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  1. I have never understood this obsession with looking at reactions down a microscope in blood bank, except looking at things like a Kleihauer or when teaching, to show mixed-field reactions. The great Peter Issitt, not a bad roll model to have, wrote, many years ago now, a passage that I attach from page 69 of his "Applied Blood Group Serology" book, 3rd edition, 1985, Montgomery Scientific Press. That having been said, all reactions seen MUST be recorded, it is just that macroscopic reading is almost all that is ever required.
    5 points
  2. MAGNUM

    Transfusion Errors

    I have even gone so far as to tell the nurse taking care of the patient that when they learned the patient's name and not the room number to give me a call back and we will discuss the patient at that time.
    5 points
  3. Not sure about just one answer - We had a labeled Rh negative RBC from the ARC that retyped as Rh positive. Upon investigation, it was found the Immucor anti-D reagent we use for retyping had anti-Crawford while the ARC automated process for D typing used an Ortho reagent which was from a different clone. Not very unlikely but certainly more than one answer.
    5 points
  4. Decades ago I worked w a tech who worked w Peter at NYBC. I had always looked under the scope (as that was how I was trained). I'd ask her to look at 2 or 3 or 4 cells stuck together microscopically. Her comment was always, "If you want to call that positive go ahead, but I'd call it negative." High anxiety to give up the scope but I did.
    4 points
  5. Please don't apologise; I found your question (your question - not the question) quite stimulating. I totally agree with your opinion re the question setter.
    4 points
  6. Have you thought of hiding his glasses?
    3 points
  7. When tube testing was all we had, my moto was; "when in doubt, shake it out!" One of the first things I did as transfusion supervisor at a new facility was convince the medical director that we needed to stop using the microscope for routine testing. It was much harder to convince the rest of the staff. I couldn't remove the microscopes from the department because we were doing KBs at the time and I'm pretty sure a few of the "older" staff still used them for routine testing when I wasn't looking. Once again inertia is proven to be the most powerful force in the universe!
    3 points
  8. Yes, but DVI donors need to be typed as D+. Donors are not patients.
    3 points
  9. Sadly, I can't open the attachment of the answer. I was hoping to see what was considered "critical thinking". From the responses of others it would appear I am not missing much. Carry on folks.
    3 points
  10. Perhaps the monoclonal anti-D reagents had been taken out of the fridge, and not allowed to come to room temperature before being used. Most, if not all, monoclonal anti-D grouping reagents will detect an I-like or i-like antigen on D Negative red cells (see Thorpe SJ, Boult CE, Stevenson FK, Scott ML, Sutherland J, Spellerberg MB, Natvig JB, Thompson KM. Cold agglutinin activity is common among human monoclonal IgM Rh system antibodies using the V4-34 heavy chain variable gene segment. Transfusion 1997; 37: 1111-1116, and Thorpe SJ, Ball C, Fox B, Thompson KM, Thorpe R, Bristow A. Anti-D
    3 points
  11. Thank you all for your help. We do not use ARC. We have located a hospital that is willing to do them for us it is just a matter of getting it approved by our higher ups. This facility actually does them 24/7 so our turnaround time would be great. They also perform KBs for other hospitals as well, so I suspect they would be far more accurate than we would just starting out
    3 points
  12. We stopped doing LUI freeze eluates a very long time ago. If Mom has no clinically significant antibodies and there is an ABO incompatibility between Mom and infant, it is pretty clear the cause of the Positive DAT on the baby. There will be no difference in the treatment of the baby if we did the LUI freeze. Our report goes out as Possible ABO incompatibility, no further testing indicated. Regardless, in Canada we don't bill anything, it is covered by our healthcare benefits. My point is that other than a way to bill the patient, it isn't a clinically significant test.
    2 points
  13. Our document control system assigns SOPs to the appropriate staff members. They sign off in the system indicating that they've read it and that they understand it. That signoff is maintained as long as the SOP is held in the system, so pretty much forever. If there is a competency requirement along with a new or changed policy, then that is documented and stored as long as any other competency and would be included w/ the documentation for that year.
    2 points
  14. We all have these transfusion event stories. Rec'd a phone call in the middle of the night years ago. 3 out of 4 units were transfused to the incorrect patient. Fortunately both pts were O Pos. We used Typenex numbers. BB tech switched the 2 patients; could only be resolved at the bedside. 2u transfused in dialysis. When asked about the "red" numbers I was told that they no longer checked them as they always matched. I informed them that they gave 2u the day before to the incorrect patient.
    2 points
  15. I had always found it difficult to convince nurses that we were working with a person/patient and not a room/bed! This became even more difficult after all the privacy rules and regulations came about. It was almost as if they were terrified to say a patient's name aloud!
    2 points
  16. mrmic

