lauried01

Justin- It was fairly comprehensive. There were quite a few questions with regard to more uncommon systems, Cost, Rogers, etc. Most of the ones I realized I missed, I was able to find the answers straight out of the Technical Manual. I think if you really study the latest version, you should be good to go. Remember that the questions get progressively harder, the more you answer correctly, so it kinda adjusts as you go along. When are you taking it? (I really didn't spend all that much time preparing- maybe like a month or so)

Hi there- I just took the BB Exam in July (I've been a tech for a lot of years, but spent the prior 6 years as a stay-at-home mom, so I didn't qualify to sit for the SBB). I read through the Technical Manual twice. (By read through, I mean I read it cover to cover). I, too, didn't know anyone who had taken it recently, so I had to figure what to do for myself. I figured between the studying I did, and my experience in Blood Banking, I would do okay. Have to tell you, I wasn't too sure how I was doing- the ASCP has a way of wording questions that can be confusing. Passed it the first time, though.... HTH- Laurie

Thanks so much for all your input. Irregardless, we are so looking forward to Go Live- and to unloading a lot of routine screens (Prenatals, etc). We have seen the Echo miss a few, but after reviewing things, they may have been newly forming. You guys are all absolutely right- just THINK of what we've missed when all we had was our beloved tube system!! Again, thanks for your thoughts- hope everyone is doing well (I am sure if anything, you are warmer than we are here!!)

I totally agree- in the process of our validation, we have seen some that have been called negative, but when you look at the camera shot, it looks to be weakly positive. Unfortunately, it won't let you edit those results! How do you guys handle those? Do you record the results on the panel sheet as your visual read (in those instances where you don't agree w/ what the Echo called)?

Point taken, John:). I guess we would all like to see that 100% perfect system- I guess I have just really come to trust Gel results- it's hard to get used to something new, I suppose. Thanks for the response (and for the reality check)!!!

Hi everyone- We are finished validating our Echo, and are scheduled to go Live next week. We've seen it miss a few antibodies, ones that are a 1+ in gel. This obviously concerns us a little- have you guys seen this same thing? We used to have the ABS2000, and it missed an Anti-E that was also about 1+ in gel. Immucor said it was just below detectability of the ABS. I know they are both solid phase, but I sure was hoping somehow the Echo would be a little more sensitive than the ABS. Anyone have any thoughts? Oh, and I have also read the posts about those of you that picked up stuff with the Echo that was not detectable in gel- we actually had 2 of those in the almost 200 screens we ran. I guess that's an acceptable rate of false positive (I'd personally rather see false pos than false neg ) I am anxious to hear input from those of you already live and running- overall we think everyone will like it, but I don't like missing antibodies!

Hi Marilyn- So good to see you're still around- I used to work in the QC dept. at Gamma 12 years ago (Gosh, that much time has passed?!?) under Norma. I have always had nothing but the utmost respect for you, and it is so great to know that you are around to depart your wisdom and knowledge to us all!!!

Well, it seems Dave's initial thought about antigen typing may have been the solution- the ref. lab couldn't get an answer on the eluate (too weak now), but I decided to play a little more. I recrossed the c neg, supposedly E neg units with the POSTTRANSFUSION sample containing the Anti-E- lo and behold, one unit is now INCOMPATIBLE. I retyped that unit AGAIN with the only source of Anti-E monoclonal we have- still types as E neg. Weird.... She must've had the E before, though, for it to just jump up so quickly (possibly a pregnancy exposure). Sure don't want to see her come back in for a while.....

Well, we got the ID back- Anti-c (no shock there), -E, and Sda. So, the big E is there, but how- since we gave all E neg? Maybe my platelet theory is correct.... Now I am off for a few days (good thing, too, because the roads are really bad- people sliding off the hwy-quite snowy)-so I guess we'll wait and see what else pops up when I go back. We saved the cell suspensions from the units she received- we retyped 'em like 3 times, but the thought occurred to me to recross them with her post transfusion sample, see if any of them are incompatible now. If so, we might need to further evaluate that donor's E status (like Dave was talking about earlier- maybe some weird antigen that the monoclonal isn't picking up). Hmmmmm......

That is our procedure, as well (giving c neg, E neg), to try to diminsh the development of an antibody in a known responder- I did talk to our path about the possibility of this scenario- platelet pheresis are supposed to be pretty clean, but I guess it wouldn't take too many cells to elicit a secondary response. He did agree that it is possible.:cool: The other option, being that of a mimicking auto, is also still a possibility- we'll know more when we get the results back from Puget Sound (our reference lab for such problems). I work tomorrow and Sunday, so chances are we'll get a prelim back on one of my days off (Mon. thru Wed.)- I can hardly stand the suspense! Just another prime example of why I love what I do...

