Jump to content

Leaderboard


Popular Content

Showing content with the highest reputation since 07/20/2019 in all areas

  1. 7 points
    Neil Blumberg

    Neil Blumberg

    And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses. In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).
  2. 7 points
    Malcolm Needs

    Kell & Antibody screening

    PLEASE do not worry. Your midwife is COMPLETELY wrong, and really should not comment about something she patently does NOT understand, and about which she has a pitiful amount of knowledge. She should never have answered your questions with her lack of knowledge, but should have left it to your Obstetrician. I note that you are a fellow "Brit"! Within the British population, the percentage of people who have the R1R1 type (which is a type within the Rh Blood Group System) is 16%. Also within the British population, the K- type (which is part of the Kell Blood Group System) is 91%. What that means is that 91% of 16% of the British population is R1R1, K-, or, give or take, a few decimal points, 15% of the British population (about an eighth of the British population). On Friday, 19th October 2018, the British population was measured as 66,690,116! Let's call that 16.5 million in round numbers. This means that, give or take, 9, 975, 000 in Britain are R1R1, K-. Now, admittedly, your midwife will only be looking after women, but, even then, that means 4, 987, 500 women will have the same Rh type and K type as you! How your midwife has only come across your "rare" type four other times in her career, is beyond belief (and I genuinely mean BEYOND belief), unless, as I say, her knowledge of blood groups and blood group serology is incredibly poor, and I repeat, she should NEVER have worried you like this. Just in case you think that I do not know what I am talking about, I have worked in the field of blood transfusion/blood group serology for 43 years, have been an internationally invited lecturer and am the Chief Examiner in Transfusion Science for the Institute of Biomedical Science in the UK, and am a co-author of the British Society of Haematology's Guidelines for Blood Grouping and Antibody Testing in Pregnancy. I don't write that to "blow my own trumpet", as it were, but to try to reassure you that I actually do know what I am talking about. I should warn you that "consulting Dr Google" is equally as useless as listening to your midwife. You should really relax. YES, it is possible for you to produce red cell antibodies during your first pregnancy, but it is INCREDIBLY RARE. It is even more rare for such an antibody to cause any problems in a first pregnancy. I notice that the report from the Blood Bank was that they detected WEAK reactions with 26 of 30 panel cells, but they could not identify a specificity. They have requested three further samples of blood to send to the Reference Laboratory. Again, to give you some comfort, I hope, I ran a Reference Laboratory in London for 16 years before I retired in 2016, and we saw, quite literally hundreds of cases like yours. For a red cell antibody to cause any problems within you pregnancy, it would have to have a titre of 32 or above (this means that it would still be detectable when it has been diluted THIRTY TWO times). I can assure you that the mere fact that the Blood Bank reports weak reactions means that there is ZERO chance that the titre will be 32 or above. If a Hospital Blood Bank, however big or famous the hospital may be, cannot identify an antibody, it is almost universal practice that samples will be sent to a Reference Laboratory for further testing - AGAIN, DO NOT WORRY ABOUT THIS. There are many, many red cell antibodies that are clinically insignificant, both in terms of transfusion reactions and haemolytic disease of the foetus and newborn (which is what your midwife has left you worried about). I KNOW it is difficult, but PLEASE do not worry. PLEASE take no notice whatsoever of your midwife on this matter (I am sure she is an excellent midwife, but she is patently no expert in the field of blood groups), but DO talk to your Obstetrician, who, I hope, will have talked to your hospital's Haematology Consultant, who, in turn, will have spoken to the Consultant in Charge of the Reference Laboratory, and I am sure that they will echo my opinion that there is NOTHING to worry about. Oh, and lastly, I am R1R1, K- myself!!!!!!!!!!!!!
  3. 6 points
    Malcolm Needs

