Brenda K Hutson

Oops.....sorry; I will look at that. Brenda Hutson

Ok, I'll bite...what is a Ceppellini effect? Brenda Hutson

Just a comment regarding your last sentence (and perhaps it is just how I am interpretting it). That is your statement that you give c,E,K matched blood. Not sure if you mean "Rh system" (i.e. DCcEe matched) ; or if you were specifically saying c,E,K only? The reason I say that is due to a scenario we had here once; again, due to Physicians here not having much experience with SS patients and maybe having read "just enough" to throw around some terminology when it may not be accurate. While the most common phenoytpe of these patients is going to be Ro, that certainly is not always the case. So we had a Physician Order C-E-K- RBCs (and for that matter, the patient could also be K+). I had to explain to him that we would never make an assumption of the type; that we will need to type them first but that we will match them to their type. Brenda Hutson

Only to Sickle Cell Disease. We also provide Rh (complete) and K matched RBCs if the patient has no history of clinically significant antibodies; and complete phenotypically matched if they do have any history of antibodies. Like you, we do not see a lot of these patients in my current Institution. Because of this, I have found that even Physicians admitting those patients here do not always know that standard of practice (I have worked other places that do service a lot of Sickle Cell patients). So they may not even request any of these attributes; in which case, we call and "educate them" so they can modify the Order to reflect our practice. Brenda Hutson

A centralized system is nice to have, but I have never used one that only documented temps. every 4 hours; they were all continuous. While regulations do state documentation only required every 4 hours, like you, I would be concerned about that. Even with our continuous system, the Facilities Dept. in our Hospital had set them to have a 5 minute delay between the time the out-of-temp. range was noted (which was set at 0.5 above and below the extreme acceptable temps) and the time we actually received a warning. There have even been occassions where in that 5 minute window, the temp. has come dangerously close to being out-of-range due to equipment failure. I would leave the charts if they are not willing to have continuous monitoring (in which case, the system is not as helpful for your dept. as it could be). On the couple of occassions where the continuous monitoring system had some type of failure, we immediately placed temp. charts on all of our equipment. Brenda Hutson

I have a comment about a different aspect of your posting based on the scenario you gave. When the Rh type of the baby is unknown, we go straight to a KB; not a Rosette Test. Without knowing the Rh Type, if the Rosette Test is positive, that may be helpful information (though you would then proceed to KB anyway to quantitate). If the Rosette is Negative, you would then not know if it was because the fetus was Rh Negative, or because there was not a large bleed. Brenda Hutson

It could just be that he was surprised; given that the prenatal screen had been negative (in that I'm sure they do not like to get those kind of surprises)?? He would have wanted to monitor her and/or the baby. Also, we find that some contracted labs can be a little sloppy in their work so that we end up with different blood types and/or different Antibody Screen results. It is possible that her screen was positive before and was just missed. Anyway, just some thoughts... Brenda Hutson

We received a cord blood recently where the mother's last name and the baby's last name were completely different. Our first thought was a mislabled specimen (since L&D is notorious for that); but turns out it was a surrogate mother! Brenda Hutson

Actually, since the performance of an I.S. XM with a GEL XM is the new part, my concern is the opposite (so I have been auditing GEL crossmatches); I am concerned my staff will perform the GEL XM (when appropriate) and forget to do the I.S. NOTE: A couple of people did forget the I.S. the first month or two; with "reminders," there have been no recent ommissions. Brenda Hutson

We do not use SOFT (though the rest of the Lab does; but that is a story for another Thread). But in the system we use, we can enter the I.S. results in the same row as the GEL results so it only prints a tag once; and only when the "entire" row is complete and Verified. Brenda Hutson

I have worked in 6 different places and my current Hospital is the only place I have worked at that did NOT have a Lab Assistant! And I am working to change that. If you get an intelligent person with a good work ethic (and there are plenty out there; with or without college degrees) they can do the following: Process Orders and Specimens (whatever all your protocol requires for that); Issue blood products; assign non-Red Cell products to patient; Thaw FFP (physically and in computer); Thaw and Pool Cryoprecipitate; prepare pediatric RBC aliquots; Freeze; Wash and Deglyc (if you perform any of those); Answer the phone (turn over any technical questions and/or questions they do not know the answer to, to a Med Tech); Take Daily Temps; Order Blood Inventory from Supplier; change temperature charts weekly if your Institution still uses them; Receipt of Blood Products into computer system; print out any daily reports you might need; perform paper audits of various systems if you have anything you audit (i.e. maybe forms coming back from OR; etc); pack coolers if you use them (and take them to ER if you are a trauma center and respond in that way); and probably other things I have left out. A good Lab Assistant is worth their weight in gold! Brenda Hutson p.s. in case anyone wonders why I write my responses in blue, it is not so I stand out (and with some of my responses, the last thing I want to do is stand out....); rather it is because I am a very color oriented person....I can't help it!

