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I have followed this forum as a "guest" for about 4 years. Never checked the education/quality forum. I am retiring after 44 years in blood banking. I have a 4th edition of the Peter Issitt Applied Blood Group Serology book that I will no longer need. Since I am brand new to this forum, I am not sure how any interested parties would contact me other than a post in the forum. I am actually heading to my job right now, so I won't be available to respond until Saturday, 16 January 2016. Would love for this book, to continue to be used in the blood bank setting.

That's a very perceptive question from a student!

If miscarriage > than 13 weeks and/or unknown Rh type of the baby, we perform the FMH screen. If we are doing the FMH screen, it needs to be drawn after all 'products of conception' have been delivered/removed. So for the >13 weeks or unknown age, we do the FMH screen on a specimen drawn after the D&C, if they do it, or after the miscarriage if it's 'complete'. The patients that need the FMH screen done are usually the ones that we see post-op rather than through the ER.

Since you wash the cells several times anyway before use, it seems logical that any anticoagulant is washed away (or at least mammothly diluted). We have this issue more frequently finding enough cells for an eluate, or an eluate and autoadsorption. For both procedures I have successfully used citrated cells and cells from lithium heparin chem tubes if you can fight your way through the gel. (Speaking of lithium heparin, if a patient has a juicy antibody, I collect all the lithium heparin chem tubes and EDTA heme tubes I can to pool and freeze to torment future generations of students. If validated, does anyone know a reason why lithium heparin plasma cannot be used for, say, a panel if your serum or EDTA plasma is in short supply? Seems to work fine for the students.)

I will get back to this post on Monday, as I think I have a couple of things to say, BUT, I will say one thing immediately, and that is that if I gave a midwife my considered opinion as to whether the lady was D Positive, D Negative, Weak D, Partial D or DEL, and he or she ignored me and decided that he/she knew more about the Rh Blood Group System than do I, with particular reference to the D antigen, AND ignored my opinion as to whether anti-D immunoglobulin should or should not be offered to the lady, at the very first opportunity (when one of the ladies produced an immune anti-D), I would offer my services to her, for free, as an expert witness, and take the midwife for every penny (or cent) we could squeeze out of her.

Very generous AuntieM. And congrats on your retirement!

First - I would verify that we drew the right patient and verify that our results are correct as reported - immediate spin results. I would also do the weak D test to confirm what the reference report is saying. That makes the discussion we may be having with the patient's doc about the discrepancy easier. Then we would report our results - Rh negative - and recommend RhoGAM (with a Kleihauer-Betke performed). This is the protocol for our facility. Until there is a published guideline for molecular testing results and who gets RhoGAM (which is going to be coming soon from the College of OB/GYN), if the patient is IS D negative, we recommend RhoGAM. Our house, our rules (our liability). I would take the results to the pathologist on call so that he/she is on top of things if the physician calls for a consultation, which they generally don't. For the rare occasions that we've dealt with this, the OB/GYN docs have given the RhoGAM and a midwife refused it. If the provider declines to give RhoGAM, that is their perogative, however I would request that they document in the patient EMR that they have seen our Rh results and have declined to issue RhoGAM. And that's the end of it. If we had a previous result on file for testing performed by us that was weak D positive, we would report it as Rh negative, previously reported as variant or weakly reactive D. I have sent a letter out in the past explaining why results for D testing can vary from lab to lab (or change from pos to neg here) that goes into a few details about the complications of D typing. (I'm sure their eyes glazed over reading it). All the medical staff currently with us have now seen that letter if they so desired. Thankfully we are back to doing almost all the prenatal panels for the OBs we deliver.

Yes, she got a gold Star for the day! Note that she caught the same donor cell on two Ortho panels that are now outdated. However, when they were both in use at the same time for two weeks in December! scott

Sorry, I mssed that part when the system was first introduced.

I've used it myself Phil, but, to be honest, I don't think that I have ever done a formal validation on it.

Tricore; yes, in Sweden many larger hospitals use PI instead of irradiation when preparing platelets, the methods are equivalent. In moderately sized hospitals it's more convenient and cost efficient to irradiate the (rather few) components needed at the irradiation center instead.

Discontinued routine washing of cord blood cells for standard tube testing decades ago. Routine washing assumes all cord blood samples are contaminated to the extent that false-positive results would be obtained without washing. In the absence of supporting data, it is a "solution looking for a problem".

We keep an inventory of irradiated products sent by our blood supplier for our infusion center patients who require it. Much easier.

I would try to convince the cancer center to keep using the LINACs!! You are probably looking at $300,000, or somewhere around there, and all kinds of obnoxious security requirements. Try Best Theratronics or JL Shepherd for pricing.

Become accustomed to grey area.

Sorry, but I am going to don my PEDANTIC hat again. There is no such thing as an individual (male or female) who is Du+. There cannot be, as there is no such thing as anti-Du. When Dr Fred Stratton first described "Du", he, together with Drs Rob Race and Ruth Sanger tried to separate anti-D from anti-Du, and vice versa, and, of course, they could not so do, as anti-D was adsorbed out by Du red cells and this proved that anti-Du did not (and still does not) exist.