labgirl153

Have used Meditech (current facility), Cerner classic, Cerner mill, Sunquest, HCLL. - Cerner classic despite its primitive look is quite good. No longer supported however. Easy to branch from one function to another. Can see essential info on patient quickly w/o needing to dive through a maze (unlike meditech) to retrieve info. Very handy in emergent cases. Many faciities hang on to it for these reasons despite lack of support now. -Cerner Mill is quite different. Takes a day or so to get acclimated to the icons but is quite good as well and handy in all sorts of situations, esp. with emergent cases. One can turn off/on features for individuals too if the screen gets too busy with icons. -HCLL might be okay if properly programmed, but it was a nightmare at one facility where the techs programmed it instead having professional programmers build it; therefore it crashed often, was slow, illogical, circuitous and in general made everyone want to scream and hate coming to work. Horrible for emergent cases. -Sunquest: Have worked off/on with Sunquest/Misys/Sunquest again for years. Used to love it back in the old days. New GUI was fine too but haven't worked with the newest iteration so am not sure why it suddenly is frowned upon by some. -Meditech: NOT impressed with the BB functionality. Maze-like to getting essential info. On looking up an accession, must scroll endlessly to find exactly what was performed. The screen info is very primitive in its presentation. Everything is run together as though it had been programmed by a high schooler on DOS steroids. It's fine with routines but there are coding issues and as everyone knows, the $$ is often not there to address those issues, or there is $$ but it's directed elsewhere.

Like Elizabeth's idea validation-wise. Wish this was adopted by all. Good story Mabel. This was definitely where I was going. Oh Scott! You slay me!

Why yes I do. Not playing advocate with that one :coffeecup

Thank you BMarotto for weighing in - and thanks too for the rest of you as well (yes, even to you Malcolm, you really are a super blood banker and we all idolize you). Now I'll 'fess up. I had an ulterior motive and used you all as guinea pigs. Knew I'd get "beaten up" for playing devil's advocate but then I enjoy that role Truth? I don't mind using the saline 37C 30-60 min. technique at all. On the contrary, I think it's a fine technique. BMarotto summed it up best. I put this pseudo concern to you all because over the years, have seen the same techs on one hand go overboard with technique after technique hour after hour to generate sheets of panels - and little if anything is achieved. Certainly from a clinical standpoint, it didn't benefit the patient, particularly if the etiology was autoimmune in nature. On the other hand, those same techs will take a case and throw all techniques to the wind - by just using the old-fashioned 37C 30 min. saline technique. Sometimes this makes sense, but the 180 degree contrast is striking at times and confusing to newer techs. Mea culpa if I got anyone's BP jumpy or if anyone wanted to find me on the map and commit a criminal act. I promise to be "good" from here on out. At least I finally got some honest to goodness opinions.

Dr. Pepper asked: Think about it, there is no enhancement medium "in vivo" so what's wrong with using this technique?

A wise man you definitely are Scott

Mabel I've used the saline titration as well...some of the antibodies successfully titrate to a decent degree but I've seen where others are "wimpy" and unsatisfactory. Depends on the antibody and Ig class.

Scott, yes we too can readily see that it's a cold in gel...what do you mean by "settle"? Am assuming you allow the gel to sit for that 30-60" and then re-read? Do you perform I.S. x-matches and then prewarm them for a few minutes prior to re-reading them? Mabel...when we suspect it's a cold in gel, we automatically run a panel in gel, then do a quick screen with 2 cells in LISS and PEG to ensure it's a cold ab. Then we proceed to a mini cold panel in 4C. I liked the prewarm panel technique from years back, and yes as you noted, one must first ensure it's a cold and not something more serious.

Gang, my workplace uses both gel and solid phase. The solid phase instrumentation usually doesn't pick up on colds, but the gel actually does. I work in a high volume trauma hospital so we see just about everything. Most of the time we can get away with not detecting colds. Unfortunately, we perform I.S. crossmatches instead of electronic ones and we do sometimes start out in gel and pick up colds - so we can't ignore them. An abbreviated SOP on cold panels is fine and I've seen my share of them here and there, but wanted a quick answer to this w/o having to dive back into the paperwork. Were it up to me, we'd have no I.S. crossmatches and would start all screens in sold phase. The prewarm technique has been frowned upon by the gods of blood bank for a few years now so we can't "go there" any longer. A quick panel to ensure it's "just a cold" is usually a winner but the protocol I have to deal with is nebulous at best. If you two don't encounter colds but rarely in your work then that's wonderful. I'll let others weigh in as they see this. Thanks.

