Brenda K Hutson

Along the lines of Malcolm's response, just a little education for anyone that doesn't already know this (though perhaps this has been presented here before??). When all cells are positive (with negative autocontrol), it could be a High; or it could be Multiples. A way to distinguish is to perform a Complete Phenotype; then run a Phenotypically similar cell (it is ok if something on the cell you test is negative for something the patient is posiitive for, as you are not concerned about them making that; but it must be negative for what the patient is negative for). If the cell reaction turns out Negative, you are dealing with multiples; if Positive, a High Incidence. That actually occurred with a CAP Survey a few years ago; some of you may remember; anti-U. The Tech. ran a couple of panels (all positive) before consulting me. I told her to do what I stated above. When she did, she typed the patient as S-s-; then I knew! When I was a Reference Lab Supervisor, I was helping on the bench one day when 2 specimens came in that "appeared" to be High Incidence Antibodies from the work-ups at the Hospitals. I was going to tell my Tech. how to approach it, but she said NO; you do it your way and I will do it mine (which was first to run panels to see if she got any negative reactions, then to just start pulling frozen High Neg cells and test); let's see who finishes first. Well, lucky me; my patient ended up being Jk(a-b-) so I didn't even have to find the phenotypically matched cell (not that I could assume it was Jk3; but I knew there was a good chance and pulled frozen Jk3- cells to confirm and rule-out). She spent the day on her work-up, which ended up being anti-Vel. Brenda Hutson, MT(ASCP)SBB

Well, I would think that from a billing standpoint, one would then use that argument for all special needs (i.e. Irradiated; CMV-, Antigen Negative, HgbS Negative, etc.); that we want to restrict ALL patients because we are afraid we might miss someone. I think that if you are in an Institution that has a large number of patients who do have a specific requirement (i.e. IRR and possibly CMV- in Cancer Center), that you probably can get away with that. Otherwise, I am told you cannot (but that is just what I was told). Thanks, Brenda

I asked my Techs. today about patients who are group B or AB (though obviously, that would represent a much smaller population). They have not noticed these reactions with B Cells. My predecessor is out-of-state at the moment but happened to call a little while ago. She said they had this happen before and that it had to do with changes in the computer program. She said the Service Rep. came out and adjusted the camera (as another responder mentioned) which seemed to help (though that was just 1 of our Hospitals; would not seem to me to be a camera issue at both locations, at the same time). Not having a good understanding of how the ProVue works (yet; but I will; I always want to know the "why" of things), I am at a loss at this point. I have run out of "patterns" I know to look for. Thank you all for your replies. Brenda

We have been having problems for a couple of weeks now with our Revers A1 cells on the ProVue. We are getting a lot of NRD results. When we look at the cards, we do not see any problem with the A1 cell well (and these are on patients who should be NEG with A1 cells). We have: 1. Had both machines serviced since then (we have 2 Hospitals); though it would not make sense to me that both machines would suddenly have the same problem (and we are seeing this at both locations) 2. Received a new Lot# of Reverse Typing Cells (still have the problem) 3. Tried a new Lot# of Cards (still have the problem) 4. It is an intermittent problem; not with every patient who should be NEG It is getting to be very frustrating! I have had the Techs. repeat them manually (in tube) to see if we could "see" anything in the tube; nothing... 1. Any others having this problem recently? 2. Any thoughts/suggestions/recommendations? I am not new to GEL, but I am new to the ProVue. But as a Blood Banker, I am used to looking for "patterns" and for things to "make sense;" and I can't find the sense in this. Thanks, Brenda Hutson, MT(ASCP)SBB

Right; I think what you are actually looking for is the C:T Ratio; the number of Crossmatches Ordered to the number of Transfusions. "Ideally" (though I have not seen it anywhere), it would be 1:1. Brenda Hutson

I agree with you Malcolm (does that make me a grouch too )! And typing the same specimen twice (which has been done in other places I have worked; some requiring a 2nd Tech., and some, allowing the same Tech.) only catches (maybe; you have to allow for biased Testing) a mistype; not a misdraw. Having worked in 5 Hospitals (this being my 6th), I have seem a LOT of misdrawn/mislabeled specimens in my day. I think the 2nd blood draw (at a different time; by a different phlebotomist) is a great idea; regardless of the method of crossmatch. Brenda Hutson, MT(ASCP)SBB

Oops, forgot one other example; see below...

