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Also, were any of the transfused units antigen positive? This is the quickest way to get a negative indirect antiglobulin test ;).

My greatest apology for leaving you all hanging. We've been so incredibly busy and short-staffed that I could not even think about anything else but trying to finish up my daily duties. Anyway, seems that the patient also had an impella device that had to be "adjusted" and I believe that corrected the hemolysis. I'm only reading the responses today (2 weeks later)☹️so hats off to you all who thought mechanical causes. I would have not thought that the device would be that far-off to cause the gross hemolysis we saw. We do see slight hemolysis with impella devices but not like this one. I guess never say never. Thank you all for your responses.

What? All this time I have been using the wrong stuff! Ha! SPELL CHECK IS NOT YOUR FRIEND! 🤣🤣🤣🤣

Um, sorry Jason, but I think you mean Dithiothreitol (DTT), rather than Dichlorodiphenyltrichloroethane (DDT)!!!!!!!

I rarely post about me, or my family. I was raised by a single mom from 2 until I was about 10. That was probably really hard for her in the 60s. Whenever I ask her, she just says it wasn't so hard. We had a lot of roommates to help with the cost of apartments, one was Georganne (Giorgi Baino Sr.). She seemed to be around the longest. I really liked her, she was like an aunt to me. Maybe 10 or more years ago, we got back in touch - Sadly, just on Facebook. I am going to try to have a video chat with her to catch up. Anyhow, it seems my mom wrote a poem about me when I was a kid, and Georganne has always played guitar. The song was about me riding bikes, I never heard it until yesterday. For those that know me, you know I've been a cyclist (avid at times) for the last 15 years. She put the poem to music and sent it to me yesterday. I cried. Here it is if you're interested. I cried.

I agree Darin, it is almost certainly a dilutional effect, BUT, it could also be the effect of a soluble antigen (obviously not within the Duffy Blood Group System). If the antibody had a specificity within, for example, the Lewis Blood Group System, or the Chido/Rodgers Blood Group System, the antigen in the plasma could well adsorb out the circulating antibody. That having been said, this explanation is FAR less likely than your suggestion of the dilutional effect.

AGREED - and killing the patient in some circumstances!!!!!!!!!!!!!!!!!!

How many units of uncrossmatched blood did they receive? How active were they bleeding? How much later did the other hospital preform their own T&S? Inquiring minds want to know!!! 😉

Thanks for all your input

We did a Plasma Exchange recently on a patient 5 days in a row with approximately 10-12 units of FFP each time. On day 3, the band expired and we retested the new sample to find the previous antibody had disappeared. It's a dilutional effect where the titer is dropped below detectable levels.

Question to those wiser than I. Is the primary reason for these required validation comparisons to ensure we in the lab know how to follow the package inserts and so use the reagents correctly? I ask because I can't imagine any lab will be able to test the reagents to the level the manufacturer can with respect to numbers and variants (see package insert).

Your policy (to draw and test your own specimen) is the strictest interpretation of the standards (and one that most blood banks likely follow), but I do believe you'll find systems that share MRNs, share LIS, share policy & procedure (may even share technical staff) that will use pretransfusion results performed in blood bank A to transfuse the patient at location B by technical staff in blood bank B and are doing so within AABB and CAP standards. All that is to say, I don't think you'll find a standard that explicitly says you have to draw and test your own specimen at your own physical location. We come to that conclusion because of all the other standards.

Today is Biomedical Scientist Day 2025 UK. I would like to wish best wishes to all laboratory staff throughout the world.

We have seen this phenomenon from time to time, albeit rarely. We use R1wR1 red cells with all of our antibody identifications, purely because it is always cell 1 in the panel! We also, however, use two R1R1 panel cells and an r'r panel cell. I'm not too sure why we get the odd sample that reacts like that, because the C antigen on the R1wR1 panel cell is not that much weaker than the C antigen on the R1R1 panel cells, and certainly no weaker than that on the r'r panel cells. Remember that the "w" of "Cw" stands for "Willis", and not "weak", as it was named after the donor who caused the immunisation to the antigen in the first example of anti-Cw described (something I forgot a few years back in an article I wrote, much to my embarrassment, if that is any solace to you) and that RH8 (RHCw) is allelic to both RH9 (RHCx) and RH51 (MAR), and not to either RH2 (RHC) or RH4 (RHc). Therefore, any weakening must be due to steric hinderance, or something similar. :confuse::confuse:

Thanks to the recent publications sent by @Malcolm Needs I knew this one! 😊

We do not have Meditech anymore, but when we did, we would create a worksheet in BBK worksheets. At first it seemed complicated but it worked out well in the end. Specially because we did not have to save paper QC for inspectors. I would just download a file to my desktop daily.

