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Whole Blood
John C. Staley and 4 others reacted to Neil Blumberg for a topic
Switch back to the patient's own ABO type as soon as possible is my advice. For everything. RBC, platelets, cryo, plasma. Worrying about the anti-A and anti-B in low titer whole blood is relevant, but so is the smaller amount of incompatible plasma in group O red cells, which are not low titer. There are rare reports of severe hemolytic reactions to group O red cells in non-O patients. Furthermore, the patient is continually making their own group A, B or AB red cells, so hesitancy about transfusing their own ABO type is not helping things get better. By giving additional group O products we are making the problem worse, not adding safety in any way. Furthermore, the non-O patient's endothelial cells, platelets, von Willebrand factor, hepatocytes, etc. are all incompatible with the transfused group O plasma, and their function is impaired when modeled in vitro, and leads to increased bleeding. Thus there is no benefit whatever in giving group O red cells (or whole blood for that matter) to non-O patients once the hemorrhagic problem is largely under control. And there is likely added risk. It is only adding harm and reducing the inventory of group O blood for group O recipients. A total mistake of the last few decades in my opinion. Giving group O plasma containing products to non-Os is only reasonable when you don't know the patient's blood group, or don't have their blood group in stock, or it's an emergency with no time for giving type specific. No one ever went broke overestimating the importance of the ABO blood group in transfusion. See attached for the literature references. ABO trauma commentary Frontiers bioengineering.pdf Reconsider ABO compatible:universal donor.pdf ABO ARC MAC copy.ppt5 points -
Whole Blood
John C. Staley and 2 others reacted to jshepherd for a topic
I'm with Dr. Blumberg, we cap our LTOWB for trauma MTP at 4 units. This is due to inventory as well as not wanting to give non-ABO identical as little as possible. We have had zero adverse events thus far. The more O you give a non-O patient, the harder it is to determine their true type as well, especially if you don't get a sample drawn ASAP. Switch to patient's ABO type as soon as you can, and only fall back to type O red cells if inventory is in trouble. Also agree with Bet'na - the patient has to live to have a problem, but we can mitigate the problems by capping how much potentially incompatible plasma we give. There is an AABB standard 5.27.2 that states that your SOPs must indicate the maximum volume/units allowed per event. You can define that yourself, there isn't really a guide as to how much is too much. There are facilities out there that have no limit and some that have a limit, as evidenced by the responses in this thread. Standard 5.15.4 applies to this as well, which states that you have to have a policy concerning transfusion of significant volumes of plasma containing incompatible ABO antibodies, ie type O plasma to non-O patients. I've been doing level 1 trauma for almost 20 years, and it can feel like the wild west, reach out if you need clarification or real-life examples of things. Happy to help.3 points -
We had issues with our Visions not reading barcodes also. We did learn that the Vision needs approximately 4 mm of a white margin on either side of the barcode to read. We adjusted our barcode printer and that enabled the Visions to read the label. Not sure if anyone at Ortho told you that. I think it was our service rep that let us know that hint! Good luck!3 points
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Backtype discrepancy.. is it anti-a1?
Yanxia and 2 others reacted to San Diego Blood Banker for a topic
So we ended up sending it out to ARC. Patient is subgroup A2 and Anti-M identified.3 points -
Our Blood Bank uses Hemotemp II's but they are only good applied to the bag for about 2 days. They also have to be activated with a 40C incubator. We use those for units in OR coolers and trauma. If you want tracking for the life of the unit, Safe-T-Vue's are pretty much the only option. I second everyone's frustration with the Timestrip BT10's. We tried them for our trauma bay and they fell off all the time despite prepping with alcohol and wiping condensation off the bag. They'd also activate if you looked at it wrong. Our rep said the lots we got might be bad because they were in her hot car. @RRay I think the decline might be due to hospital networks going single source and racing to the bottom to get the cheapest things. There's no incentive to make a higher quality instrument/reagent/etc. if the hospital networks are only going to look at upfront costs and ignore the issues caused by low quality/bad service/insufficient supply.2 points
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It's been a few years, but the 800+ bed hospital I was at had two IH1000. I'm not saying they were perfect, but they were workhorses, and I don't remember them not reading or misreading the barcodes.2 points
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regulatory requirement to read updated procedure?
