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Anyone else use LowT WB for emergency release or MTP? Our current facility SOP states a maxiumum of 4 WB units to be issued. However, it doesn't list a time frame. I'm having trouble finding any study or recommendation on when a patient would next be allowed to receive WB. Never? For the life of the current specimen? For the current admission? 24 hrs? 90 days? Anyone know? I'm also making the assumption that this would be for those patients who are not Opos if all we issue is Opos WB. Is there any reason we would have to stop at 4 Opos WB units if the patient is Opos?

Have you ever found anything unexpected and clinically significant?

For your facility in the UK - this may be common practice and I can only speak for OUR facility - but we have to do eluates on ALL our pos cord DAT's...... We didn't have a Labor and Delivery unit for many many years - so I can't say this is being done "because it's always been done this way" this time... Our L&D opened up maybe 4-5 years ago.

I would upgrade both of my blood storage refrigerators to the Helmer i-series and set them up for downloading temps so less paper trail. I would bring in a new Echo (ours is upgraded, but old). I would remodel Blood Bank (knock out a wall) to give us a little more room and a more ergonomically friendly space to work, maybe add another spot to flex to workspace for MTP events and for our students. Actually, I want a whole new Blood Bank with more room and windows! I don't want much really............

New Transfusion Service Lab with all the current technologies available. Additional FTE.

We would rarely perform an eluate on the baby's red cells unless there are clinical (as opposed to laboratory) signs of HDFN. In other words, an elution is not considered to be a "reflex test", just because the baby has a positive DAT.

Is it your facility's policy to perform an eluate on cord blood when baby is Rh-positive and mom is Rh-negative with a passive anti-D due to RhIG? Or do you only do cord blood elution when mom has a "real" alloantibody? Just wondering about policies at other health systems. Thank you!

If you have any, you could try D Negative Cord or Neonatal red cells, which express the LW antigen comparatively strongly (certainly compared with adult D Negative red cells).

Thanks everyone for your replies and comments. Yes to Malcolm, the last wash was negative. The Elution kit we use is from Gamma, the Elu-kit. One correction though, I only had one eluate recover the anti-D, the other one was a warm auto. We no longer stock the DTT, I wish we did, so I am not able to confirm if it is anti -LW. I really suspect it is.

While the Ogata-Matuhasi phenomenon has been recognised since the early 1960's, it is, that notwithstanding, a very rare phenomenon to actually come across in practice. With all due respect to you Bet'naSBB, if you "see this quite a bit", I would be a bit worried as to why.

With respect to RBCs. If the patient has unidentified antibodies (as the title states) then NO. If you have identified the antibodies but can not confirm the patient’s antigens (as your question states) and the AHG crossmatch is compatible with units negative for the antigens that the patient has antibodies to then yes, though there are some/many possible caveats. Hope that is not too convoluted. It would help us if you give more details. Can you please explain what you mean by filters as in this context it is a little concerning to me.

What eluate kit do you use? If you use one with a "working wash" - try repeating your eluate, washing with normal saline instead...........usually takes care of it. We see this quite a bit - especially with Rh's and K's. Our Medical Director refers to it as the "Ogata Phenomenon" https://www.bbguy.org/education/glossary/glm06/

Given that red cells are, in themselves, a blood component, the answer has to be no.

Just to clarify is it safe to give blood components to patients before identifying the antigens present without having to use filters juliedel23

Careful, now. You're bordering on "spatial discrimination".

How about a "Del" ? Fits the description perfectly. One the other hand, "twice in the last few days" is worrying. While not impossible, it's highly unlikely that a facility would encounter more than one of these anomalies (zebras) in such a short period. I assume Malcolm's question regarding the Last Wash is an allusion to some laboratory artifact - bad technique, bad reagents, etc.

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Welcome!

Does acquiring more good blood banking staff count?

Have you considered that your patient could be a particularly low-grade weak D, a partial D of some kind (such as an RoHar), which would explain the anti-D in the eluate as a result of the RhoGam, or that what you are detecting in the eluate is not an anti-D, but is an anti-LW? I also assume that the last wash is totally negative? Sorry to ask this.

Thank you! Got some great lay out ideas! much better than what I currently have. Seems like the last person in my position had a very "horizontal" brain where I am a "vertical" kind of person. Haha!

This has happened twice in the last few days , where we are picking up Anti-D in the Eluate of an Rh negative patient. Patient has received RhoGam but no transfusions.

Thanks everyone for the feedback! ACHC looks like a great alternative to CAP for many reasons. Might investigate that route.

If you had grant money available to apply for, to be used in the blood bank... what would you use it on and why? Let's assume all your current equipment is functional and doesn't necessarily need replacing. Looking for ideas.