Jump to content

Leaderboard


Popular Content

Showing content with the highest reputation since 03/21/2019 in all areas

  1. 11 points
    If you put a drop of blood on something like a filter paper, and then add a drop of 1M NaOH, if it is adult blood, after a couple of minutes it will turn a sort of yellow/brown colour, as the Hb is denatured by the alkaline, whereas, if it is blood derived from the baby (including cord blood), the red cells will stay red, as HbF is not denatured by the alkaline for much longer. It is rather like doing a Kleihauer, but by "bucket chemistry", as it is known!
  2. 10 points
    Bb_in_the_rain

    Mock-up cases

    For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so..
  3. 8 points
    My advise for safe patient care is confirmation of the patient blood type by a laboratory professional.
  4. 6 points
    SMILLER

    Just for fun

    LOL! We would send it to our reference lab! We have other things to do here... Scott
  5. 6 points
    Agree with AMcCord. Can't and don't want to imagine nursing personnel performing this test.
  6. 4 points
    Malcolm Needs

    Homozygous M

    I certainly wouldn't use your nomenclature (only genes can be homozygous, heterozygous or hemizygous), but I know what you mean. I would most certainly say that the patient's plasma contains an anti-M, but, despite the fact that many cases of "cold reacting" anti-M are IgG, if the anti-M does not react at strictly 37oC, it is not clinically significant.
  7. 4 points
    Mabel Adams

    Just for fun

    We just got our first anti-CD47 out here in the sticks on a patient who went to Seattle for a clinical trial. That drug is Hu5F9-G4. No other name yet. It interfered with her reverse as well as all gel testing. We did a 30 minute saline screen and it was 4+ at 37C but negative at IAT using Immucor's anti-IgG which doesn't react with IgG4. She was antigen typed before starting treatment so we got that information and gave her K and Fya negative units (lucky she is positive for most antigens). We called them incompatible because we have not validated the Immucor anti-IgG as our test of record, the screen was 4+ at 37C and because the drug causes the patient's H&H to drop so I wasn't sure that the units would be certain to have normal survival. I didn't expect to get one of these for a few more years since we aren't in a big teaching hospital region. It would have been nice if the big center had sent her home with information that she was on this and instructions to tell the blood bank. We lucked out finding clues in Epic's Care Everywhere so we called the Seattle blood bank.
  8. 4 points
    Most transfusion practices in neonatalogy, including this one, are not evidence based, but rather empirical expert opinion. The use of reconstituted whole blood is more historical than anything else. A unit or two of recently collected (perhaps 7-14 days) whole blood would probably be as rational. One might check the potassium before using to make sure it isn't super high. That is the rationale for washing a red cell. It removes potassium from hemolysis during collection and storage, and makes the red cells more likely to absorb potassium once transfused. It's definitely more useful if the baby is hyperkalemic to begin with. Otherwise, whole blood would be fine. The reason for using plasma is fear of hypocoagulability, which is probably mostly mumbo jumbo for small exchanges, but might be more of an issue for larger exchanges (2 or more blood volumes). There is no real proof that any of these approaches is superior or inferior. Calculating the hematocrit is a case of weighing the red cells and measuring their hematocrit and then diluting accordingly with plasma or albumin solution (5%). You don't want a hematocrit higher than 40 in the exchange as normal neonates do not have high hematocrits and oxygen delivery is actually worse at hematocrits much above 30 in experimental models. In this case, more is not better as far as anyone knows. Once again, this is expert opinion not evidence based.
  9. 4 points
    Our experience w/ bedside testing for glucose at bedside and for stool occult blood card tests by nursing staff demonstrates that they don't understand QC, don't understand that if things don't look right you don't report it, don't document what they should document, etc. The thought of letting them perform confirmatory blood types for transfusion therefore scares the living daylights out of me. You can train some to perform the steps reliably, but without the lab background, I don't think you can expect good performance in dealing with unexpected results and test system problems (QC failure, weak/missing reactions, discrepant results). Those are the things that can result in a hemolytic transfusion reaction.
  10. 4 points
    Malcolm Needs

    RHD Molecular Testing

    Sorry, but can I just point out that you should be sending out the tests if the patient is a female of child bearing POTENTIAL, rather than child bearing age. If the female is four (for example), she is not likely to be of child bearing age, but she will be one day, and if she is an individual who has a Partial D type who can produce an anti-D, she deserves as much care as does a female of, for example, 25 years.
  11. 3 points
    David Saikin

    Homozygous M

    I find a considerable number of anti-M's using gel. The majority only react w MM cells. Gel is known to enhance anti-M activity (at least Ortho's). When I find any anti-M I set up prewarmed testing to see if it is clinically significant. Usually these types are not.
  12. 3 points
    SMILLER

