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It seems to me that you have covered all bases Mabel. There is a telling sentence in Reid ME, Lomas-Francis C, Olsson ML. The Blood Group Antigen FactsBook. 3rd edition, 2012, Academic Press (page 419), which states, "Experts agree that anti-Yta are often benign and antigen-negative blood may not need to be transfused." Certainly in the cases I have seen over the years, I have never had to give Yt(a-) typed blood (although, because of the geography of England (it's a lot smaller than the USA!), such blood could easily be obtained from the National Frozen Blood Bank, and/or from "tame" donors.
- Today
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We have recently identified (with reference lab confirmation) an anti-Yta in an A neg pregnant woman. She has had one prior pregnancy--miscarriage-- and no transfusions. We are 3.5 hours from our blood supplier (over a mountain pass) in good weather and she is due about Christmas. We are convinced that the risk of HDFN is nil so I am devising a plan for managing the patient if she should bleed during delivery. We can have the MMA done for significance but it is expensive and maybe not worth it when the patient isn't all that likely to bleed excessively. I am about ready to decide that we should just wing it because I can't get in compatible units "just in case" because they probably would have to be deglycerolized and thus would have a 24 hr expiration. If she massively hemorrhages, I won't have any choice but to give her Yta untested units. If she doesn't have a life-threatening bleed there might be time to get in Yta negative blood in a day or 2 to fill her back up. Autologous donation would give us only maybe 1 liquid unit and they probably would want to transfuse it even if she didn't need it. Not sure if there is a family member but they can only donate every 56 days and I would want a liquid unit for the month around her due date. Maybe a sibling could donate a double red cell but that's about the best it will get (assuming there is a Yta neg sibling). We would try to send out an antibody workup in the last 2 weeks before her due date just to make sure there aren't any new antibodies that we will want to honor. Of course she will have RhIG on board by then I'm sure. I will happily take all suggestions and input.
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we will not transfuse in this situation
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Hello all, it is possible to transfuse red cells even if the patient is febrile?
- Yesterday
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Let me spin this differently. I'm unlikely to detect an anti-A1 or any other weakly reactive (1-2+) IgM antibody in routine room-temperature gel testing. Secondly, I have eliminated the immediate-spin crossmatch in favor of an electronic crossmatch to detect ABO incompatibility between donor and recipient. Lastly, by adopting the electronic crossmatch, I have accepted that any reactivity (limited to room-temperature) between donor and recipient (not demonstrated to be due to anti-A and/or anti-B) is rendered clinically irrelevant!
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Is there a HCPCS code (P code) to charge for platelets that are leuko-reduced, irradiated, and washed?
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Not only that, but they are amongst the few IgG antibodies that cause agglutination of "normal" red cells without a potentiater (never sure how to spell that - and spelling is my bogey subject anyway!), but also do so at 4oC, through to the warm.
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I just have a hard time transfusing red cells that yield a 1-2+ positive reaction at immediate spin (can't call that compatible :o) ). That being said, we do what our pathologist requires. I agree that O mothers delivering incompatible type babies have destructive IgG ABO antibodies. We still do Lui Freeze Elutions on all neonates with positive DAT's to identify the "culprit" antibody. I'm not sure many facilities continue to do that. Thanks for the references.
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Hi Susan, I have only been able to get it somewhere between 2301 and 2359 based on rules. Meditech was not helpful at all. If the specimen was collected exactly on the hour, then it will expire at midnight. However, if it was collected any time after the top of the hour, it is 23xx (coll time = 1220, then it expires at 2320; if at 0501, then it expires at 2301).
- Last week
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Can anyone with meditech experience provide me with a rule that will have a patient sample expiration date be 3 days from sample collection at 2359 (per AABB). Meditech has only been able to assist (?) me with an expiration date/time of 3 days at 2301 since we went live in 2009. Thank you.
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I have the products orderable separately in the product dictionary, i.e. PC; PC,IRR; PC,IRRA1;PC,IRRA2, etc. I have the associated patient tests for crossmatch, type and screen set up the same for each product as far as I can tell but PC is the only product for which the associated tests are actually automatically ordered. Any ideas on what I could be missing? PC,IRR is a substitute product for PC but the opposite is not true.