Dave, We are using Immucor Anti-E monoclonal. I am not sure if we even have any old expired Anti-E to do a double check, and our higher-ups don't care much for Ortho (fine with me- I used to work for Gamma years ago- I'll always be partial). I am gonna talk to our TS Pathologist when he comes in- as it stands, now, we are sending this out today for elution and ABID. She has had so many units of blood in the past few years, she coulda easily developed an E, and it might have fallen below detectable limits, 'til a little stimulus. Nice theory, eh? Sure would be nice to get to the bottom of this, before she comes in needing more "STAT" transfusions!

This refers to my earlier thread about the lady with the anti-c that we gave unxm'd c-pos units to- here we are almost 2 weeks later- her DAT is now 1+ macroscopically positive- we repeated her ABID on a new sample- and she appears to have developed anti-E!?! Interesting, considering all the units she received, even the unxm'd were all E neg. We have gone back and repeated EVERYTHING we've done, from initial RzR1 cells to rule out anti-E(initially negative- new sample from 10-7- 2+ at 37 and AHG). Everything checks out- no way we could have stimulated an Anti-E, and it definitely wasn't there on admit. WTH? We are probably gonna have to send this to Puget Sound for an elution and whatever else to figure this out. We were thinking maybe she's developed a warm auto that is mimicking anti-E- what do you guys think? The snow is fallin' in Anchorage, and roads are slick- better stock up on that O neg;).... Oh man, the thought just occurred to me- she got 2 Platelet Pheresis- could she have gotten enough RBC's from those to have developed Anti-E?!(I thought Pheresis Plts. were pretty clean)

Nope- she never showed any evidence of hemolysis whatsoever. We figured it just was due to the fact her body was too "preoccupied" with her current condition to worry about the incompatible units. We were also surprised- she also received 4 c-neg, E-neg units, and quite a bit of fluids within a few hours- dilutional perhaps (or maybe she just bled them out too quickly?)? Yet another argument for getting our computer system up and running- it is quite cumbersome to do a record check as things are now- card files, old computer system lookup- it's insane! We are required to have those units to the ER within 2-3 minutes...

Thanks for your replies- it just reinforces that we acted more than appropriately. Have a good day everyone!

Hello everyone- I am new to BBT- I have already begun asking questions, so I figured I should introduce myself. My name is Laurie- I work at Alaska Native Medical Center in Anchorage, Alaska. I have been a tech for many years, and have 5 wonderful kiddos. This is a really neat resource- how cool to be able to communicate with other bloodbankers in other parts of the country and world. I look forward getting to know you guys!! Laurie Davis, MT(ASCP)BB

Yeah- as a matter of fact the ER doc was wanting MORE uncrossmatched even after she was aware that the patient had an antibody to a relatively high frequency antigen. It was at that point we gave her the number for our path, so he could help her understand the problem (They don't understand that O neg doesn't mean a total lack of antigens). We were also lucky, and able to find some c neg, E neg units within an hour. I personally feel we did the best we could in the situation, but it is the fact that we had to defend what we did to the powers that be. Or, that it was some error on our part that allowed this to happen- we all know it is an inherent risk in giving emergency issue blood. Thanks for the responses- aside from delaying patient care further by doing a record search, we could not have done anything differently- the doc probably would have wanted to give them anyway, and manage appropriately. Laurie Davis, MT(ASCP)BB

I totally agree. This patient wasn't a trauma, but a GI bleed- we had an ID on her (as opposed to Doe pt.), but our procedure is the same- treat the immediate need first, ask questions later. I guess it's just a chance we all take, but it is still quite unsettling to realize we have given incompatible blood.

Hi everyone- I am kinda new to the board, but I would love everyone's input on this issue. We had a pt. last weekend- ER ordered 2 O Neg UNXM'd- we prepared the 2 and sent 'em down. When I was doing the record check (in preparation for a sample), lo and behold, the pt. was an A2B with Anti-c (a real holy crap moment:eek:). Of course, the units were transfused with the rapid infuser, so it was too late by the time I called ER (and given the condition of the patient, the doc woulda probably wanted them anyway). We got our TS pathologist involved immediately, to help manage the patient. The screen was 2+ positive w/ the R2R2 and the rr cell, and of course both units were incompatible. The patient never appeared to have a trn rxn and the DAT was only ever microscopically positive. Obviously, there was this big investigation by our Medical Director and QA coordinator- there was nothing we could have done any differently (per our procedures) to have prevented this from happening. My question is this- do any of you out there have anything in place to try to minimize the risk of this happening? We all know this is exactly why we have the docs sign off on UNXM'd units, but if there is a way to improve this process, I'd love to hear it. We currently do not have our Blood Bank package functional, so everything is manually done- we are required to have our unxm'd units to the ER w/in 5 minutes of the request. Do any of you actually take the time to do a record check before issuing UNXM'D? We were thinking of having a list posted of "problem patients" (much like the list in the store of bogus check writers)- it would be quite a long list, though. Thanks- Laurie D.