    Repeat antibody investigations

    If the patient has been transfused or pregnant in the last 3 mos, one has to r/i r/o significant atypical antibodies every three days. This going to involve more than a screen. Scott
  13. 3 points
    Without a doubt, we would follow your method srichar3, otherwise, what is the point of performing a reverse group on ANY sample?
  14. 3 points
    John C. Staley

    Daily QC (again)

    I'm pretty sure any of the commercial QC systems will have this covered and I don't remember them being all that expensive. I have used both the Ortho and Immucor systems and don't remember any issues.
  15. 3 points
    ANORRIS

    Daily QC (again)

    ORTHO CONFIDENCE
  16. 3 points
    We do this test on all Rh (weak D) negative cord blood specimens from babies with Rh negative moms -- just to make sure that it is baby blood and that mom doesn't need RhIG.
  17. 3 points
    Works well when someone brings you a 'red' diaper or burp rag and wants to know if you can do a blood type to see if the blood is mom's or baby's. (Doesn't work worth a darn though for cherry/red colored meds or drinks )
  18. 3 points
    Could be maternal blood. Have tried testing the red cells with NaOH?
  19. 3 points
    Nurses performing ABO/Rh testing, scary. AMcCord and R1R2.
  20. 3 points
  21. 3 points
    When leukodepletion first became "popular" in the UK, before the NHSBT and other Blood Services performed universal leukodepletion, we used to provide the ward with an "in-line" filter. As Ensis01 says above, there were several drawbacks with this, but, in terms of whether it was actually efficacious, it was marginal then, because part of the problem involved with febrile non-haemolytic transfusion reactions (this is a problem separate from the fact that we want to prevent "HLA" type sensitisation) is the release of such things as cytokines, in particular tumour/tissue necrosis factor-alpha, interleukin-1-alpha, interleukin-1-beta and interleukin-6. These are released from white cells upon storage and, of course, by the time the platelet concentrates reach the hospital blood bank, these will already have been released, and so it is too late, and leukodepletion will not prevent FNHTR.
  22. 3 points
    SMILLER

    Cold case?

    We do see cold anti-Ms (or colds that mimic anti-M) causing trouble with gel often enough -- they have to be resolved in tube, often with the pre-warming, We are unlikely to do any further testing to identify what kind of cold antibody this is. Its just unusual to get a patient with a strong cold agglutinin that does not interfere with our manual gel screen testing. We are not complaining! The patient has been transfused a few times with no problems. Scott
  23. 2 points
    This is not a popular concept but at some point we have to accept there are things we can not control. Once the blood leaves the blood bank we are at the mercy of other humans and as long as the human factor is involved there will be human error be it unintentional or intentional. Attempting to complicate a process will only provide inventive humans the opportunity of coming up with creative work arounds to circumvent your best of intentions. At some point you just have to step back, do your job and hope for the best. I had a corporate transfusion QA director who could not accept that human error could not be completely eliminated with out eliminating human involvement in the process. Her directives became horribly complex solutions with multiple, redundant checks and balances only resulting in increasing problems. Bottom line, pick your battles and fight those you have a reasonable chance of winning. Make suggestions, offer insight, provide training opportunities but at the end of the day realize that you have to accept some things are simply beyond your control and even your influence. On that happy note I'll step off my soap box and stop my philosophical ramblings.
  24. 2 points
    Dansket

    Daily QC (again)

    By definition, reagent reverse grouping A1 and B cells are used to detect anti-A and anti-B antibody in patient plasma. Accordingly A1 cells should react with anti-A but not with anti-B, and B cells should react with anti-B but react with anti-A. Therefore, A1 cells should not be agglutinated by anti-B. No agglutination is a negative test result, i.e., a negative control test. Likewise, B cells should not be agglutinated by anti-A. No agglutination is a negative test result, i.e. a negative control test. Testing A1and B cells with AB plasma, Diluent, Albumin or saline may demonstrate that the test cells are not spontaneously agglutinating in their presence which serves as a negative control for those reagents, but does not serve as a negative control test for A1 cells or B cells.
  25. 2 points
    Malcolm Needs

    Homozygous M

    Hi Maryann, The point is that the terms homozygous, heterozygous and hemizygous can only refer to genes, but, of course, red cells do not have a nucleus (it has been extruded during the maturation process), but, in any case, the terms should not be used for antigens. In this case the closest to being correct is that M+N- red cells have "homozygous expression" and M+N+ red cells have "heterozygous expression". However, particularly in the case of the MNS Blood Group System, this terminology is not completely correct. There are many low prevalence antigens associated with both the glycophorin A and the glycophorin B molecules, and the many hybrids therein, that a red cell that groups as M+N- may not be as a result of MM homozygosity at a genetic level, but may have heterozygous expression, because there is one "M" antigen (for want of a better way of putting it), and one low prevalence antigen expressed on glycophorin A (or a hybrid), so that, in terms of expression, the M antigen has the strength of an M+N+ red cell, rather than an M+N- red cell. I hope that helps. Malcolm
  26. 2 points
    AMcCord

