Brenda K Hutson

Eric, Coinicidentally, I was looking online at centrifuges because we need to purchase a new one. I came across a statement while looking at the size of EDTA tubes (because 1 Manufacturer asked that question), and came across this sentence: All non-gel blood collection tubes, including those that contain heparin, EDTA and non-gel serum tubes can be centrifuged at ≤1300 RCF for 10 minutes. Interesting..... Brenda Hutson

Your seniors will likely be much more willing to listen to you if: 1. You treat them with the respect due to their position (which hopefully comes with the knowledge and experience); and refusing to do what they have requested of you does not fall into that category in my book (I would not be happy if I asked one of my staff to do something and they simply refused on the grounds that I am wrong and they are going to keep doing things their way)..... I can assure you that insubordination is not the way to a Manager's heart. You may very well be correct that 10 mins. is inaccurate....but it doesn't sound like you "know" the right answer either......and 2. You back up your disclaimer with evidence (i.e. look at the Manufacturer's Insert; do a study; state your make and model of centrifuge and perhaps others could product the evidence you are seeking; etc. etc.). You are upset that they are not proving their case....but neither are you. Just some suggestions... Brenda Hutson, CLS(ASCP)SBB

By the way....never did figure this mystery out but it stopped soon after this Thread began....so I am "thinking" it was a Lot#/Reagent issue. Just didn't have time to do all of the research and comparisons on the samples. Sorry.... Brenda Hutson

That was going to be "my" guess but I didn't read the e-mail in time! Ha Ha Ha Brenda Hutson

In large Facilities, you have the luxury (usually) of giving type specific. And often in those Facilities, they also have the type of patients that could, on any given day, use a lot of Platelets (i.e. Bone Marrow Transplants; Traumas; Liver Transplants potentially); so they are more inclined to watch how much incompatible plasma they are giving. In smaller Facilities, we have the problem of both stock (store very little), but also may not encounter many patients who require > 1 Platelet on any given day (which they can usually tolerate with incompatible plasma). That being said, 1 of the larger places I worked once actually had a patient die when given a group O Platelet (patient was not group O) with a very high A,B Titer! They are serviced by their own Donor Center which now titers all of the group O donors (for awhile, they were actually packing all of the group O Platelets in the Transfusion Service if given to a non-Group O individual)! They would literally have them lined up on the counter, waiting to be centrifuged. Yikes! Brenda Hutson

Ah, got it.... Brenda

Actually, should that Orthopedic Surgeon end up with a critically bleeding patient during one of his surgeries where he sent the specimen at the last minute, and the patient has antibodies, it absolutely will be his problem! And NO, I cannot imagine any regulatory agency faulting the Blood Bank for the "normal" amount of time it takes to perform an antibody identification. Now, if you take a lot longer than is reasonable, you may have to answer for that; but even then, Best Practice is that the patients have their Blood Bank Lab work performed before the day of surgery; period. With all of the regulatory agencies we have breathing down "our" necks, it is easy to become cynical and feel like everything is made out to be our fault. But those agencies are very much aware of what the Regulations are; what the Standard of Practice is; what Best Practice is; and what is a reasonable expectation. Brenda Hutson

Case #1: Not sure on this one....but don't think it is just because you violated your own policy. I do not see that listed anywhere in the list of BPDs! Plus, there are many ways (minor even) one could not follow their own SOPs and they certainly would not all be reportable. I know that sometimes they can be picky about people being discharged; then coming back (i.e. Neonates); and suggesting they be redrawn. But that also does not seem reportable in that it happens all the time with Pre-Op patients or Outpatients being drawn for future Outpatient Transfusion. There was nothing else in this scenario?? 2. Case #2 is much more clear-cut. Without investigating the Positive DAT, the patient was potentially at risk. Anytime you do not complete required testing (which now that you know the results of the DAT, you become responsible); with the exception of Uncrossmatched Products, you are putting a patient at risk and it is that potential risk, and the fact the Blood Banker let the blood go out that made it reportable. Along those lines (and I suspect some will disagree with me on this); if someone performs an Antibody ID and gives out crossmatched, Antigen Negative blood based on their interpretation.....but then say the next day, the BB Supervisor reviews the work-up and sees that the Tech. neglected to rule-out a clinically significant antibody (could be any of them; let' s just say they did not test any cells that were negative for the identified antibody but positive for Jka), that would be reportable; regardless of whether further testing "at that point" revealed that there was no Jka present. It has to do with "potential risk at the time the blood leaves your possession." And what you don't know, could have been a risk (it could have gone either way). Brenda Hutson, CLS(ASCP)SBB

I also do not believe it to be Reportable. The Blood Bank did not wrong. I have even seen instances where we did have a Transfusion Order; and a Transfusion took place; but it was based on erroneous CBC results which were based on Nursing drawing above IV lines that were not shut off! That is a serious error in my mind; and one that could have grave consequences for a patient with volume issues; but even that I do not would be a BPD in that the Blood Bank would not have made an error (and it is US that they are after when it comes to BPD Reporting). Brenda Hutson, CLS(ASCP)SBB

Do you extend specimens (given appropriate criteria) for your inpatient surgeries? If YES, why not use the same extended policy for Outpatients? Extending specimens has become the trend as Physicians try to better accomodate their patients; especially those that live far away and/or are very ill. Brenda Hutson

