Everything posted by Bet'naSBB
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Because the "test system" used to test an eluate is the same as an IAT, we do Direct Observation on the preparation of the eluate itself......and do blinds on other IAT techniques to make sure they get the right answer using those methods. -
once thawed, ours are changed / relabeled to "Thawed plasma" with a 5 day exp immediately....but we get very little FFP - most of our inventory is FP24
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On the contrary - The quality IS there and we are saving lives better than before. Statistics show that: 1) - most "Trauma" MTP patients are male... So, making anti-D is the least of their worries - like our team always says......they have to LIVE to have a problem. And, 2) - it is not nearly as likely for RH neg females who are bleeding excessively and get Rh pos units to make anti-D as you may think........and the quality of care for the few females who do get pregnant after an Rhpos transfusion AND make anti-D is so much better now. Again - they have to LIVE through the traumatic episode to make anti-D and then get pregnant and have a baby. IF all that is possible after their trauma experience I think they'll be thrilled and having anti-D will be a non-issue. You might want to read the articles I posted above in this thread. They're really helpful.
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We use our CAP samples AFTER the results have been submitted and results have been received from CAP. We just finished assigning a BUNCH of "Internal Assessments" and "Method Comparisons" using our first batch of CAPs that we'd already received our results for. All these count as "blinds" for the staff. Instead of making 1 tech do the whole survey, we give each assignee one sample to do and then compare their results with those expected by CAP. works great! For FMH, we get two CAP "TMCAF" surveys per year. 1/2 the staff does the first and the other 1/2 the second so everyone gets a blind for FMH.
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We give Rh pos WB to any patient over 50kg that they call MTP on and keep it as the primary resource in our adult ED refrigerator. That being said, I have attached two articles concerning this very subject should you like to read about some studies done. Anti-D in Trauma Patients.pdf Rh negative risk with Rh pos RBC.pdf
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former management was a huge proponent of OVERKILL - so we have: REES system for doors and internal temps (temps are compared weekly to "manual" temps to assure all are within acceptable range) Document temp of "built in" digital readout daily (High and low alarm checks quarterly) have separate, digital thermometer probes measuring top and bottom temps, documented daily calibrated annually AND, last but not least, a global tracker that shows temp and stores info so if there's any question, the logged info can be downloaded and printed. calibrated annually no one will ever be able to say we weren't tracking our temps!
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I know......this is a smart-A$$ remark...........but, thankfully, it is not in our job description to do the transfusing...... At our facility, the "how" is decided by the clinicians. Not the lab. That being said - we would thaw and issue the vol they want and they would use a filter / method of choice to TX
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we can only use it with tests that require the addition of anti-IgG - such as an antibody screen or full XM. we are not allowed to use it for IS testing such as reverse testing or ISXM. so - in my mind, I'd say it could be used when a patient has a cold-auto ab and you want to see if there are any underlying clin.sig ab's after the addition of anti-IgG if our reverse and/or ISXM are positive due to the presence of cold auto - we have to cold adsorb and retest with absorbed plasma.
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Our supplier titers all our WB and it's marked with </=200. We only go "farther" and do an extra dilution for Oneg LTWB that we set aside for pediatric trauma use - it needs to be <50
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The question was, do you have to do ISXM when the patient required full XM........ The visions can do the ISXM when they do the full XM - you just have to program it correctly - and it uses a buffer card. If you don't want to do the IS XM in a buffer card, you would have to do the ISXM in tube to verify ABO Compatibility. As stated above, The IgG card used for full XM is not "approved" to "catch" ABO compatibility. I think you have to do it - even if your BB LIS is capable of flagging an ABO incompatibility - but someone correct me if I'm wrong.
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ortho vision IgG cards are not validated to detect ABO incompatibility...............unless you do validation studies and validate it yourself - you must do IS in buffer card or the old fashioned way, in tube.
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HemoBioScience has some "Simulated Patient Plasmas" that work quite well - and "keep" past their expiration. They even work when aliquoted and frozen. We have, in the past, requested "Antibody Containing Plasmas" from our blood suppliers. We use several different suppliers - some will and some won't save them for us. Usually pay a nominal fee - but not nearly as much as manuf. antisera. When we get them, we aliquot and freeze. The least favorite way is - when a patient has an antibody - or you ID a new antibody - we scavenge as many CBC's as possible, combine the plasmas and freeze. We do have some dilute antisera - but as said before - often times does not work as expected.
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Our hospital provides WB, RC and liquid plasma to 4 Air units, and to about 5 county EMS units in our state, We take care of it all. We receive the inventory from our supplier, we disposition it to the units, they transfuse (and ALL of them do) they then notify us to prepare them a new cooler, when they return the cooler in use, they include a signed Emergency Release form and we do the final disposition here. Our management traveled to the EMS sites when their blood programs are initiated to give them in person training. We also have set up power point presentations and online training for them that they are supposed to complete annually to maintain competency, The Flight Nurses and Paramedics follow the instruction of the ER docs to transfuse. Our program has saved countless lives over the last....?almost 10 years..... It's A LOT of work for the techs and crews involved - but so worth it. of note: a few of our EMS crews have validated refrigerators on their units that they use in lieu of our coolers. this allows them to keep blood for a longer time period. if they use our coolers, they are validated for 3 days in the summer months and 4 days in the winter months, the date / time of return is on the cooler when it goes out and there is a downloadable temp monitor on the unit that they check a few times daily.
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we use ours too quickly - but we would not extend......they seem to have more ?? the longer they are on the machine - the more they are used.
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I've sent you a private message with a lot of specifics about how we do things with the coolers we have - but came back here to say that we don't "Pre-cool" the coolers before we start the validation as we would not do that in our normal every day process. When we issue blood or plasma, the cooler is chosen, inserts placed and blood/plasma units go in. that is how we validate.
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If your patient is O, it would be hard to tell if there is a cold auto or cold reactive allo antibody present. If your patient is A and the reverse is clear, that can R/O anti-A1 - but your reverse cells might be ag neg for whatever the person "has" so the reactivity might be as expected......same with a B patient. we would run a cold screen with an auto control (IS, RT, 4C). use the reactivity for that to decide your next steps......ie - pursue a cold auto or a cold allo. we would also run a DAT + monospecifics and if complement is positive, we would do a thermal amplitude and a cold adsorption.......but, we're also an academic medical center and our BB is as close to being a reference lab without being a reference lab as you can get and we work up EVERYTHING!
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what coolers are you using and what kind of inserts? do the inserts need pre-conditioning? if you can let me know these things,.....I may be able to help!
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