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I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year. It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK. Sorry if this sounds egocentric, but I am very excited.

I will be retiring on August 9 and wanted to tell everyone that the forum has been a great source of information (and amusement at times). I have spent time reading Malcolm's posts trying to imagine what he sounds like (just love a British accent). Thanks for keeping the forum a place where we can all learn from each other

To address this question of safety, I would like to see hard data from the AABB community as to the frequency of events where an ABO discrepancy was detected in the second ABO determination that was not detected in the first ABO determination. More importantly, did the detection of an ABO discrepancy (missed by the first ABO determination) prevent the transfusion of ABO incompatible red blood cells? My responses above assume that the ABO discrepancy was demonstrable by repeat testing of the first blood sample.

Hi Enamul, This is a known "Limitation" of the Vision Analyzer stated in the Operator's Manual-I've added the statement below. "When a sample is collected from a recently transfused patient, the potential exists for the transfused red cells to concentrate after centrifugation at the bottom of the sample tube below their autologous cells. The probe aspirates from the bottom of the tube where the transfused cells generally concentrate which may lead to an unexpected result." We actually have this statement in our SOP as it can be very confusing! ~Ann in CA

Congratulations Malcolm and well deserved. Very happy that you chose to share this with us. It's gratifying when some one in our profession is truly recognized.

This approach becomes very problematic when dual-population (mixed-field agglutination) is observed in ABO/Rh typing in a highly computerized transfusion service. Do you segregate these patients to a manual system on paper or other type of non-standard handling or do you mainstream the patient in the computer system? I prefer to mainstream these situations so that staff are not forced to rarely used manual systems. One of the main tenets that I taught staff was 'to record what you see, not what you think it should be'. So I designed the computer system to make this possible, without exception. For example, if you see dual-population in gel test, that is what you enter into the computer (there are results mnemonics 4+m versus 4+ to differentiate dual-population from uncomplicated agglutination). The computer is configured to reflex additional tests to the sample which prompt user with additional information and questions. If there is a blood type on file (done prior to transfusion) and there are recent ABO/Rh non-identical transfusions, computer will calculate blood type as Rh Positive when Rh Negative red cells are transfused to an Rh Positive recipient that resulted in the observation of dual-population in the anti-D tube of gel card of a post-transfusion blood sample. That's one heck of a run-on sentence. The same thing will occur if a non-group O recipient is transfused with group O red cells. Your computer system may/may not be able to do this.

DTT SOP.pdf This procedure is based on the HemoBioscience SOP and the AABB SOP. Works for us. Prior threads on this topic have indicated that the DTT treated cells will not last long, so we do this only at need.

John, I used the same system, Biologics, Inc, out of Utah. The beauty of this system was that all samples collected by the phlebotomists were labeled with this system. Secondly, the specimen container labels could only be made at the bedside and that the information on the label was generated from a plastic tag (attached to the patient) that was embossed with patient information. This was a mechanical system that has now been mimicked by electronic systems that generate specimen container label from a barcode on the patient wristband. With this type of system, mechanical or electronic, there is no need for a secondary blood bank identification band.

Your reverse cells are probably Rh- and may react with anti c. Using gel will only enhance this reaction since the plasma/cells are in contact for 10+ minutes or more especially if using automation. You probably ran your reverse tube without delay so you did not pick up the anti c. If you incubated your tube reverse B cell at 37 you would probably pick up some reactivity. I have seen this many times especially with anti c.

Would you call that a limitation of the automat? Personally I would not - any more than saying that sampling from the top of the tube is a limitation of manual sampling. It implies that there is a problem and it lies with the automat - when in fact it's a simple manifestation of a biological property of red cells

There is no standard that requires a transfusion to be started within a certain time frame from release. the only timing that is critical is that the unit needs to be complete within 4 hours of release.

Fantastic. Can't say I'm surprised, it's been a honor honour having you here.