You know, I kept thinking about this last night so I looked again in the Technical Manual this morning. I do see the reference above where Ms. Callaghan from the FDA (who I have spoken to many times in the past; called for clarification on issues) lists Exchange Transfusions as a process requiring FDA Registration. But looking back at the Technical Manual and the list of procedures that fall under this category, it used the term rejuvenation (which is not the same as Exchange Transfusion). Specifically, it lists the procedures requiring registration as: Irradiation, Washing, Lab Leukocyte Reduction (vs filter at the bedside), freezing, deglycerolization, and rejuvenation. I have to believe the statements above are correct if she stated that; but I am going to call her for my own clarification now because I have to say, that has never been my understanding (which certainly does not mean it is not true). Stay tuned.... Brenda Hutson

Yes, their amount of Blood Bank training can also be evidenced if one looks under the "Just for Fun" Thread and counts how many people noted that when telling a Physician that blood was not ready yet because the patient has antibodies (or has a positive Antibody Screen; etc) that they respond with "well just give me O Negative then! Brenda

You know what, I stand "humbly" corrected on this! I do see the logic of differentiating "pooled" products from exchanges; just did not recall seeing this in the "list" of functions requiring FDA registration. Some days the S in SBB in ones certifications can stand for something other than Specialist; I think this is one of those days! Ha Ha Brenda Hutson, CLS(ASCP)"S" BB

As anyone who has worked with me would agree, I am very strict when it comes to specimen labeling. However, in all honesty, I have to say that unless I had a different middle initial on a specimen label, from what was on the Order, I would not lose any sleep over it. We often receive Autologous Units from out supplier which have a middle initial. We do not enter the middle initial into our computer system when receiveing it because we do not want the computer to think there is a mismatch (or not find the unit when entering the specimen/order) because our Hospital computer system did not put a middle initial. In fact, if that is the biggest problem you have with your Admissions dept., I think you are doing well! What I see all too often (everywhere I have worked) is that Admitting does not seem to have the same strict protocols for finding a previous record on a patient, as we do in the Transfusion Service. We perform a search 2 ways (both ways; everytime; every specimen; every order). First we enter only the Last Name. We then find our patient in the list that comes up and look at the name before and after our patient. If there is an exact match, we look at the D.O.B. (also shows in the field). If we have a birthday match, we look into the possibility that Admitting missed the previous record and have assigned a new MR#. With that same list still in view, we sort by D.O.B. That will catch the patient who likes to go by different names inbetween visits (just to make us crazy I think). For example, interchangeable names like Robert and Bob (obviously those would not come up next to each other in a Name search). Or maybe they use their first name one time; and give their middle name the next. All of which could be caught by Admitting if they searched as diligently as we. In fact, I had a patient just yesterday who had been given a new MR#. When I searched by Last Name, I only found 1 patient with that name. But when I then sorted that field by D.O.B., there was another patient with the same D.O.B. In this case, the first names were totally different. Upon further investigation in the Hospital computer system, I noted that the addresses matched. I called Admitting to let them know the patients would need to be merged (and they did confirm it was the same patient). And of course all of this is critical in our field because there may be an important history (i.e. antibodies) under the previous name. Anyway, sorry to go on....that addressed more than your initial question. Brenda Hutson, CLS(ASCP)SBB

But there is still the issue of the repeat of the "positive" specimen, coming up negative. Brenda

Not necessarily. At 1 large Trauma Center I worked at, we kept 2 Trauma baskets ready to go in the refrigerator. 1 basket had 6 units of O NEG RBCs; the other had 6 units of O POS RBCs. When the trauma alarm would go off, we would call the ER and ask if it was a male or female; and if female, did they have any idea of the age. If they could confirm that it was either a male, or a woman past child bearing years, we would take the basket of O POS RBCs in a cooler to the ER. If a patient is actively bleeding to the extent that they cannot wait for crossmatched blood, there is a good chance they will not make the anti-D. That is because the Rh POS units (assuming now we are talking about having given them to an Rh NEG patient) are not in the body long enough for the immune system to detect these "foreign" Rh POS cells; so they rarely make the antibody. But once the bleeding slows down, you would definitely want to switch them to the Rh NEG (if it was determined once you received a specimen that the patient is in fact Rh NEG). And that is the "trick;" catching them before they slow down (you just don't always know the exact point at which that occurred). Having done that many times at numerous Insitutions, I have only once seen a patient make anti-D. The supply of O NEG RBCs just does not lend itself to being able to give O NEG RBCs to all bleeding patients with unknown blood types. Brenda Hutson, CLS(ASCP)SBB

