labguru

We do this to cover all of the bases in the event of a transfusion reaction. We keep an unopened segment and the segment that was used in the crossmatch. We keep everything related to the crossmatch for a period of ten days.

We do not do the testing in tube to confirm. We will send the sample to American Red Cross for Genotyping for RHD variants if the reaction is 1-2+. The majority come back as weak D type 1 and are not considered to be at risk for production of allo-anti-D. It is generally accepted that females of child-bearing potential with weak D type 1 can be considered D positive for transfusion and are not candidates for Rh immune globulin. Their type will be updated with that comment. If the patient comes back as one of the other weak D types and there is a chance for production of the allo-anti-D, we will leave it as Rh negative and put the comment that testing was done in the patient history.

Do you need to send notification to the FDA on these since the crossmatch will be positive?

What is everyone doing in TAR with a patient that is being transfused and then needs to be transferred to another facility? You may never know the actual stop time. Should the nurse put the stop time as when the patient left and approximate the volume of blood transfused or is that falsifying records? When I go in to look at these units it tells me that PCS is still in the process of entering transfusion data, which to me means the nurse is still on the transfusion in TAR, but will probably never look at it again since the patient has been transferred.

When we switched to the Ortho workstation, I asked CAP what to do about the temperature and this was there response: Taking daily temperatures on the Ortho workstation which contains an indicator light can be satisfied by having the techs record that the green light is lit and is "acceptable". Prior to allowing the techs perform this task, best practice would to verify initially that the temperature in the incubator is accurate against a certified NIST traceable thermometer. If you are unable to verify that prior to installation, that the temperature is accurate, then the manufacturer would need to provide to you that the internal temperature has been calibrated by the company. The process that other labs are doing that you described would also be acceptable. Thank you for your inquiry, Ljiljana Petkovic, MT(ASCP)SBB Laboratory Accreditation Program

We use Ortho Gel for the Blood Group, and tube for the weak D.

According to the limitations of the FMH screen, if you have a weak d (which we don't know if it is or isn't because of the positive DAT) you must use a test to detect feto-maternal hemorrhage other than the screen. You only know if it is a weak D if you do the weak D testing on an Rh Negative specimen and when you add the Anti-IGG it will show up in this patient as positive due to the DAT. I think the positive DAT was due to the ABO incompatibility. We perform a weak D on all our Rh negative cord bloods to determine if the mother needs RHIG.

Over 100 views and no comments? Is it safe to say I'm the only one with this issue?

CAP standard TRM.40130 is a new standard that deals with alternative control procedures. It states "If the laboratory performs test procedures for which control materials are not commercially available, there are written procedures for an alternative mechanism to detect immediate errors and monitor test system performance over time. The performance of alternative control procedures must be recorded." We use the Ortho Confidence system for gel. We also use AB Plasma (we aliquot one unit of expired FFP and use it until gone) for our reverse type in confidence cell 1, to test the buffer part of the card and also to test our screening cells in the IGG card to make sure they come up negative. If you use the Ortho system, do you test your buffer cards (or last 2 cells in the ABO RH Reverse card) and IGG cards in the same way? It sounds like this new standard applies to what we are doing, correct? We don't have a procedure, but we do monitor and review. We even do a 20 sample crossover before it is put in use.

Mother is O negative, baby is A negative. The DAT on the baby is positive, so the Weak D is inconclusive. According to the limitations of the FMH screen, if you have a weak d (which we don't know if it is or isn't because of the positive DAT) you must use a test to detect feto-maternal hemorrhage other than the screen. We send out a KB for this determination. However, the limitations also state that "in cases of ABO incompatibility between mother and child, the mother's natural ABO antibodies may destroy any fetal cells in the maternal blood specimen before testing is performed. This is true for any method of detecting fetal cells in the maternal blood." So my question is would you send this ABO incompatible specimen out for a KB or would you just issue the mother one vial of Rhogam and not worry about the KB since nothing may be detected? This was an uncomplicated vaginal delivery.

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So tube is your back up method?

We run the current positive and negative controls (before they expire) with the new lot of Indicator cells and D reagent. We are not comparing results, we are just making sure our new reagents are giving us a positive and negative result. This was under direction from a call to CAP. I guess it could depend on who you talk to there as to what answer you get though.

My Ortho rep informed me that for a patient with an antibody the immediate spin in a buffer card still needs to be done because the IGG card does not pick up the ABO incompatibility. So we have both crossmatches in our result field. We will put the immediate spin results in first, then we will replace the IS XM with the extended XM (AHG).

We have Meditech also, and once the doctor orders additional product, Meditech will attach it to a viable sample if there is one through a Daemon. If the current sample is due to expire shortly, it will order a new TS and XM which will need to be collected.