It is a cGMP Standard that you only use blue or black ink. I have been stressing that for years (have found otherwise, everywhere I go). Another cGMP standard (just throwing it in for free) has to do with Error Correction: the "correct" way to Correct Errors is to draw 1 line through the error; write the correct information; date and initial. That has also been an issue everywhere I have worked, with people scribbling out wrong answers. I always start out by educating staff on cGMP. When that doesn't work (and it usually doesn't), I start giving them back any documents I see where they did not make changes correctly, and asking them to correct it. Eventually, they "get it." So the question would be then (don't have time to look right now); does the CAP Checklist refer to following cGMP Standards? Brenda Hutson, MT(ASCP)SBB

Ah, thanks.....2 brains are always better than 1!!!!!!!! Brenda Hutson

Looking in the Technical Manual, I see that they are still making the same comment with regard to Return of Blood Products: "Transfusion services may set limits, based on validation, to the time that a unit can be out of the controlled storage environment before it is considered unsuitable for reissue (usually 30 minutes)" Yet as others have pointed out, the "move" is towards actually determining the temperature upon Return; at least for RBCs. Years ago, I was told of another Hospital using an Infrared Thermometer; and that they worked great. At that time, I was ordering it because the FDA had cited that Hospital for not taking temps. on blood products that they received from their Donor Center (and up until then, we didn't either). I ordered the same one and set about to validate it. What I found was that you could get quite a variation of temps., depending on where on the unit you pointed it! Upon calling that other Hospital to ask them about their validation studies, the supervisor told me they got the same results. But her comment was: If they want me to take a temp., I will give them a temp.! That being said, I did purchase an IR thermometer at my last place with the intention of validating it (hoping they are more reliable) for units Returned from Issue. This did not get done prior to my leaving, but hopefully is still on the to-do list of the person to whom I assigned the project. Brenda Hutson Brenda Hutson

Actually, I have found out (through Blood Bank Billing consultants in this country) that you cannot charge all patients for Irradiated just because your Medical Executive Committee approves the product. I believe that would probably be an exception if your Facility is a Cancer Center. I was told emphatically that you can only charge Irradiated if the patient needs it by diagnosis. This is different than Leukoreduction. I know that some time ago, I changed all of our RBC products at the Hospital I worked at, to Leukoreduced. That was before so many Donor Facilities had switched; but Red Cross had already switched. I think there was a lot of data out there and it was becoming the standard-of-practice; that is why it was different. Brenda Hutson

Can't give you a number, but a lot of experience tells me it is very infrequent. Most instances have been women without prenatal testing (which does not include the population you asked about), and some patients who had erroneous testing by outside Labs (does happen; not sure of frequency since not all patients have a Type and Screen ordered when delivering). Brenda Hutson

I don't know if these exist anymore, but one of the companies used to hand out calendars that listed the exp. date of each of the different anticoagulants, in a different color in the space for a given date (i.e. looks like a regular calendar; in square with today's date, it would have in small print in a corner, 2-3 other dates listed which represented the expiration of RBCs drawn today, based on the type of anticoagulant used; a legend would define that for you). Wish I could recall the company, but perhaps someone else out there knows? Maybe someone that works at a Donor Facility that makes components? Brenda Hutson, MT(ASCP)SBB

I know that in reality, plenty of places work with only 1 Blood Bank Tech. on off-shifts (or even 1 Generalist who "kind of" knows Blood Banking). That really scares me! At my last place (about 400 beds), I was always the one insisting on having 2 trained Blood Bank Techs. on every shift. My biggest concern was a bad bleeder. I guess that stems from working at a place where the 2 Midnight Shift Techs. had a patient bleed to death. They were both competent Techs. and worked their hardest; but it wasn't enough. Would it have been different with 2 strong Blood Bank Techs.? Don't know (and in actuality, the Nursing Unit was a large part of the problem with erroneous orders and delays). But I think it goes without saying that someone who works in the Blood Bank often and feels comfortable in there, stands a much better chance at keeping up with a bad bleeder. Blood Banking is just a "different beast." Brenda Hutson

Thanks, good to know about the "batch thing." They didn't mention that, but I think I will follow-up with them for future reference. Brenda

I have been training (Med Tech Students; Residents; Fellows; New Technologists) almost since my first year as a Tech. (29 years) in 5 different Institutions. I always prefer to teach people in an order such that they are building on information learned previously; that it has a logical sequence. I too have worked places where staff wanted non Blood Bankers to Issue. However, for me, that is one of the Last things I train them in. That is because, in my mind, they should have a good understanding of the following in order to avoid errors in Issuing (which can be a risk to the patient; not to mention, FDA Reportable): 1. Order Processing (so when Issuing, you can see if something does not make sense based on what you know about Order Entry, Specimens, Special Requirements, etc). 2. Serology: So you know what you are looking at in the computer, and on the paperwork attached to the unit; what is acceptable and/or expected under certain circumstances. This should also include a basic understanding of antibodies (i.e. does it require antigen negative blood, or just crossmatch compatible).Note: Obviously, Lab Assistants have very limited knowledge in this area. They should at least have the knowledge to know "what they don't know; and be sure to ask questions." 3. Blood Product Receipt: you really should have a good understanding of the different types of products; what requirements go with what type of product (i.e. IRR only applies to RBCs and Platelets); expirations; Product Codes; and much, much more. I know many will disagree with me, but that is my opinion. I have seen too many errors; even among people who were trained in the process! Brenda Hutson

