bbbirder

For reimbursement, CMS codes reflect the 'parent' product, not the final product. You can link to the latest CMS stuff here, but this is a huge file and you'd want to search for the product. http://www.cms.hhs.gov/HospitalOutpatientPPS/downloads/cms1392fc.pdf This shows just a couple of them: P9017 is for Plasma Fzn w/in 8 hr 2007 rate is $70.21 P9059 is for Plasma Fzn w/in 8-24 hours 2007 rate is $76.77 Linda F

If you are using gel cards manually, have you experienced problems with the cards recently? When we peel the foil back, a filmy-plastic-like layer is staying on top of the gel cards. Sometimes it is not much, sometimes it covers the entire opening of the gel well. It can be hard to see, and can interfere with pipetting. (I emailed Ortho about this problem, but there has not been time for them to reply, since it is the weekend.) Linda Frederick

I was looking at the book on CPT changes for 2008. There is a transfusion medicine code, 86885 "Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell." The antibody screen is 86850 and AB ID is 86870. I was just wondering when 86885 would be used? Linda Frederick

The ISBT Blues... could we get a song for that? Or some support group? (BBTALK works pretty well for that support.) I don't think that when AABB mandated that everyone switch to ISBT they really considered all of the complications for smaller transfusion services. We pool, aliquot, etc. so we need to use ISBT. Getting hospital IT departments to understand how to set up the printers, so we can even start our BB portion of it, has been a real challenge to most facilities that I know. The computer and other vendors have not done a good job with this entire process, leaving us in the lurch. Linda F

You are exactly right, Mabel. The Rh negatives who get mistyped as Rh positive are bigger problems than the other way around. It can be difficult to get the OB docs to understand this, or think they should check the type a second time during the first pregnancy. Linda F

We selected wand-typereaders when our computer system went up about 4 years ago, because the gun style readers were reading multiple bar codes off the bag at once and we couldn't get them to work without doing this. This caused problems while trying to scan our units into our computer system. We have not had any issues with our wand readers. Now, with ISBT coming down the pike, we will probably wish we had this function (concantenation, did I spell that right?), so future readers will be of this type. If your bar code scanners can read Code 128, they should be able to read ISBT without any problem, ours do. Linda Frederick

I don't think that the FDA would consider immediatelyl abeling a product as "thawed plasma" to be a mislabeling. Your are labeling it as a 'lesser product' so your labeling claims are not incorrect and you are not claiming it has something it doesn't. Just like putting a shorter expiration date on a product, while it might not be correct, does not violate the FDA regulations. While 'misbranding' with a longer expiration date is clearly a problem. Linda Frederick

We have been looking at both of these analyzers as well. I am leaning towards the Echo, because of the simpler sample handling. In addition to needing to wait for loading a STAT on Provue (I think this would drive the night shift nuts!), when you unload specimens, you need to tell it what you have removed. It seems more cumbersome that necessary to me, and not up to par with the Echo. One reason I would get the Provue is that we currenly use manual gel technology, and the techs are used to it. However, what are Med Techs if not adaptable people who constantly get new technology? Linda Frederick

Sorry about that, you may need to register with them, but there is no charge just to register. There are some articles I can read, but others require a subscription. I don't subscribe, so can't read all articles. LF

I found this article in "Blood" and thought it was really interesting and very readable. I think most BBer's would find it interesting. It is a free access article at: http://bloodjournal.hematologylibrary.org/cgi/content/short/blood-2007-03-077602v1 (I probably need to get out more.) Linda Frederick

I do think that RhIG is necessary, I just wonder about the frequency of it. She gets at least 6 apheresis a week, sometimes more. So we could be giving her RhIG once a week... that seems like overkill, but I don't know. Thanks, Linda F

I am wondering if other hospitals pretty much follow the AABB Technical Manual recommendations to give 1 dose RhIG after 7 Rh positive PLT apheresis are given to an Rh-neg patient? We have been using these guidelines, but now we have a patient, Rh-neg young woman who is requiring lots of (CMV neg) PLTs while she waits for a bone marrow/stem cell match. We can't always get Rh neg PLTs for her, but I am not sure giving her RhIG once a week (even if she has rec'd 7 Rh pos apheresis in one week) is necessary, but I don't have any thing to back this up. (Fortunately, we have IV RhIG to give her.) Thanks, Linda Frederick

Here are a couple of links for this type of band if you want to check them out: http://www.typenex.com/ http://www.pdcorp.com/healthcare/blood_bands.html We use these in addition to the usual patient ID band. There are other designs, but both of these work essentially the same way: Band with a unique alpha-numeric number goes on patient arm, peel off portion goes on the tube, "tail" (with stickers with number) and tube goes to the transfusion service, stickers with the number go on unit along with compatibility tag, nurse checks this number in addition to everything else when hanging the unit. This way there is a complete link or chain back to the patient. I know many BBer's don't like these, but personally I do. I have worked in 4 different hospitals of various sizes and all have used a similar system. We are very strick about the labeling at the time of collection, no adding the band/ stickers later. If the nurse collects incorrectly, they must do it again. They whine, but they usually only make this error one time. (Also, when you ask them they actually like the system for their bedside checks.) Most examples of transfusion related death due to ABO incompatible transfusion that I have read about could probably have been prevented by using a similar system. Back to the original question, we encourage the OB docs to get a "Band to hold" or whatever you want to call it on all of their OB admissions (especially the C-Sections), but it is up to them. Type & Screens not done routinely (even on C-Sections), it is up to the doc. We do not charge anything for the "Band" specimen. Linda Frederick ( I don't know how I magically changed the font size and now can't change it back....hum.)

