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  1. 12 points
    Malcolm Needs

    e and C titer

    The thing is tkakin, that most examples of anti-C (anti-Rh2) are not; they are actually anti-Ce (anti-Rh7)! This is largely because almost every red cell that causes immunisation against the C antigen expresses both the C and e antigens as a result of having the RHCe gene, rather than both the C and e antigens as a result of having both the RHCE gene and the RHce gene (which is why both the DCE and dCE haplotypes are so rare). On the other hand, monospecific anti-e is comparatively common. So, your lady's plasma is more likely to contain anti-Ce and anti-e, rather than anti-C and anti-e. As a result, if, as yan xia suggests, you would undoubtedly adsorb out the anti-e, but you still would not know if the remaining antibody specificity is anti-C or anti-Ce (or, of course, a combination of the two). Anyway, the specificity really doesn't matter. The point is that, as you suggest, the individual titres of what ever antibodies are present are totally irrelevant. Normally, an antibody, such as anti-C (or anti-Ce) or anti-e, are not going to cause clinically significant haemolytic disease of the foetus and newborn, until the titre reaches 32, and it really doesn't matter whether the specificity of the antibody is anti-C, anti-Ce or anti-e. Your Pathologist should explain this to your OB doctor to get him or her off your back (actually, to be honest, your OB doctor should already know this, but hey, life ain't always like that!).
  2. 5 points
    John C. Staley

    CAP TRM. 40670

    Malcolm, you make me laugh. Just like a bull dog, once you get hold of something you just can't let go. I think the moto from a place I once worked is appropriate. "An exercise in futility is better than no exercise at all!"
  3. 5 points
    Malcolm Needs

    DAR/Cdes question

    I am a little confused by your question, in as much as, in one place you say that the patient has the Partial D Type DAR, but in another you say that the patient has the Dw antigen, sometimes known by its trivial name Weil, or more properly as Rh23, which is a low prevalence antigen associated with Partial DV Type 4. I think you mean that your patient has the DAR D Type, and that the D antigen is typing weakly. Am I correct in thinking this? I hope so, otherwise it doesn't make sense (at least, to me). Turning to the CdeS type, there are several (at least 8) of these in terms of genetic background. All have one thing in common, and that is a Leucine to Valine substitution at position 245 of the mature position, due to a point mutation in exon 5 of the RHCcEe gene. Five of these also have the Tryptophan to Cysteine substitution at position 16, resulting in the expression of (normally) the C antigen, due to a point mutation in exon 1. However, 74% of C-, c+ Black Americans with normal expression of c have Cysteine at position 16. The thing is though, that any C antigen that is expressed is weakened, and some anti-C reagents do not react with it. On the other hand, because there are at least 4 amino acid residues that are involved in the expression of the C and/or c antigen (at positions 16, 60, 68 and 120), it is more than possible (in fact, probable) where mutations are present, that the c antigen is expressed at a normal strength, whilst the C antigen is also expressed in the weakened form. Indeed, the C antigen itself is a Partial C antigen, and such an individual can produce a form of anti-C, rather in the same way that an individual with a Partial D can produce a form of anti-D. So, to cut a long story short, this is why the individual will express the c and e antigens in the cis position, even though they also express the C and e antigens (in a manner of speaking) in the cis position, and why the ce (compound) antigen can also be expressed.
  4. 5 points
    jalomahe

    Proficiency Testing

    I may go to the extreme but when we receive surveys all of the "patients" are registered in the computer and the appropriate tests ordered. The vials can then be labeled with barcoded patient/test labels and can be scanned. I also enter the "donor unit" into our inventory and print donor unit label for the specimen and place the DIN label on the vial. This way everything is done in the computer just as it is with a real patient. When the tech has completed testing they can print their results from the LIS and if need be I can always go back and look at the results.
  5. 4 points
    I just run the old controls with the new lot kit. Never had a problem with inspections. My anticipated results are positive with the old and new pos cts and negative with the old and new neg cts.
  6. 4 points
    Never say never - bet you get an Rhnull next week!!!!!!!!!!!!!!!!!!!!!!!!
  7. 4 points
    I'm fairly certain the chat could last well into adult beverage time. Once that started the stories will get even better!
  8. 4 points
    jalomahe