    Kell & Antibody screening

    Thanks ELondon. Could I just say again, even if the Reference Laboratory does detect an antibody (or more than one, come to that), it is not a particularly abnormal thing in pregnancy, but it does not mean for one minute that the pregnancy will be affected; Mother Nature has seen to that. There is another Blood Group System named Lewis. The antigens within this system are soluble in the plasma part of your blood, and are adsorbed onto the red cells from the plasma (they are not intrinsic to the red cell membrane). During pregnancy, the concentration of plasma lipoproteins (fatty proteins in the plasma) can increase enormously (about four-fold). These plasma lipoproteins "mop up" the soluble Lewis antigens, and a pregnant woman, who would normally be, for example, Le(a-b+), can become Le(a-b-), and may even, temporarily, produce antibodies against the Lewis antigens (an individual hardly ever produces antibodies against an antigen that they express - but strange things happen in pregnancy!). In addition, ALL babies are born as Le(a-b-), so any Lewis antigens Mum produces will NOT affect the baby! There are many, many other antibody specificities that will not affect the pregnancy at all. Now, I should say two things. Firstly, I cannot say, from a distance, what is the antibody in your plasma (that can only be done by the laboratories at the Hospital and the Reference Laboratory, but it does not sound at all serious). Secondly, i am what is called a Biomedical Scientist, not a doctor, and so I am, by Law, not allowed to diagnose (as far as I know, neither is the midwife), and this is why I am so glad that you are going to see an Obstetrician, who, I hope, will be able to reassure you even more. Mean while, sleep easier, and enjoy your pregnancy!
  4. 5 points
    Awesome responses as usual Sir!
  5. 5 points
    David Saikin

    Emergency Release Blood

    You may have exchanged your pt by that time - then what type are you giving? I want a sample ASAP. I worked in a large tertiary care hospital, we would only give you one O= and then only if you gave us a specimen. We opened that hospital brand new and set up the rules like blood bank should be run. It was great - no one could say "we've always done it this way."
  6. 4 points
    Neil Blumberg

    Patient Blood Management

    Patient Blood Management is a comprehensive, multi-modal approach to reduce/prevent anemia prevalence and reduce transfusions to only those that are life saving or absolutely essential. While the AABB has some materials and interest, they are relatively less likely to explain to you that the primary rationale is that anemia and transfusions are mostly harmful to patients in current practices. The pre-eminent organization in the USA in this matter is SABM. The founders of PBM include anesthesiologists such as Aryeh Shander at Englewood Hospital and Tim Hannon at St. Vincents, who saw that (1) Jehovah's Witnesses who refused transfusions actually had better outcomes than similar transfused patients and (2) transfused patients had dose dependent increases in nosocomial infection, thrombosis, multi-organ failure and mortality in the literature and their own practices. In other words, less is better. None is best when possible. Needless to say, the initial reaction in the blood banking and transfusion medicine community was lukewarm at best when these ideas were first put forward a couple of decades ago. But preventing anemia by doing fewer lab tests, and less frequent lab tests has begun to catch on in some places. See: https://www.sabm.org/patient-blood-management-programs/ Good place to get some initial education and join if of interest. A typical PBM program will include a part-time medical director (often an anesthesiologist, intensivist or hematologist, but also surgeons, transfusion medicine physicians, and other specialties) and one or more full-time nurses or medical technologists who focus on educating practitioners about current practices. You need a clinical champion at the bedside who other practitioners respect and will listen to. Changing practices is arduous and sometimes rather unpleasant work. When Bernard Fisher showed that the Halstead radical mastectomy for breast cancer was harmful to patients, the initial reaction was anger, disbelief and pushback. So it sometimes is with PBM. Physicians change their practices slowly or not at all. At our institution, PBM is heavily weighted towards collaborations between specialties, including, for example, an anemia management program prior to cardiac surgery, advocating restrictive transfusion practices where there is evidence (and there is tons of evidence that liberal practices are lethal at worst, wasteful at best). Happy to answer further questions.
  7. 4 points
    Mabel Adams

    Picky anti-C?

