Brenda K Hutson

Wow, thanks for taking the time to give me so much feedback! I do not yet have the mindset you describe; but I will work on it. One of the problems I have seen with sending things out to a reference lab that is hours away, is that like most places I have worked, we are often not given a lot of notice (i.e. they recently had to postpone surgery on a guy). So I need to find that happy medium; where we at least keep enough reagents to work up a fair amount of things (not Warm Autos; don't have the staffing and/or experience of all staff). But you are correct, I am already having to decide which antisera to keep stocked. I was wondering how they were able to complete so many of their own work-ups, with only 1 panel! Found out it is because they will use them up to a year's expiration! That will stop. I will keep your name close by; in case I need a shoulder to cry on once in a while! Thanks! Brenda Hutson

Hello All! I am glad to be back on Blood Bank Talk! Had a major move a couple of months ago: moved from California (Tech there for 29 years) to Maine (had never lived in Maine, but family moved there over the years). It appears I will now have time to come to this website more consistently than previously. So, it is difficult enough to move to a new location; much less across country. But the Tech. field is also very different than my experience (thus the Title; Where am I). I am trying to interact with my peers here in Maine, but thought there might be others of you out there who have some of the same "issues/challenges/learning opportunities" that I have encountered, and might be able to share some ideas? 1. So there is not an actual Donor Center in the state! It is my understanding that the closest distribution center is in Mass. So, in addition to a standing order, we have to place any additional orders by 7pm the evening before. Obviously it is not feasible (and certainly not cheap) to just place an order anytime you want you start running low. 2. So, because of #1, there are certain Hospitals in the state that are called Overstock Hospitals; they will take some extra stock from that Donor Facility with the understanding that Hospitals can call them when in need (though their own need for a given product would take precedence at any given time). These overstock Hospitals can be an hour away or more (vs. competing Donor Facilities as I am used to; all close by). 3. Because of #1 and #2, we have a big problem with wastage. Since any additional blood would take time (and money; cab costs) to obtain, one tends to keep a little more in stock; thus increasing the possibility of wastage. 4. Currently, we use ALL Irradiated RBCs (apparently due to a case of GVHD at a Cancer Center in another state some years ago). This is something I am looking into. That then creates 2 other "issues:" a) Can only obtain blood from overstock Hospitals that utilize Irradiated Units and/or that have an Irradiator so can Irradiate for us (we are moving into a new Hospital in 2014 and space has been provided for an Irradiator; but I don't think that decision is final). One of the larger overstock Hospitals, which like us, has been using all Irradiated RBCs, will be going back to giving IRR by diagnosis only. And of course, once you Irradiate a unit, you have shortened the expiration also; thus adding to our wastage problem. 5. $$; not a lot of it in the state of Maine (actually, kind of an issue any place these days with the economy). But add to that, building a new Hospital, and the belt gets tightened even more. 6. My Hospital is actually made up of 2 Hospitals and a Cancer Center (all relatively small; at least by my experience); so as with most smaller Hospitals, we staff a lot of Generalists who may not be as knowledgeable and/or confident in the Blood Bank (and I emphasize "may not" in that I have certainly seen excpetions to that everywhere I have worked). So already things like Warm Autos are sent to the Reference Lab; which is also in Mass. 7. MLTs: Calif. used to be one of the strictest states in that it required Calif. State licensure in addition to ASCP. MLTs were never used anywhere I worked (though I believe Hospitals are starting to phase them in; largely due to Tech. shortages). So I was "apprehensive" about that at first; only to see that if you take an intelligent, motivated person with a little college background (though some are 4 year) and give them good training, they can be as good, if not better than some of the Calif. licensed Techs. I have worked with! This part was a pleasant surprise! 8. $$ leads to issues like using a 2 cell screen instead of 3 (I have always used 3 and feel much better with that when it comes to trying to catch "new" antibodies in a patient with a history of antibodies, inbetween your Antibody Work-Ups; whatever that time-frame is for you. $$ also affects other Reagent purchases such as # of Panels; Antisera you stock (for primary major allos; which could be in form of bottles or GEL Cards); additional potentiating media such as PeG or RESt. So, I would love to hear from others out there who have faced some of these same issues; and what you may have learned and/or accomplished re: then. Thanks much! Brenda Hutson, CLS(ASCP)SBB

We actually cut the flaps off of 3 of the boxes the screening cells come in (we keep 3 racks) and place the box upside down over the Screening Cells. That way, they are always in the dark (even when out of the refrigerator). I have to admit, I was skeptical about the flourescent light theory; but it seems to have worked! Brenda Hutson

By consignment program, do you mean notifying you of other Institutions needing that product? We did that one place I worked. It was helpful to at least have a chance of getting rid of it and not losing the money. Brenda

I have seen it both ways in several large Institutions I have worked at (100+ beds). In fact, one of those Institutions, used to keep the products in the Transfusion Service, but have since successfully had that moved to the Pharmacy. It was my understanding when I came here 4 years ago that the Pharmacy has always stocked them (or at least, for quite some time). Not sure what their resistance then is this time; unless this product is more expensive than some of the others. Brenda

My Medical Director came to me yesterday asking who should purchase and store Coagulation Factors (various VIII; VII; IX; Prothrombin III); the Transfusion Service, or Pharmacy? A physician really wants us to store Antithrombin III and is making it sound like we are not following the standard of practice. Having worked in a number of facilities myself, I told him that I have seen both. That being said, I also told him that they are usually very expensive; cannot be returned to the distributor; and Physicians frequently end up cancelling administration before utilizing all they wanted us to order and the Lab ends up eating the cost. So, I think I know why the Pharmacy here is refusing to stock it; for the same reason we would not want to. But of course, someone has to provide it. So I told him I would see what others are doing. Just trying to get an idea of statistics; how many of you store it in the Transfusion Service vs. how many store it in the Hospital Pharmacy? Thanks in advance for your input! Brenda Hutson, CLS(ASCP)SBB