Ah yes! Al Chemy! An old school chum of mine. He still owes me $20... Scott

Very simply - NO, NO and NO. It is not for nothing that it is called ....'for donors'. However, just so something else is well understood. Using a card that is 'negative for DVI' does not mean it will be negative for any other Partial D.

NO! Under no circumstances, even if the DAT was negative with anti-C3d (as it usually is in cases of PCH). The titre (Tabbie, you are in the UK, so spell it the correct UK way! ) is of no relevance whatsoever, and knowing it would make no difference to the way the patient is treated.

the same as you would for any other antibody But you need to make sure that if there is an anti-Lea or -Leb present that it is reacting strictly at 37°C. Otherwise no clinical relevance at all

Malcolm, that is so wonderful! What a grand way to cap off a career. Well deserved.

Congratulations!

Agreed! From the 31st Edition of the BBTS Standards: Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor. 5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells.... TRM.40550 Forward/Reverse Typing Phase II For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells. NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping. CAP and AABB are in agreement.

TRM.40200 DAT Controls Phase II When performing an antiglobulin test with anti-IgG or polyspecific antiglobulin reagents, IgG-coated red blood cells are used as a control in all negative antiglobulin tests. NOTE: IgG-coated red blood cells must be used to confirm all negative antiglobulin test results when the antiglobulin reagent used for testing has anti-IgG reactivity. Tests found negative by tube methodology must be verified by obtaining a positive test result after adding IgGcoated (control) red blood cells. If a licensed blood typing system is used that does not require verification of negative test results using IgG-coated red blood cells, an appropriate quality control procedure must be followed, as recommended by the manufacturer. Evidence of Compliance: ✓ Records of testing that include control results confirming negative antiglobulin tests TRM.40210 DAT Phase II When performing an antiglobulin test with anti-C3 antiglobulin reagents, C3-coated red blood cells are used as a control in all negative antiglobulin tests. NOTE: Complement-coated red blood cells must be used to confirm all negative antiglobulin test results when the antiglobulin reagent used for testing has anti-C3 reactivity. Tests found negative by tube methodology must be verified by obtaining a positive test result after adding C3- coated (control) red blood cells. If a licensed blood typing system is used that does not require verification of negative test results using C3-coated red blood cells, an appropriate quality control procedure must be followed, as recommended by the manufacturer. If a polyspecific antiglobulin reagent is used, refer to checklist item TRM.40200. Evidence of Compliance: ✓ Records of testing that include control results confirming negative antiglobulin tests ********************************************************************************************************************************************** I was cited for this years ago. I called CAP and was told that because poly AHG has anti-C3 reactivity as well as anti-IgG reactivity, both had to be confirmed. In addition to this std, she also referred me to the all common checklist which requires that we perform QC on reagents every day of use. So unless the manufacturer of our reagent had some other recommended QC procedure for C3 reactivity, we were required to use the complement coated cells. I put a standing order in for C3 coated cells that day, sent the confirmation email to CAP and my citation was considered corrected on site. I would assume that AABB would view this in a similar way, not to mention CLIA. When we do a DAT, we are looking for both anti-IgG and anti-C3 activity. If the DAT is positive with poly and anti-IgG, that doesn't preclude anti-C3 activity. If you aren't doing QC for the anti-C3 activity of your poly AHG, how can you demonstrate that your reagent is reacting properly? If you send all DATs out to check for C3 activity, then you would only have to QC the anti-IgG activity and your reference lab would be responsible for the C3 activity. Having said all that.....have I ever seen a failure with the C3 activity? Nope and I don't expect to. I've given students anti-C3b, -C3d reagent that's outdated by years and it still works just fine. But that's irrelevant and not how the game is played. We don't do very many DATs, but that's also irrelevant. So, I stock the C3 coated cells. Cost of doing business. I find ways to save in other areas.