    Thermometer Calibration

    I keep a notebook with calibration certificates in it. I also have a reminder on my on line calendar that comes up about 4 weeks before the calibration on that item expires. When I see the reminder(s), I order new thermometers. Ditto for the stop watch. Those things are not big budget items. Once they come, new thermometers go into service, old ones are removed and discarded, new certificate goes in notebook, old certificate goes into archive file. I decided a couple of years ago that I am too hard pressed for time to check calibrations on things like thermometers. Biomed has put my scale (for the Echo) and the tachometer on the list of things that their outside contractor checks yearly. My pipettes get sent out for calibration check - one of our evening techs is responsible for that, so all I have to do is check the certificate and file it in my notebook. When the inspector wants to see that stuff, it's all in one place. Prior to this, I had a simple spreadsheet with all of the thermometers on it, listed by serial number. Each year I used a fresh copy of it. Part of the thermometer ID was where it was at. If it got moved, I changed that info on the spreadsheet, so at least I could find them. If they failed the annual check, I would note that and indicate that they were removed from service on that document. Once removed from service, that one was removed from the spreadsheet and the replacement was added. Those went into my notebook. I make a note at the top of each item's calibration certificate the date it is placed into service and the date it is removed from service. I don't have a huge number of these types of things, so it works for me. If I had more, I think I'd add a 'permanent' spreadsheet for tracking everything that documented in service date, removal from service date, and anything else that seemed important - just adding new lines for new stuff to the bottom of the ever growing list. I'm trying to put as much of those kinds of documents as I can into MediaLab to make review/approval documentation easier.
  27. 2 points
    Could someone re-post the link to the NYCBC poster? It looks like the link on these posts is no longer valid.
  28. 2 points
    In my opinion, if we cannot select an antigen neg reverse cells, there are things we can do, it is adsorbing the plasma/serum using pooled O cells, then do the reverse typing, to get a neat anti-A or anti-B result.
  29. 2 points
    I don't think you can do much "assuming" like this in the BB, much less healthcare in general. A unexpected positive reverse cell is most likely due to something innocuous, but it could be, at the least, a sign of an ABO subgroup or whatever. In any case, you would want it all documented for the next time you see that patient. Scott
  30. 2 points
    Malcolm Needs

    Daily QC (again)

    Anti-A for the group B red cells and anti-B for the A1 red cells.
  31. 2 points
    Best patient safety care..DO NOT ALLOW NURSING TO DO THIS!
  32. 2 points
    I wouldn't trust a nurse in performing ABORH testing, they have a hard enough time with other point of care tests.
  33. 2 points
    A very bad option. Look at it this way. You probably could not do their job. They cannot do ours - and ABO matching is THE single most important in transfusion. Most ABO types are, I agree, pretty easy, but some are most definitely not. For example, could a nurse tell the difference between a group O and an Oh? I have huge doubts.
  34. 2 points
    So is having nurses "confirm" the ABO type at the bedside; believe me!
  35. 2 points
    exlimey

    Cold case?

    If by "odd antigen" you mean a low incidence/frequency antigen on that specific A1 cell/donor, it should be easy to resolve using another A1 cell (or set of Reverse Cells) - the forward and reverse would compliment each other. However, if everyone is having problems with this patient, it's unlikely to be the reverse cell(s). Is the GI bleed due to ulcers ? H. pylori, perhaps. I think I read that some folks with H. pylori make cold autoantibodies.
  36. 2 points
    I suggest you contact other facilities in your area and see what they have been doing. You will want to know how they are satisfying any regulatory requirements with whatever method they use. Scott
  37. 2 points
    As ABO typing is so important I think you will have difficulty justifying to your regulatory bodies this test done at the bedside by nursing professionals. Who or which department are you researching this for?
  38. 2 points
    Malcolm Needs

    RHD Molecular Testing

    I don't know what happened, but I tried to answer three times on here, and each time it locked up, so Dansket, I have written a Word document in reply, and attach it should you want to read it. PathLabTalk Answer.docx
  39. 2 points
    exlimey

    Cold case?

