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In this paper from 1985, "The Lui elution technique A simple and efficient method for eluting ABO antibodies c. s. FENG, K. c. KIRKLEY, c. A. EICHER, AND D. s. DE JONGH, TRANSFUSION 1985; 25:433-434.", the authors thank A. Lui. MT(ASCP)SBB, who introduced this technique to them. Therefore, I believe Lui is the name of the MT who invented this elution method.

That has always been my impression as well. On a related topic, the u in Du stands for Underwood. The first patient who was discovered (or at least the first one written up) was named Underwood. Frances Wideman told me that at a CAP Transfusion Medicine Seminar ages ago.

In the blood banks that I have worked at, all used the screen cells to test the last wash except for the ARC IRL which had a very different method of testing the last wash.

Yes, and yes, although it is a highly unusual finding. The attached PowerPoint lecture may (or may not!) be of interest, in particular the fourth reference. The P1PK Blood Group System.pptx

We do a screen and, if indicated, A and B cells. sandra

Years ago, we kept the segment used for the crossmatch in a covered tube rubber banded to the patient’s specimen. When we went to the electronic issue, we switched to pulling an extra segment when we received units. It was bulky keeping the segs with the patient specimens. Plus, we did a lot of add on crossmatches and had to keep all the specimens organized and spaced in case we needed to rubber band more segments to the tube. It was about 600 beds with a busy OR. In the decades we kept the crossmatched segments, we never found one time where a crossmatched segment did not match a segment from a unit involved in a transfusion reaction. When we started pulling and keeping an extra segment on receipt, I thought we might miss keeping some segments, but we never had a problem finding a seg for a work-up. Our specimen refrigerator looked a lot neater and specimens took up less room. You could check your reaction work-ups to see if there has ever been an error found when doing the reaction work-up. If not, you could demonstrate the extra time and supplies involved in keeping the crossmatched segments was not justified. .

I never considered keeping the opened segment used for the crossmatch. While I can understand the idea behind it I personally consider it over the top in our blood bank paranoia. Each segment in the line can be positively linked to the unit transfused and that should be all you need.

In the UK, unless a piece of work (such as running positive and negative controls) is signed and dated by the person carrying out the work, it is regarded as not having been done in the first place. While I am not, by a long way, in favour of everything suggested by either "Internal Quality", or "External Inspectors", in this I stand four square with them. On the other hand, when they prescribe what colour ink we should use, they can go take a running jump, as far as I am concerned.

My Medical Director still has to approve this switch.

I attached it below as a pdf. The P1PK Blood Group System.pdf

We didn't label the freezer drawers. But we do have a job aid hanging on the door with the freezer contents (by drawer). It makes it much easer if/when you move your contents around. sandra

I think Anita Lui was a blood banker in New Orleans. I was there 1977-78 when I first heard of the Lui elution. I believe it was first published in the South Central Association of Blood Banks' Journal.

How can you prove anyone did anything? Unless you watch. Inspectors cannot impune your work is bogus based on your process, unless something seems amiss. I would immediately contact their regulatory agency and ask for the official stance on such and/or a replacement inspector.

We do this to cover all of the bases in the event of a transfusion reaction. We keep an unopened segment and the segment that was used in the crossmatch. We keep everything related to the crossmatch for a period of ten days.

I might be dating myself - years ago I worked for a transfusion service that manufactured packed red cells. CAP had required proficiency testing for the manufacturing process - if I remember, it was measuring the hematocrit. Just looked on the test menu and it seems that is no longer 'a thing'. So use the word 'competency' instead. Our trauma program uses a lot of blood and liquid plasma before we know the patient's blood type - I don't think I would choose Group O liquid plasma even though it is low-titer. As I write this, I realize that I'm looking at the problem with a distinct bias against more work for my team so please forgive. When we implemented whole blood, I was definitely averse to splitting the product to create components because of the work - both physical and intellectual - and I am still thinking that way. If it is feasible for you and you embrace the process, go forth!

