L106

We have a policy/procedure somewhat similar to DebbieL's. (Nice job, DebbieL!) Then we also have a sheet where we record any problems we have encountered with our current suppliers. We also document (at least once a year) that we have looked at various suppliers, evaluated if they could meet our needs, list their pros and cons, and state what our decision is for who will be our supplier for the coming year. (It usually takes only a few minutes to fill our the form.) Donna

Dang! I should have slipped in "probably is an A1 individual". (You are very alert for a Monday morning!) Donna

P.S. Malcolm a tip for the next time......the bride is supposed to carry the bouquet. Glad you had a great time. Donna

I agree with David.

No. If the patient's red cells demonstrate a positive reaction when tested with Anti-A1 Lectin it indicates that the patient is an A1 individual (and there is no reason to test the patient's plasma against A2 cells.)

Great to have you with us, KatarinaN. Hope you enjoy this site. Donna

We do the same as AMcCord.

I actually encountered this phenomenon a couple times in the mid-1970's, but I haven't seen a case since. I never knew the cause, and I often wondered if it had something to do with the type of treatments they were using for leukemia at the time, since I haven't seen this situation since then. (Wrong!) So I really appreciate the explanation, Malcolm! Thanks! Donna

Only need a lavendar top tube for the Fetal Maternal Hemorrhage Screening Test. (Why are you collecting a sample for this test if the infant is Rh Neg?)

I think I must be missing something, because this sounds too easy. If your last sentence is true, then simply transfer the episode from the incorrect MRN to the correct MRN. Donna

Thanks, Terri. I can see how doing just one of each type of method and no elutions, titrations, etc., cuts it down to a reasonable time. (I'm assuming you also consider the tests that they do to be "unknowns," so that knocks off another aspect of the competency testing?) Donna

Terri: I think what you are doing is great, and there's no doubt in my mind that scenarios questions, etc., can tell you whether the techs are up to snuff. But how can you accomplish direct observation of all testing procedures within 3 hours? (ie: elutions, etc.) Donna

Initial Competency = Done once training is completed. Semiannual = Within 6 months of the date of the initial competency. After that, they get thrown in the regular annual schedule with all the other techs.

I echo SMILLER's post. It all depends on the individual's training, experience, & attitude.

We moved our Rh Immune Globulin to Pharmacy many, many years ago. Our Pathologist at the time felt that it should be handled as a drug (which requires a doctor's prescription/order, etc.) I originally opposed moving it from Blood Bank to Pharmacy, but I have become very comfortable with the change. We in our Blood Bank do not routinely have access to patients' diagnoses. I have a question to those Blood Banks who do control/dispense RhIg: If Blood Bank is responsible for generating the order to give RhIg, how does the Blood Bank staff become aware of patients' diagnoses? (ie: Say you get a Type & Screen order on an Emergency Dept patient. How does Blood Bank know it a miscarriage or a post-abortion?) As mollyredone wrote above, the institution is responsible for identifying candidates for Rh immunization and ensuring that they receive it, etc. So the institution has to have appropriate policies/procedures, which our Nursing staff has (and the policies were approved by the OB/GYN Medical Staff, etc.) Donna

This sounds way too confusing for me. (Going back and crediting Patient A for antigen typings done a month ago??) Sounds the personnel time to do the charging, tracking, & crediting might cost more than what you charge for the antigen typing.

Boy......you can't slip anything past John!!!

Welcome, John. Glad to have you joining us. Donna

Answer to your question, David, is YES. I basically agree with what David has said. However, we do not routinely do crossmatches on our Echo because: 1. It takes too long 2. Since the Echo does only the AHG phase of testing, you must do some other method to assure ABO compatibility (such as a tube immediate spin crossmatch, or perhaps a computer crossmatch if your truth table is set up properly, etc.) Donna

Agree.

Now, this type of problem I have not heard of lately. Donna

Good for you, Carrie!! Our staff loved our Echo for the first several years, and no one was a bigger cheerleader for the Echo than me. But there have been a lot of problems lately, and I am disappointed at Immucor's lack of response and failure to resolve the problems.

This week we are having a drastic recurrance of our problem of Positive Screens (lot # 535) on the Echo. Panels are all Negative (except as RW00D27 mentioned above; every patient we test with the Ready ID Lot 239 Cell #4 gives a Positive reaction.) For example, 5 our of 7 patients tested gave 3+ reactions on all 3 Screening Cells. I called Immucor and they sent me a new lot # of Screens (lot # 557). Retested 4 of our problem pts with the new lot # and they all worked perfectly with the new lot #. (Immucor has not offered me any explanation for the problem, which makes me very concerned.) Donna

That's interesting. Any idea why the Helmer cell washers seem to do better? Donna

Service suggested I clean the washer manifold and use a different lot # of Indicator Cells. That seemed to help (at least, for a while.) Yes, a Service Log Sheet is very helpful. Ours just has our facility's name and location as a header on the top of the form, then the rest of the page is just a lined sheet. I document the date and handwrite what the problem was, the Service Case Number, and what we or the company did to fix the problem, etc. Or, you could keep a service log in your computer (ie: a Word document.) Just make sure your staff can access it so they can record problems and look up previous problems and solutions.