Karrieb61

You can have it from me- You did a great and thorough job from what you are telling us! Good for you! I don't think the pit in the stomach ever really goes away and I think having that keeps you on your toes, keeps you from getting complacent and potentially miss something. So you had a rotten situation, did all the right things, and it worked out- again good on 'ya!!
I can't think of an antibody situation offhand that I was witness to, but I have "fond" memories of working alone overnight when a newborn was in crisis and the MD came flying into the Blood Bank begging me for blood, no time for any paperwork, just PLEASE let him have one of the Oneg Pedi units off the shelf. He grabbed one as I opened the frig and out the door he flew. That one has stayed with me for 40 years.
Oh yeah, about 15 years ago there was the actively gushing patient on the OR table with 5 antibodies and the surgeon came rushing in begging for "ONeg blood, that's all we need" and I had to 1) try to explain to him (calmly so he wouldn't hear my heart beating very loudly) that ONeg wasn't the solution to multiple antibodies 2) make the BB tech who was screaming at him "you're gonna kill the patient" sit down and shut up and 3) pray as we waited for delivery of several screened units from the Blood Center next door.  We got the units, out he went and the patient did well.
So your future events will likely happen. Try to read up on problem situations when you can to keep fresh, including any online teaching tools you can use from your vendor or here in the wonderful PathlabTalk. We are here for you!

You can have it from me- You did a great and thorough job from what you are telling us! Good for you! I don't think the pit in the stomach ever really goes away and I think having that keeps you on your toes, keeps you from getting complacent and potentially miss something. So you had a rotten situation, did all the right things, and it worked out- again good on 'ya!!
I can't think of an antibody situation offhand that I was witness to, but I have "fond" memories of working alone overnight when a newborn was in crisis and the MD came flying into the Blood Bank begging me for blood, no time for any paperwork, just PLEASE let him have one of the Oneg Pedi units off the shelf. He grabbed one as I opened the frig and out the door he flew. That one has stayed with me for 40 years.
Oh yeah, about 15 years ago there was the actively gushing patient on the OR table with 5 antibodies and the surgeon came rushing in begging for "ONeg blood, that's all we need" and I had to 1) try to explain to him (calmly so he wouldn't hear my heart beating very loudly) that ONeg wasn't the solution to multiple antibodies 2) make the BB tech who was screaming at him "you're gonna kill the patient" sit down and shut up and 3) pray as we waited for delivery of several screened units from the Blood Center next door.  We got the units, out he went and the patient did well.
So your future events will likely happen. Try to read up on problem situations when you can to keep fresh, including any online teaching tools you can use from your vendor or here in the wonderful PathlabTalk. We are here for you!

You can have it from me- You did a great and thorough job from what you are telling us! Good for you! I don't think the pit in the stomach ever really goes away and I think having that keeps you on your toes, keeps you from getting complacent and potentially miss something. So you had a rotten situation, did all the right things, and it worked out- again good on 'ya!!
I can't think of an antibody situation offhand that I was witness to, but I have "fond" memories of working alone overnight when a newborn was in crisis and the MD came flying into the Blood Bank begging me for blood, no time for any paperwork, just PLEASE let him have one of the Oneg Pedi units off the shelf. He grabbed one as I opened the frig and out the door he flew. That one has stayed with me for 40 years.
Oh yeah, about 15 years ago there was the actively gushing patient on the OR table with 5 antibodies and the surgeon came rushing in begging for "ONeg blood, that's all we need" and I had to 1) try to explain to him (calmly so he wouldn't hear my heart beating very loudly) that ONeg wasn't the solution to multiple antibodies 2) make the BB tech who was screaming at him "you're gonna kill the patient" sit down and shut up and 3) pray as we waited for delivery of several screened units from the Blood Center next door.  We got the units, out he went and the patient did well.
So your future events will likely happen. Try to read up on problem situations when you can to keep fresh, including any online teaching tools you can use from your vendor or here in the wonderful PathlabTalk. We are here for you!

Yup, done that too! I also say "negative" to answer questions sometimes then say "no pun intended". No one gets that except other Blood Bankers

Yup, done that too! I also say "negative" to answer questions sometimes then say "no pun intended". No one gets that except other Blood Bankers

Yup, done that too! I also say "negative" to answer questions sometimes then say "no pun intended". No one gets that except other Blood Bankers

Yup, done that too! I also say "negative" to answer questions sometimes then say "no pun intended". No one gets that except other Blood Bankers

Great! Mine was a toss up between #46, 42, 28 and 10. Still all true after all these years......

