bbbirder

So you added reagent anti-K to a specimen? Was this monoclonal? We have an Echo now and it has never missed a K. (It has had 'difficulty' with some anti-E's...for the most part these were weaker but "eye-readable". The specimens were submitted to Immucor. Not all reports are back yet, but at least one of them was probably an IgM.) E and K are both antibodies that can occasionally be naturally occurring. Any chance this is an IgM? Have you submitted it to Immucor? Linda Frederick

No, we still use tube. We used to just add a drop of reagent red cells to each, now we use a calibrated pipette to deliver 50ul as the article recommends (big difference? I don't think so). And, we used to use a 1+ positive as the end point, now we use "W+, macroscopic" as suggested in the article. I personnally call anything you can see macroscopically 1+, so this really isn't much change either. LF

We recently switched to the method referenced in CAP's 2008 ABT-B survey: Archives of Pathology and Laboratory Medicine: Vol. 132, No. 7, pp. 1194–1201. Reducing the Variation in Performance of Antibody Titrations http://arpa.allenpress.com/pdfserv/10.1043%2F1543-2165(2008)132%5B1194:RTVIPO%5D2.0.CO%3B2 Linda Frederick

So, Mabel, are you billing both the IgG and C3 DATs? Linda Frederick

CLIA regulations are different for a "General Supervisor" and a "Technical Supervisor". According to CLIA, I don't qualify as a Technical supervisor in BB, even though I have BS, MS, MT(ASCP) because only a "doctor" can qualify as the technical supervisor of Immunohematology. For all other subspecialities, MTs qualify. So, on our CLIA certificate, a pathologist is named as the Technical supervisor of Immunohematology. Go figure! I honestly think that this is the area of the lab where pathologists have the least knowledge (unless you are in a large center with a transfusion medicine specialist pathologist.) (This is not to put down our pathologists! I love ours!) Link to CLIA regulations: http://wwwn.cdc.gov/clia/regs/toc.aspx Linda Frederick

WOW! I would think only doing this for the O's would be important. I am looking for a good way to track O plasma (from Platelets) given to non-O's. Does anyone have a good way to do this that is not just hit or miss? Something in their comptuer? Thanks, Linda Frederick

We pull at time of issue and then keep for 2 weeks (for the easy rotation.) One thing we did to help remembering to pull at time of issue: when we get the units in, we label a plastic 12x75 tube with a unit bar code sticker, pull the end of the segments out and stick inside this tube, then place all in the rubberband with the segments. This serves as a good reminder at the time of issue (we even have nurses helping us pull these off.) We have more time when we get units in, vs when we issue them. We could pull the segments when we get them in, and stash them away, but then they would probably never get cleaned out, plus it is harder to find the one you need after a transfusion reaction. Linda Frederick

So do you pull segments and label with a unit bar code, then label again with a specimen bar code? Do you autogenerate labels for the unit specimens when you receive the units or something else? I am just trying to figure out the best process for this. Thanks! Linda Frederick

Can you get any of the IVIG to test? In our BB, we get a print out from pharmacy whenever IVIG is prescribed. We add a comment to the patient's BB history that they got IVIG and it may affect antibody screen results. I think your case is a very puzzling one. Could there have been intrauterine bleeding that caused the neonate's anemia? and the elevated bilirubin just due to prematurity or something unrelated to red cells? Was there ever a K-B stain done on mom's blood? Linda Frederick

But don't forget, you can bill for each unit screened, not just the antigen negative units. Linda Frederick

Our hospital has been busy. We just took over a physician's office laboratory practice, so our numbers are up, all of our outpatient numbers are up. This doesn't impact transfusion service directly much (a few more prenatals), but overall lab numbers are fine for us so far. We have not had any cuts, just 'cautions' for the future. We are bringing automation into the blood bank. Most techs are getting older, and will be difficult to replace, but perhaps no one will be able to retire now, if their 401k's lost too much value! Linda Frederick

Long time no post... We are still working with Meditech on our interface with the Echo. It will send across the t-type reactions for ABO/Rh. The Antibody screen t-type tests won't go into a 'standard' ABS type test, because of the <shift> <right arrow> function (at least that is my understanding of this). However, our facility just decided to upgrade to 5.63, because of the "Clinical Initiative" (whatever that is...). That means the DTS to transmit ABS type tests will be loaded for use soon. I am electing to have the Blood type go across (reactions... still having trouble with the interpretation type part not translating right from Echo to Meditech). Since I have a blood type calculaiton, I am not too worried about the interpretation part. We will manually enter the antibody screen reactions until we are upgraded to 5.63 (in a few months). Regarding donor unit retypes... do you need to label the donor segment specmiens with a bar code with a specimen number, or can you use the unit number? If you use the unit number, how are you doing this in the interface? Thanks, Linda Frederick