    The antibodies didn't read our books???
  8. 3 points
    cswickard

    Management Question

    A - to find out the specifics of the problem - personnel may not talk in front of supervisor, so this needs to be done 1st. B - to get the other side of the story - if there is one. Don't spring a meeting on the supervisor with other personnel present without discussing problem 1st. 3 - to work things out - if possible.
  9. 3 points
    tbostock

    Specimen Expiration

    3rd day at midnight, with day of draw being day zero.
  10. 3 points
    AMcCord

    Neil Blumberg

    Congratulations! and thank you for your contributions to modern blood banking practice.
  11. 3 points
    Neil Blumberg

    Neil Blumberg

    Malcolm, my sincere appreciation of your kind words. I've enjoyed and learned from your comments on this website.
  12. 3 points
    We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it. We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.
  13. 2 points
    Dansket

    positive dat w cord blood

    An important aspect of this conundrum to remember is that physicians do not treat newborns just because of a positive DAT, they treat infants who are anemic or hyperbilirubinemic regardless of the DAT results.
  14. 2 points
    John C. Staley

    Management Question

    Actually, if you look back at the responses you will see that the best answer is all three in the proper sequence.
  15. 2 points
    I would think it would need a pretty significant bleed to find a macropositive DAT from a fetal bleed in utero. I've had patients pregnant develop an autoimmune process. Never impacted the baby.
  16. 2 points
    Malcolm Needs

    Neil Blumberg

    A fairly short, but very interesting interview with Neil Blumberg in the July 2019 edition of AABB News, as he his one of three new inducts into the National Blood Foundation's Hall of Fame. Congratulations Sir and, from what I know and have read, thoroughly well deserved.
  17. 2 points
    AMcCord

    Lot Verification

    Before you set a specific number across the board, I would suggest that you check you package inserts. Some of the human source rare antisera have positive agglutination defined as 2+ or greater and don't usually give much stronger reactions. The monoclonal rare antisera usually seems to react 3-4+. I would also expect stronger reactivity for anti-A or anti-B, depending on what you are testing them against. I would see 2+ reactivity for them as an indication that the reagent is not OK. We look for reactivity consistent w/ previous lots - +/- one grade of agglutination.
  18. 2 points
    thank you Malcom and Scott for you responses! We spoke with the clinicians, who seem to understand the anti-S titer number will not tell them much of anything, and they had already realized the Jk and the C were useless to titer (which saved us a lot of grief). They could not provide any references or good reasons for needing the anti-S now, but pretty much insisted, and we acquiesced on this patient ONLY since her situation is quite unique. So we are treating the clinician rather than the patient this time; I've been covering clin path long enough to know that sometimes this is just the way it goes. Anyhow, we have at least opened a line of communication to the clinicians in the case and they feel we are trying to help them (even if we think it's silly), and that may be all the reassurance they need. And was better to know about this patient sooner rather than later, b/c if she does make it all the way to delivery with a chronic anemia we were gonna need to plan for her anyway. At least she's now on our radar in BB. Again, thank you all for your expert opinions! LCH
  19. 2 points
    Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!
  20. 2 points
    Two reasons. The first is that severe HDFN caused by anti-S is very, very rare, but it does happen. The second, and much more importantly, is that a titre is a snap shot that tells the obstetrician ABSOLUTELY NOTHING in isolation. Supposing the titre is, for example, 512, the pregnancy can be monitored (as it can be anyway, whatever the titre) and there can be clinical intervention, if required. On the other hand, supposing the titre is 2, what does that mean prior to conception? Again, the answer is ABSOLUTELY NOTHING. The baby may not inherit the GYPB*S gene from the father, so the antibody will not increase in titre, or the baby may inherit the GYPB*S gene, but that doesn't mean the titre will automatically rise during the pregnancy, although, of course it can. It sounds to me that the clinicians are fishing, but without either a rod or a net (they haven't got a clue)! I know that the UK Guidelines do not apply in the US, but it might be worthwhile suggesting that they at least read "British Committee for Standards in Haematology (BCSH): White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S. Guidelines for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine 2016; 26: 246-263 (doi: 10:1111/tme.12299) and/or Royal College of Obstetricians and Gynaecologists (RCOG). The management of women with red cell antibodies during pregnancy. Green-top Guidelines No.65; May 2014. https://www.rcog.org.uk/globalassets/documents/guidelines/rbc_gtg65.pdf.
  21. 2 points
    ELondon

