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I have never heard of any such requirement but like Kathyang I have seen studies indicating that anything over 10 hours was not a good thing. The last 14 months I worked is was Friday, Saturday and Sunday from 1800 to 0600. It was a small hospital and I was not consistently busy by any stretch of the imagination but I can tell you that the last 2 hours were the most difficult. That may have be age related more than anything else. Having spent many years in facilities where the nurses in the most critical areas (ICU and ER) work 12 hours shifts, most of the nurse related mistakes I had to deal with as Transfusion Supervisor were with those nurses.

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 56, not just OB patients. Discrepancy Resolution What is a discrepancy? Let’s keep it simple. Regardless of what methodology was used for their previous type, if it was interpreted differently than the SOP says to interpret it now, it’s discrepant. If we get conflicting info from an outside facility, or the patient themselves, it’s discrepant. Discrepant is defined as: Rh pos when previously resulted as Rh neg, or Rh neg when previously resulted as Rh pos (at BWH, at any other institution, or per patient history.). For Male Patients and Female Patients ≥ 56, follow the Rh Discrepancies chart in Rh Tube Test SOP. For women < 56 with a discrepant result, interpret as Rh Neg. Notify a supervisor to have molecular testing performed.

:Raises hand: Yep, I'm the Blood Bank and Coag supervisor at my facility, assist with POC and charge entry, plus spend ~50% of my time in Chemistry. The reality is I'm less knowledgeable than a Blood Bank bench tech at a medium sized facility just due to the lack of volumes we see. The majority of my 'supervisor' time is spent making sure we're CAP compliant and trying to put out the small fires that arise from having a staff that just doesn't do blood banking very often. At a small facility you end up with your hand in as many pies as you want, but there's just no way to be as proficient at each as you could if you were able to devote 40 hours per week to one thing. For reference we transfuse about 300 units yearly, don't do any antibody ID's, and a simple cold agglutinin was enough to upend one of our Tech's whole routine for a day. It's just the reality when your entire staff is 7 or 8 people, half of whom are MLT's that graduated in the last few years.

You may be interested in "Strategies to identify candidates for D variant genotyping" by Luo, Keller, et. al. (Blood Transfus 2018; 16: 293-301). Our facility currently uses BioRad Anti-D via tube testing. If an OB patient reacts 1+ or less at immediate spin we send the patient out for Weak D molecular testing. We just got an Ortho Vision, so I am looking at implementing the strategies outlined in the paper to help identify those Weak or Partial D patients.

I've used 9 segments from an Rh neg unit plus 1 segment from an Rh pos unit with about 6-8 drops of anti-D. Let that concoction incubate at 37 C for 15 or 20 minutes. I washed the sample once or twice to remove some of the anti-D, then handed it off to the student. When they followed our SOP, the sample worked just fine. I'm sure you could do something similar w/ different antisera, but I've never tried. I just needed to teach the method, not evaluate for a competency.

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In my case, working in a Reference Laboratory, we usually have to work on the sample that is sent, which is usually the cord.

So they don’t forget?!

For donors; molecular testing provides a full predicted phenotype which becomes their historical phenotype. To send out labelled antigen negative units they need to be serologically confirmed. If there is no anti sera it will be labelled to that effect I.e. “historically negative by molecular methods”. This will efficiently provide the supplier more combinations of antigen negative units. Though they will proberbly still screen for the Rh and only send out if good. Another very important and useful part of the information molecular testing provides is the antigen variant information for both donor and patient (several other threads on this!). Also If the volume sent out is high enough it may be less expensive and provide more information than the usual full serological phenotype.

