word?) and interesting points about how reliable/contaminated these Hemo tubes may or may not be, I have a concern about the dilutional factor causing a false negative Antibody Screen/ID. 

 

Maybe I'm dating myself but I was told those little lavender top tubes used for Hemo contain liquid EDTA ... enough of which the hemo machine uses a calculation to 'correct' the values.  The pink top tubes used in BB have a 'dry' EDTA in them (concentrate sprayed on the inner walls) so the dilution factor is much less.  This was the reason presented for why BB needed to use pink tops while Hemo still uses lavendar tops when we switched to plastic.

 

No?

Link to comment
Share on other sites

 

Are you referring to the podcast "Kell Kills?" Did look at that and see that he took a lot of time to point out the correct nomenclature for the Kell Blood Group Antigens/Antibodies (and yes, I do cringe when I hear someone say Anti-Kell....however). And when I am teaching, I do go through this.....but the degree to which I try to get my staff to use the correct nomenclature, depends on the staff. When a Reference Lab Supervisor....yes, I expected them to call them by their correct names. When working at Hospitals where the staff was "Blood Bank" only, I at least "made an effort" to get them to use the correct nomenclature. But when working with Generalists (as I do now)....they are doing well to remember so many things in so many depts.; just to be able to get the work done, that I would seem foolish (and very pedantic) to keep harping on them about something like this. If they tell me they have an Anti-Kell (which they all do); I know what they are referring to and I leave it at that.

Also from the podcast.....saw that he discussed the McCleod Phenotype. I was fortunate at 1 large Hospital I worked at, to see one of those. But what really stayed with me was that I was very impressed because it was the Pediatrician who had requested that we type the patient for all Kell System Antigens (the child had CGD).

Brenda Hutson

Umm, it's not just me. Anyone heard the latest lecture form BBGuy about Kell????????????????????

 
Link to comment
Share on other sites

Yes, that's the one Brenda, and I actually do agree with you about the staff levels.

You were very lucky to see one. I've only seen two in my life - one with CGD and one without (a tame donor). I am also impressed with the Pediatrician thinking of that. He/she must have done some reading!!!!!!!!!!!!!

Link to comment
Share on other sites

  • 2 weeks later...

In response to Dr Pepper, I've got to step up to the plate in defense of our lab assistants. Maybe it's because in California all lab assistants have to be certified by the state, or maybe it's because we have good leadership in our lab assitant area, or probably a combination of both, but I'd like to state that our lab assistants take their responsibilities very seriously, are professional and do a very good job.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.