Hello everyone,

I'm new to this forum and I'll take all the advice you may have to offer! LOL Basically, I've been refreshing my Blood Bank knowledge by on-the-job training, after not having worked in that department for nearly 20 years--aka--"flying by the seat of my pants". I've been primarily a Chemistry/Lab Safety Tech for most of my career, but as times change, so do job requirements, hence my Blood Bank rotation. I used to be very good in Blood Bank, but I need to dust off the brain cells a bit, and I even bought a textbook to do some reading, so if you have any suggestions, advice, good things for me to read, etc.--feel free to pass them my way!

Thanks and in advance, nice to meet all of you!

Good luck Lisa.

Nice to have you on board.

Just looking through some of the esxcellent posts given by people on this site will help (it has me), but I'm sure other people will have better suggestions.

:D:D:D

For readability, I recommend Denise Harmening's textbook on immunohematolgy (she has a very good one for hematology as well). The AABB Technical Manual is very good for reference. AABB has many very good resources on their website and through their bookstore. They have a download free for members on blood administration. The TraQ program in Canada has some excellent information on their website (www.traqprogram.ca).

At the grave risk of sounding big-headed, you could try going into References at the top of the page, then go to Document Library on the drop down list and then go to Educational Materials, where I have put a number of PowerPoint lectures, together with explanatory Word Documents.

They may, or may not be of any help, but they might be worth a quick look (if only to ensure that you want something else).

Be warned, some of them are quite "UK-centric" and a few need updating.

Since Malcolm has mentioned the Reference area, there is also information there on red cell antigens and on citations made by accrediting and regulatory agencies ("bloopers"). The bloopers section can help you avoid problems on inspection/assessment/survey (whatever the group you are dealing with wants to call their visit).

^^Thanks Malcom and Adie! The book I have is Denise Harmening's, which is also the updated version of the one I had in college back in the late 1980's. I'll definately check out the info on this site, too. I did find another site, about a year ago: www.bbguy.org which has some quizzes on it and other good info, but I really need to crack down at this point in my career and re-gain all the knowledge that I haven't used in years!

Welcome to Blood Bank Talk, Lisa. I have found this site to be very helpful and educational. (I just recent discovered all those Power Point lectures in the Reference area...Wow! I decided I'm going to try to plow through all those lectures by going through one or two every day.)

Don't be too worried about being rusty in Blood Bank. One of our 30-years techs who hasn't done Blood Bank for 25 years asked to be retrained in BB. Several of our techs were very leery, but I said "She was a pretty good blood banker 25 years ago, so I bet that good blood banker will come out again!" And she did! (And I bet you will too!!)

Looking forward to your posts, Lisa.

Donna

Thanks, Donna! I'm getting there, slowly but surely. I've been getting training here and there over the past year and a half, by basically just going into the department and doing the work, but it's difficult where I work second shift and must rotate around the lab. I have picked up knowledge as I go along, and I'm the type where I learn best by actually writing a procedure for how to do something--that way I can research it and make a step-by-step that "clicks" in my mind. We're taking on more blood bank samples where I work, to the point of it almost being like a mini-reference lab, and some of the patients we have now are very tough cases. I'm comfortable with the straightforward, basic stuff, but what I need most is knowledge on those hard cases that present with multiple antibodies and things that are difficult to resolve. --Actually, it's almost laughable that those sorts of cases haunt me a bit, and I swear those particular patients sneak in and check the schedule to see when I'm working so they can plan their emergency blood needs for when I'm there--LOL!

Enjoyed your post. Do you have any coworkers who are particularly good in blood banking (and seem to be able to explain things in simple language?) Here I am 35 years later, and I still credit a huge amount of my knowledge (and pragmatic judgment) to an SBB coworker that first year of working on 3-11 (2nd shift.) (Looking back, I must have acted like a 5 foot tall sponge!) (However, there's still plenty I don't know or understand!.)

LisaM,

You will find this site most helpful. If you lab uses gel is is more sensitive (I think) than LISS but can also muddy the waters sometimes.

I go for the simple (lazy) fix first. Rouleaux, not real agglutination. We use gel, sometimes we just have a plain old cold that can be prewarmed away. Take a look at the big picture, pt tx history, medical problems, age, etc. Remember Blood Banking is part science, part skill and sometimes a little luck too.

You are not alone, I now have a 15 year veteran Chemistry person who functions very well in the BB. Glom onto the best blood banker in the lab and suck their brain dry.

And remember, 2 heads are better than one when trying to solve a discrepancy or a panel.

Welcome back to the BB!!