Mabel Adams and one other reacted to illinoisbloodbanker for a topic
COM.10300 Knowledge of Policies and Procedures Phase II The laboratory has a defined process and records indicating that all personnel are knowledgeable about the contents of the policies and procedures (including changes) relevant to the scope of their testing activities. NOTE: The form of this system is at the discretion of the laboratory director. Annual procedure sign-off by testing personnel is not specifically required. Evidence of Compliance: ✓ Records indicating that the testing personnel have read the policies and procedures, new and revised, OR records of another written method approved by the laboratory director2 points -
Backtype discrepancy.. is it anti-a1?
Bet'naSBB and one other reacted to Melanie Oliveira for a topic
Sounds like ABO discrepancy due to a cold agglutinin which may or may not have specificity. I would run 3 M+ cells and 3 M neg cells at IS, RT and 4'C along with an autocontrol. IF only the M+ cells react at IS or RT, then I would ficin treat the A1 and B cells and repeat the reverse grouping using ficin treated cells. Just a suggestion.2 points -
positive dat w cord blood
Bet'naSBB and one other reacted to Malcolm Needs for a topic
Oh it is!!!!!!!!!!!!!!!!!2 points -
positive dat w cord blood
exlimey and one other reacted to Malcolm Needs for a topic
Do you think somebody should tell them that ABO HDFN sometimes gives a Negative DAT result in the fist two or three days of life, and that they might actually be better off looking for clinical signs, rather than performing diagnoses on the result of pathology results???????2 points -
positive dat w cord blood
exlimey and one other reacted to Malcolm Needs for a topic
I think that it depends upon the state of the baby. For example, if the mother is D Negative, and has been in receipt of anti-D immunoglobulin, and the baby has a positive DAT, but is showing no other signs of HDFN, then we wouldn't perform any further testing. If the baby has a lowish Hb, and the mother is group O and the baby group A or B, we may take a look at the mother's IgG ABO status, and then perform an eluate on the baby. Where we might really "go to town" is if the baby is showing overt signs of HDFN, we might well go the "whole hog" and perform an elution, just in case there is a maternal alloantibody directed against a low prevalence antigen also expressed on the red cells of the father. If this is suspected, it would be easy enough to adsorb out any IgG anti-A or anti-B on the baby's red cells, without adsorbing out the potential antigen against a paternal low prevalence antigen. The specificity of such an antibody would be interesting, but not necessarily vital, as, should the baby require a transfusion, suitable blood should be easy to obtain.2 points -
Correlation Testing in Blood Bank
Kelly Guenthner and one other reacted to Mabel Adams for a topic
Can anyone explain the value of this effort to me? How do you change your tests if your results don't agree? (In Chemistry you probably recalibrate.) Do you just sign off when it is expected due to different sensitivity?2 points -
Correlation Testing in Blood Bank
John C. Staley and one other reacted to Cliff for a topic
This is a good solution, I would like to suggest that you do not retest them until after the due date, not just the date you reported them.2 points -
New Blood Group System.
Jsbneg reacted to Malcolm Needs for a topic
A research team led by NHS Blood and Transplant scientists based in Bristol, at NHSBT’s International Blood Group Reference Laboratory (IBGRL), and supported by colleagues at the University of Bristol, has discovered a new blood group, MAL. 🙌 🩸 They identified the genetic background of the previously known but mysterious AnWj blood group antigen, thus allowing identification and treatment of rare patients lacking this blood group. Louise Tilley, Senior Research Scientist, IBGRL Red Cell Reference at NHS Blood and Transplant, said: “The genetic background of AnWj has been a mystery for more than 50 years, and one which I personally have been trying to resolve for almost 20 years of my career. It represents a huge achievement, and the culmination of a long team effort, to finally establish this new blood group system and be able to offer the best care to rare, but important, patients." hashtag#NHSBT hashtag#GiveBlood hashtag#SaveLive hashtag#NHSCareers Activate to view larger image,1 point -
New Blood Group System.