    CAP TRM.30450

    When I asked CAP about this they stated that for Blood Bank it only applied to kits that come with their own Pos and Neg QC. So Fetalscreen Kit Yes, Elution Kit No.
  9. 3 points
    Here's the one our entire lab uses. Validation Plan and Results Review.docm
  10. 3 points
    I've attached my process validation plan. Let me know if you need more info. Process Validation Template.doc
  11. 3 points
    Malcolm Needs

    Case study mentor

    Even better, if they could be published in the Case Studies section of this site (no patient names, of course - or, come to that, hospital names). That way, we could all learn, as none of us knows everything!
  12. 3 points
    Which book are you using, and at what "stage" are you in your professional life? The reason I ask is that I may be able to suggest an alternative (but do not want to advise you read the same one! - and I stress an alternative book, rather than a better book; each to their own), and I need to know where you are in your professional life, so that I do not suggest a book that is either too basic, or too advanced.
  13. 3 points
    yan xia

    e and C titer

    Maybe you can adsorb the anti-e with ccee cells, then to see if there are still reaction with Ce cells, then you can figure out if there are anti-C here.
  14. 3 points
    I did mine FT while also working FT. It was brutal, but it was the fastest 12 months of my life. Takes a lot of discipline, at least 3 hours every night. You can't skip more than 2 days or you reach the point of no return. As soon as I started to feel overwhelmed, I would take a day off from work to catch up. You have NO social life during this time. However, you have a MUCH better chance of passing the test if you do it FT and then commit to take the test within 2 months of ending. Private message me if you want more info.
  15. 3 points
    SMILLER

    Training new employees

    You are to be commended for going the extra mile to ensure safe patient care. Like others here, i would suggest at this point that you put all of this stuff into a document (impassionately written of course). End with your concerns about patient safety, corporate compliance, etc. Be sure to list all of the management people you have alerted with dates. Then send the email it to all management and administrators above the BB and Lab (including directors and V.P.s) You should have a corporate compliance officer you need to send a copy to as well. Hopefully some responsible person will realize that they can no longer ignore a disaster waiting to happen, as you will have created proof that all responsible parties were alerted. Scott
  16. 3 points
    MOBB

    Antigen Negative Labels

    We recently stopped documenting the unit number on our tags and just document antigen neg/pos, date and tech. The antigen results are in our LIS too.
  17. 2 points
    V1 x C1 = V2 x C2 where V1 is volume of initial unit in mL, C1 = hematocrit (%) of initial unit, C2 = desired hematocrit (%), and V2 = final volume in mL V1 - V2 = volume of plasma to remove in mL 1.06 g/mL is approximate specific gravity of whole blood. You will need to subtract the tare weight of empty collection bag and convert weight to volume using specific gravity.
  18. 2 points
    Leukoreduction, by no means that I know of, can get rid off ALL WBCs in a blood product. So if you are worried about Graft-Versus-Host Disease in an immunocomprimised patient, you do not want to rely on leukoreduction alone. The residual donor WBCs may "engraft" into the host recipient's system, and attack the recipient as a foreign threat. So to avoid GVHD, you must kill all of the WBCs in the donor blood product. This is accomplished with radiation. Scott
  19. 2 points
    Malcolm Needs

    CAP TRM. 40670

    They obviously do! Patty, PLEASE do not think I was getting at you. As you will guess from John's post above, this is (just) one of my pet hates. It was nothing personal!
  20. 2 points
    Malcolm Needs