The FDA responded! See below if you're interested. It sounds as though this IS allowed, provided I follow the regs mentioned, which I had planned on doing of course! Dear Janine, Thank you for your inquiry. Please see our responses below: I would like to start splitting donor whole blood (originally collected by the ARC) into a packed red cell and a liquid plasma unit. I am unclear on if the creation of a liquid plasma unit is allowed? Response: Yes, it is allowed to separate Liquid Plasma from the Red Blood Cells, provided it is performed in a closed system using a bag attached to the original blood collection set or using a bag attached by a sterile connecting device. Per 21 CFR 640.35(c), Liquid Plasma shall be separated from the Red Blood Cells and stored at a temperature of 1-6○C within 4 hours of filling the final container or within the timeframe specified in the directions for use for the blood collecting, processing, and storage system. I would like to split the WB 5 days before it expires, creating a red cell with the same expiration, and a liquid plasma with essentially a 10 day expiration. It seems as if this CAN be done by the regulations I’ve been able to find, but I also cannot find anyone who is ALREADY doing this, which makes me concerned that it’s not allowed. CFR 640.34 dictates that the liquid plasma must be separated from the red cells “within 4 hours after filling the final container”, and I wonder if this is why it seems that liquid plasma unit cannot be made from WB that has been anticoagulated and stored at 1-6C? Response: Please note in 21 CFR 610.53(b), Liquid Plasma must be stored at 1-6○C and has an expiration date of 5 days from the end of the Whole Blood dating period. I understand that I can make a red cell from a WB unit, but I would like to be able to attempt to use both portions of the units if possible, hence my questions about the validity of making a liquid plasma. Response: As stated above, this is allowed. Also, I am already registered with the FDA, but I believe doing this splitting of WB will also require me to change my registration to “prepare” both RBC and liquid plasma. Can you confirm that? Response: You are correct. Transfusion Services who routinely perform component preparation (e.g., separate whole blood into RBCs, Liquid Plasma) must be registered and the blood establishment registration will need to be updated to reflect that information. In addition, please note the following Regulations: Subpart B - Red Blood Cells. Per 21 CFR 640.11 General requirements Storage. Immediately after processing, the Red Blood Cells shall be placed in storage and maintained at a temperature between 1 and 6 °C. Per 21 CFR 640.16 Processing Separation. Within the timeframe specified in the directions for use for the blood collecting, processing, and storage system used, Red Blood Cells may be prepared either by centrifugation… Subpart D - Plasma. Per 21 CFR 640.32 Collection of source material Whole Blood must be collected, transported, and stored as prescribed in § 640.4. When whole blood is intended for… Liquid Plasma, until the plasma is removed, the whole blood must be maintained at a temperature between 1 and 6 °C or as specified in the directions for use for the blood collecting, processing, and storage system…The red blood cells must be placed in storage at a temperature between 1 and 6 °C immediately after the plasma is separated. Per 21 CFR 640.34 Processing ( c) Liquid Plasma. Liquid Plasma shall be separated from the red blood cells and shall be stored at a temperature of 1 to 6 °C within 4 hours after filling the final container or within the timeframe specified in the directions for use for the blood collecting, processing, and storage system. Subpart F – Dating Period Limitations Per 21 CFR 610.53 Dating periods for Whole Blood and blood components Table of dating periods. Product Storage temperature Dating period Liquid Plasma Between 1-6○C 5 days from end of Whole Blood dating period. We hope this information is helpful. Let us know if you have further questions.

The Petz and Garratty book Immune Hemolytic Anemias has been very helpful tp me. There is so much between those covers!

Your search is over, here I am.

We give Rh positive to males and females >45 for traumas and MTP's. The medical director still wants to be made aware of the switches though.

Agree with donellda, with the addition that a “foray into manufacturing” is not to be taken lightly and will be resource heavy in time, training, paperwork, inspections etc. and so may not be justifiable for your facility.

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On the back of that, can I ask what is the ethnicity and underlying pathology of the patient please? If there is no bleeding point, has the Hb dropped below the level it was before transfusion?