Malcolm Needs reacted to Arno for a topic
I thought this would fit quite well with this discussion on new blood group system/antigen discovery Advancement of new molecular tools for discovery of blood groups - Transfusion Today - October 20241 point -
Whole Blood
John C. Staley reacted to Neil Blumberg for a topic
If the donor antibody screen is negative then the unit does not need to be labeled. Otherwise it does.1 point -
Whole Blood
John C. Staley reacted to Neil Blumberg for a topic
"Just to make sure I've understood, even if a patient just got their total plasma volume replaced with Group O albeit Low titer plasma, we should switch all products to their blood type the second we get a result?" Yes. Even after a one volume blood exchange 30-40% or more of the original red cells (recipient type) are still there, and more will be made during the recovery from anemia. So giving the patient's own red cell type is almost certainly better than infusing more anti-A and anti-B antibody via O red cells to A, B and AB patients. (I am also curious what you think of blood centers labeling red cells from antibody positive units as regular red cells and don't treat them as antibody positive units needing a minor crossmatch. The blood center claims that the Additive Solutions dilute the titer "enough." I admit I haven't looked for any research on this yet. I don't know if they titer the supernatant or what to prove this. I think this is irresponsible and scientifically indefensible, if I understand you. Also against FDA regs as the product is misbranded if the known antibody present is not identified on the label. The remark about additive solutions is totally without merit and once again, irresponsible. There are no data to support this approach. I don't want to be infusing anti-X antibody (that I don't know about) to a patient who might be X positive. Makes no sense and one would be crucified in a court of law.1 point -
Whole Blood
John C. Staley reacted to BB Gal for a topic
Thank you everyone for the replies! I definitely have a lot of reading to do. @Bet'naSBB I definitely agree that the patients have to live to have a problem. I appreciate the info about your facility. I hope to read more research about the WB that's being done at hospitals like yours! I am also curious about studies going on that involve obstetrics and cardiac LTOWB MTPs. @Neil Blumberg Thank you very much for the articles. I am also worried about the incompatible plasma in the regular red cells for sure. I feel like I'm in between a rock and a hard place. Just to make sure I've understood, even if a patient just got their total plasma volume replaced with Group O albeit Low titer plasma, we should switch all products to their blood type the second we get a result? (I am also curious what you think of blood centers labeling red cells from antibody positive units as regular red cells and don't treat them as antibody positive units needing a minor crossmatch. The blood center claims that the Additive Solutions dilute the titer "enough." I admit I haven't looked for any research on this yet. I don't know if they titer the supernatant or what to prove this. Maybe this also needs to be brought up in paradigm shifts alongside rethinking out of group ABO compatible red cell transfusions.) @jshepherd Right now, I would like to limit it to 4 LTOWB and then switch to components until more research is done, but my hands are tied. No amount of articles or concerns has changed our Trauma department's mind. They want unlimited LTOWB in their perfect world, but we were able to limit it to 10 to match the "model" facility's protocol. Maybe a retroactive study can be done here at some point. To be clear, thankfully I have no evidence that any of our patients have experienced harm because of the LTOWB specifically. This is more of a proactive worry. We are unfortunately not accredited by AABB, but CAP has a similar standard and I outlined our policy as no limit for LTOWB, but if more than 4 transfused, give Group O red cells. After getting Dr. Blumberg's insight, I may be editing it again!1 point -
We are a Level 1 adult and Peds trauma center.....we don't have a limit............ We will give any MTP patient O POS (leuko reduced) LTWB until our supply runs out. We will give Oneg to peds - but if we run out of Oneg - they will get Opos. Our facility is currently involved in several studies using WB in the trauma setting. In the words of our Medical Director and manager..........."They have to live to have a problem" Might sound crass to many - but, it's true. For all the patient's we have transfused out of group WB to - we have had VERY FEW delayed reactions - maybe 2 anti-A's in the eluate and a few anti-D's - but all were males. Our 1st concern is saving the patient.........1 point
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Ortho Vision Not Reading Barcodes
John C. Staley reacted to RRay for a topic
@John C. Staley I totally agree and am currently in that process. We have other demo analyzers coming in a couple weeks and the first thing I'm going to do is throw on some barcodes that I know the Vision won't read. I'm very nervous though that if they don't read on other BB analyzers then I HAVE to figure this out. Vision is easy because a lot of techs have had exposure to it (at least in this general area), but that's the extent of the pros. I'm pretty tired of shipping and stock issues and generally poor customer service compared to other companies I have experience with.1 point -
Ortho Vision Not Reading Barcodes
RRay reacted to John C. Staley for a topic
