Leaderboard

Very proud to have received this through the post earlier this week, to go with being elected to Fellowship of the British Blood Transfusion Society earlier this year.

My personal system was virtually identical to yours except for the the reverse type I used JH-RA and JH-RB. In the facilities where I was the Transfusion Service or Blood Bank supervisor my tube labeling requirement for the staff was that anyone in the department could set down an take over the testing and know who and what was in each tube.

We understand what happened. We received the patient 12 hours before this transfusion. Despite having denied previous transfusions, we contacted the health service of origin who informed us that he had transfused platelets in pool (600 ML) the group O. Therefore, we believe that the reaction after red blood cell transfusion was a coincidence, and the anti-B of the transfused platelets must be the cause of hemolysis.

Tests on the adsorbed serum (with ZZAP-treated cells) give confidence that the are no underlying alloantibodies to common antigens. However, the use of allogeneic cells risks removal of a cold-reactive alloantibody to a high incidence antigen, e.g. anti-Vel, -PP1pK. A low risk, but still concerning. Does you facility also test the ZZAP-treated patient cells (now presumably DAT-negative) back against the patient's own serum ? This is ultimate proof that the cold-reactive antibody is an AUTOantibody and adds more confidence in the results of the adsorption with allogenic cells. I may b

I do as David does - a note to indicate that the patient is a Jehovah's Witness. If the patient has accepted plasma but not red cells, I will also note that. Saves them a bill for an unwanted crossmatch sometimes if I can notify the provider that he/she should discuss transfusion with the patient before we perform testing to set up red cells for them. (And yes, I think that providers should discuss transfusion with their patients, ideally before ordering the products, but we know that the real world doesn't always work that way.)

So if you first saw anti-D when she was 20 weeks pregnant and she is now 30+ weeks pregnant, have you compared the strength of the anti-D then and now? If the anti-D was due to injection it will have decreased somewhat. If it has risen or stayed stable the chances are that it is real. Also, I have to say, I do find the comment: I am under the impression that she is homeless and have very poor antenatal care. I could be wrong though. She probably likes dressing like a homeless person a bit flippant and very insulting. If she is homeless, or too poor to buy decent clothes, where is yo

Just as a matter of interest, were the samples tested by the Blood Bank for compatibility EDTA samples? If so, it might be worthwhile testing a clotted sample (i.e., using serum in the tests, rather than plasma) and using broad spectrum AHG. It would be highly unusual, but it could be an antibody specificity (such as an anti-Vel) that requires active complement to be detected.

We validated using Anti-C3 in a Neutral Gel card.

Yes on every question except the 2u limit. If we have verified the ABO Group and we need to use 'incompatible' plasma (i.e. emergency), we use our Emergency Release Protocol, e.g. MD signs for it. If you want to view our policy, please message me.

There are many plasma proteins that can cause allergic reactions. Transfusing washed cellular products frequently prevents additional reactions. In addition, there have been several case reports of a donor consuming an allergen (peanut butter is classic) before donating. The recipient who is sensitive subsequently has an allergic reaction. One that comes to mind was well documented in the NEJM. And of course don’t forget the controversial IgA deficient patient allergic reactions.

Patient first and last initials and reagent in the tube so for blood type it would be: JH-A, JH-B, JH-D, JH-DC for the front type and JH-AC, JH-BC for the reverse type.

If you are talking about tube tests, I label A,B,D,Dct, a,b. ABSC: 1, 2, 3. With the pt initials underneath.

I'm a huge fan of dedicated BB staff for larger facilities. Currently, only day shift is comprised of dedicated staff and 2nd and 3rd shift manned by generalists who work in at least one other specialty. With a 6 on/8 off schedule, some of the 3rd shift work only 1-2 days per month and are VERY uncomfortable given that we are a Level 1 trauma center, large outreach services and serve as the "reference" Blood Bank for 7 other satellite hospitals. Turnover is a problem on 3rd shift because of the extra stress caused by only being scheduled 1-2 days per month and being responsible for at least h

True, but I suppose we can also say that there has been years and years worth of testing performed that way with no evidence of harm reported from the practice.

It definitely should be a part of the medical record, electronic or otherwise. No need for BB to keep the document - medical record. I'd put a note on the patient record card/BBIS for future reference.

Usually, pre-natal Rh Immune Globulin is given at 28 weeks gestation. She should have received it if she is seeing her OB regularly. Maybe she is confused?

Our facility uses MobiLab. This system prints labels after scanning the patient identification band. The specimens are then labeled at the patient bedside when collected. We have Meditech that uses Bar-coded Transfusion Administration. Nurses scan the patient ID band and unit identifiers (DIN, Product, and Blood Type barcode labels). If something doesn't match, an error message pops up to return the product to the blood bank. This system is used for all transfusions except some emergencies (i.e., Massive Transfusion Protocols). It works very well. In the past, we used Biologics wristb

There is a very good reason why "generalists" avoid Blood Bank and transfusion medicine - it's complicated and you need a lot of specific training to do it well. Even today, with a significant level of automation, a warm body is often needed to interpret results and give recommendations. And then add the fact that there is a seemingly endless list of "exceptions", "equivocal", "indeterminate", and other levels of results that confound even a trained (SBB) person, let alone an "every other weekend, third shift" employee. Cross-training is a must for very small, low volume facilities. No qu

I think this is highly dangerous, and I also think that your Pathologist should tell your "LEAN" department to butt out, if you will excuse the language.

I just answered this question. My Score PASS  

This is a CAP and AABB requirement. We get a new tube on any inpatient, OR patient, or ED patient whether they are getting blood or not. That way if they do need blood, we already have the second type. The tube should be drawn by a second person at a different time.