    CAP TRM. 40670

    If you have sorted out what is causing the unusual reaction pattern, then it is no longer a discrepancy. However, I would still not perform an electronic cross-match, AS THERE IS NO SUCH THING (a computer does not, and never has, performed a cross-match). I would, however, perform ELECTRONIC ISSUE.
  21. 2 points
    No David, you’re not an old timer (or we both are). I feel the same way. We would never transfuse from a cord blood. I had never heard of such a thing before yesterday. There is a video on YouTube about it. I hoping someone has some experience with this request.
  22. 2 points
    I never have. Don't know how I feel about it. Have never used cord blood for transfusion purposes either. Always have confirmed w a heel stick specimen. If you have the mother available I would think you would use a specimen from her. Or am I just an old timer?
  23. 2 points
    Most warm auto-antibodies have a specificity within the Rh Blood Group System, although some others, more rarely, have a specificity outside of this system, such as auto-anti-Wrb. Most of the auto-antibodies from within the Rh Blood Group System mimic anti-e, anti-E, anti-C, anti-c or a combination (or even a compound antibody, such as anti-Ce or anti-Rh7), but, in reality, they are actually weak forms of anti-Rh17 and/or anti-Rh18, although strong examples are not unknown). As they are usually mimicking antibodies, they can usually be adsorbed out with red cells that do not actually express the actual antigen on their surface (for example, an apparent anti-e can be adsorbed out using R2R2 red cells). PLEASE DO NOT try to identify them yourself, as the actual specificity is not significant, but will take an awful lot of time and you will require some VERY rare red cells, such as Rhnull, D--/D-- and the like, and these should be reserved for when they are required to identify the specificity of rare allo-antibodies, such as anti-Hr, anti-HrB or anti-Rh29, where a true specificity may well be vital to identify. In contrast, most "cold" auto-antibodies are true specificities. For more information, you would find it hard to beat reading, Petz LD and Garratty G. Immune Hemolytic Anemias, 2nd edition, Churchill-Livingstone, 2004, although I would advise you to be selective, as it is a very detailed book!
  24. 2 points
    QCDan

    Competency on Couriers

    ...attach a note to container that the blood product is in that reads that "This product must be delivered to the patient care area without delay" or something to that effect. In the end, everyone gets trained every time they pick up a product. This would account for all the techs and volunteers that come and get blood products depending on the facility where you work. Just a thought :-)
  25. 2 points
    Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) : Select Product in this order ... Indated product using shortest outdate first. (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.) ABO Group: ABO compatible are preferred but not essential. (And then there's a chart because it is a procedure and that has to have everything in it.) Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist. Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period. Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated. (And then instructions about how this is done and documented.)
  26. 2 points
    AMcCord

    Quarterly Alarm Checks

    I've been doing the ice water/warm water checks once a year and electronic check the other quarters for a long time. I've not had any concerns from CAP inspectors.
  27. 2 points
    Malcolm Needs

    Allo anti-D

    A classic case of don't believe EVERYTHING you read!
  28. 2 points
    exlimey

    Allo anti-D

    Please supply the reference for this absolute nonsense. It sounds like I would enjoy reading such fiction.
  29. 2 points
    AMcCord

    COOLER FOR THE OR

    Good laugh to start my day!
  30. 2 points
    Malcolm Needs

    Allo anti-D

    I don't know where you are reading this Tabbie, but I can assure you with absolute certainty that this is NOT accepted by either the Royal College of Obstetrics and Gynaecologists (see their Green Top Paper) or the British Society of Haematology's Guidelines, and the reason for this is that IT DOESN'T WORK. I should warn you that, if you do decide to go down this road, and there is a single case of HDFN as a result, you will end up in court.
  31. 2 points
    tkakin

    COOLER FOR THE OR

    I could not get my igloo coolers to maintain temps between 1-6 C. I found these really neat coolers from Camp-Zero. I am going to use the mint green for plasma and the pink ones for red cells. 2 Down falls 1. The latches are meant to keep the bears out! I figured it would probably keep the Dr.s and nurses out too, so I validated them for 24 hours with the lid closed, not latched. They maintain temps beautifully with the lid not latched. 2. Stickers don't stick to the plastic very good, so I am gluing the stickers on.
  32. 2 points
    We've been doing it for over 15 years (from the time we had Ortho's gel cards). Whatever validation was recorded, it's from eons ago and I wasn't involved with that one. I would imagine it was similar to the validation done with the DAT method in gel cards (from my other post in that section)
  33. 2 points
    AMcCord

