Leaderboard

My experience is that interference from rouleaux and cold autoantibodies in Gel is not unusual but this may depend on your patient population. As rouleaux is not an antibody an AHG crossmatch is not required. If you IS crossmatch you must (in my opinion) saline replace so you show any agglutination is interference and can therefore enter a negative/compatible/non-reactive result into your LISS, probably with a comment.

It's not uncommon to see rouleaux interference in Gel testing but it's not something we see frequently. The crossmatch question is interesting: Technically, the screen is negative for alloantibody reactivity so I think you'd be able to follow your procedure for that result. However, with the immediate spin crossmatch, you may have to perform a saline replacement to obtain a "compatible" unit. I wouldn't want to assume an incompatible IS crossmatch is due to the rouleaux without confirming that.

This is where having a transfusion service director who knows something about clinical medicine and hematology comes in very handy. It shouldn't be the medical technologists' job to triage requests. Many transfusions do more harm than good, so it's not that difficult to figure out which patients urgently need transfusion and which can wait, but this requires a knowledgeable and tenacious physician to handle the individual requests and screen them. As a field, pathology has paid little attention to the need for those who can do such tasks, as compared with surgical pathology skills, cytopathology, etc. You may need to involve your institution's hematologist(s), intensivist(s), surgeons and anesthesiologists to help make these decisions if your lab physician(s) aren't up to the task.

The vast majority of trauma patients only need TEG/ROTEM as these are the only assays shown to improve clinical outcomes when used to drive transfusion therapy. For patients who don't respond well (keep bleeding), it's important to have the fibrinogen level, platelet count, PT, PTT as well. The individual factor assays are largely irrelevant and unneeded. Hemophilia A and B are vanishingly rare diseases, and vWF is usually mild to moderate in most patients so individual factor analyses would be needed very uncommonly. A test of platelet function such as the closure time (PFA-100) might be a useful thing to have too, but less relevant in trauma patients.

Then we do not QC new panels aside from visual inspection and any insert changes. Apart from damage in transit it seems any in-house validation is FAR less than the manufacturer must do.

I had in my policy that we would review the Changes to Standards document published by the AABB and document on each change whether it affected us or not. (We did not draw donors so we just reviewed and put those changes as not applicable.). If we were already in compliance with the change, we would document no change in policy required with the policy number. If a policy had to be updated, we documented when the updates, training, etc were completed. The Medical Director signed this review and we kept it with our policies.

Personally, I would consider this extensive QC and not validation. There really is a difference. There truly are things that can not be reasonably or realistically validated in the clinical setting, antibody panels and antibody screens are just 2 of them and for the same reasons. I think I'll stop there.

You are a cruel man John.

It snowed outside my window Saturday. I prefer the snow in this window actually.

And Happy Boxing Day! Scott

Dang! I should have slipped in "probably is an A1 individual". (You are very alert for a Monday morning!) Donna

Can't answer that one John. From the ER.

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

We issue Group A Plasma (or whatever is shortest outdate as long as it is not Group O) until we have a BB Specimen and the ABO/Rh is verified. Then we switch to ABO compatible/specific. The expiration date of the specimen does not apply to non RBC containing blood products, so as long as the patient is wearing the corresponding BB Band, we will issue Plasma, Platelets and/or Cryo. I agree, the non-ABO match allogenic stem cell transplant recipients are a challenge, but as someone pointed out in an earlier post, these patients become obvious and we can deal with their 'new' blood type 'in the moment' according to our current protocol.

We require a ABO/Rh specimen for the current admission.

The other hospitals in our system do not require a current specimen. We don't do it at our hospital. I worry since I have seen it too often someone using a relative's Health Insurance Card and having a complete different type. We don't need a specimen though form 3 days. If they have had a specimen during the stay, we will thaw plasma.

I just answered this question. My Score PASS  

Yes. Last month we implemented a trial program where our supplier got our standing orders from another location. We are a very large facility and our standing order is at least 100 RBCs a day. During the beginning of the trial (no returns allowed) we quickly got oversupplied, at one point we hit twice our optimum level. Our O Neg inventory was unethical. The supplier agreed to take back some of the units because there was a glitch in the cancelling process. I insisted they also take back some of the O Neg. Sorry, I hope you don't feel I was blaming any suppliers. I do not envy the job you have, it must be really hard keeping a facility like us, and the rest of the country, happy.