We have one of those but the tape is not very wide (we have 2 different widths; but both seem small for a refrigerator drawer). Thanks, Brenda

Right, I think one key is being able to put labels on "before" a unit is turned on (as another member mentioned). But alas, that does not describe any of my equipment. Brenda

Do you recall the vendor; or were these something you created? Brenda

Thanks, I will give it a try! Just seems that after all of these years, someone would have come up with a label for refrigerator drawers that is clean, professional looking, adheres well, etc. There should even be pre-printed ones that most Blood Banks use (i.e. O POSITIVE; REAGENTS; CROSSMATCHED A-F; etc etc). And then something similar for freezers (probably a different type of product to adhere in those temps). Sturdy labels with a magnetic backing that can stick in the cold would be nice. Brenda

Are you using the 0.8% Ortho cells? Because that would not be the correct concentration for antigen typing. Also, I don't think the issue is with washing (or not), the cells being typed (at least not according to Ortho). What changed (dramatically) for us, was washing manually after the coombs incubation phase (vs the cellwasher). But, it might be worth trying to wash our control cells (in that I know some antisera do state to do that). Thanks, Brenda

Ah..... Brenda

Ok, so is "wellie" a British term? But yes, the cell button seems the most logical explaination to me also. Brenda

We use an outside vendor for our cellwasher preventive maintenance (they seem to be pretty good actually). I would have to ask; but my guess is that they do not check pH. That may be a good suggestion though in that Ortho also brought up the pH as a possible cause. Thanks, Brenda

Is that a special kind of white labeling tape; one that is known to stick in cold temps? Thanks, Brenda

Just curious, does anyone have (or know of) labels that can be used to label drawers in a refrigerator (i.e. O POS; Quarantine; Autologous; etc) which will actually stick (and stay) to the drawer? In all of my years I am just used to homemade labels that do not stick well in the cold temp. and eventually fall off. Thanks, Brenda Hutson

Thanks. It still does not make sense to me (or my staff) that our cellwashers are the problem (for reasons listed above). And we use the same saline for our cellwashers as we do the saline bottles. Brenda

Thanks for your thoughts! As far as incubating longer; while that is often a tactic used in antibody identification, it would not then be strictly following the Manufacturer's Instructions for this antisera (I looked; it does not suggest a longer incubation in the event you obtain negative and/or weak reactions). As you mentioned, our centrifuges and cellwashers are calibrated annually for the spin times. Also, the same spin time would have been used in this case, both for the tubes washed with the cellwasher, and the ones manually washed. Brenda Hutson

Correct; that is what I meant in saying it is not ruling things out using the same criteria one would normally use. So I see this as a "happy medium" between doing nothing (just assuming it is Passive D), and "some sort of screen" for other alloantibodies. I guess it is a game of statistics and it depends on how comfortable each Institution is with various assumptions. Brenda Hutson

So, Ortho believes this indicates a problem with our cellwashers. While I cannot explain the discrepancy, I do not believe we have any cellwasher problems. We regularly perform PM and change tubing. We use coombs control cells for AHG testing with no problems noted. We perform Daily Fill Level Checks and Weekly Volume Checks. Anyone else have any thoughts on this? :tongue: Would be interested in hearing some theories. Thanks, Brenda

Ok, so here I am replying to my own Thread again! But thought you guys might be interested in what I found out. I called Ortho and they asked the pH of the saline we use (in that the Fyb antisera is a coombs reactive reagent). I told them it was Blood Bank Buffered Saline but I did not have the exact pH in front of me. They suggested we try washing it by hand after incubation (before adding AHG) and said they would call back (so waiting for that). Much to my surprise (since we use the same saline cubes for the cellwashers as we do in the saline bottles), the positive control was now 2+!! It will be interesting to hear the explanation. Any "thoughts/guesses" out there? The only thing I can think of is some difference in the dryness of the button between washing with a cellwasher, and washing manually; but have no other thoughts at this point. Stay tuned..... Brenda Hutson

Right; but any system should be validated before use anyway (even if a brand new pneumatic tube system). Brenda Hutson

Ah, so perhaps this brings up the need for clarification then on what one means by "identification." We also do as you (run the cells designated by @). But in a "less than perfect" way, I am considering that a form (albeit modified) of antibody identification (or at least, elimination of other explanations). Those cells do not rule out all major alloantibodies in with the same criteria we rule them out for non-Rhogam patients. Rather it is kind of a "quick and dirty" way to make some attempt to feel more comfortable in stating (concluding) the antibody is just Passive D. But of course, if one of those cells comes up positive (which has happened to us), we would then proceed with a full panel. Brenda Hutson

The issue can take on more significance depending on what your Institutional Policy is on what blood types (date performed) you will accept on a patient for either FFP or Platelets. For example, we will transfuse Platelets (only) if we have an historical type (at any time). A larger Institution where patients might use several Platelets daily, might differ on that (due to volume). But for FFP, I am currently changing the requirement to be a blood type performed "on the current admission." So not every 3 days; but at least in same admission. FFP are more frequently given in multiples so a large volume of incompatible plasma becomes more of an issue. So as long as we are requesting a new specimen (i.e first on this admission), for reasons previously mentioned, I prefer to perform a Type and Screen. Brenda Hutson

Oops...sorry, my mistake! These Lot numbers are from Ortho; not Immucor! FYB073C and FYB073A. Brenda Hutson