Phil and Malcolm neglected to mention his almost run in with the law as he almost committed a federal felony (if that's even a term). But all was well, we escaped lunch with no signs on fingerprints left on the mailbox disguised as a trash container.  HaHa, what happens in Providence, stays in Providence.
 
For those of you who will get to see and hear Malcolm in Las Vegas later this year, be prepared for a wonderful, and interesting talk.  He is one cool and smart dude!! I look forward to your next visit Malcolm!
 
Nice to see Pathlabtalk up and running again also. When its down, its like a piece of my work day is missing.....

Enjoy your flight Malcolm. We have a no-snow forecast for you, you are actually arriving when our flowers are in  bloom, trees are budding, some of us even have green grass. The nasty snow is long gone thank goodness! Make sure that Dr Pepper gets you some good old fashioned chowda' once you arrive along with a Narragansett beer or a glass of Saconnet Vineyards wine. . Pack a light rain coat maybe.....Meet 'ya soon!

Has anyone told Malcolm yet that What Happens in Las Vegas stays in Las Vegas?

Gees, I don't even remember making the suggestion but I am old. Can't wait!!! That's a place that does flights of beer Malcolm, I think you might like it!! Less than a week to go!

These things give me gray hairs, or more of them to cover that is. My favorite line about this is when I witnessed an ER nurse draw two patient's in one room, put the UNLABELED tubes in his short lab coat pocket (one set in each pocket) and start to walk out of the room. I stopped him and said "how do you know which patient is which?" His response was "we never make mistakes in the ER usually", all in one breath. He was fired shortly after that thank goodness.  Enough said- tubes arrive with no labels, in the biohaz trash they go!!!

Thanks tbostock, I did read that here previously so I am trying to be very cautious in how we do this. At the moment, I am telling the techs that if the  cold is very strong, (4+) in tube, then they can pre-warm the plasma up to 30 minutes before running it on the Echo. I am mindful that warming has its issues. And yes Goodchild, we have a fair number of known colds that we will continue to use to validate this before I make it official. Lots of fun, especially for the techs who think that pre-warming for 60 + minutes (like they used to do) is the answer to all problematic antibody IDs. The flack I am getting back from that small group is ridiculous. The lack of immediate transfusion reactions is their comeback of course, no worries on their part about a potential delayed reaction or a full blown antibody discovered later. .....

Wow, since we are on Memory Lane, I remember back a good 40 years or so working at a prestigious hosp in Boston and needing fresh blood for newborns. We had donors come in from a paid donor service and they frequently arrived filthy dirty, drunk, and desparate for the $25.00 or so that they got for the donation. After cleaning the arms multiple times to get rid of the dirt, I would draw them. If I missed, I would hear 'stick it again, stick it again"!!! OMG, not the kind of memories I am happy to have. Then there was the sweet early 20's hemophiliac guy who came in to infuse his own Factor VIII from our Blood Bank in the late70s-early 80s. Died of AIDS somewhere in the 90s I heard.

Wow, since we are on Memory Lane, I remember back a good 40 years or so working at a prestigious hosp in Boston and needing fresh blood for newborns. We had donors come in from a paid donor service and they frequently arrived filthy dirty, drunk, and desparate for the $25.00 or so that they got for the donation. After cleaning the arms multiple times to get rid of the dirt, I would draw them. If I missed, I would hear 'stick it again, stick it again"!!! OMG, not the kind of memories I am happy to have. Then there was the sweet early 20's hemophiliac guy who came in to infuse his own Factor VIII from our Blood Bank in the late70s-early 80s. Died of AIDS somewhere in the 90s I heard.

RaeRae251 and anyone else reading this for Echo -interest. We finally got a few weeks of equivocal results "corrected" with a new lot of Indicator cells and Immucor is telling me that they think the equiv. results had something to do with the donor mix in some lots. Whatever, all I know is that now things are much, much better. I didn't have a choice of new technologies here for political reasons but would probably have not chosen manual gel as it would still constrict our second and third shift techs from working in other parts of the lab due to the clock watching. We are way toosmall for a Provue and my experiences with the Provue is that there is frequent downtime due to mechanical issues. So for our volume and convenience of crosstrained 2nd and 3rd shift people, Echo was a good choice. We are certainly struggling with the What to Do When xxxx Happens but nothing is perfect. Now its a matter of slowly convincing a few older techs to trust it and stop running to the tube every time the Echo presents them with a challenge. I am at least insisting that even if we have a nonspecific antibody on the Echo that crossmatches be done on it so we have the same level of sensitivity for the donor units/patients.

