Brenda K Hutson

When I was a Reference Lab Supervisor at the Red Cross, we actually had 2 sites in the local area that I oversaw (large area so centers far apart). Anyway, I was more frequently at one center than the other, just because it was headquarters. One day I went to the other center just to check things out. I was reviewing a work-up the Tech. there did on a patient with multiple antibodies; among them, Anti-M. Obviously a patient with multiple antibodies (and we are talking maybe 5) plus an Anti-M would be difficult to find blood for. I asked her if she tried to prewarm it. She said Yes and that it was prewarm positive. I then told her that we needed to honor the M then. Unfortunately, she had already sent blood to the Hospital that was negative for everything else, but not the M. I asked her why she did that; she said it was too difficult to find blood. I told her that next time, she needed to find the blood. Much to my embarrassment, the patient was transferred to a local Hospital (where I had previously worked) and they eluted an Anti-M! Aaahhh Brenda Hutson, CLS(ASCP)SBB

Ah, so it looks like certain words automatically turn into ****. Sorry, I don't think the word I used was bad so not sure what is up with that (maybe it depends on the context in which that word might be used; not sure). Honest, it is not what one would think of when seeing the ***. Ok, reworded: "If you are going to make a mistake like that, check out the family first." Brenda

Hmmmm...not sure how my ***** up turned into ***** I did not say anything like that?? That is a little disconcerting. Brenda

Hmmm...kind of missed the point, didn't he?! Brenda

Yes; what is that saying, "if you don't laugh about it you will go crazy." You reminded me though of something regarding diagnosis. One Hospital I worked at always entered the diagnosis of patients coming into the ER, as their initial complaint. So we got such Diagnosis as "nausea;" dizzy;" "headache;" etc. So what if the patient was "also" a Bone Marrow Transplant who needed CMV-, IRR, LR blood products!! Details, Details! Brenda

I personally prefer the "scorch and vortex" method of Antibody ID! And when I was a Reference Lab Supervisor, I would swear we had clients who did something along those lines...Aaaaahhh Brenda Hutson, CLS(ASCP)SBB

I will get them to you Monday, Aug. 17th. Brenda

Oh, sorry to keep responding to my own post, but your responses remind me of things (and after 26 years in the field, I have heard a lot). I once had a patient with a positive antibody screen and I needed more specimen for the antibody work-up. I called the floor and told the Nurse we needed 2 more EDTA tubes on the patient. A little while later a biohazard ziploc bag appeared; guess what was in it? 2 EDTA tubes (NO BLOOD in them). Upon calling her, she said she sent what I requested.. for real!!! Brenda Hutson, CLS(ASCP)SBB

Ah, the old "increase the titer method of Antibody ID!" Brenda

Well, along the lines of "scary" scenarios: RN sent for unit on patient (pick-up slip was a duplicate; 1 copy went back with unit and 1 stayed in BB). We received a call a little later for the Nurse, complaining that we sent her blood on the wrong patient (now the fact that she had hung the blood, obviously without checking it with another RN and/or the patient armband, was besides the point). We told her we sent the blood for the patient requested (and we had 1 slip to prove it). So she said, "well that is not the patient I asked the clerk to send for;" still not taking responsibility for her actions. On the good side, the unit was group O so no reaction. On the bad side, the patient's children found out about it; Oh, and did I mention that 1 daughter who was a doctor and a 2nd who was a lawyer? Moral of the story: If you are going to ***** up, check the family history first! Brenda Hutson, CLS(ASCP)SBB

NO WAY!!!!!! Brenda

Oh ....my ...gosh.....!! Brenda

You know what would be a really fun Thread on here sometime: The funniest and/or scariest remarks we have heard from Hospital staff. We could call it "Just For Fun." Here is mine, just for fun (and it is not Blood Bank oriented; I will think more on that): A Physician calling at one Hospital (called the wrong dept.) asking: Is it ok if I draw the Peak and Trough at the same time (drug levels). The Tech. responded: I am going to hang up now and I want you to think about that for a minute. Brenda Hutson, CLS(ASCP)SBB :D:D

Ok, I am going to add a Thread to Hot Topics called Just for Fun; hope you will all join in. Brenda Hutson, CLS(ASCP)SBB

You know what would be a really fun Thread on here sometime: The funniest and/or scariest remarks we have heard from Hospital staff. We could call it "Just For Fun." Here is mine, just for fun (and it is not Blood Bank oriented; I will think more on that): A Physician calling at one Hospital (called the wrong dept.) asking: Is it ok if I draw the Peak and Trough at the same time (drug levels). The Tech. responded: I am going to hang up now and I want you to think about that for a minute. Brenda Hutson, CLS(ASCP)SBB

Yes, sadly I have noticed that. "Dr. X, the patient has a positive antibody screen; it is risky for you to continue to transfuse." "That's ok says Dr. X, I am giving O Negative blood!" Downright scary! Brenda Hutson, CLS(ASCP)SBB

When I have worked places with Electronic XM, patients with known alloantibodies do not qualify; they must have a AHG crossmatch performed. And again, as I responded in many e-mails now, I think there is a risk in not screening units. As far as low Incidence antibodies, I guess my thought is that there are 2 things accomplished by performing a AHG crossmatch on patients with known alloantibodies: picking up incorrect antigen typing results, and catching antibodies to Low Incidence antibodies in a patient who is a known "antibody producer." Just my thoughts... Brenda Hutson, CLS(ASCP)SBB