OK, not Rh, but D. We were using solid phase technology and recently switched to gel (IH-1000). We've had a policy for many years, if you test less than 2+, we call you Rh Neg. Now with gel, people who were 1+ are testing 2 or 3+. This is concerning for OB patients. Do we give Rh immune globulin or not? We've sent a few of these out for genetic testing to determine if they are capable of forming an anti-D, but if they've just delivered an Rh pos baby, and we don't get the results back for weeks, it's too late. We are a big organization and have a very active labor un

I just answered this question. My Score PASS  

Yes.

We used the carryover validation exercise provided by Immucor when we received our instrument. No problems with CAP.

Welcome TomEd.

Congratulations!!!! Malcolm well deserved.

We use combo gel card IgG/C3 In case the result negative is great. if the result positive then we do tube method IGg and(C3b,-C3d).

With the COVID pandemic, my institution demoted me and resulted in a significant pay cut. I decided to leave and go where I feel welcomed and valued for my 30+ years of experience in BB and as a generalist, LIS and manager. I have been on call, even during my vacations for over 5 years, coming in the middle of the night, holidays and weekends. I am leaving a no one is trained to do elutions, Ob titers, Dara protocol and master log review. I feel bad, but administration seems to realize nor care that I am just leaving an empty opening in the schedule! I have read all the previous postings from

Especially if the beast in question is largely IgM.

Sorry Malcolm, I was referring to women who are D pos R1R1, given rr in an emergency and then develop anti-c! We wouldn't have time to Rh/K type or match these patients before the provision of emergency units, which are selected to be O Negative, K negative to protect against anti-D and anti-K, but we're a bit limited in protecting against anti-c.

Could you be more specific? Are you asking about units, or whether results need to be verified?

Personally, I would give Rh and K-matched to all females from the age of 0 until the official age when they are "no longer of child-bearing potential" (this differs from country to country and, indeed, from individual to individual, but most countries "state an age"), unless there are extenuating circumstances, such as either an incredibly rare Rh phenotype or an incredibly rare Kell type, when "matched blood" may not be available, or may not be available in the time required. There is a theory that if "unmatched blood" (Rh and K of course, NOT ABO!) in the first few days/weeks/months of

When I was working in a hospital, very rarely, we did.

Congratulations Malcolm!

NONE!

When I first joined the wonderful world of blood transfusion, with particular reference to blood group serology, at the International Blood Group Reference Laboratory, when it was in London, my mentors were Dr Carolyn Giles and Joyce Poole. In those days, yes, we did use microscopes (albeit with very little magnification) and, given that we were using human-derived antisera, and the fact that I was anxious not to miss anything, I often got Joyce to check my sightings down the microscope. These were invariably "kissing cells", as you suggest, and Joyce christened them "Malcolm weaks", a term

I don't believe that an optical aid necessarily refers to a microscope. In my pre-retirement years we used the agglutination viewer when an optical aid was required. Example: https://www.fishersci.com/shop/products/fisherbrand-tube-agglutination-viewer-5-watt-bulb-w-magnifying-mirror/22363560

Hope this is okay to post administrators, but I have been asked to publicise the MHRA Discussion Forum, especially for members of PathLabTalk who are either UK citizens, or who are working in a laboratory inspected by the MHRA. The address is forums.mhra.gov.uk/forumdisplay.php?60-Blood-Forum. You can go on there anonymously and ask virtually any questions you like concerning their inspections, quality, haemovigilance and SABRE, and a whole lot of other subjects. This will also help the UK TLC group (of which I am currently a member) formulate their standards. Lastly, you have

After a lot of reading and deliberation, here is what we ended with. Testing of Male Patients and Female Patients ≥ 56 Interpret according to Rh Tube Test SOP. Follow discrepancies as outlined for women below, except for sending for molecular testing. Testing of Female Patients < 56 For newly tested women less than 56, if result is 0, testing is complete. If > 0 but < 2+, interpret as Rh neg and perform Rh molecular testing. Notify a supervisor to have molecular testing performed. If ≥ 2+, interpret as Rh pos. This is for all women less than

I too think it is 16% for pregnancy Mabel. The lower number is because not all foetuses will be ABO compatible with the mother, and so her ABO antibodies will destroy the red cells in a small FMH, and, of course, not all pregnancies result in an FMH. In transfusions, however, the units given will be ABO compatible (or so we would hope!) and so the dose of D Positive red cells will be a great deal bigger than an FMH, and will not be destroyed by the recipient's ABO antibodies, so they stay in the circulation a lot longer.

I would just like to add one 'grain of salt' to this debate. You cannot detect all D variants - whether D weaks or partial Ds by serological methods alone. Neither D weaks or Partial Ds behave in a way that allow one to say that all D weaks or partial Ds react with such and such a strength. You will always miss some. You will miss some D+ donors because their D antigen is so weak that it is not detected by even the most sensitive of routine serological tests - or because despite using at least two different monoclonals the donor has an extremely unusual variant that is detected by neither.

An EXCELLENT question Darren ! I look forward to some interesting debate.

NO! I am a professional blood group sereologist!

We have dedicated blood bankers on each shift. This was suggested to us by an FDA inspector. We supplement with generalists on evenings and nights.

I too am the only dedicated Blood Banker . I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists. I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training. They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school. It takes years to become a

Staffing in NYS labs right now is reaching catastrophic levels. Can't even find generalists.

Thanks, Brenda! I feel the same way. No matter how good a procedure, you have to understand the process enough to open it.

Well said.

Our "LEAN" department makes us use everyone. In my opinion-this has cost us quality. Not a good idea to have a casually trained tech working-no SBB in charge for reviews.