If I were you I would cut my loses and go with a different company for my next analyzer. I never did like anything about Ortho and avoided dealing with them any time I had the chance. Just my opinion for what ever it's worth.1 point -
3% to 0.8% conversion
John C. Staley reacted to RRay for a topic
I have the official conversion guide from Ortho and it doesn't recommend any specific QC apart from the general QC of the method it alludes to (the general MTS procedure manual). I mention visual inspection of cell button size in my SOP. Has always covered it in the past, but you know how it goes... Quick Reference Quide - Conversion.pdf1 point -
We use Ortho-Vision Max and manual gel techniques. During our validation for manual testing, we found that we sometimes missed reactivity in the IgG card when cells were diluted to 0.8% and incubated for only 15 minutes. The reactivity was then present when incubation was extended to the maximum allowable time for the IgG cards so that's what is now in our SOP.1 point
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I have several "real patient" antibody panels that I can share. I give to my students that come through the lab and new employees to make sure they understand rule out/ dosing, etc. (Have an answer key as well). May not be exactly what you are looking t hough. I'll be glad to share if needed.1 point
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General Lab: Immunoglobulin
Cliff reacted to Malcolm Needs for a topic
I just answered this question. My Score PASS YEE- HAH!!!!!!! I got one right!1 point -
I just answered this question. My Score FAIL1 point
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BloodBankTalk: Largest blood donation event
Cliff reacted to Malcolm Needs for a topic
I just answered this question. My Score FAIL1 point -
Using platelets returned in a cooler with ice
John C. Staley reacted to Neil Blumberg for a topic
There is no evidence that cold stored platelets returned to room temperature need any change in outdating. I wouldn't go beyond 7 days for pathogen reduced platelets or 5 days for non-PRT platelets. Would just use clinical judgement. The reference above relates only to frozen platelets in any case, an entirely different critter, so not necessarily informative.1 point -
New QC manufacturer for blood bank automated analyzer
John C. Staley reacted to Cliff for a topic
I always start with the manufacturer. They will often provide suggested plans that you can then modify.1 point -
Happy Thanksgiving to all of our Canadian Pathlabtalk members1 point
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yes, that's what we wait for...........and we usually get behind and don't end up handing them out until we've already received the results.1 point
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It is standard 5.1.2.4: The laboratory shall evaluate the comparability of test results obtained using different methods, instruments and if applicable testing sites. This shall be performed twice annually. We use old CAP samples or known patient samples with antibodies. Test them on the analyzer and with PEG on the bench.1 point
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We use our "old" CAP samples........... Once they've been turned in and reported, we assign them to techs using our "other" methods. SOP is gel/Ortho Vision Max Additional testing then would be manual gel, Peg, LISS, Saline. Same for titers and DAT's Seems to work pretty well for us!1 point
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Antibody Work-up
Ensis01 reacted to Malcolm Needs for a topic
I tend to think that there are a number of factors affecting the reaction, such as changes to the pH, rather than just dilution, that would change the equilibrium constant within the Law of Mass Action that governs antibody/antigen reactions, but pH is only one of them.1 point -
This a classic case of Sensitivity vs Specificity. Clinical assays (including those in the transfusion medicine arena) are often designed to be as sensitive as possible, especially those intended to be frontline screens. Nobody wants to miss anything. However, the downside of this approach is that sometimes specificity suffers - more positives are obtained than desired. Solid Phase, Gel and PEG assays are super-sensitive, but may detect "nuisance" antibodies like weaker autoantibodies (warm and cold), or things like anti-P1, anti-Leb, or "HTLA-like" antibodies. Less sensitive assays that employ no enhancement (saline) or thing like LISS are sometimes used strategically to avoid the nuisances. Many institutions have policies that allow the deliberate down-regulation of sensitivity to ameliorate such problems. For example, performing crossmatches in LISS rather than Gel. Certainly, there's a risk that something might be missed using a less sensitive assay, but I think it's important to realize that in years past, the use of those less sensitive assays didn't leave a trail of bodies. In patients with long-term autoantibodies, it's not unusual for the autologous cells (DAT/autocontrol) to react weaker than Screening Cells or panel cells. The appears to be some kind of weakening of native antigens to which the autoantibody is directed. Sometimes, that may even mean the DAT is negative, but still yields a reactive eluate .1 point
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New Blood Group System.
Malcolm Needs reacted to Arno for a topic
Hats off to Nicole and the whole IBGRL team1 point -
Transfusing high Hgb because "patient still in shock"?