I believe newborn and maternal red blood cells do not have exactly the same density. So, on 2 different sampling even from the same tube of packed cells, you may have diff. proportions of maternal vs newborn red blood cells. It is the same in case of transfusion, as transfused cells are heavier, depending on the way RBCs are sampled (bottom/middle/top of packed cells) you may have diff. results/pictures (DP, no DP...).

We purchased bins from VWR International. They are manufactured by AKRO MILS if you want to check their website: https://akro-mils.com/ They are inexpensive and come in various colors: Red, Blue, Clear, White and many sizes. We got Item# 75854-808 ... a case of 12 clear, 4" tall x 11.625" deep x 6.625" wide. 6 fill one of our drawers (3 in front, 3 behind them) very nicely. If you message me, I'll tell you the price (very reasonable). They sell dividers for them, too ... again, in the same colors. We also use them for our reagents. We stole the idea from Chemistry, by the way, so I can't take all the credit for this idea.

In general, an MTP policy is set up between ER, OR and the Lab. Here it was the OR and ER physicians who decided what it should include. We started with an MTP partly directed by lab results, but found it unnecessarily cumbersome in practice. For our BB, an MTP includes setting up sets of blood products until the MTP is called off. If you search here with the word "massive" you will see a number of threads that may give you a few ideas. Scott

I think you mean standard 5.19.7. At other places we would split units. Since I don't have that capability presently I would recommend infusing half a unit over 4 hours. I'd also get my Medical Director involved.

We only QC the antibody panels, both for pos and neg reactions, when they are being put into use--specifically to make sure they were not "damaged in transit". Scott

Not sure if this response is too late. After your new hires receive 6 weeks training and pass the test are they then expected to be competent in your blood Bank? What exactly are they expected to be able to deal with? My opinion (and experience in a similar setting) is that you have trained your new hires in the theory of your Blood Bank; the next 3 (probably more) months will/should provide practical training in how to use those skills in practice, increasing complexity and especially under pressure.

I just answered this question. My Score PASS  

And Happy New Year! If you are off on New Year's Eve....please celebrate, but responsibly so that you are not one of those dreaded MTPs!!!

If I remember correctly, we QC'd new panels on the day we received them and then each day of use (daily for us). I started doing that 9 years before David and never had an issue with any inspecting/accrediting agency.

I would agree completely with these statements (especially #1). If it was me I would remove the requirement to check the pH from your SOP.

I believe the topic -- QC for panel cells -- has been discussed a few times here on Pathlabtalk. As far as "validation", not sure you need anything beyond what the manufacturer suggests. And I think Ortho only mentions QC. Scott

Within NHSBT in the UK, and despite the fact that the commercial antibody panels were tested centrally, we ALWAYS performed validation of these panels (and, indeed those produced by NHSBT itself) before they were put into use, to ensure that they had not been "damaged" in transit. We then QC'ed them twice a day when in use with weak anti-D, weak anti-c, weak anti-K and weak anti-Fya. We took no risks. There was little or no risk involved with patients' samples. There was a HUGE risk with the accreditation people who inspected us (usually, with little or no knowledge of blood group serology), as they had the power to shut us down (see my previous phrase in brackets).

And to you too MyHerpesItch. Well, yes and no! EDTA certainly does chelate Ca++, but it also chelates Mn++ and Mg++, and all three are required as co-factors for the Classical Complement Pathway, rather than actually being part of complement, which is why you don't see immune-mediated haemolysis.

That is very sad. The final decision should depend upon a clinical discussion between the pediatricians, who know about babies, and the pathologists, who know about the value of the test results. No one discipline knows everything about everything.

Are you using solid phase by any chance? We have seen solid phase does that, since a lot of our hospital used solid phase method. When that happened, we usually look for antibodies using PeG Tube method or by testing ficin-treated cells. We were usually able to find the suspected antibod(-ies) except for Kidd antibodies. You may be looking at some method-dependent antibody? Anti-C in your 2nd sample may be stronger than that in your first sample? What is the patient's ethinicity? Is the patient e- or e+? I am also thinking about anti-Ce like antibodies if you see this anti-C reacting stronger with e+ cells than e- cells.