    Kell & Antibody screening

    @Malcolm Needs: Thank you very much for your response, I can not describe in words how grateful and relieved I am. I have been so incredibly worried that I've not even slept since speaking with the midwife, and that was 36 hours ago. I really wish Google had a 'Pregnancy filter' that blocks any attempt to look up medical information. I am under 'Midwife care' at the moment but will request a referral to an Obstretician for reassurance. This is my first pregnancy so I am still figuring out how the system works. I'm not familiar with the set up in other hospitals but the one I am registered with uses an app to send out test results. In my case I first had a message saying 'Abnormal blood test results, with no further details or comments" followed by a call from the midwife. I'm not sure what scared me the most, knowing that something abnormal had shown up on the blood test but not being able to see exactly what it was, or the call from the midwife saying how rare my blood type and antibodies are. I sincerely hope this is not the future of NHS medicine as I could very well have had a heart attack had a been a bit older. I went to the hospital again today and submitted three further samples. Hoping and praying that they will come back normal. Thanks again for your input. I feel like a great weight has been lifted off my shoulders just from reading it.
  22. 2 points
    Malcolm Needs

    Picky anti-C?

    Most antibodies identified as "anti-C" are, in reality, a mixture of anti-C and anti-Ce (with the anti-Ce portion often being in the majority). This is because many of the antibody producers are R2R2, sensitised by the DCe or dCe haplotype - not all, of course, but many. According to my mentor, Joyce Poole, this was true even of monoclonal antibodies that are considered to be "anti-C". This is why you often get weak reactions with RzRz red cells with most examples of anti-C. As you are getting variable reactions with your panel cells, it could be that you have a rare example of a pure, monospecific anti-C, or an "anti-C", made in an R2R2 or R2r individual, who has been who has been sensitised by a DCE or dCE haplotype, and that you have an "anti-C" that is a mixture of true anti-C and anti-CE. All that having been said, I can't see that the above information would necessarily give a reason for your patient's odd reactions, but it might just be one of several reasons. What those other reasons may be, I don't know!
  23. 2 points
    SMILLER

    Emergency Release Blood

    You may want your lab manager to talk to your trauma docs. I am pretty sure that they are going to want to know that you can provide type-specific blood ASAP before the Blood Bank runs out of O negs. Scott
  24. 2 points
    ANORRIS

    Neonatal transfusion

    Same here, entire unit...except well over 30 years.
  25. 2 points
    I agree with Dr. Blumberg that pathogen inactivated platelets are probably safer than the "cultured" platelets and that the psoralin compound used in the process currently approved by the FDA crosslinks DNA/RNA thus preventing proliferation of most organisms and WBCs. However, to my knowledge the FDA has not given blessing for pathogen inactivation to supplant irradiation yet. Reading a copy of the "prescribing information" from Cereus would answer this question. However, it is expensive, $150-$200 premium on the current cost of the products. It is not yet approved for pooled platelet concentrate products. (six-pack) It is not yet approved for three products collected from a single donor (triple product). It is not yet approved as a 7 day product. There is about a 5-6 % decrease in the donors that qualify for giving two or three products at a time. This is because the pathogen inactivation process decreases the platelet count by 5-6%. This means that blood centers will need to replace this number of donors in order to keep up with current product demand. There are some who suggest the platelet efficacy of these products is diminished at as the product approaches day 5. Whether or not this is seen clinically, I do not know but this would have a bearing on whether or not the product will be approved with 7 day out-date labeling, There is a third option that can be entertained by the providers of these products. That is "delayed high volume culturing". This process makes it standard to obtain both aerobic and anaerobic cultures from each product. This process has been used quite successfully in Great Britain to interdict contaminated platelet products. I understand this process would be approved for labeling the product with a 7 day expiration date, without the need for the consignee to do point-of-release testing (Verax). I believe it is important for hospitals to discuss the product desired with their blood supplier. Opening the discussion now will make for an easier transition when the guidance becomes final. We expect to hear from the FDA on this topic later this year.
  26. 2 points
    Can you get a copy of the policy from your supplier that they use to validate their shipping containers? Type up a letter for your pathologist to approve explaining it and give that to your Quality people. Then if they want something more, ask them to show you the regulatory standard they are worried about. Scott
  27. 2 points
    I disagree with this statement unless pathogen reduction will prevent lymphocyte activation.
  28. 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.
  29. 1 point
    AMcCord

    positive dat w cord blood

    I had a similar experience when a Family Practice Dr, who was chair of the OB committee at that time, brought back the Immune Anti-A, -B test. The only 'reference' he offered was his experience with his children. We wanted to ask if those tests affected how the infants were treated, but refrained....tongue biting was involved. The pediatricians say they don't need the test.
  30. 1 point
    David Saikin