I just answered this question. My Score PASS  

Sounds like a dilutional effect. How big is the patient and how much plasma/platelets did the patient receive during the time frame between blood draws? I have seen this with massively transfused patients and with plasma pheresis patients and with patients who have received multiple products over a few days.

Several units of blood and plasma, in fact an MTP was called. Patient was actively bleeding.

We do BB QC in Meditech (we are in 6.x). I would not have it any other way!! I had to build it, but can pull reports, make it flag out of range QC and it is downloadable so you don't have to keep paper copies.

That's really awesome and thank you for sharing! 😊 I also used to be an avid cyclist / endurance racer and have great memories of those times. Races such as the Vail 100, Brian Head 100 and 24-hour races were my "jam" during those years.

My question would be - how strong was the pre-transfusion reactivity? If it was only 1-2+ in SP / and the patient isn't a "larger" person, I personally would suspect that the antibody titer was diluted to such a degree that SP did not pick it up anymore....... (but I REALLY don't like SP.....it's just too wishy-washy.....JMHO)

Happy Birthday! 🎂

Happy Birthday to all, including our fearless leader Cliff🎂🎆

Like @Bet'naSBB said, there's really no easy answer. My first response is ALWAYS, check with the manufacturer to see if they have documents or guidance. Then, read the package inserts, they may have info. Then, barring anything definitive from above, you and your medical director need to review your patient population and determine how many of each type of patient you want to test. Do you have a lot of antibody patients? Do you treat cancer patients?

Definitely!

I actually didn't have to google the answer for this one! I knew that Landsteiner discovered ABO typing at the beginning of the 20th century :)

In our facilities, it also has to do with the Cost Center. Even if they transfer with the same MRN/FIN, our "Mother" hospital cuts off the band and repeats testing.

(Slightly paraphrased from the Guidance to the 34th Edition of AABB Standards for Blood Banks and Transfusion Services) AABB Standard 5.14.8 requires that there be 2 determinations of a recipients ABO group..... the first determination must be on a current sample and the second determination may be determined by one of the following methods: 1) comparison with previous records 2) testing a second sample collected at a time different from the first sample 3) retesting the same sample if the patient identification was verified at the time of sample collection using an electronic identification system. CAP standards (12/2024) Changes to Standards clarifies the requirement even further: "In the transfusion medicine checklist, TRM.40300 Historical Record Check says ABO, Rh, and antibody screen test results must be compared with results of the same tests recorded previously to detect discrepancies and identify patients requiring specially selected units. “New language was added to this existing requirement to clarify what is acceptable ABO and Rh historical records,” says Matthew Karafin, MD, MS, chair of the CAP Transfusion, Apheresis, and Cellular Therapy Committee and clinical professor of transfusion medicine services at the University of North Carolina at Chapel Hill. The revised requirement now says the acceptable ABO and Rh historical records for transfusion purposes are only those generated or entered by laboratory personnel into the health system’s laboratory information system and performed by an accredited lab or certified by the relevant government agency in its jurisdiction. “We learned that assessors have encountered facilities that were using blood types from other institutions, such as from Epic Care Everywhere,” Dr. Karafin says. “Moreover, we were made aware that blood typing information from these other institutions was sometimes being added by non-blood bank personnel, so we had concerns about the reliability of this information.” For patient safety, the CAP wants to ensure that the ABO and Rh used for transfusion are the ones that laboratory personnel have entered into an LIS. This “implies that a transfusion service reviewed the information and was responsible for its data entry,” Dr. Karafin says."