    RHIG Workup

    We do an Rh type on all OBs predelivery, so we know which babies should have cord blood testing performed and then, which mom's are candidates for Rho(D) immune globulin. The physician/nurse is responsible for ordering the workup, but we are the backup to make sure it happens.
  34. 2 points
    We include a step in our method corelation (twice a year) where we run Ortho gel panel (0.8%), Tube panel (immucor 3%) and Immucor gel panel(dilute immucor to 0.8%). Our method was correlated almost 20 years ago!
  35. 2 points
    Tech repeated and got the correct result. I do not know if maybe she picked the wrong thing on the sheet. She can not remember and did not save the cards that she used. I just want to make sure I have a corrective action in place for JC that is sufficient. Any suggestions?
  36. 2 points
    tbostock

    Training new employees

    Document every issue. Then cut him loose at the end of his probationary period. He sounds dangerous.
  37. 2 points
    In this day and age it can be very easy to offend people and while I don't mind offending them I just want to make sure they know where I'm coming from. Your right Mable, it's been a while. I've met some great people online and especially here on this site. Some day I would like to meet you and Malcolm and Cliff, Dave, Ann, Steve and all the rest in person over coffee. I'll bet the stories would be entertaining.
  38. 2 points
    Malcolm Needs

    Rh phenotypes

    I agree entirely David, for the USA and others, BUT, have a look at the flag besides gagpinks' name; it is the Union Flag. This means that she is working in the UK. In the UK, all of the units are typed for ABO, D, C, c, E, e, K and, now, Hep E by the various blood services, so there is no added cost to selecting Rh and Kell antigen matched units of blood.
  39. 2 points
    Malcolm Needs

    Rh phenotypes

    According to BSH Guidelines (and work performed by such luminaries as the late Prof Patrick Mollison - who knew a bit about blood transfusion!), those who have already made a clinically significant atypical alloantibody are more likely than others to make other specificities. It is for this reason that a patient who has made such an antibody is no longer eligible for a transfusion of blood selected by electronic issue (or, as people STILL insist on wrongly calling it, computer crossmatch - GRRRRRRRRRRR!!!!!!!!!!!!). The more antibodies in a person's plasma, the more difficult it is to sort out all the various specificities, and the more difficult it is to supply antigen negative blood. As a (former) Reference Laboratory Chief, I prefer either to work on really easy samples, or really, really complex samples, but not on samples with two or three antibodies present, particularly where one or more are avoidable Rh and/or Kell Blood Group System (BGS) antibodies. Therefore, although not mandated by either the BSH Guidelines, or, indeed, the UK Transfusion Services as a whole, as a personal preference, I would advise that Rh and Kell BGS,antigens are matched (particularly as, if the individual has already produced an antibody - probably from a previous transfusion - although other stimuli are "available" - and needs another transfusion, the chances are that this individual will require further transfusions in the future, if not actually become transfusion dependent). I fully admit that this is a purely personal point-of-view, however, I would be more than a little annoyed if I was to be sent a sample at 3 o'clock in the morning, to sort out an additional, but avoidable specificity. It is, however, down to you.
  40. 2 points
    I want to preface the following remarks by saying that I am, or at least spent over 35 years, a blood banker in various capacities. I am one of you. Blood bankers, with good reason, can generally be described as untrusting to the point of paranoia. No one can do the job as well as we can and that includes other blood bankers. I have never known one of us who would willingly trust a sample drawn at another facility. It's hard enough to trust our own phlebotomy staff! I don't even want to get into nurse draws! We are this way because we understand the potential dangers and in all honesty most of this comes from a true concern for patients we never personally see. I had one staff member quit a blood bank day shift to work as a generalist on the night shift because she was convinced that the use of the new automated analyzer would result in the death of all of her patients because she would not personally be doing the testing. Granted that's a little extreme but it is an example. So to answer the original question of this thread, I am fairly confident you will find little or no support for "using a blood bank sample drawn and tested from another facility".
  41. 2 points
    Malcolm Needs

    Training new employees

    I would agree with mollyredone, but would go further, Not only do you need to record everything you say to him (and get him to counter-sign the record), you need to record everything you tell your own seniors, and get THEM to counter-sign what you have told them. THIS PERSON IS DANGEROUS. You, as a conscientious employee, should not have to take responsibility for this person, but, if the worst happens (and it well could), you want to make certain that you are not held responsible in law, but that the finger is pointed in the right direction. If you get your own seniors to counter-sign your written concerns, you will, not only be protecting your own future, but will also cause them sleepless nights until they do something about the situation.
  42. 2 points
    Pony