    Specimen Expiration

    3rd day at midnight; draw day is day 0.
  31. 1 point
    My idea was just a guess. If you come across any clinical reasons for this testing in the future, I would be interested in seeing them here. Thanks, Scott
  32. 1 point
    Mississauga

    Welcome Mississauga

    Thank you I am touring in this wonderful site .
  33. 1 point
    Okay Scott, but can either the clinician, or you, tell me what constitutes a "significant increase"? Surely, the absolute titre is much more significant than an increase? I am not for one moment decrying an increase, that is certainly important, but we also need to know at what titre the anti-S becomes clinically significant in pregnancy. In the original report involving fatal HDFN (Levine P, Ferraro LR, Koch E. Hemolytic disease of the newborn due to anti-S: a case report with a review of 12 anti-S sera cited in the literature. Blood 1952; 7: 1030-1037) the authors state that the titre was between 64 and 128, BUT, it is very important to remember that this was only seven or so years since the IAT was first described, when the sensitivity of the test was, shall we say, primitive, usually involving tile techniques and an AHG made in sheep, goats, rabbits, etc. The evidence is, therefore, not 100% reliable. I would have thought that, in this day and age, it would be much more reliable to monitor any pregnancy by such techniques as ultrasound/MCA Doppler, than by the antibody titre, when we do not know what titre is clinically significant in the first place.
  34. 1 point
    ElinF

    Kell & Antibody screening

    I could "listen" to Malcolm explain stuff all day!!
  35. 1 point
    I just answered this question. My Score PASS  
  36. 1 point
    Thanks for this. I love the marriage quote. Any idea who it should attributed to? You?
  37. 1 point
    slsmith

    Emergency Release Blood

    We do the type and screen as soon as we get the sample which almost comes immediately after the patient arrives as other labs are drawn at the same time too. Not so worried about the screen part but would like the ABORH especially if it is a female of child bearing age and she is RH pos so you don't use up the O neg supply
  38. 1 point
    Malcolm Needs

    Picky anti-C?