Ya, Malcolm. I can think of a few other situations where this may not be the best policy. When requested by physicians, we have done eluates on compliment-only positive DATs where we ID antibodies, showing that one can have a "false IgG negative" DAT in certain situations. Anyway, in most cases we would repeat the eluate if, in the first place, we identified that an allo-Ab was present on the patient's cells. But as for initially negative eluates, if a repeat DAT is still positive but not stronger than the previous, we would not bother with another eluate. The idea being that if the patient is producing a significant amount of antibody, the DAT reaction would be stronger. Scott

1. We will perform an elution with a positive DAT within 3 months of a transfusion, BUT, will also perform elutions on other cases (even if the DAT is negative) if the clinical symptoms give us reasons to suspect that an elution may be of help. Nothing in the world of blood transfusion is pure black or white. 2. Normally, we use the acid elution technique, but will, occasionally use the Lui technique. 3. Usually, but not exclusively, gel IAT. 4. Full panel, as a minimum, but may include A1 and/or B cells, and others as required partner's red cells in the case of a suspected case of HDFN due to an antibody directed against a low prevalence antigen). 5. I can't think of any - YET!!!!!!!!!!!!!!!!

What I was saying is that, if a "mixed-field" ABO reaction was regularly due to there being a mixture of maternal (presumably group O) blood and baby (presumably A, B or AB) blood, then if a Kleihauer test were to be performed on these samples, you would see a substantial number of ghost (maternal) red cells in the film, in which the HbA has been destroyed - and you don't. This proves that, in most cases where a "mixed-field" ABO reaction is seen with cord blood, all (or the vast majority) of the red cells are from the baby, with HbF intact, and staining with the eosin. I've just re-read this, and I think I could have written this more clearly, but the problem is that "I know what I mean"!!!!!!!!!!!!

Yes thanks Terri, she's back home now and feeling fine - although I suspect that once the shock wears off, it will be mighty painful. Have no fears for me - she will never read the post about the dinner. If she does, PathLabTalk will have one less member!!!!!!!!!!!!!!!!!!!!!!!!!!

Oh no...hope your wife is OK, Malcolm. And I hope for your sake that she does not EVER see your comment about your dinner.

Actually, I have to disagree L106, as, if the anti-A1 being used is Dolichos biflorus, this lectin will also detect Tn activation and Cad polyagglutinability - both highly unlikely, but both possible. Sorry!

I only use the A1 lectin if I am dealing with a reverse grouping discrepany (grA backtypes as an O).

Certainly, in the UK, this is not, to say the least, a routine procedure.

I'm SO glad we don't have one of these. OK: chart/alarm shows temp stayed within range, temp was recorded once during the day. Keep the blood. Not OK: chart/alarm shows temp stayed within range, temp was not recorded once during the day. Throw away the blood. I kind of like Dave's point "Better to eat them and use the incident as a means for better compliance with regulations." However, I don't see a difference in how the blood was stored in the 2 scenarios, aside from a note on a logsheet, so I side with goodchild and kirkaw. The real issue, as Dave continued, is that the units could have been taken out of the fridge, sat and cooked for half a day on a counter, then put back in. In either scenario you wouldn't know it. There's my non-answer. Throw them away if you want to make a point to the OR, but I see no difference in safety whether someone recorded a random temp or not.

Just trying to get an idea of how many Transfusion Services are having a second specimen collected when the patient has no historical group & type. We are trying to implement this in our facility as a safety feature, not as part of an e crossmatch implementation. Thank you.

My first question is: is the ICU refrigerator an acceptable devise for the storage of blood products? If not that should stop immediately. If so, then I suggest that any syringe loaded in the OR be discarded in the OR if not transfused in OR. If the unit goes with the patient to ICU then they could load a fresh syringe on an as needed basis in the ICU. This could still be done with out refrigeration for the 4 hours the unit has for complete transfusion. The problem is training the ICU staff to understand the limitations. While blood is, indeed a precious commodity, the risk it to great to the patients under the circumstances you have described. If there were more than one patient in the ICU with a syringe in the refirgerator..... I'm sure you can imagine all the possibilities. Good Luck. In my experience anesthesiologists can be amoung the most difficult to deal with. :abduction :abduction