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I am sorry BldBnker, but I, amongst others, thoroughly disagree with you about the clinical significance of anti-A1. You must do what you feel safe to do, but I fundamentally disagree. If you look at Marion Reid, Christine Lomas-Francis and Martin Olsson's book, The Blood Group Antigen FactsBook. 3rd edition, 2012, Academic Press, anti-A1 causes either no, or mild/delayed haemolytic transfusion reactions. Their findings are backed up by Geoff Daniels in his book Human Blood Groups.. 3rd Edition, 2013 Wiley-Blackwell, Geoff Daniels and Imelda Bromilow in their book Essential Guide to Blood Groups.. 3rd Edition. 2014, Wiley-Blackwell, Robina Qureshi in her book Introduction to Transfusion Science Practice. 6th Edition. 2015, British Blood Transfusion Society and Harvey Klein and Dave Anstee in their book Mollison’s Blood Transfusion in Clinical Medicine. 12th Edition, 2014, Wiley-Blackwell. In other words, most of the world's leading blood group serologists and blood transfusion doctors disagree. You are perfectly correct when you say that the anti-A1 detected by immediate spin is probably IgM, but, if you look at the findings of haemovigilance organisations throughout the world, most adults have an element of IgG (and IgA come to that) ABO immunoglobulins, and this is particularly so in the case of group O individuals, and, within that cohort, group O females who have been pregnant with an ABO-incompatible foetus. It is these IgG antibodies, in conjunction with the ABO IgM antibodies that cause the worst (often fatal) transfusion reactions, but it is actually the effect of complement that makes these antibodies so clinically significant. In addition, if you perform titration studies on anti-A and anti-B (and anti-A,B), the titres are almost always much higher than the titre of anti-A1, and this, again, influences clinical significance (human-derived high titre anti-A1 is as rare as hen's teeth). The anti-A and/or anti-B in the small amount of plasma left on units that are not ABO identical to the recipient are, therefore, much more likely to cause a transfusion reaction (graft versus host) than is any anti-A1 (host versus graft). Sorry to go on for so long.
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I would worry more about the Anti-A1 antibody than the low amount of Anti-A in the residual plasma of a B unit of packed cells. If the Anti-A1 is present at immediate spin, then it is probably IgM just like Anti-A and Anti-B that are naturally occurring (which cause HTR). We see these individuals occasionally and transfuse them with O blood (if it is an A subgroup with Anti-A1 antibody) and with B blood if its an A subgroup B individual with Anti-A1. The transfusions are successful. I worry more about having to give type incompatible platelets that have way more plasma than a unit of packed cells.
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Theoretically yes, but in practice no - not unless the need for transfusion becomes more frequent. I have NO idea why three weeks was chosen. There may be a reason, but it seems pretty arbitrary to me!
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I am a little worried about the fact that there is no serological cross-match if the mother has made an atypical antibody. The reason I say this is because it is well-known that when a person makes one antibody, they often make more than one. If a mother makes, for example, an anti-K, which is easily detected, she may well also make another antibody specificity, such as an anti-Dia. As the Dia antigen is a low prevalence antigen in most populations, it could well be that the Dia antigen is not expressed on either the screening cells or the antibody identification panel cells - in other words, it may not be detected. Even if the baby does not express the Dia antigen on its red cells, the maternal anti-Dia will still go through the placenta, and so this anti-Dia will still be in the baby's circulation. If, the unit to be transfused is K-, but Di(a+), the baby could well have an unexpected haemolytic transfusion reaction, which could be avoided by a serological cross-match against the mother's sample. Once the unit has been cross-matched, and found to be compatible, then aliquots from the same unit of blood can be safely transfused without a further cross-match, but I feel that, for the first transfusion from any unit of blood, a serological cross-match should be performed.