    Hmmmm. Unless that particular cell is actually a DCe/--- (which I doubt, as they are disappearingly rare), and so has hemizygous expression, where homozygous expression would be expected, this is a bit of a mystery - unless the RHCE*Ce gene contains either a homozygous mutation, or a double heterozygous mutation - but again, this would be exceedingly rare. I'll keep thinking, but hope someone else comes up with a more realistic reason!
  39. 1 point
    Just a thought that maybe your process is more complicated than it really needs to be and the nursing staff fail to see the need for it to be so complicated beyond you telling them that's how is has to be done. Sorry but I have never been a fan of blood bank specific arm bands or blood samples (pink top tubes). If I said it once I've said it hundreds of times, complicating a process NEVER makes it better. My first blood bank supervisor, bless her heart, instilled in me the importance of the KISS principle: Keep It Simple Stupid! and I tried my best to adhere to it even in the face of adversity (corporate Transfusion QA)!! OK, I'll get off my soap box before I fall off.
  40. 1 point
    We used to have Typenex but we removed them since they were causing more problems than anything. We collect two specimens to verify we have the correct patient, if only one sample is drawn, we give group O until we have a second sample collection. We also allow for the use of a hematology specimen to verify our blood type.
  41. 1 point
    Not sure how I missed this discussion when it first came out but here's my 2 cents worth. It is the physicians responsibility to inform the patients of ALL risk / benefits of every aspect of their treatment to include transfusions of any and all blood products! Granted, this is not always possible due to the situation but that does not absolve the physician of the responsibility! In no way should this responsibility ever be dumped on anyone else.
  42. 1 point
    Does your investigation-of-an-adverse-reaction-to-blood-transfusion-protocol for non-cellular blood components require testing the pretransfusion blood sample? I think this standard could stand an infusion of clarity. I read it as 'Patient samples for all transfusions and a segment from any red-cell-containing component shall be stored at refrigerated temperatures for at least 7 days after transfusion.' Maybe someone can get clarification from the AABB as to their intent for 5.11.4.
  43. 1 point
    The Ko phenotype is incredibly rare in all ethnic groups, but, some cases have been published involving a transient loss of Kell antigens, and the concurrent appearance of apparent antibodies directed against one or more of the antigens within the Kell Blood Group System. "Naturally Occurring" cases of anti-K are not unknown, but, once again are very rare. A few of these have appeared in the literature, such as: Morgan P, Bossom EL. "Naturally Occurring" Anti-Kell (K1): Two Examples. Transfusion 1963; 3: 397-398. Marsh WL, Nichols ME, Oyen R, Thayer RS, Deere WL, Freed PJ, Schmelter SE. Naturally occurring anti-K stimulated by E. Coli enterocolitis in a 20-day-old child. Transfusion 1978; 18: 149-154. Kanel GC, Davis I, Bowman JE. "Naturally-occurring" anti-K1: Possible association with mycobacterium infection. Transfusion 1978; 18: 472-473. Algora M, Barbolla L, Contreras M. Naturally occurring anti-D, anti-K, anti-Fya and anti_Leab. Vox Sanguinis 1991; 61: 141. In each case, you will notice, there is either an accompanying infection, or, in the last case a form of neoplasm. This may fit with your patient, if the early gastric cancer has allowed the escape of, for example, E coli into his circulation. I was also interested in the fact that you tested the patient's red cells, and found them to be phenotypically K-k-, but genotypically KEL: -1, 2, -3, 4, -6, 7. Did you also test the red cells with anti-Kpa, anti-Kpb, anti-Jsa and anti-Jsb, to ensure that these antigens were not detected? I am not asking this to be facetious, but because there have been examples of an apparent lack of the k antigen due to amino acid residue substitutions either at position 193, usually threonine for the k antigen, or very close to position 193 (see Millard GM, Lopez GH, Turner EM, Lizarazu ME, Roots NM, Liew Y-W, Flower RL, Hyland CA. Modified expression of the KEL2 (k) blood group antigen attributed to p.Leu196Val amino acid change three residues from the K/k antigen polymorphism site: implications for donor screening. Transfusion 2019; 59: 1156-1158 and Yazdanbakhsh K, Lee S, Yu Q, Reid ME. Identification of a defect in the intracellular trafficking of a Kell blood group variant. Blood 1999; 94 (1): 310-318). However, the amino acid residue substitutions can be "geographically remote" from position 193 affecting the expression of the k, and other Kell antigens (see Velliquette RW, Hue-Roye K, Lomas-Francis C, Gillen B, Schierts J, Gentzkow K, Peyrard T, von Zabern I, Flegel WA, Rodberg K, Debnath AK, Lee Soohee, Reid ME. Molecular basis of two novel and related high-prevalence antigens in the Kell blood group system, KUCI and KANT, and their serological and spatial association with K11 and KETI. Transfusion 2013; 53: 2872-2881)). To complicate matters further, some anti-k reagents may give weak or negative reactions, while others give apparently normal reactions. I remember a case I was involved in myself. We were following a woman with anti-D during her pregnancy. She was K+k+, and her partner was D+, K-. Upon delivery, her baby typed as K+k- in our hands (which excluded the father, unless he had a Ko haplotype). Sadly, he was no longer available to check his red cells again. I sent a sample of the baby's blood down to the IBGRL, and they made the baby a straightforward K+k+. Anyway, to cut a long story short, they were using an anti-k from a different clone to the one we were using, so I sent Joyce Poole some of the anti-k we were using, and Lo and Behold, they also got a negative reaction! I asked if they would perform a KEL gene sequence, and they did find a mutation, miles away from where the KEL2 locus was found, and yet it affected the expression of the k antigen. Sadly, I can't remember exactly the location of the mutation, and, because we couldn't type Dad again (or sequence his KEL gene, we couldn't prove it was inherited, and so could not write up the case. So, what to do? 1. Retest the patient's k antigen using a selection of anti-k reagents with different clones. 2. If you haven't already done this, test for the expression of the Kp(a), Kp(b), Js(a) and Js(b) antigens, to see if the patient is, at a phenotypic level either a Ko or a Kmod. 3. It might be worthwhile performing adsorption and elution tests, IF these are negative. 4. It COULD, POSSIBLY, be worthwhile just checking that the patient has a normal XK gene at position XP21.1, as, of course, it is possible to have the McLeod phenotype without having McLeod syndrome (in other words, these people do not have Chronic Granulomatous Disease [CGD]) - we had a donor like this where I worked (the only one in the UK). 5. If transfusion is required in the meantime, give K- IAT cross-match compatible blood. SORRY FOR THE VERY LONG POST.
  44. 1 point
    AMcCord