BB Gal reacted to Neil Blumberg for a topic
Just for the record, I am not aware of any data, nor can I conceive of a mechanism by which red cell transfusion would correct base excess. This patient apparently had an extensive and severe infection, so vasodilation due to septic shock seems a real possibility. Transfusing a patient to a hemoglobin of 14.6 is not something I've ever heard experts in anesthesiology and intensive care medicine advocate, and transfusion to this level would be expected to increase the risk of thrombosis greatly. And just for completeness, the diagnosis of septic shock in a patient with a recent serious infection and also likely receiving broad spectrum antibiotics does not require the presence of positive cultures for diagnosis. Hard to grow bugs in vitro when there are high concentrations of anti-microbials. This is why DNA tests are probably a better tool to diagnose infection in such patients, if available. Does not require growth, just the presence of bacterial nucleic acids.1 point -
"Keep Ahead" Orders
BB Gal reacted to James Spears for a topic
When we were performing electronic crossmatches and had Cerner there was an 'additional units' field built into the product request order. The provider was free to write whatever they wanted in that box but we were never going to look at it. The nurses would sometimes come down with 'doc wants to make sure we have additional units available', if I was feeling particularly sassy I'd get up, walk over to the fridge, pull out a shelf, make a big production of looking at the units, and say 'yep.'1 point -
At my institution. the Donor Network is now asking for 4-6 units of RBCs for organ perfusion for their machine after the organ has been harvested (similar to ECMO for the organ). Those RBC units will not ever touch the organ donor patient. Our policy is to always issue them the oldest O Pos units (uncrossmatched) we have on our shelf. They will rinse all of this banked blood out of the organ before transplanting it into the recipient, and it is added to the perfusate solution to provide oxygenation to the organ during transport from the donor hospital to the recipient hospital. AABB offered at least 1 very informative session at their annual meeting on this last year in Nashville, and I'm guessing that they will offer more in Houston this year (or perhaps an eCast session or articles in AABB News or Transfusion) since this practice is becoming more and more widespread. The unique nature of the process is proving to be a challenge for hospital transfusion services as far as who places the order, what testing is needed (if any), tracking for final disposition, what kind of records need to be kept because they are not being "transfused", billing of the products, etc..1 point
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Another update: After I sent the experiment results I got an email for the rep to refund me of all my hemo-trac purchases and for me to find another product being that their product is not performing as intended and for my needs. They also emphasized that these are mainly for transport and not intended to be left on its in storage (although that is allowed per the manuf. insert). I think they should adjust their marketing strategy. So, @JOJOER I think at this point I am going to look at cooler temp loggers instead. Possibly Max Connect or LogTag. In the long run, these are one time purchase +annual recal and that will be a fraction of the price we're currently spending having to replace sticker indicators or switching back to safeTvues. *Rant incoming* Is it just me or has options for blood bank specific products in general really dwindled across the past 10 years? Now, it's almost "This is what you get, you have to use THIS." Want a blood irradiator? Here's your 2 options. Want a blood kiosk? Hate haemonetics? Too bad, this is what you get.1 point
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Using platelets returned in a cooler with ice
Mabel Adams reacted to jshepherd for a topic
We have a Temp Check device. Temp-Check Rapid Response Thermometer For Healthcare| Digi-Trax® This is what we use to take temps of all products being returned to us.1 point -
Using platelets returned in a cooler with ice
Mabel Adams reacted to butlermom for a topic
This happens a lot at my hospital. How do you take the temp of the platelets?1 point -
Using platelets returned in a cooler with ice
Mabel Adams reacted to jshepherd for a topic
Agree with Dr. Blumberg. If platelets are returned in an RBC cooler "on ice", we take a temp of the unit. If out of 20-24C range, we check for swirling, and if still swirling we will ask pathology if we can keep it, based on our current platelet inventory and the temp we got. Always up to them, but in general if it's only out of range by a degree or two, we'll accept it back. The coolers we use for RBCs are only out for 4 hours max, so these units are never in there very long, and they often come back within temp range (like they tossed the unit in the cooler right before bringing back the cooler).1 point -
Using platelets returned in a cooler with ice
Mabel Adams reacted to Neil Blumberg for a topic
Short periods of time (<12 to 24 hours say) at refrigerator temperatures have no known deleterious effect on platelet transfusion efficacy, so I would use them as I would use any platelet component stored at room temperature. I routinely approve this at my own institution when this happens.1 point -
Using platelets returned in a cooler with ice
jtemple reacted to drmsherpiny for a topic
activated platelets are good for plugging holes in bleeding patients when they are naturally activated and inside the body with physiological limits but those activated outside the body by ice or violent shaking for example, cannot be used , you will never guarantee the good results1 point -
@BldBnker Yes, Ortho did tell us that and we have more than 4mm on each side, closer to 8-10mm. Even some barcodes that don't have the white space, say because of date/initials in the way or blood smear, will often read when the perfectly printed and clean labels will not. It's making me crazy.0 points