I don't think there is a requirement to share between hospitals, only that a search of previous records was performed for ABO/Rh and antibody screen. The lab needs to define how they will perform the search. The reasoning that labs use 2 types is a. to limit mistransfusion events and b. to use electronic crossmatch. You don't need 2 types is you aren't using electronic crossmatch and if you use other ways to reduce mistransfusion risks- you can always use immediate spin to allocate type specific blood. To use a type from another hospital, personally, I would want the testing/results to show up in my LIS automatically, and know that my lab and the other lab follow the same policies for patient ID, labeling, testing, etc. TRM.40300 Historical Record Check TRM.40670 ABO Group and Rh(D) Type Verification TRM.30550 Misidentification and Mistransfusion Risk Monitoring TRM.30575 Mistransfusion Risk Reduction

I think this is the key: Is initial testing at that ED is under one patient identifier/armband and the testing at your facility under a completely different patient identifier/armband? It's less about the testing, more about the patient identification. From CAP: TRM.40230 Specimen Labeling for Pretransfusion Testing Phase II All blood samples used for pretransfusion testing are labeled at the time of specimen collection in the presence of the patient with: 1. Patient's first and last name 2. Unique identification number 3. Date of collection 4. A method to identify the individual collecting the specimen. NOTE: Blood specimens collected for pretransfusion testing must be positively and completely identified and labeled before leaving the patient. Acceptable practices for positive identification of patient and blood specimen labels must be defined in the procedure manual and may include visual inspection and/or an electronic system to read the identifying information contained in bar codes or radio-frequency identification (RFID) microchips or the patient's wristband. Acceptable practices for generating specimen labels must be defined in the procedure manual (refer to GEN.40490) and may include electronic devices utilizing information encoded in bar codes or RFID microchips. There must be a dependable method to identify the individual who collected the blood specimen, such as initials or another identifier on the tube, or an electronic record. Evidence of Compliance ✓ Properly labeled blood specimens AND ✓ Records identifying the individual collecting pretransfusion testing specimens

In my opinion, if you have: A cold antibody (not pathological), and Have done the workup to show that there is no other antibody present (i.e. a clinically significant antibody such as anti-E), and Your LIS dictionary set up so that your reported antibody is not deemed as clinically significant You can set it up so that the computer (electronic) crossmatch can be used. If it is a pathological antibody, we use incompatible (i.e. Least incompatible in Meditech)

At our facility, we have to do a cold adsorption IF the cold auto interferes with the reverse and/or ISXM. Since testing with "neat" plasma is our standard of practice, we would still report the XM as incompatible and send it out with a release stating the incompatibility was due to an autoantibody. We are not "allowed" to prewarm away IS reactions. 🥶 IF we prewarm - it's only if the cold has a high thermal amplitude and causes interference after 37deg incubation / antiglobulin phase...........but that's just us.........

Are you doing the immediate spin for a crossmatch or antibody screen? Well, we use the prewarm method for Cold agglutinins. We enter the results to the prewarm technique which is Negative, so the computer doesn't have a cow. Then we write in the test comments that the prewarm technique was used due to cold agglutinin, or history of cold agglutinin.

I leave that for the physicians to respond to, but I suspect that since there will be lingering lymphocytes, no, they would not be protected. I, too, was part of a large level 1 trauma center. Our inventory was typically 700 - 1,000 RBCs. We were 100% irradiated. Once they were received, they went right into the irradiator room (we had a double door fridge in there. We usually had someone in irradiating most of the first and second shift, we had two old cesium irradiators. It was very hard to keep up. We looked into getting two x-ray irradiators, but it was cost-prohibitive, even with the government program where they would take the cesium ones away and pay for half the cost of the new ones.

It is most unlikely to be anti-f, as this specificity will not react with either R1R1 or R2R2 red cells (I presume that you are using both antibody screening cells and antibody identification panel cells that have these phenotypes represented). Anti-f reacts with red cells where the c and e antigens are the result of an RHCE*ce haplotype where, for want of a better way of putting it, the c and e antigens are the result of the RHc and RHe genes being in the cis position - NOTE THAT THIS TERMINOLOGY IS (KNOWINGLY) WRONG! Like all Rh antibodies, anti-f reacts most strongly with its cognate antigen on red cells that have been treated with a proteolytic enzyme (such as papain or ficin), but will very often react with untreated red cells by IAT.