    LIS Product Categories

    Keep it simple. Let them order red cells, just red cells. If they need irradiated or CMV neg or leukoreduced (assuming there is a choice at your facility) or whatever, let them select that option. In Epic they can be required to select a reason why they are ordering irradiated or CMV or whatever - the reasons should come out of institution policy. That way they are less likely to order inappropriate special attributes. Ditto for platelets and plasma products.
  45. 1 point
    SMILLER

    High Risk transfusion form

    Signature each admission. After discussion, this is usually done by a hematologist. (It is really not that big of a deal "bureaucratically" for us. Perhaps large medical centers have more turf issues with this type of thing.) Scott
  46. 1 point
    John C. Staley

    Emergency Release Blood

    Just curious, is it still acceptable to provide males and women "older than child bearing age" (we used 55 as the cut off) with O pos units in an emergency situation preventing an unnecessary drain on the very limited O neg supply?
  47. 1 point
    Dansket

    Emergency Release Blood

    1. See AABB Standard 5.27 Urgent Requirement for Blood and Blood components, page 43 in the 30th edition. 2. No, if completed type on armbanded sample is not group O, we continue to issue Group O until completion of the 2nd confirmatory type.
  48. 1 point
    We had a Terumo SCD 312 a few years back that never gave us any problems until one day it just flat stopped working and couldn't be fixed. I had been talking to Fresenius about the ComboDock but we have limited space and it was too big for our area. We ended up with the Terumo TSCDII because they were the only ones to get us a same day quote and had the equipment to us in 2 days plus they let us return the 6 boxes of wafers we had from the previous version and gave us out money back (minus 25% stocking fee). Working at a children's hospital we have to have a sterile docker so for us fast was what we needed. With the Terumo TSCD you have a clear catch bin for the used wafers so it's easy to tell when you need to empty it. I was watching a youtube video on the Genesis TCD and it looks more complicated than the Terumo. You have to load a wafer every time and your tubing has to be longer. Here's the link to the video: The only problem we've had is during a emergency generator load test one night it revered back to the LED screen being in German instead of English but the user's guide has a really good troubleshooting guide and I was able to fix it in about 5 minutes. I don't like the way you change cassettes though. It's not as easy to change them as the older SCD 312 model. Here's a video on the Terumo: Hope this helps!
  49. 1 point
    exlimey

    Blood Bank staff

    Even the very best of managers or management teams cannot work miracles if they lack the appropriate resources.
  50. 1 point
    I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!! Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous. An antigen can be described as either showing homozygous expression, or heterozygous expression. That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we had one!). That's got that off my chest. Now then, there is NO doubt that there are some anti-K's around that only react with K+k- red cells (dosage), but they are fairly rare, however, how many people use antibody screening red cells that are K+k-? I doubt if there are any. Therefore, we are all ruling out anti-K using red cells with apparent K antigen heterozygous expression on every single sample that (apparently) has no atypical alloantibodies present. Am I wrong about this? It follows, therefore, that, over the years, there MUST have been occasions when a patient with a very weak anti-K (one that is only detected using red cells that are apparently showing homozygous expression) and who has been transfused with K+ blood (do the maths). As far as I know, there are no papers within the literature that report a case of either a delayed or an acute transfusion reaction as a result of this. Yes, this may cause the anti-K to become stronger (and, hence, be detectable using an apparent heterozygous red cell sample showing K+k+ expression), but then, if this happens, you give K- blood. So, my considered answer is that you can exclude using K+k+ red cells. I shall now go and lie down!!!!!!!!!!!!!
×
×
  • 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.