    Transfusion Errors

    Ok, I'll start. The story of "Who turned off the Light". The year was 1999. Hospital "Notme Medical Center" supported an outpatient clinic for patients requiring transfusion, some due to sickle cell anemia. Often these were young adults that came into the clinic very early in the morning. After their blood was collected and they were waiting for the crossmatched packed red cell units to arrive, the patients preferred to sleep (pre i-phone years). Normally at least one light was left on, usually the bathroom light, while they were waiting. At 0530 the first of two tagged crossmatched
    2 points
  17. I disagree. Most gel cards and Anti-D reagents won't detect DVI for patients. Fortunately I can find numerous suitable quotes, because it's true. https://labs-inc.org/pdf/361_3.pdf
    2 points
  18. Malcolm Needs

    Transfusion Errors

    In the UK, we have the SHOT Report (Serious Hazards of Transfusion) that reports every year, and has done so since 1996. Their reports, which anonymise the reporter, are always both interesting and informative.
    2 points
  19. I especially like the way you phrased it as "transfusion error stories" and not transfusion horror stories. Looking back I sometimes think I could write a book on the subject. Well, maybe not a book but at least a novella! Some of the stories would be comical and others terrifying. Luckily, in over 35 years in the business none of my stories are fatal but a few had the potential.
    2 points
  20. TS- Dithiothreitol -DTT- Treatment of RBCs.pdfThis is our procedure for the HemoBioScience product. it will be open for 30 days only. (I think) Don't worry about thawing it too many times - there is only 2-4 mls in each tube, so it doesn't last for that many pts. We have just thawed ours at room temp. We wrote the procedure using both the HemoBioScience procedureand the one in the AABB Tech Manual. Best of luck
    2 points
  21. Hope this works for you John, but you are correct; you were not missing much!
    2 points
  22. Anti-D reagents are specifically formulated to detect DVI - that is REQUIRED by the FDA in the USA. It was also true of the human sera-based reagents I manufactured in the UK during the 1980s. There was a period when anti-D reagents were approved for donors or patients. The reagents used for donors were required to detect DVI, arguably the "weakest" expression of the D antigen of the known D-variant and typically that meant an antiglobulin phase was required. Those reagents formulated for patients often were not designed to detect DVI (had no IAT) and subscribed to the "it's better to tre
    2 points
  23. Me too. I have a DVI patient here (has anti-D and anti-Jka)
    2 points
  24. I have ABSOLUTELY no doubt that there is more than one answer! That having been said, the Crawford antigen is encoded by the RHCE gene, specifically RHCE*ceCF (I'm sure you knew this already - but for those who didn't), and is not D Positive (for anyone interested in a damn good read, see Flegel WA, Wagner FF, Chen Q, Schlanser G, Frame T, Westhoff CM, Moulds MK. The RHCE allele ceCF: the molecular basis of Crawford (RH43). Transfusion 2006; 46: 1334-1342. doi: 10.1111/j.1537-2995.2006.00901.x.).
    2 points
  25. Yes, I don't think the original question setter meant the question to be a difficult one to answer. He is teaching a beginner level MLT course. He said there was only one correct "straight forward" answer. Just my opinion , but I think this person has no business teaching college level blood banking. As far as I know, he is a MLT with no experience with the tube, slide, or microplate testing methods, so I highly doubt he was talking about Anti-D reagents being the source of the discrepancy. But I could be wrong. I apologize for wasting people's time with this. I just can't understand how
    2 points
  26. Thanks, but I would almost guarantee the original question setter hadn't read either of the two papers that I cited!
    2 points
  27. mrmic

    S.C.A.R.F.