Funny that another Echo user just emailed me about this belt thing. Overall, it appears to be an issue with the cells getting older in their little bottles, as it only seems to happen when we've been using the bottles for many days.
We are too small for a ProVue but I have to say that where I was before, they had constant mechanical breakdowns. So nothing is perfect. Both are better than tube for sure for a variety of reasons so despite occasional problems, I would hate to give up the Echo.

We use clear plastic. In a former job, the BB was using lunch bags till the day when a transporter went to the Caf first, left the bag on the table and it was scooped up and tossed in the trash somewhere. That was the end of the lunch bags.

Hey all Echo users, we seem to be experiencing an increase in the number of patients who are backtyping very weakly, 99% of the time on the B which drives us to double check the type manually. These are not elderly (although our new young 23 ish tech though that the current patient at 52 was elderly..... ) or immunocompromised patients to the best of our knowledge. Daily QC is fine. Anyone else seeing this?

We use clear plastic. In a former job, the BB was using lunch bags till the day when a transporter went to the Caf first, left the bag on the table and it was scooped up and tossed in the trash somewhere. That was the end of the lunch bags.

We dispense it but we don't call the medical staff to tell them that they need it. Its up to them to read the report sent with fetal  Hgb results or Mon's  bl od type, whatever which they can read from their monitors.

OK, thanks, I will let this ride until I am on site. I am still not clear  on what the word "label" implies- little sticker on bag? Separate label with all kinds of official sounding words and references to standards??? I'm probably worrying too much about it anyway plus I am 9 plus hours away from a short vacation so my brain is shutting down LOL

RaeRae251 and anyone else reading this for Echo -interest. We finally got a few weeks of equivocal results "corrected" with a new lot of Indicator cells and Immucor is telling me that they think the equiv. results had something to do with the donor mix in some lots. Whatever, all I know is that now things are much, much better. I didn't have a choice of new technologies here for political reasons but would probably have not chosen manual gel as it would still constrict our second and third shift techs from working in other parts of the lab due to the clock watching. We are way toosmall for a Provue and my experiences with the Provue is that there is frequent downtime due to mechanical issues. So for our volume and convenience of crosstrained 2nd and 3rd shift people, Echo was a good choice. We are certainly struggling with the What to Do When xxxx Happens but nothing is perfect. Now its a matter of slowly convincing a few older techs to trust it and stop running to the tube every time the Echo presents them with a challenge. I am at least insisting that even if we have a nonspecific antibody on the Echo that crossmatches be done on it so we have the same level of sensitivity for the donor units/patients.

My first concern here is- who's overseeing your training? This sounds pretty scary to me if you are being left on your own to figure out old SOPs. Is there no Blood Bank Supervisor? Did they ever put together a flowchart about what to do when you get what looks like a cold auto or allo from your screening? Do you have a Lab Director to talk to and ask who should have answers for these questions. I do understand that many blood banks are not overseen by blood bank experts but that's no excuse for leaving a tech helpless. Are you accredited by CAP or AABB? Why are only screens done on the Echo? That sounds weird too. Bottom line is that someone needs to be held accountable for the validity of your SOPS but if people are saying they don't understand them, then I would get the heck out of there unless you find someone to help you.
 
I was out of BB for many years when I landed back in one and have re-learned  A LOT right on this site. So my first suggestion is to look at the tons of previous posts here on how people handle colds and whether or not they do prewarming. You will see many opinions but they pretty much fall into a pattern. Overall, the consensus is to avoid prewarming since a traditional screen will use 37 degrees incubation which should take care of most colds. Otherwise, you risk warming-away a significant antibody.
Colds I have a problem with myself. Unless they are Anti M's which may carry through to IgG/Coombs testing at the end of a screen or xmatch, colds are generally harmless. Your unique patients may  be those who require a blood warmer but those are few and far between. One problem with colds we have here (which I am trying to address around other stuff) is that we do cold screens and panels in the 4 degree frig which the reagent manufacturers don't approve of. So what happens if there is an adverse event with the patient and the FDA says show me how you were able to validate a procedure not approved by the vendor?
 
Hopefully lots of the GREAT folks here will respond to you also but my experience as a consultant working with 19th century labs is that I've seen these situations before and you are smart to be worried!!