Transfusion Services

We use Ranger blood warmers in OR and sometimes other locations (but Belmonts for rapid infusion). I have been presented a question asking if we can still use them for blood because they warm the blood to 41C, but UpToDate says that blood shouldn't be warmed above 40C. I see no references listed in UPToDate to support their 40C requirement. We test the alarms on Ranger blood warmers, and they must alarm by 43C. From the Ranger Service manual: "The Ranger blood/fluid warming system is designed to warm blood, blood products, and liquids and deliver these at flow rates from KVO to 500 mL/min. At these flow rates, the device maintains fluid output temperatures ranging fro…

We have a patient with autoimmune aplastic anemia and hx of anti-E. This is our first time seeing her, and current ABSC and ABID are pan-reactive due to WAA. The autocontrol and DAT ( both IgG and C3) were positive and WBC count = 1.5 K/ul. Pre-transfusion Hgb was 6.2 and over last 2 days has rec'd 2 units of E-neg "least incompatible" RBCs. Her Heme Onc is now requesting all add'l units be both E-negative and K-negative. I was not able to reach her directly, but curious why she's requesting K-neg. Anyone see the connection? All I can think of is she doesn't want to risk alloimmunizaiton to K (we do phenotypically match C, E, K, Fya/b, and S for sickle patients), but wond…

I'm a little newer to the blood bank, so often need help understanding / reconciling our current policies - appreciate any help or insights (or references!) Situation: Mother has known alloantibody (a potentially clinically significant one). Baby is born and our testing shows negative antibody screen. Our current policy requires antigen-negative units for transfusion (with resultant AHG crossmatch) if maternal alloantibodies are present, but it doesn't say HOW LONG we need to give those antigen negative units. Questions: Is the use of the antigen negative units in this neonate with no detectable antibodies (negative screen) because of the possibility of "missing" low t…

Please looking at malaria testing prior to transfusion especially in endemic areas like in Africa, in Europe someone coming from endemic zones are usually deferred from donating for a period of time but here in Africa during transfusion some centers will screen for malaria and some will not screen. The first question will be, it's necessary to screen for malaria in endemic areas before donating blood or not screening knowing knowing half or more than half of the population can test positive for malaria? and the second question what is the better tool for screening microscopy or rapid diagnostic test using serological cassette? Going to be grateful with feedback 🫲🫲🫲

Has anyone seen the antibody screen become completely negative after a patient was transfused with plasma and platelets. We saw a patient the other day in the ED with positive screen and Anti-FYA. Received uncrossmatched blood and plasma and was transferred to another facility. Later they performed a type and screen on the patient and it was completely negative. Both our facilities use solid phase testing. Wrong blood in tube was ruled out. Thank You

Hi, I would like to get rid if ortho reagents antisera and red cells to replace with immucor reagents.. how many samples are needed and how many aborh,dat,etc to validate this immucor reagents. Please share your procedure. Thanks

Can immediate spin be eliminated for cold agglutinins? We are going back and forth with this because immediate spin detects ABO incompatibility but the computer system is also set up to detect this.

Over the weekend the overnight shift received a Type and Screen, later the patient received blood. They did get a positive screen, but they were able to rule out all antibodies. When I followed up on the patient, I found out that the patient had history at another hospital in the area, not in our system. When I called the hospital, the patient actually had received blood at that facility earlier this month and had developed Anti-JKb and little c. Obviously, blood we gave to him was not tested for those antigens. Is that an FDA reportable error? This is first time something like this happened with me as a supervisor. I notified the patient's care team, immediately. Other…

If a small site that doesn't stock irradiated blood has to give emergency transfusion or a bigger place can't provide several rounds of an MTP that are irradiated, what are the risks? I know that patients who had a Stem Cell transplant in recent years must get irradiated products or face a very dangerous form of GVHD. I know that patients on purine analog drugs should get irradiated blood, but I don't know how dangerous it is if they don't. Otherwise, most patients seem to get irradiated because they are candidates for future transplants. Clearly, we can't let patients bleed to death but, if we get an MTP order on someone our system says needs irradiated blood, what do…

Pt is 50 y/f on ECMO A+ AB scene negative. We are on day 5 or 6 and she is hemolysis lime crazy. I remember something about hyper hemolysis syndrome on this site. Recheck AB screen still negative DAT is negative. LDH super high, sorry I was off a couple of days got called at home about this case. I’m writing this on my break and have to go back and work on other patients. Will try to respond when I can. Saline used was 0.9% . Patient also has impella device which we’ve seen hemolysis with but not like this. This looks like intervascular hemolysis.