    Changes to Manufacturer's Inserts

    Just to clarify a few misconceptions: 1. Once a package insert change has been approved and new stock is in, IT IS SOP-driven that all old versions are destroyed and not used in new packages. If you ever get 2 packages of the same product with different version inserts - report it immediately to the company. Major labeling booboo! 2. Changes in inserts are marked as changed until the next revision when those changes become what is marked and the previous set become repeated text. You never know how long it can be between product orders so a customer may not get a revised insert until they order the same product 2yrs later. The changes are tied to the revision number and at any point can be identified for lookbacks. 3. Any change in insert must be approved by the FDA as this is a labeling issue and part of the license. This is not a free process. Any company makes sure the change is necessary and cost-effective within their Regulatory budget before making it. So small word change requests to "clarify" in the users' opinion are not likely to happen until the cost, changes and patient testing impacted make sense. 4. The 6 - 12 month timeline is usually correct. as is the large amount printed for cost containment. It really hurts when branding or reagent changes happen and the Materials Management group just ordered a huge number of inserts which must now be destroyed. Hope this helps
  43. 2 points
    Lcsmrz

    Can leuko-reduce prevent GVHD

    I vaguely remember a study in the early 80's showing 25Gy, 30Gy and 35Gy, with the recommendation that 30Gy might be a tad better than 25Gy at getting complete inactivation in all products. But my memory fades me today -- actually, it faded years ago, but I forgot when ...
  44. 1 point
    That came up at an AABB session I attended last year. Policies seemed to range from 1-2 units up to 6-8 units of incompatible plasma. Some policies specified a time frame as well as number of units - X number of ABO incompatible units over X number of hours. I was hoping to hear some kind of concensus, but there didn't seem to be one from the comments I heard. Do your research, draw a line in the sand for what you think is reasonable, and write your policy accordingly. Since the standard does not spell out what reasonable is, you get to decide.
  45. 1 point
    mld123

    CAP TRM.30450

    I was told by CAP when I contacted them that this applies to Kits only in Blood Bank. We perform lot to lot on Fetal Screen Kits only, but we do not perform Elutions. I believe the Elu-Kit would require a lot to lot if you perform that testing.
  46. 1 point
    mollyredone

    Antigen Negative Labels

    Brenda, why do you need the unit number on the label? You are attaching the label to the unit, correct? We have red antigen positive labels and green antigen negative labels. We also document in the blood bank module that the unit is P/N for an antigen. That way if there is a label that comes off the unit, we can still see that the unit has been tested and verify it in our antigen testing log. I have found that attaching the label to a little bit of the whole unit label helps it stick on better.
  47. 1 point
    Malcolm Needs

    ABO incompatibility

    It is the latter yan xia. The various metal ions have no effect on either sensitisation or agglutination, but, are vital co-factors for the complete initiation of the classical complement pathway (C1qrs), leading to the membrane attack complex (MAC), and it is this MAC that allows haemolysis to take place, and it is this haemolysis that allows the Hb to escape from the red cells, which we see as a pink/red colour in our tests, which equates to a positive result. As the classical complement pathway is a huge amplification system (one C1qrs complex, for example, results in the generation of some 8, 000 C3b molecules), it makes the test very sensitive indeed - much more so than just looking for agglutination.
  48. 1 point
    SMILLER

    Cold Agglutinin Panels

    If you haven't already, you should keep a copy of this response, Malcolm. I have lost track of how many times this issue has come up here! Scott
  49. 1 point
    Nate S

    Biotin Interference

    Hi Everyone, Wanted to see how other labs are handling education of Biotin interference to physicians. I am looking at putting a canned comment on all tests that can be affected by high levels of Biotin ingestion - wanted to see if anyone has done this yet and what comment they are using. Thanks.
  50. 1 point
    I think our pneumatic tube might be a her. If it were a him, it would never ask for directions before it goes anywhere.
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