How do we survive without a BBIS? Well, it takes a boatload of paperwork and even more time to deal with the paperwork. We've never had a BBIS, so we don't truly know what we're missing (though I have a vivid imagination, did work with a BBIS validation years ago, and I am soooo looking forward to getting SafeTrace Tx up and going - I have been the squeaky wheel for years pushing for a system and they finally said YES ). We've given as many as a thousand units of red cells a year with paper records, though we are currently down to 700ish with patient blood management taking effect. I track products with an Access data base and we had a DOS data base before that . We use report forms built into our LIS - the LIS we are using now and what we were previously using. These are strictly reports, nothing more. All other documentation of testing, etc. is on paper. Prior to that (and not so many years ago) we typed our reports on a typewriter - I kid you not! Our entries in the LIS are made manually from drop down boxes, a minimal number of free text boxes and using barcode scanners for DINs and product codes. We have rules in the LIS to remind staff about required testing. All entries are verified by a second tech and are further reviewed at a later point by myself or a designee. Old school, but it works. The pertinent information passes from our LIS to EPIC, so BPAM works. I wish we were going to use the SafeTrace blood admin module, but that decision was made for us. I stress to every nurse that I talk with about patient ID that the information that BPAM is checking is a manual entry, so is not a guarantee of anything. If something doesn't look right, they are instructed to stop instantly and contact us. The 2 person bedside check of armband and unit tag/bag information that we were doing prior to BPAM is still critical. And our medical director and I meet every new nursing hire for a pep talk in Blood Bank about patient ID, transfusion safety and MTP/emergency release. We pass Joint Commission, CLIA and CAP inspections w/o issue and transfuse our patients safely because I am a well known, absolute DRAGON about following procedures and doing things right! (Did I mention that I can't wait to get SafeTrace up and running ??? )

You are by no means alone John, but (I THINK) most of these acronyms are to do with Information Technology (IT) than actual blood confusion!

We know that Malcolm - I was using the terminology that was existing at the time when Du was being used AND that we did not give RhIg to Du+ individuals then. Besides, whoever heard of anti-Du (not me)? Was it always Weak D in Great Britain? Aside from the Pedantics, what is your take on RhIg for Weak D individuals? I do not routinely perform Weak D testing on maternity patients.

I got this message from a member, and they gave their permission to share. -------------------------------------------------------------------------------------------------------- Dear Cliff, First of all sorry that I haven't react in any way your welcome message, but 4 years ago when I joined the Hungarian Blood Bank and a bit later the Blood Bank Talk community (beeing a logistic expert) I was sure I would never be able to contribute your conversations. You know I had a foggiest idea what blood banking ment at all, and to tell you the truth even now I only guess what the majority of the topics are about. Anyway I thought reading the threads was an excellent chance to practice my English. So I became your diligent reader. Slowly I got acquainted with Malcolm, Deny Morlino, David Saikin, Auntie-D, Mable Adams, and the others and enjoyed so much their communication except for those horrible abbreviations... I must say I am really envy of your profession and the helpfulness and devotion what is so tipical of every single one of you. The event that is accountable for my turning to you is that soon I am leaving the Hungarian BB and continue my career in a business that has nothing to do with blood. I looked for the suitable point on the home-page to unsubscribe the e-mail list, but I failed. As fare as I noticed you are a sort of a system administrator here, so I hope you can solve my problem. I wish all the best to your blood bank community and farewell, Eva Jaszay Budapest PS: If you think so, share my letter with the others, and please forgive me my grammatic mistakes. -------------------------------------------------------------------------------------------------------- Eva, Thank you very much for your kind words, and this is an international forum, don't worry about your grammar enhancements. Cliff

I agree that the zygosity of the cells is the important issue. When institutions started looking at immediate spin crossmatch in lieu of the antiglobulin phase, it became necessary to examine the makeup of the screening cells very closely. Most times it was found that 3 cells were needed to get the desired homozygous cells. That again is the important consideration for an institution using the electronic crossmatch.