Well, well! Looks like I rattled a few of you. :cool:. Just didn't want someone to get away with patronizing me after that first response regarding "history" (and yes, it was patronizing). I do appreciate many of the insightful and thoughtful responses that eventually were offered. I will re-read and take each into consideration as well (honestly). Have worked with some very tough crews and frankly, blood bankers often "eat their young" so if I came off as snippy, then I apologize - my background and experience surviving the "superior" crowd has shown through. Have asked many a question here and given a few in reply over the years w/o being "snippy" so this is a first. I do grow tired of the "priesthood" and the stuffiness encountered over the years.

Hi Swede...you're the first tech I've read of that's found positive reactions using it to uncover significant allos. Thanks for your input. And to BMarotto...no, I don't have my own agenda at all...am looking for the science behind it, not a history lesson.

Well, that's mighty nice of you to suggest busy work for me RRavkin. My question relates to literature in the past half century. Surely, in the 67 years since its introduction, someone has made a comparison of the saline incubation technique to other methods. If not, then that speaks favorably toward tradition but is not so flattering toward the upper echelon in blood banking. Believe I'll take this SOP question up with the AABB folks and possibly CBBS. Hopefully I'll get a response directly pertaining to "papers" and "research". If not, then the answer will finally be clear.

Malcolm, now you don't really expect me to adhere to a single paper from immunohematology's ancient priesthood to hold water do you? Hope you were being sarcastic. Where's any recent evidence (in this century) to support that this "technique" is actually capable of detecting significant antibodies? I want facts - not a 67 year-old paper. Have been a blood banker for many years, but have not seen any studies of comparison with this technique with any other to validate its existence. Are there papers on this since that time? Believe we're doomed if we don't revisit a technique that's older than most of us here. Immunology has come a long way since 1945. My question was valid and deserves a better response. Can tell from the responses that this "technique" is indeed suspicious.

Folks, need some tech info on my facility's cold mini-panel SOP. The SOP was written by a former manager who then provided no documentation, references etc. [gee, refs for any SOP should be a given, eh?]. The SOP states that all cells tested must react at > 2+ at 4C to consider the id "a cold antibody". Given that colds often don't react at exactly the same strength since cells vary in their "I" epitope numbers, all cells might react but some at 1+ while others react at 3+. According to the protocol, then even if all cells reacted, it would not qualify as a "cold antibody". I would even wager that if 3 out of 4 cells react - even with one negative, that a cold antibody is possible, if all other alloantibodies have been ruled out by other means. Am saying that the SOP author arbitrarily chose a reaction strength level by fiat w/o any documentation that I can see. The technical manuals seem to be iffy on this as well. Our mini-panel consists of 2 screening cells, an auto control and one or both of the reverse cells (A and/or depending upon the patient's blood type. Thoughts on this and if you don't mind, offer a better alternative SOP-wise. Thanks.:fingerscr

Folks, have noticed over the years blood bankers getting out of performing adsorptions on warm autos etc. by resorting to saline incubation at 30 minutes (no enhancement) and then "calling it good". I really have a problem from a technical standpoint supporting what I consider a bogus SOP. Can one actually detect alloantibodies via this method? I've never seen where it could. I mean really now. NO enhancement, then washing the cells, followed by AHG. I understand the convenience but what's the science to prove its reliability? I see where the AABB technical manual still lists this "SOP" in their manual so of course this gives people tacit permission to use it. Opinions please.

Nope. Thx for letting me know however.

Thx Phil.

Have seen recently where a patient with negative screen was given one unit of antigen positive packed cells...but only because it was later discovered that the history was missed (anti-e) due to the Admissions Dept. giving a different birthdate and medical record number to that patient from what they'd originally had. The patient suffered no repercussions. We do an alpha search on the name and if different med. record numbers pop up we check DOB and SS#s to ensure they're one and the same person. BUT if DOB differs, it might get missed. Am guessing my lab made this FDA reportable but heard nothing about it.

Any suggestions as to where a decent blood banker is needed - most anywhere in the nation? :coffeecup

Thanks much for all the replies. Excellent advice from all here. As to the system...it's actually worse than what I initially suspected. Have been a bench tech there for several months. I've not detailed the most egregious of their policies but use your imagination. And yes, it is a disaster waiting to happen. My vast experience and instincts are quite good. They've been warned by agencies yet remain defiant. As to anyone in ER or administration being amenable to listening - that's not going to happen. Everyone from the top down has made it clear that no input from anyone is wanted - period. I've decided to "live" with it until I get employment elsewhere. Am not willing to risk what's left of my reputation and certification on this facility. In other words, I'm job-hunting. They are not ready for anything beyond a single trauma and are too ego-driven to see themselves. Can't help 'em.