What is your BB/TS computer system? Do your tags need to be label type (with sticky back?) or in paper? Duplicate? What do you use now for a printer?

I would call it negative. no weak D. (Remember, you will need to do a fetal cell stain to determine Post-partum RhIG dose, because the fetal screen will be positive in these women.) I don't know if the "many" is accurate, but Partial D's and even some Weak Ds (and DELs) can definitely make anti-D. The "D variants" reactions with anti-D reagent can vary from weak to very strong in some partial Ds, depending on the reagent, but more so depending on the type of partial D. The only way to really tell Weak Ds from Partial Ds is to do molecular testing. We try to follow what the AABB "Guidelines for Prenatal and Perinatal Immunohematology" says... "Only when prenatal tests for Rh are unequivocal and clearly reactive (>/= 2+) should the woman be considered Rh-positive." Interestingly, John Judd, who put this together, said on the AABB member forum that he uses </= 3+ when using Gel anti-D testing. Linda Frederick

Shily, DELs are more common in Asians than other groups, so you are more likely to encounter them than we are in the US. From what I read, DELs will normally be typed as RhD neg (at least by all typing sera licensed in the US). They usually only get investigated if they were a donor who caused anti-D formation in the recipient. They can only be detected by absorption/elution or molecular testing. Do you do more investigations of RhD negative patients or donors than we usually do in the US so that you identify the DELs? Because DELs routinely get typed as RhD neg, they will get transfused with RhD neg blood, so are not likely to be exposed to RhD positive blood. However, there is an article in Transfusion Oct 2005 that is titled "A comprehensive analysis of DEL types: partial DEL individuals are prone to anti-D alloimmunization." So I guess the answer is, Yes, DELs can make anti-D. (I did not read this full article yet, but it looks like there are 6 different kinds of DELs, so they type may play a role.) The entire "D variant" topic is really interesting, and very complex. Linda Frederick

After a hiatus of several years, our hospital recently started doing in-house dialysis again. Many of these patients get transfused during dialysis. We have a policy for a 'slow' transfusion (2 ml/min, I think) for the first 15 minutes for RBCs, in case of possible reaction (except for emergency transfusion). Is that same criteria normally used in dialysis settings? Thanks, Linda Frederick

While I know that a new specimen is technically not required, we have found that for inpatients, we like to get a new specimen for FFP. We have had too many times when a patient getting FFP now needs red cells (STAT! or so they say). I would not want to be without a fresh specimen that I can use for RBC XMing. For oncology inpatients, we will stretch the 3 days if they are just getting PLTs. For oncology outpatients, we will let them keep their BB ID band and use it for 2 weeks if they are just getting PLTs. Linda Frederick

Bob, you will be missed! I always enjoyed your posts and learned somthing from you. Thanks Good luck. Linda Frederick

Nope, no specificity for this antibody. LF

The patient had negative cold screen with adult, cord and auto cells, and the Donath-Landsteiner test was negative. Specimen was also sent out for flow testing for IgA on red cells. Seems like we did some other testing, but I don't remember everything... Because the DAT using cold LISS wash was strongly positive (3-4+ IgG), I don't think hemolysis of cells was an issue. It pretty much fits the descriptions given of "DAT negative AIHA associated with Low-Affinity IgG autoantibodies" described by Petz & Garraty in their wonderful book on Immune Hemolytic Anemias. This patient did not respond to steroids or IVIG and required a splenectomy. Linda Frederick

If I remember right, anesthesiologists are also very interested in nitric oxide effects. It is used to treat pulmonary hypertension. (?) I don't know if they add it routinely when doing surgery, or if inhaled NO can impact transfused RBCs.

We send a newly ID'd antibodies back to our pathologists for a consult. I have worked places that did not do this, but at my current hospital, they always have, so I just continued the practice. I would guess doctors are likely to read comments from the pathologist. LF

I have been considering switching to gel DATs but have been hesitant to, for the reasons discussed above. We have been running a few both ways and occasionally get positive in gel but neg in tube. What does this mean? For these patients, if they have a normal haptoglobin, LDH, etc. they probably don't have any hemolysis. We had another patient not long ago with obvious severe, hemolytic anemia (low haptoglobin, elevated bili and LDH, etc.) and negative DAT (tube and gel). DAT was positive using cold LISS wash technique. So... you can have hemolytic anemia with negative DAT and positive DAT without hemolytic anemia. I am hesitant to routinely use a more sensitive method that might have more positives, but these might really be more false positives. LF

We moved our entire lab a few years back. We moved one BB refrigerator first, and let it sit for several days. Then moved the 2nd one later. For some reason we used 72 hours. At the time, we had a reason for 72 hours, but now I don't know where 72 hours came from.... duh. We had some problems with electrical outlets in our new area, so don't forget to have heat blocks, centrifuges, gel stations, etc. set up and 'validated' before the day of the move. Make sure your phones work and everybody knows the new numbers. Linda Frederick