If you're looking for a procedure see attached. BBI0023 Exchange Transfusion 031522.docx

We have SafeTrace instead of Soft, but we have made reconstituted whole blood for many years. We normally use it to prime a circuit. We treat the reconstituted units as if it were two units in one bag. We sign both units out in the computer even though they are in one bag. SafeTrace does not allow pooling of products which are of different product types. If Soft will allow that, you may be able to use that to avoid dealing with two unit numbers, etc.

Welcome

I specifically remember doing the Lui freeze -thaw on DAT + ABO incompatible cords samples in 81' at the Blood Bank in Bethesda MD so possibly the name and method predated the article.

Welcome mollymotos.

Agree with @donellda. Running the antibody screen on the last wash is all that is necessary. It will show that there is no reactivity verifying adequate washing for the elution procedure, which is why you are testing the last wash.

Our machine is a combo color printer/photocopier/scanner. Just like most "multi-tools", it's OK, but doesn't really do all of its tasks exceptionally well. Grey shading often comes out bluish and when it scans colored materials, the colors are badly translated. Ho-hum, First World problems.

Curious if anyone has ever heard of retaining the open segment (in a capped tube) post crossmatch. The justification given is to ensure the segment used for crossmatch is the segment used in workup, should a transfusion reaction be suspected. I have only ever pulled an unopened segment (either upon receipt of unit or prior to issue depending on the facility) but never heard of this other option. Please help me! If this in an antiquated process, please explain the origin or if it is of value, help me with some references. Look forward to the dialogue.

I like the not black or red ink logic; all other colors clearly indicate an original document and not a photocopy. As long as it is permanent and waterproof any other color or shade of ink works. I personally like weird blues

We keep the opened segment used for the crossmatch instead of pulling segs on receipt or issue of units. I've done that at other facilities - seemed like just another thing to store and then toss. When a TRX is called it's easy to pull the sample with the segs used (rubber banded to sample), do the clerical check (match up the segment DIN and the seg # with #'s on the returned bag) and then get a couple more drops out of the seg for testing. Have never run out of cells and can "confirm" the right seg was used for the crossmatch.

Thanks Malcolm. One issue with a very long life is that few are left who remember you. Larry was a remarkable and important contributor to progress in transfusion medicine, particularly on the subject of autoimmune hemolytic anemias, along with his long time collaborator, the late George Garratty. I remember both of them well and wish peace to their family and friends.

Thank you very much.

You will need to develop a validation and QC plan to ensure that the hematocrit on the RBC product meets pre-defined criteria and regulatory standards. You will need to have proficiency testing program as well. We transfuse LTOWB as well but consider the wastage as part of the provision of products meeting the Trauma programs needs - I do not want the headache of manufacturing regulation (I might have skipped over the FDA inspections as well- don't forget that....)

Basic guideline from our trauma center-- O Pos to all males and females over 50 Critical shortage--use O Pos. The Medical Director can sign after the emergent event

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Antibody / Antigen Reaction Antibody/Antigen Reaction This question was submitted by forum member, Malcolm Needs. Any errors are those of the site admin, not Malcolm. Antibody Antigen Reactions - Clifford Reeves.pptx Submitter Cliff Category BloodBankTalk Submitted 11/27/2020  

Get a disclaimer from your administration that you are not responsible for cell saver operations. Your Medical Director should offer advice on what is acceptable practice even if you get the disclaimer. You don't want to be responsible if you are not the responsible party operating the device(s).

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Found this old gem while cleaning out our retired doctor´s office. It´s Claes Högman, a real giant in Swedish blood banking, who (among other things) was a delegate in AABB during the 60's and recieved the Karl Landsteiner award, James Blundell award and the ISBT award. He sang in the Uppsala band "Blodsbandet" (transl Blood relations) under the name "Captain Blood". The song on the tape is "Give blood! Mr Sagman", which I suspect is a cover of "Mr Sandman"... Enough written, now I've gotta go find a cassette player!

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