Correction, both of those practices help "when/if" the Surgeons use them! And therein lies the problem faced by most Hospitals to some degree. We know what Best Practice is; however, the Physicians don't always follow that. I have had my Medical Directo at 2 different Institutions send letters out to ALL Physicians stating our Policy for specimen acceptance (i.e. how many days prior to surgery they can be drawn); and that if we do not receive a specimen until the day of surgery, we cannot guarantee we will have blood for their patient (thus putting the patient at risk). Then when I would receive one on the day of surgery and the patient had an antibody, I would write it up as a Hospital Quality Report to get my message across. And yet, there were still the Physicians that sent them on the day of surgery; then called every 2 minutes to "crank up the stress level a little" by telling you that if their patient dies, it is your fault! I say HA!!!!! Learn your lesson! :mad: But that does not answer the initial question; and no, I have no such data. Brenda Hutson, CLS(ASCP)SBB

That is the commonality I too am trying to find; something along the lines of what you are suggesting. And we had another patient this past Friday. However with this one, they did have a history from another Hospital a few months ago of a "possible" Anti-E (which we did not see), and a Warm Auto spilling over. What it looks like in our hands is a Warm Auto (Panagglutinin) in the Eluate (4+); and an Anti-D and Anti-C in Serum. So could be mimicking Anti-D and Anti-C; could be Auto Antibodies; could be Warm Auto spilling over but just happened to hit those cells :cries:Could be I am going crazy!!!!! I hope to have some time to day to start a Table with all of the patients; listing every aspect from collection, to final Testing; to see what the common denominators are. Brenda

Absolutely; I was just testing you! Actually, it hit me (what I had said) right about the time I hit ENTER! :tongue: I am brain-dead on all of this at this point. I am going to sit down Monday and write down every single thing I know about those 3 patients; then see what they have in common. It has to be some strange aspect of the blood draw; or the tubes; or the reagents; etc. etc. It has to be an internal issue (maybe they all drank from the Hospital water fountain and someone poured Anti-D in the drain....I know, the conclusion of a desperate woman)!! Thanks, Brenda

Thought I should make a new Post; but this goes along with the Anti-D Epidemic issue....or not. We just had a work-up on a new patient (for us). She had been transfused elsewhere so when the screen came up Positive, the Tech. called there. They said that when they worked her up early June, it looked like "maybe" an Anti-E and Autoantibody (they did not say any specificity). So, for us: 1. Screening Cells I and II POS (3-cell screen) 2. Panel 1+ with all Rh POS Cells, and 1+ with the 1 r'r cell. 3. Autocontrol 3+; Eluate 4+ on all cells 5. Patient is Rh POS and C+ Anti-C and Anti-G?? Warm Auto; non-specific? Yikes! :cries:Wouldn't be so concerned if it weren't for our Anti-D Epidemic problem. This one may just be straight forward! Brenda Hutson, CLS(ASCP)SBB

Correct, the GEL Cards are pre-loaded. In addition, if a patient does not have a historical blood type, a manual tube type must also be performed (in addition to the ProVue). Brenda

Well, the thought did occur to me. However, that would mean: 1. The same phlebotomist happened to draw all 3 patients 2. The phlebotomist misdrew/mislabeled specimens on 3 different patients, drawn on different days, at different times 3. And the reality is, regardless of whether they were drawn on the correct patient, the blood types for all 3 specimens still typed as Rh Positive; and the Antibody Screens still showed what they did.... So, I can't figure out how that could be the issue?? Brenda

Just wanted to update all of you on where this is at..... 1. So as mentioned, the Reference Lab obtained Negative GEL Antibody Screens on all 3 patients (1st patient had a cold agglutinin though) 2. We asked for the specimens back from the Reference Lab (since they were drawn a different day than those we Tested) and the Antibody Screens on them were Negative 3. I had a Tech. pull "our" original 3 specimens and repeat the Antibody Screens....still Positive! There must be a common link but I just cannot figure out what that is! It is making me crazy (er). Thanks to all of you for your attempts to figure this out also! Brenda

Ah, did not read your reply until I replied with the same! :tongue: Good, now I don't feel like I am just "hanging out there" in left field. Brenda

We sent a different specimen. So I asked for them back. I only know that 1 of them which we tested, was also Negative by us. Not sure I am going to be able to solve this one..... Brenda

We have had 3 such patients; 2 of which are pregnant (and had a positive DAT). I would have expected to also see an Anti-C with a G. I have seen a fair number of G's, but none alone. The Reference Lab cannot even duplicate our GEL results though; and I have NO idea what that is about. Given the perfect Anti-D pattern, I can't say it is a problem with a GEL Lot#. Also, these 3 patients spanned 2 different Antibody Screen Lot numbers; so that makes that possibility unlikely also. Brenda

Aaaaaaaaaahhhhh, well truthfully, I have only heard of Ortho GEL use so I would have to confirm that with them. That being said, I think they only keep GEL Cards because so many of their clients use it and they want to be able to compare "apples to apples;" so I am guessing they would use the GEL technology used by most; with is Ortho. Did I get the right answer this time? Thanks, Brenda

I am guessing they are all manual. And while we would have performed the initial Antibody Screen on the ProVue, the Antibody ID Panel would have been manual. Brenda

Well, the mystery only deepens. The 2nd and 3rd patient specimens we sent (both pregnant women; Rh POS; Appeared to be Auto Anti-D), were Negative at the Reference Lab! They said they could not even duplicate our GEL results! This is very confusing to me; these were not weak reactions (2-3+). Any other thoughts?? Thanks, Brenda

This came up in another Thread sometime within the past 2-4 years (sorry, previous job; don't recall at what point it was discussed). But I think I had either e-mailed my AABB contact, or spoken to her by phone; and that she told me it was from the time it left the Blood Bank. I also know that at one place I worked at years ago, we audited those Forms when they came back form the floor; making sure the time from Issue to completion of Transfusion, was not >4 hours. Those audits were viewed by AABB and FDA Inspectors. Brenda

There is a lot to be said for Standardization of Reactions! That is one of the best qualities of GEL. Brenda