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Our PreAdmit patient samples are valid for 30 days after collection if patients have not been pregnant or transfused in the last 3 months. We usually perform the group and screen test on the day of collection and if applicable, antibody workup ASAP. If required, we usually do the crossmatch one the day before the scheduled surgery date. Previously, we had separated plasma from cells for all samples. After we did validation to show that the reactions strength of ABO antibodies in the unseparated samples on their 30th days is comparable to that in the separated plasma, we stopped separating plasma if the antibody screen is negative and only immediate-spin crossmatch is required.
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We can extend specimens collected to 30 days as long as they have not been pregnant or transfused in the last 90 days and that they don't have an antibody (either currently or historically).
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We use an armband system on our NICU babies although they are allowed to keep the band on the isolette (do they still call them that?) so it may be more for consistency's sake than the usual function of the BB band. Because of that we wouldn't use a sample from Hem or Chem. We give only O neg in NICU (unless it would be incompatible with mom's Abs which hasn't happened yet). We have not had a NICU baby need transfusion after 4 months of age so far. If it happened, we would have to go to drawing a new specimen on baby every 3 days. We keep the same band on patients for their whole stay so that # would be checked and recorded on specimen at each redraw but the band not replaced.
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Below is the source of my 1st question. " If the patient has been transfused within the past three months, but not within the last three weeks, an elution may be omitted if all of the following apply: a). The DAT was positive on the last specimen tested (i.e. collected more than three weeks ago) and was investigated, and b). The positive DAT (i.e. strength of the reaction) on the current specimen is not stronger than the DAT performed on the last specimen, and c). The antibody screen (i.e. strength of the reaction) on the current specimen is the same as on the last specimen. Note: Clinical circumstances, evaluation of transfusion, test result history and/or specimen history may override the above criteria and elution may be desirable for selected patients." Could any one explain why "three weeks" is specified here but a longer or shorter duration? Thank you.
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Hi Malcolm, Look at what I found in the link below http://www.transfusion.ca/Resources/CSTM-Blog/January-2017/I-will-remember-you-Malcolm-Needs Clarest
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We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow: Transfuse order for RBCs is received in blood bank We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC." Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup) We look up the mom's record to see her antibody status If no antibodies, we result the "mom absc" as negative. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.) I hope this is helpful.
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Hi Malcolm, 1. I agree with you if we suspect there is a transfusion reaction which causes the positive DAT with IgG, it makes sense to do an elution on the new sample in case some other antibody(ies) are being detected this time but not from the previous sample. 2. Even we test an eluate once every month for the patient with an autoantibody, it is exactly as what you said the eluate shows pan- agglutination. Unfortunately, we do not perform alloadsorption on site. So, the eluate really does not mean that much for detecting underlying alloantibody(ies) developed due to transfusion reaction, especially when the auto is strong and the eluate always shows 3 to 4+ reaction strengths. Do you think it's necessary to send to our Reference Laboratory once every month for an alloadsorption or just send out when there is a sign of hemolysis process going on? Clarest
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Occasionally we have neonates who are still in the NICU after they become 4 months of age. At that point we begin treating them like any other patient in that we must do an antibody screen on the baby's blood every 3 days if they are receiving RBCs. My practice has always been to use the pedi lavender in hematology or maybe a pedi red from chemistry to do the baby type and screen. One weekend the blood bank tech actually was able to have a phlebotomist collect a small sample on a 4-month old NICU baby and place a blood bank armband on the baby too---we have NEVER armbanded babies in the NICU. (Had the 4 month old baby been in our pediatrics center he would have been armbanded.) I'm just curious how others handle neonates who are still in NICU after 4 months. Do you go find their other lab samples to perform the screen or have the baby stuck again? Also, if you have a BB armband system, do you armband babies in the NICU? Thanks!
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Ya, Malcolm. I can think of a few other situations where this may not be the best policy. When requested by physicians, we have done eluates on compliment-only positive DATs where we ID antibodies, showing that one can have a "false IgG negative" DAT in certain situations. Anyway, in most cases we would repeat the eluate if, in the first place, we identified that an allo-Ab was present on the patient's cells. But as for initially negative eluates, if a repeat DAT is still positive but not stronger than the previous, we would not bother with another eluate. The idea being that if the patient is producing a significant amount of antibody, the DAT reaction would be stronger. Scott