Welcome to BBT Lisa, and thanks to all those who made such great comments about this site!

We use a combination of gel and tube testing where I work, and we're also in the process of training new-hires as well as retraining exsisting techs, and the procedure manuals need a good overhaul, so there's a lot of work to be done. I've volunteered to work on the manuals because I'm good at writing procedures and that will help me tremendously to get more comfortable in the Blood Bank, by actually writing them in a dummy-approach, step by step, me being the "dummy" LOL! Maybe once that occurs, I'll stop referring to the Blood Bank doorway as the "Portal to Hell", and the coat closet as "Lisa's Cry Room" !! LOL LOL!

Seriously, though, I do know that it takes time and practice, but I also feel that you almost need a dedicated staff in the Blood Bank as your institution takes on more work--"floaters" and Per Diems who don't get in there on a regular basis are harder to sufficiently train, and that's what I'm finding with myself--I have many other responsibilities in the lab that I must attend to along with Blood Bank and I'm a good multitasker, but I just need to find a way to re-balance my job responsibilities. So for now, I study Blood Bank reading material during the day in between the rest of life, while my daughter is in school, and I work at night!

Hi LisaM,

Welcome to BBT!, you certainly don't sound like a 'shy poster' so please join in, we look forward to your questions and views on topics as this helps us all continue learning too.

.

Thanks.

Hi LisaM,

Welcome to BBT!, you certainly don't sound like a 'shy poster' so please join in, we look forward to your questions and views on topics as this helps us all continue learning too.

.

Thanks.

Thanks and I look forward to educating myself! And I'm not shy at all--LOL. I'm a well seasoned poster over at nin.com, hence my avatar, where I go for mindless fun and laughs in the forums there, but this place will be very good for me to use as a resource as I'd like to eventually consider the possiblility of doing Blood Bank exclusively. Sometimes you just need a change of scenery to keep your job interesting and remind you that you really do still love what you do. I've felt for a few years now that some changes would be coming along for my future, but couldn't pinpoint what exactly, but as time unfolds, I see a little more, and it looks like Blood Bank may be playing a major role in where I'll end up for the next phase of my life. So I'm going to run with that thought and see where I end up and in the meantime, it can't hurt to refresh my memory!

Here I am over at nin:

http://member.nin.com/profile/view?user_id=172733

What is nin.com about?

What is nin.com about?

It's the webpage for the rock group, Nine Inch Nails--I'm a music-lover and they're one of my favorite bands!

Hello again! I completed my first week of blood bank training and it went well. We did have one issue that arose, so I thought I'd throw it out there to see what everyone else thinks:

At our lab we participate in CAP surveys--for those who may not be familiar with that, CAP (College of American Pathologists) is an accredidation agency that provides "unknown" samples throughout the year, for testing and peer evaluation to ensure that we are getting the results we should be for patient testing. Last week, we had a DAT survey and the kit instructions said "washing is not recommended". In our test procedure, it states that we must wash the red cells prior to addition of the polyspecific IgG/C3D reagent, but I interpreted the CAP instructions to do just what they said--don't wash, just test.

We got into a discussion about this, and some thought that we should wash first, so we tried it both ways, and got much stronger reactions with the not-washed samples as opposed to the washed samples. I explained my rationale as to why I felt we should not wash, and even called CAP (they said not to unless our procedure called for a lighter cell suspension than what they provided). Everyone was able to make sense of my explanation, and the supervisor chose to have us not wash the samples, after that, so I thought I'd see what everyone here thinks and here's my reasoning for not washing:

Any test procedure can be broken into parts--sample preparation, the actual test itself and the post-analytical/resulting phase. Washing red cells for DAT testing is not the test, but the sample prep part--addition of the IgG reagent to the washed cells is the test. With the CAP survey, they were telling us they had already done the wash phase of the procedure when they said "washing is not recommended" and to go right to the test phase.

Some of the techs were confused by my explanation, so I likened it to chemistry testing: centrifuging the tubes to obtain the serum/plasma, is sample preparation, putting the serum onto the machines and pressing the "run" button" is performing the test, because it's there that the machine starts mixing in the reagents, etc. Both steps are part of the overall procedure, though, but separate phases.

Therefore, washing the DAT survey samples is like double washing a real patient sample, or double spinning a chemistry tube. You wouldn't double-spin tubes because then you get into recompaction of the red cells, lysing them a bit, and falsely elevating things like LDH and potassium--it's improper sample prep and you affect your patient results. By the same token, washing the DAT survey is improper sample prep, because as we saw, the reactions were weakend because of this.