    So the A1 cells are reactive, but the O cells are nonreactive. Interesting. I would have guessed autoanti-H, but that doesn't fit. Have you tested A2 cells ? Might be a weird compound antibody like anti-HI - needs the presence of both antigens to react well. Have you looked at something simpler, like anti-M, for instance ? The DAT results suggest IgM/complement binding, but as you imply, further testing is required.
  40. 2 points
    I think that this would very much depend upon whether the red cells are from a donor or a recipient. In the UK, for example, the anti-D reagents used in hospital laboratories, where they are testing (almost exclusively) patients, are designed not to detect Partial DVI, whereas those used in the NHSBT for donors and, to a certain extent, some of the reagents used in the Reference Laboratories are designed specifically to detect Partial DVI. This means that an individual could be designated as D Positive as a donor, and D Negative as a recipient. This would take a bit of explaining to the individual involved and, very often, to the doctor looking after the individual if they were not too familiar with transfusion. I would be amazed if manufacturers would make such a direction, because it is unlikely that all anti-D reagents are guaranteed to detect ALL partial D types (notably the DEL types) but WILL detect ALL Partial DIII type individuals, which can, and often do produce an allo-anti-D. I would be very confident to defend my own policy to a knowledgeable inspector, although I HOPE such an inspector would be knowledgeable enough NOT to ask about this in the first place! The attached diagram is of Partial DVI Type 1 (copied from a diagram by Geoff Daniels). Partial DVI Type 1.pptx
  41. 2 points
    There are three types of people. About 10 - 15% are non-responders, and never produce an antibody, however many times their immune system is challenged. About another 70 - 80% are normal responders and, given sufficient stimulus, will produce antibodies. The other 10 - 15% are super responders, and produce antibodies with the slightest insult to their immune system. I once heard the wonderful Dr Ed Synder describe these people as being able to produce an anti-D after being given a "virtual transfusion". When questioned as to what was a "virtual transfusion", he said that you showed a photograph of a D Positive red cell to such a person, and they produce an anti-D!!!! I would suggest, Kathyang, that your mother was an extreme member of the first group.
  42. 1 point
    SMILLER

    Repeat antibody investigations

    That caveat is used for inpatients who have a continuous stay. We cannot take the patient's word for it if they have been away from our facility. However, we have an exception for pre-admit testing, which we will allow up to 10 days before the procedure IF the patient gives us info regarding pregnancy, transfusions and other hospital stays. Also, in a similar vein, we generally will not repeat an eluate on a positive DAT if it has been worked up recently and the strength has not changed. Scott
  43. 1 point
    I just answered this question. My Score PASS  
  44. 1 point
    Bb_in_the_rain

    Just for fun

    I am sorry I apologize for failing to realize that there may be more than one blood group recombinant proteins available for use in immunohematology. We may be talking about different recombinant proteins. The protein that I was thinking about is soluable CR1 recombinant protein (Mould JM, et al, Neutralization of Knops system antibodies using soluable complement receptor 1), which may be different from that of recombinant glycophorin protein by Schawalder A et al. Therefore, when I made up the result that "rRBG-treated plasma was positive", I meant to exclude antibodies to Knops and Ch/Rg blood group proteins. I also failed to mention that the suspect would be anti-EnaFS (but not Anti EnaFR or anti-EnaTS, which I almost have forgotten about since I have not seen those before). In this case, I suppose we can throw in anti-Pr to the mix of possibilities (if the patient's cell is glycophroin-deficient, with autocontrol negative, long shot??). Thank you very much for an opportunity for further learning. Awesome as always!!!
  45. 1 point
    Bb_in_the_rain

    RHD Molecular Testing

    Since it is widely publicized to consider Weak D Type 1,2 or 3 as D+, I think it will be a good idea to document anti-D production in Weak D type 1,2 or 3; at least as an abstract to professional organization if not as a full case report. Each case may count as "exception" and if there were too many exceptions, the hypothesis (or proven theory) may be challenged. That is just "my feeling" anyways. I can be very wrong since I am not an expert .
  46. 1 point
    Bb_in_the_rain

    Critical Thinking education

    That may be because she missed the 4th year of college where she has to start thinking about what to do after she finish school and real life situations.
  47. 1 point
    I just answered this question. My Score PASS  
  48. 1 point
    TACO is congestive heart failure. Hypertension is not congestive heart failure, but may be of concern. Transient rises in the range of 170 to 200 that last minutes, not hours, are usually not of concern. That can happen with rapidly climbing a flight of stairs.
  49. 1 point
    Malcolm Needs

    What to transfuse?

    I would go for the r'r', because that gives us time to get in more r'r' donors. If you give R1R1, sounds like the patient will make an anti-D (as they appear to be a strong responder), and then we could be in trouble. Have you tried any other frozen blood banks other than ours John? Amsterdam?
  50. 1 point
    There is every chance that the UK may be to blame for this. The MHRA, our equivalent of CAP (for want of a better way of putting it - maybe Mafia is the correct word, I don't know) have had high level meetings with people in the USA, and they have exchanged ideas as to how to make our job even more difficult and beaurocratic (sorry, "safer", and with a higher degree of "quality", I meant to write), and we have had this rule in the UK now for some years. I would not be surprised, therefore, if they have infected your Quality System.
×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.