Hello Pmanager, ISBT 128 does not preclude the use of an additional label on top of the ISBT 128 label, such as the “Irradiated” label you referenced, as long as it does not obscure/cover any of the ISBT 128 information. I hope this helps! Kind Regards, Kaytee from ICCBBA (Organization that maintains and develops the ISBT 128 Coding and Labeling Information Standard)

Blood bank specimens here require 2 patient identifiers plus a sticker from a blood bank armband that is directly attached to a patient appendage. Our required identifiers for inpatients are full name and MR#. The labels that print at bedside include the birthdate, but birthdate is not a required identifier. We do, however, use birthdate as one possible patient identifier for outpatients. Specimens from outside clinics for reference work (prenatal panels) are acceptable with the name and a birthdate. We've stuck with our blood bank armbands because we've watched how some patients have gotten armbanded on the floor...staff member walks into room and slaps on band OR staff member walks into room, says 'Are you Fred?' and slaps on armband OR any other similar variation. That is definitely not policy, but it is human behavior. Blood bank specimens are lab draw, with some exceptions from the OR. We have a very strict policy about the removal of blood bank armbands - only we cut them off, or give permission for them to be cut off, unless the patient is being discharged. We've been doing that for long enough that we lose almost no bands. We have the full support of Quality to enforce the armband policy.

PERHAPS weak D was included because a positive weak D would alert you to a possible false positive fetal screen.

There are two books that I would recommend upon the subject. The first is Avent ND, Fundamentals of Biomedical Science, Transfusion and Transplantation Science. 2nd Edition, Oxford University Press 2018 (ISBN: 978-0-19-873573-1), Chapter 1. The second is Sompayrac L. How The Immune System Works. 5th Edition, Wiley Blackwell 2012 (ISBN: 978-1-118-99777-2).

Absolutely the advice given to you was correct. For a start off, as you say yourself, 80% of A2B individuals do NOT make an anti-A1, but of those 20% who DO make an anti-A1, how many will make that anti-A1 as a result of immunisation as a result of transfusion or pregnancy? The answer to that, if you read any book concerning blood group serology (and that is NOT a criticism of you - we all started somewhere, including the very best, such as Herr Dr Willy Flegel, and others - and I have HUGE respect for Willy), you will see that a clinically significant anti-A1 is amazingly rare. For an anti-A1 to be clinically significant, it has to react strictly at 37oC, and that is a VERY rare "animal", and no example of anti-A1 has EVER been implicated in a case of HDFN, so, PLEASE, do not worry about giving A1B (or even A1) blood to an A2B individual, even if they have an anti-A1 in their circulation, UNLESS they have an anti-A1 that is actually active at strictly 37oC.

You know, I hate to be the bearer of bad news but the manufacturer's instructions for gel cards do NOT support recentrifugation of the cards as a valid test method. There may be other reasons that results are not reproducible (e.g. fibrin, weak antibodies, variations in samples collected), but centrifuging the card again is not the way to resolve the problem! I hope no one is using this method to interpret patient test results! From the insert: 1. False positive or false negative test results can occur from bacterial or chemical contamination of test materials, inadequate incubation time or temperature, improper centrifugation, improper storage of materials, or omission of test samples. 2. Proper centrifuge calibration is particularly important to the performance of the MTS Anti-IgG Card. TheMTS Centrifuge has been exclusively designed to provide the correct time, speed and angle. and For best results, it is recommended that following centrifugation, results should be read immediately. If tests are not read immediately, results may be affected by the drying out of the gel; hemolysis of the red cell and slanting of the reaction patterns due to storage in a non upright position.

Yes...we've seen this phenomenon at our facility as well. Am not certain if it's a problem with centrifugation or if it could be remedied by pre-spinning the gel cards prior to use. I vaguely recall some facilities having pre-spun the cards on receipt but never got an explanation of this practice. Upon getting a positive reaction on the 3-cell screen, I always set up a new card and repeat prior to running a panel to avoid this problem. Have not seen anything from Ortho to suggest that others have this problem and/or explanations to this. Also...I like the Immucor cells myself, and do often reduce them to 0.8% and run them in gel as you do ... does Immucor sell 0.8% panels? If not, they should...have found their cells to have a stronger antigen expression than the Ortho cells.