Similar to many others (and has been the protocol in all 6 Institutions I have worked at). We will give multiple units of 1 type of product, and/or different products if/when: 1. Patient bleeding out (usually OR, ER, Cath Lab, L&D, Intensive Care Unit); but could occur anywhere. If they plan to transfuse it you do not have to put it in a cooler; but if uncertain, could do so (and because sometimes these patients end up dying before they can give all of the products; so this way you decrease the risk of wasted products). 2. Patients who have 2 lines going if picking up > 1 RBC. These are usually in the same locations listed above; but again, could be other places (i.e. Dialysis patients) 3. Plasma products can generally be infused quickly; so giving multiple plasma products, or red cells plus plasma products "in the appropriate situations" is not uncommon. One place I worked at used to call the heart surgeries "closing moments of the case," infusion of a "cocktail" which included FFP, Cryo and Platelets; all Issued at the same time. But again, if the intent is just to have the products "close by" just in case.....I would consider putting them in appropriately packed coolers (based on the type of product). Brenda Hutson, CLS(ASCP)SBB

An exchange transfusion unit is not considered creating a "new product." A Transfusion Service would need to register with the FDA only if they: leukoreduced blood, irradiated blood, and/or washed blood. An exchange transfusion does not change the inherent properties; it is just "combining" 2 types of products (just as pooling Platelets or Cryo is not creating a new product; it is just combining products). So, bad news; you cannot use the FDA to get out of doing Exchange Transfusions (ha ha). I am not surprised that the MD would not accept the products separately in that they are trying to create the optimal product to replace the baby's normal blood; one with a specific Hematocrit. There are formulas you can use to determine how much FFP to add to a given RBC; based on the volume and pre-hematocrit of the RBCs. It is tedious; but do-able (is that word?). Brenda Hutson, CLS(ASCP)SBB

At my current Hospital, we will dispense it to "trained" Transporters or Nurses (a read-back is performed). We are soon moving to what I have done in 2 other Hospitals where I worked; that is sending the blood to the Nursing units through the pneumatic tube. So there will be no read-back on our end (but will still occur at the Nursing end). At 1 Institution I worked at (not described above),only Nurses could pick up blood products. Now I would like to say that would help ensure that any "errors" were caught at issue. But sadly, their knowledge about blood products, blood types, antibodies/ antigens and attributes can be very limited. For example, I recall 1 Tech Issuing a unit of RBCs to a patient that required Irradiated blood. The unit was CMV-, but not Irradiated. I know the Tech. should have caught that, but when I questioned the Nurse as to why they did not catch it, his response was that he thought CMV- was the same as Irradiated. Sad but true. I inserviced new Nurses coming to that Institution and I spent a lot of time describing the different products; what they are used for; and attributes such as Leukoreduced, CMV-, Irradiated, hemoglobin S negative, Antigen Negative, HLA Typed, etc. Brenda Hutson, CLS(ASCP)SBB

I also used to think it was rare....until I went to another Hospital where it was "somewhat" common. At first I thought the Techs. must not know what rouleaux looked like and that they were over-reading. So I asked them to let me look at any reactions they were calling rouleaux for awhile. Turns out it was rouleaux. 2 explanations: 1. Duh....I had just come from a Medical Center where I had worked for 12 years...performing an electronic crossmatch! No problem with rouleaux there! 2. The frequency will vary baed on your patient population and their conditions. Brenda Hutson, CLS(ASCP)SBB

Similar to what we do only we do not attach the "sticker" to the unit; we attach it to a cardboard Tag (created by our Copy Center) which has a hole in it so we can then attach it through a hole in the bag with a tie tag. Just wondering if it might be easier to cut off these tie tags than tear off a sticky label? Maybe not; just a thought.... Brenda Hutson

YES! It is on my to-do list....along with about a hundred other things(I'm sure none of you can relate). But absolutely; have used that elsewhere and it is a definite goal here. Brenda

We have a couple of conflicting acceptable Hematocrit ranges for our Perioperative Transfusion QA. I have misplaced my Perioperative Standards book and wondered if others could tell me what range you use? Also, please indicate the source of your data. Thanks, Brenda Hutson, CLS(ASCP)SBB

This brings up something that we had this past weekend. The patient had a very strong cold agglutinin (hemolytic; high thermal amplitude). The CLS called me at home asking how to peform the I.S. crossmatch since of course everything was positive. Even if the GEL had been negative (which it wasn't), we are still now required to perform I.S. with the AHG crossmatch. The PeG was negative so I also had him perform a PeG crossmatch (but recently we have been told that we still have to perform an I.S. crossmatch). So I did tell him to prewarm the plasma to perform the I.S. crossmatch. Otherwise, they would have printed out on the Form as Incompatible. We had established that there were no uderlying antibodies but seems to me that when you "change up" your system like that you are opening yourself up for missing something. Brenda Hutson, CLS(ASCP)SBB