Our policies are very similar to Dawn's, except we use a pool of 6 and we don't have pre-pooled Platetets. We interchange apheresis and pooled plts for some (not all) patients, depending on availablilty. Linda Frederick

My issue is not with gel, but rather with the 'reformulated' diluent for the 0.8% cells from Ortho. In the last few weeks and months with have chased down too much garbage. Since pre-diluting our own cells, this has stopped. I don't think it has altered our ability to detect clinically significant antibodies. Linda Frederick

We don't worry about ABO for Cryo except for the little patients (babies, etc.). Our standard pool is 5. Standard dose is 1 or 2 pools of 5. LF

We have had many problems with the pre-diluted cells lately, so we switched to diluting up Immucor cells daily. Now only a very rare false positive and time wasted on a panel (for a while we were getting 3-4 each day.) Problems of false positives happened even with very fresh cells, over multiple lots of the Ortho cells. I like the comment that they are on "probation". We get a new lot this week, and will try one more time before permanently switching to diluting our own cells. Linda Frederick

Our institution uses the "implied" consent for emergencies. In our transfusion service, we don't see any of this (implied or signed for) for any transfusions. We leave that up to the Quality Care Managment department to audit. Linda Frederick

We use 3 days, and have for many years. AABB Standards allows 3 days. This give us until midnight on all specimens. Some patient's specimens are good for 72 hours and some are then good for almost 96. There are many patients we transfuse in that time between 72 hours and midnight. We have not seen any reactions as a result of a newly formed antibody. (For pre-op patients with no history of recent (3 month) transfusion or pregnancy, we use 2 weeks.) Linda Frederick

Our 60 minute TAT is from recpt to result. We currently use gel (going to the Echo... SOON, I hope!). So we have the specimen in the centrifuge for 10 minutes, 15 minute gel incubation, 11 minutes for centrifugation of gel card, a couple of minutes for pipetting, etc. So that is about 40 minutes. But just like eveyone else, you need to consider the interuptions possible: another "super" STAT, issuing blood, answering the phone, thawing FFP, pooling Platelets. For night shift they are doing ABGs, chemistry, hematology, stat gram stains, etc.... and across the lab. Linda Frederick

We have a stand alone surgery center in our town. They are about 5 miles away from our hospital. They are required by the state (MO) to have provisions for handling bleeding, despite the fact that they do no procedures that would normally be associated with bleeding. We have an agreement (contract) with them to provide blood in an emergency. (O negs picked up by them; and then the patient will be transported to us.) We review the contract periodically. In 7(??) years they have never needed to use us for anything. Since they compete with us for business, this needed to be approved by the upper administration of our hospital. I don't have any problems with this arrangement, but it sounds like what this center is requesting is way over the top. Linda Frederick

I think anyone giving RhIG in these circumstances either IV or IM should consider the affect of this amount (2 units!) of red cell destruction on the patient before they administer the RhIG. We would not give it in this situation. If a doctor ordered it, our pathologist would talk to them first. Linda Frederick

What about Red Cells? We have a patient who had PTP, her platelet count dropped to 4 after RBC (Leukocyte reduced) transfusion. She responded well to IVIG. My understanding of PTP is that it occurs when the antibody titer has dropped significantly and occurs in conjunction with the rise of antibody. Once the antibody levels are up, no more PTP....? But how handle this? There is no way to know if the antibody levels are high or low, so do you just do the prudent thing and give washed RBCs? What about women who have a history of an infant with NITP? They are at risk of developing PTP in the future. Thanks, Linda Frederick

We are Meditech Magic 5.62 Priority Pack 8 (whatever all of that means!). We have an Echo. Validation is mostly done and I am trying to work on the interface. We are NOT using TAR yet... too many other projects, I guess. Our lab will be implementing bedside scanning for Phelbotomy staff 'soon'. It is always good to share problems/solutions with other users. Linda Frederick

If a patient had Post-Transfusion Purpura, do you give washed products for future transfusions? There seem to be conflicting opinions about this. Linda Frederick

We also charge P9012 x5, but we also charge for pooling. I don't think it matters that we didn't actually do the pooling. We are paying a higher fee for the pooled cryo than for 5 individual ones. If the supplier performs irradiation, we bill for that (separately from the prodcut code if there is no HCPCS code to match) even though we don't perform the irradiation.