So my question is this: For those who participate in CAP surveys, how do you handle them? Do you follow kit instructions or do you start at the beginning of you own facility's procedure? I feel like I opened a can of worms at work, but after we looked back at some of the prior surveys and peer results, it showed a range of reactions from weak to strong that could be attributed to some places interpreting the kit instructions as "follow your own procedure" and other places interpreting as "follow kit instructions". Thoughts, anyone?

My immediate thought is, why are they sending out samples like this?

The DAT involves washing, and always has done, unless it is being performed in column agglutination technology, in which case it usually involves centrifugation, followed by resuspension in the chosen medium, to the chosen concentration of red cells.

If they want to ask you to perform a realistic test, and that, I would have thought, is the whole point of the test, then send out a whole blood sample, with the (presumably) IgG antibody sensitising the red cells and in the plasma; otherwise, what are they testing other than the AHG?

:confused::(:confused:

Hi Malcolm and thanks for the reply!

You bring up an interesting point and with the CAP samples, even in departments other than blood bank, you have to assume that they're pre-prepared for you. The chemistry samples come just as "serum only", not an entire tube to spin down, therefore, eliminating that step. We use them as is out of the vial to test, and my only thought on CAP sending the samples this way, is for preservation purposes during shipping--maybe they're more stable if they do the initial steps for you as far as sample prep. But yes, to follow procedure, you should be able to wash before a DAT. The samples did come sensitized with IgG and complement, and the third was negative, so we did see the results we were supposed to, but the strength of the reactions differed with washing vs. not washing. I think that to correctly follow kit instructions and satisfy the entire protocol of the facility, one must assume that the sample comes to you almost like from a central processing department, where they get them ready to run before they actually reach the department that does the testing (i.e., centrifuging them in one area, then bringing them to another room to test)--same concept applies with the surveys; samples are prepped in one place, tested in another.

Does make for a gray-area, though!

I agree with Malcolm. These samples are supposed to be treated exactly like patient samples. What if your institution happens to have a problem in the washing phase? It would never be detected in these proficiency samples!

Having said that, since what we have is what we have, I would follow the kit instructions. There is no use in being defiant (or deviant) for the sake of being defiant. If they say "Don't wash the sample we sent you" then don't wash it. They have chosen to send it to you with that step already done. You will only risk getting the wrong answer if you refuse to follow their instructions.

Hey Lisa,

I recently joined this site myself. I will say that it is a God send. The site is extremely thought provoking and informative; and addictive. It is the best addiction you will ever have. Good luck and enjoy.

Adiescast and Malcolm and LisaM,

I guess if we assume that the CAP survey specimens are designed to check our complete testing protocol they are falling short of the mark. I wonder if there is some sort of production issue with the CAP organization where they have to submit specimens and receive results in a certain format so they can grade in large quantities; sort of like a standardized test for college addmission.

I agree with Malcolm. These samples are supposed to be treated exactly like patient samples. What if your institution happens to have a problem in the washing phase? It would never be detected in these proficiency samples!

Having said that, since what we have is what we have, I would follow the kit instructions. There is no use in being defiant (or deviant) for the sake of being defiant. If they say "Don't wash the sample we sent you" then don't wash it. They have chosen to send it to you with that step already done. You will only risk getting the wrong answer if you refuse to follow their instructions.

That's where the question was--is are we following kit instructions correctly. In my opinion, washing the cells when the instructions stated not to, was deviating. I think that in everyone's mind at my institution, we should follow the entire test procedure, which includes washing, which is the way we're supposed to think and follow through, and you're correct--errors with this phase will not be picked up if we are not supposed to wash the survey samples. Having said that, I also do think that maybe there should be a way to include the wash phase in these sample, because aside from performing "the test", you are also testing the entire test procedure from start to finish.

I agree with Malcolm. These samples are supposed to be treated exactly like patient samples. What if your institution happens to have a problem in the washing phase? It would never be detected in these proficiency samples!

Having said that, since what we have is what we have, I would follow the kit instructions. There is no use in being defiant (or deviant) for the sake of being defiant. If they say "Don't wash the sample we sent you" then don't wash it. They have chosen to send it to you with that step already done. You will only risk getting the wrong answer if you refuse to follow their instructions.

Oh, I agree, that is what you should do, but I would still put in a strongly worded and well-argued complaint that the kit is NOT testing the proficiency of the entire test.

:mad::mad::mad:

^^Maybe I'll play dumb and send CAP an email when I get to work tonight, mentioning that the samples don't seem to cover the proficiency of the entire test procedure, and gee, (*Scratches head*) um. . . "What do you think about that, CAP?"