First, that is always the risk a Trauma Center has until they know the real name. If they knew the real name, I assume they would have also pulled up the real MR#, correct? So that would not help. Without a name, Admitting cannot search for a previous history either. I would just say that as soon as you are given their real name and MR#, do your History Search as usual . It sounds to me from your post (and maybe I am reading it wrong), that you probably had this patient's correct name, way before you discovered the 2 antibodies? So I am wondering why no none searched for a previous history, "at that time?" That would be dangerous. Also, just as an aside: Having worked a number of places in my career, I have seen more admitting errors than I care to see. Because of that, a "normal" History check (in my mind; though not all computers will support this), involves searching by: 1. Last Name only (to see if there are 2 patients with the same First Name; then look at D.O.B.; this will catch those patients that Admitting did not catch, and for whom they gave a new MR#). 2. Then take that Search and Sort by D.O.B. (that will catch the patients with interchangeable names like Robert and Bob; Elizabeth and Beth; etc.; names that will not be caught alphabetically). And believe me, both scenarios happen way too often! In summary, the minute you are given the patient's real Name, search by Name. Once you do that, you should have pulled up the previous MR# also (though I would assume that if you found the patient by Name, you would have found the entire record??). Brenda Hutson I have seen

I had something occur this morning that is somewhat unnerving; wanted to see what others thought. As I mentioned in a recent post, the new place I work at gives all Irradiated RBCs (a process I am going to re-visit; due to the time it takes for me to reverse charges; the decreased expiration; the lost cost from all of the patients we cannot charge for Irradiation; etc). Today, it was brought to my attention that we had received 3 units of "Irradiated" RBCs from our Supplier, which did not have the lavender Irradiation Label. The Product Code Label, was that for an Irradiated Unit. In my previous life, I would have sent such a unit, right back to the Donor Facility from which it came. However, 1 of these units was a Jka- unit we had requested for a Cancer Patient being transfused today. There have been some problems providing blood for him in the past, so I did not want to cancel if possible. By the time I came into work, the Tech. had asked the Donor Facility to Fax us a copy of the unit paperwork, indicating it was Irradiated (which in my mind, does not resolve the missing label; after all, the Product Code label said it was Irradiated). The Donor Facility assured me that someone "higher up" at their Facility said it did not have to have the lavender label; that is was ok to transfuse. I still was not totally convinced, but decided to keep the Jka- unit for the patient, but return the other 2 non-labeled units to the Donor Facility. The Donor Facility later called and said to just discard them! I was puzzled; after all, if the units were "perfectly acceptable" according to them, why would they discard them instead of taking them back? I expressed my dismay. They later called again and said they would take them back; but I suspect they will just discard them. Anyway, wanted your input... 1. Would you have accepted the unit(s) without the lavendar irrradiated label? 2. What is your "take" on the Donor Center's response? Thanks, Brenda Hutson

Actually, yes; you do need to credit. Just having a Medical Executive Committee state that is what they want, does not allow you to bill for this. I know because I recently checked into this exact issue! I have been at a new Hospital for about 2 1/2 months. It also gives only Irradiated RBCs (though I am planning to look into this again; due to the time involved in crediting patients not needing Irradiated; the money lost in giving Irradiated Products to so many patients who do not require it; the shortened shelf-life; etc). I spoke with some Blood Bank Billing Consultants in the country and was told that we could not charge patients who did not require it based on their diagnosis. Brenda Hutson, MT(ASCP)SBB

I could have done without "that" story! As an animal lover, that makes me very sad to hear. Brenda

You guys are making me more afraid of the Moose than all of the Blood Bank Issues I posed in the Thread!:tongue: Brenda

Thanks for the advice! I am still learning! Brenda

Thanks, I feel so much better now! Brenda

Ha...I am very nervous about that actually! There is a sign on my way to work to Watch for Moose! And add a snowstorm or freezing rain to that, and it is enough to send a Californian packing (not really; just in my head). Brenda

Right, that is what I have found with MLTs! I think that having trained in California during an era where ASCP alone was not acceptable for employment; one had to be California licenses, leaves us with what we would describe as "higher standards." However, that did not prove to be true (and I won't even go into that). While they have dropped Calif. licensure, they are still not quick to make the leap to MLTs (and I will admit, I was one of those people). But as with you, I too have seen MLTs here who know more Blood Banking that some of the ASCP/ California Licensed Techs I worked with for so many years. Thanks for your input. Brenda Hutson