Looking at those conditions listed above, cancer, bleeding conditions, heart and lungs conditions which sometimes can pose a serious problems with the donors when donating blood and to a less exend may affect the recipients. How can such conditions be identify in donors who have never be diagnosed on such conditions and might be having it and don't know they're having it? What can be done to rule out these conditions? Thanks

Greetings to everyone. Please like to get responses on this inorder to have a bigger picture. In my country mostly what's done is just the forward grouping using the anti-sera to do and confirm the patient blood group and when that's done they just sent out of the hospital to collect blood in a donor centre ( laboratory) and in the donor centre sometimes what's done in still the forward Grouping without doing the reverse blood grouping. The question will look like this, what's the importance of always doing the forward and reverse blood grouping before transfusing blood? Or even when the hospital do the forward grouping it's advisable for the laboratory to do the reverse …

Does anyone allow electronic crossmatch to be used in cases where a prior marrow transplant will never result in the usual reverse type on the patient (for example B to A)? We have a discrepancy blood type test in our computer that doesn't require the usual truth tables be met that we currently use for these patients. We require 2 separate specimens to be typed before we give any RBCs that aren't group O. We require 2 individuals to review any results turned out using the discrepancy test (this doesn't mean mistakes couldn't happen). We could have a patient with a cold agglutinin that would make an IS crossmatch incompatible (although maybe immunosuppressed patients w…

We have patients that come home from university hospitals after transplants that we need to transfuse. We can often find in their charts the recommendations of the transplant center on what donor types to use. When we can't, I would like to have a definitive source on what blood type we should transfuse to these patients. The current patient was B pos, now A pos after a transplant 6 years ago. His chart says they consider him "cured". He forward types as A and back types as AB, as expected. I think we should be giving him A pos RBCs but I want a definitive source to cite in his notes.

Sorry if this the wrong Thread. Also, I apologize for this dumb question. What does +s in the ortho Panel mean? Thank you

Hi all, I'm a fairly new tech and I have a question regarding testing methods on patients that are actively on DARA. My hospital currently uses gel as its primary testing method. DARA patients, of course, are panreactive 1-2+ throughout both in the ABSC and the ABID panel. My current policy is to perform a DTT-treated screen and treat units if they need a transfusion. We provide K matched units and perform AHG XMs on treated RBCs. Many of these patients are surprise patients and there is frustration from providers when we tell them that the work up will take a few hours. I never want to jeopardize patient safety, however, I'm wondering if there is a mor…

I have been searching for support reference material for 2 people to issue blood products. All I can find is 2 people at time of transfusion. I looked in the CFR and cannot find what I am looking for. Maybe I am not looking correctly. Maybe we don't need 2 people to issue blood products. Can anyone direct me to a reference or inform me on the correct process for issuing blood products? pretty please

Hello, Our lab recently acquired the Barkey Plasmatherm. To comply with IQMH requirements, we need to check and document the thawing device's temperature at each use, ensuring it stays within an acceptable range. However, we’ve noticed that the thawing temperature sometimes exceeds 37°C. According to AABB guidelines, plasma should be thawed immediately after removal from storage, either in a water bath at 30-37°C or using an FDA-cleared dry thawing device. My question is: since the Barkey Plasmatherm is an FDA-cleared dry thawing device, does the 30-37°C requirement still apply? Thank you!

We need to determine how we will issue cold stored platelets in a massive transfusion. We would like to put them in coolers packed like RBCs, but we found that they get too cold. Has anyone identified a packing method that works well for CSP but doesn't mean we have to annually check 16 coolers by two different packing methods so we can use them for either CSP or RBCs? We may have to dedicate some coolers to platelets but would rather not.

We have a 42 y.o. Caucasian female with chronic anemia and cellulitis/sepsis needing debridement who has anti-D (2+) & anti-C (3+) by Ortho MTS gel. She was transfused elsewhere in 2021 and here in 2022, all Rh neg units. Two units each time. Screens were negative then. She has a history that suggests she may have shared IV drug needles at some point. I don't think there is a pregnancy history but not ruled out. She is A neg. Her initial testing in Ortho gel was clearly anti-D with C (could include G) but she had some 1+ reactivity with 4 of 5 D and C negative panel cells. The cell that didn't react was E+, D-, C-. Fya+, Fyb-, heterozygous for Kidd and MNS, but Lea- …

I feel like the FDA requires that forms be controlled documents, but I can't find a regulation stating that. AABB includes forms in their definition of documents, but I can't find anything similar in the FDA regulations. FDA used to have a Guidance for inspections, but I can't find that either. Any pointers appreciated.

What would cause these results? I don't expect the A1 lectin testing to look like the other tube testing in most weak subgroups that I know of. I also thought maybe the reaction with anti-A,B would be stronger. We are still getting answers to whether there may have been a marrow transplant. The leukemia question was about suppressed antigen expression. Chimera? What else? Patient is a pregnant Native American. I assume first trimester because this is initial prenatal testing.

Anyone else using Vitalant? We do partially. Wanted to know if you've gotten any information on how frequent this low-yield supply will be? I get why they're supplementing inventory with these, but I'm having trouble getting information from my account rep. This involves a lot more than just turning on product codes for us, so putting out feelers. We're so remote I don't have a good network of other users.

Why are haemolytic reactions excluded from definition of ATR? SHOT in UK only defines Febrile, Allergic and Hypotensive Cheers

Can anyone cite any regulations that stipulate what must be documented in an electronic transfusion record? I am looking at times when the usual electronic documentation wasn't used, and they manually document in a note or on a form that gets uploaded. I can't see any Joint Commission standards that state that they must document the DIN, product code, who transfused it and when. I see medication regulations for the time and "dose" which may apply because the FDA considers blood a drug, but nothing says specifically that they need to include the product code or even the DIN. This isn't the old days when paper transfusion records were returned to Blood Bank for record k…