    Sometimes I forget what I forgot? What happened to the S.C.A.R.F. group? I don't see anything on this site mentioned about it and it was a great exchange program for Immunohematology Reference labs. It was going through some changes when I changed jobs and left the membership.
    1 point
  28. True, but, for those unfamiliar with it, the agglutination seen with an anti-Sda is usually mixed-field (see the attached photograph - not a fantastic photograph, but I have "tarted it up" a bit - from the original paper, Macvie SI, Morton JA, Pickles MM. The Reactions and Inheritance of a New Blood Group Antigen, Sda. Vox Sang 1967; 13: 485-492).
    1 point
  29. When I was trained (many years ago!) we used +/- for microscopic tube reactions. Now, I encourage MLT to only use the microscope if they are looking to verify a mixed field or rouleaux. I suppose there could be other rare times to use a microscope - like an anti-Sda? But generally - no microscope. But they love the microscope...
    1 point
  30. I was originally trained using an "inverted microscope" - that was a thing of beauty. The light source was above, the relatively low-powered lens below. The cells stayed in the tube and the tube could be rotated to get movement and/or a suitable thickness of liquid in which to see the cells. It was great and very easy to use (even though it had a large footprint), but as others have commented, if one looked long enough, one could always find "friendly cells". I'm not a fan of microscopic reading and I dissuade others from doing it. As I've said in the past, high level tools and techniques
    1 point
  31. This is how our tubes are viewed for micro reactions. Issitt seems to be OK with this method.
    1 point
  32. i've used it for ABHHDN for decades.
    1 point
  33. It isn't. We used it whenever we were looking at a possible ABO HDFN in the Reference Laboratory at NHSBT-Tooting Centre.
    1 point
  34. We do the same as Nikki. If an eluate is needed, an acid elution is done. No LUI freeze on the menu. sandra
    1 point
  35. Thank you all for your comments. To be clear, I do not advocate the removal of the control from the blood grouping test; automated or manual. My interest was sparked following a group conversation on this topic where I was surpried to find that some folk would be comfortable to omit the control, and rely solely on forward vs reverse typing as a check. They were less certain when I challenged them with the scenario of a discrepant blood group!
    1 point
  36. Hi Malcolm, Totally agree! Hence the worried face at the end of the original post.
    1 point
  37. The phrase "knowledgeable about the contents" rather says the same as I said. They don't just need to have read any changes, but know what they mean and how they are involved in the procedure.
    1 point
  38. CAP standard COM.10300 "Knowledge of Policies and Procedures" simply states: The laboratory has a defined process and records indicating that all personnel are knowledgeable about the contents of the policies and procedures (including changes) relevant to the scope of their testing activities. Our "defined process" indicates that we save those records for 2 years.
    1 point
  39. Preparation and Testing of DTT Treated Plasma.docx
    1 point
  40. John C. Staley

    Dumbwaiter use

    Regardless of all the possible causes along the way the ultimate human failure occurred at the bed side!! People are probably getting tired of me saying this but as long as there are humans involved in a process human error will occur. All we can hope to accomplish is minimizing both the number of times it occurs and the resulting ramifications.
    1 point
  41. I sincerely hope not David. If this was donor blood, they most certainly SHOULD use an anti-D reagent that detects a Partial DVI, as such individual's have been known to stimulate the production of anti-D. If it was a patient, then I would agree with you.
    1 point
  42. The donor could be a DVI but the blood center is testing using an anti-D that does not detect that epitope (usually the hospital transfusion service doesn't want to find that person as Rh+ but the donor center does). OR, the blood center has typed the incorrect unit.
    1 point
  43. I would also like to see the definition of critical thinking used by the original question setter. That might help trying to understand what they were getting at. I know from past question writing experience for students, that an answer which I considered so blindingly obvious was in fact not anything of the sort.
    1 point
  44. Malcolm's answer seems reasonable but I'm with you that all the original question does for me is lead to more questions and no answer. Such as; what does "Investigation of the label issued at the blood bank verified the unit's correct labeling." actually mean?? Was this a real case or just something someone made up?
    1 point
  45. No DAT. There are no other details to the question. Also DATs are not required testing for blood donations. I’m just trying to get people’s opinion on the question. Personally I think it is a poorly written question and the person who wrote it has no clue what he’s talking about, but I’m here to get people’s thoughts on it. Thank you
    1 point
  46. We aren't quite the same but similar. We provide blood to a cancer center in a town about 15 miles away. There is another hospital in the town that is in a different system. We provide the blood to the cancer center. We ship it in coolers through our courier system and then the cooler comes back when the courier stops. We also supply them with platelets the same way. This way we keep all the blood under the same billing number.
    1 point
  47. MAGNUM

    Kleihauer Betke Help

    We send our KB's to another hospital in our division and get nice 2-4 hr turn around time. They use flow. We started using them because the local ARC does not perform KB's, and with only 6 or 7 a year we couldn't justify the cost for performing them inhouse.
    1 point
  48. BldBnker

    Rule out Anti-K

    That is what my former supervisor used to say (he was a tech for over 50 years)! Get the titer up where you can work with it! God rest him!
    1 point
  49. 1 point
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