And what about the possibility of new antibodies being under the previously identified? You cannot always expect a change in strength when that happens. As I mentioned earlier, we had this happen with an Anti-Jka. The patient had a previously identified anti-c. The 2 Jka screening cells were also the c+ cells; no change in strenth. Next work-up, it was a new lot# of screening cells and Jka was on cell I this time (so c-). And by then, we also had a lovely positive DAT to go along with it! Brenda Hutson, CLS(ASCP)SBB

One thought I had in reading your post. I have seen a number of instances where antibodies are mis-identified because they are on the same cells as the known antibodies. This can especially be a problem with less experienced Blood Bankers. I learned a system a long time ago that I have since made Techs. in every Insititution I work at, follow; even in a Reference Lab (because of a couple of incidences of reporting a new antibody that was not in fact there). What I do is in the right hand column of the rows tested, I will put the phenotype of the known alloantibody(ies); for example, if a patient has Anti-E, Anti-c and you are trying to prove or rule-out Anti-K now, I might write: E+c-K+ in one of the rows. Otherwise, less experienced Techs. might look at the fact that all of the K+ cells are positive, and conclude the patient has an Anti-K, without taking into consideration known alloantibodies. To prove something, they are required to have 3 cells which are positive for the new suspected antibody, but negative for the others. And on an initial work-up, same thing; write antigens in the rows, depending on what you suspect is there; must have 3 for each antibody, which are negative for the others. Brenda Hutson, CLS(ASCP)SBB

Again, from my perspective, Anti-Jka is one good example of why this is risky; at least if you use Gel. I have seen quite a few Anti-Jka antibodies that not only reactive with homozygous cells only, but do not even react with "all" homozygous cells. (I posted a previous Thread on that). So again, from my persepctive, it is a risk to rely on a compatible crossmatch for transfusion purposes. Just where I am coming from; don't mean to put anyone else down who does it differently. Brenda Hutson, CLS(ASCP)SBB

I would agree with SMW that you do not need to re-identify known antibodies, particularly if you are not relying on a compatible crossmatch for transfusion purposes (which for reasons previously mentioned, I do not feel comfortable doing anyway). What would be the benefit of proving the antibody(ies) is still there, or that it has disappeared? It does take a little time to create your select cell panel, but once you do it awhile, it can be quick. By using a select cell panel and not re-identifying previously identified antibodies, your work-up can take much less time. Brenda Hutson, CLS(ASCP)SBB

I have a couple of thoughts. 1. When we see a new patient who has antibodies, we do the best we can to get an accurate history. Just asking the Nurse and/or Physician, is not always the best resource. If you can get it straight from the patient themselves, or their family members, you will probably get a more extensive reply. However, you need to emphasize if you speak to a Physician or Nurse, that you are trying to obtain their history from "anytime and anywhere;" you would be surprised at the limited information you will receive if you don't. If the patient is consulted, I will usually ask the Nurse if the patient is coherent and competent enough to provide a response I can trust. Thing is, some patients don't realize they were ever transfused (i.e. OR). 2. Having worked in a couple of Reference Labs, we would send Antibody Cards to the patients, along with a letter explaining what the card means, the significance, what it "doesn't" mean (some people see the words antibody and blood together and the 1st thing they think is Aids), and emphasizes that they should carry that card with them and present it in medical situations. That doesn't always work either. I was working a graveyard shift once at a large Medical Center and a G.I. Bleed came into the ER. They took 2 units uncrossmatched. The Antibody Screen came up positive so I immediately called the ER and spoke to the Physician, making sure they understood the risk of continuing the transfusion. They were already on the 2nd unit and the patient needed the blood. Ok, that is there call. I asked the Physician to get a history from the patient. The minute I identifed an Anti-E and Anti-c, the Physician called back and said "the patient said something about having an antibody card; would that be helpful to you?" YES, especially an hour ago!! :rolleyes:The card was also just the E and c. Thing is, the Hospital is supported by its own Donor Center. When units are antigen typed at the Hosptial, the results are sent to the Donor Center and put in a database; next time the donor comes in, there is a white label on the top of the bag, listing all of the major antigens, with + or - after the ones that were previously typed. So, I could have found units historically negative for E and c, had the patient followed the instructions. Brenda Hutson, CLS(ASCP)SBB

If anyone is interested in Direct Observation Checklists, I have them for each basic Blood Bank Test. They list the key elements of the procedure and then have spaces (it is table format) to pass or not pass, as well as signatures from both the Trainee and the Trainer and a space to remark on any needed remedial training. You would just have to keep in mind that you may need to exchange some of the key elements, depending on what process "your" facility uses. Anyway, let me know if anyone is interested. Not knowing the specifics of what is already being offered, this may be a redundant offer. Brenda Hutson, CLS(ASCP)SBB

So does this mean you do not place temperature monitors on the units going to the OR? Do you also have OR document temps. every 4 hours? Thanks, Brenda Hutson, CLS(ASCP)SBB

Found the Reference: Go online to William Laboratories; Look under subheading Blood Bank Practices with Safe-T-Vue and TRANS-VUE. Brenda Hutson, CLS(ASC)SBB