Folks, recently started at a level 1 trauma center in Texas. I've worked at 3 other level 1 trauma centers in the past 20 years all over this country, so am writing from experience. The ER here (and blood bank) don't seem to understand the "quick admit" medical record # system, i.e. most systems generate a "John Doe MR#" for incoming traumas so we, in blood bank, can tag up units and box them OR tube them down to ER before the patient arrives. The quick admit system works beautifully and efficiently. However, where I am now...our blood bankers actually attend the traumas with 8 units of group O (unrefrigerated...I'm getting the super to require a cooler now. Another horrible experience. Thought I'd have to call the FDA). Worst of all? Most of the time the ER doesn't register the "john doe" until they've been in the ER for 10-12 minutes - way too long considering that half these traumas are severe and many times the ER doc calls an MTP. We've often had to dispense products with NO armband or id whatsoever. They won't even use fenwals or any temp band. They can't seem to see the light. Our BB super and pathologist don't seem to appreciate the dire nature of this problem, esp. if multiple traumas stream in. They act as though they're a small hospital out in the sticks instead of a large facility in a large city. This is driving me INSANE. Short of breaking chain of command to insist that the trauma committee do their job correctly, what course should I steer and still hope to keep my job? Any protocols for quick admit out there I can slip under their door??

http://www.coleparmer.com/Product/Refrigerator_Undercounter_Blood_Bank_5_1_cu_ft_with_legs_115V_60Hz/WU-44173-30?referred_id=778&sku=4417330 Would love to convince my super to get this...but alas...no

Am new to Tango...long-time gel & tube user. Pros: It does not pick up on colds and anti-D due to RHIG as often as does gel. Two problems with Tango however: 1) Instrument loses connectivity to the server at least once every 24 hours causing the instrument to stop all testing and forcing operator to reboot. Loses most of the data in this process. If you're running stats or have a lot running this is a huge issue. One must start over or convert to gel testing. Could lose an hour or more time in the process. This is a busy lab in a trauma facility. We can't afford to have this happen. Am not sure when the next software upgrade is due or if more ram is needed in the instrument itself, but it's a major problem. 2) Reaction carry over. Ran a known antibody patient the other day (she has anti-E, c). One specimen running concurrently with that patient's also was positive in the same two cells. The two specimens running immediately behind the antibody patient ALSO were positive in the same two cells. Fortunately I realized the problem and did the three false-positives on the bench. All three patients were antibody screen negative in gel. Also put the tango through a rinsing cycle x 6 to flush out residue prior to using the instrument for new specimens. This is a huge problem. Imagine what would happen if other lab instrumentation was designed to allow this sort of carry over (chem or hem analyzers). For routines this instrument is fine. For stats, known antibody patients etc. I would advise against its use.

Malcolm, I mean...where the cord blood DAT is positive and weak D is +...maternal IgG coating the infant's erythrocytes diallowing us to confirm that the infant is indeed D= until those coated cells are taken out of the system. Hope that clarifies it.

Thx for weighing in all...gave a brief presentation yesterday to the crew and posted flowcharts. I did qualify my talk with the disclaimer of: "some of what's on the flowchart is a rarity so tuck it away". The flowcharts are guidelines - not SOPs - and they are very clear. Most of the scenarios I gave were to dissuade the crew from doing weak Ds on adults (some were running weak D with no DAT and wrongly reporting out adults as weak D +). I'm new at the facility and the crew there is an older crowd who have virtually no guidance. In other words they've been "making up" their own protocols (a no-no). Having said that, according to the fetalscreen inserts, if Pos, it's wise to perform a weak D on the mother and also a DAT to discover the source of that positive. Regardless, a K-B needs to be done. In addition, we do perform weak Ds on all Rh negative cords and if the weak D is + with a positive DAT, we report it out as "Rh indeterminate". The M.D. is advised to retest the child later (3 mo. or so later). We then perform a rhogam work-up on mom, under the assumption that the infant is D+. We then leave it up to the M.D. as to whether he/she wants to administer RHiG. I've seen this SOP many times at other facilities great and small over the years. Also, I'd love to get them on-board with gel (a fav of mine), or solid phase, but there are some private obstacles to that right now. For now, it's tube only.