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Well- sounds like I have TWO issues to address. The age that we perform the rosette test AND that we are not using the rosette test correctly. We currently perform the test on infants/fetus of unknown type. I don't think the core lab is going to be happy to hear that they may be doing more KBs!

For what it's worth...we really don't do that many. We are a large hospital (450+beds) w/ trauma center, and we average maybe 1 per week. We don't even have our 3rd shifters maintain competency. Most of the miscarriages are early enough that they don't need quantitated so we just give one vial. We just get the occasional amniocentesis or late loss on an Rh negative mom & trauma/fell down and bumped belly to perform the K-B's. It is on our fetal demise & pregnant trauma order set, but it's just not that common. Take care

I'm sorry CMCDCHI, I have got completely the wrong end of the stick. There is a saying along the lines of the USA and the UK being huge friends, divided only by a common language, and I think that is what has happened here. I thought that you were talking about screening for anti-D in the maternal plasma, and I now appreciate that you were talking about something else completely. Now I know about what you are asking, the answer is that, in the UK, the screen is performed at 20 weeks of gestation and beyond. Before that, we just give a minimum standard dose of 250 IU (although a higher dose would not hurt), without performing an estimation of the FMH. My profuse apologies for the misunderstanding on my part.

I also listened to the Immucor webinar. What I got out of it was BB does not have to do lot to lot for our reagents, rare or otherwise. We do daily QC and the reagents must pass before use. We do have to compare current FMH kits to incoming FMH kits. You must make sure the controls on the current kit work on the new kit and vise-versa. This is to make sure the controls on the new kit work as expected and that the shipping conditions did not cause the cells to deteriorate. We had also been comparing Elu-Kits but someone specifically asked if those needed to be compared and they do not. I think I heard that it is because there are not any controls in the kit. I am grateful for small favors so I am getting rid of the Elu-kit comparison portion of my procedure. When it comes to comparison of panel cells, look carefully at the package insert instructions. Does it say you HAVE to QC? Then you must. Does it say you MAY test, then it is up to the facility if testing is done. I personnally take that as a legal loop-hole and will run with it. Besides how could you ever compare one panel to another since you would be comparing different donors? I had talked to CAP in the past about this subject. They said you must check all incoming shipments for proper shipping conditions AND must be checked prior to use and these checks must be documented. I made up a form that reagents are listed as they come in (date arrived, #, lot number,etc.) and I added a column for checking the shipping container. Acceptable Yes or No. At the bottom of the page in small writing I listed what was acceptable and what was not so there was not question. All of this checking must be documented. We all know if it is not written down, it hasn't been done. Below is the next slide from the Immucor presentation: TRM.31241 All new lots of reagents and critical materials (e.g. blood collection sets) are inspected and tested, as applicable, before use with records of acceptance. - If manufacturer’s instructions require testing prior to use (e.g. panel cells, antisera) then lab is expected to test -If manufacturer’s instructions recommend testing prior to use, it is up to the discretion of the laboratory to test -Once reagents are put into use, TRM.31400 applies

Liz & David~ Will the fetal screen kit you use detect the cells of a weak D+ fetus? Ours (Immucor FMH RapidScreen) doesn't, so we can't do it until after delivery & Rh is known (or we would risk a potential sensitization on the off chance the fetus was weak D+ and a large bleed was missed). If your kits do detect them, I'd love to hear about it so we could reduce the K-B we perform. Thanks!

No, it is not down to you to change - it is for me to realise that not everyone speaks or writes "English English"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We are doing antibody screens on early prenatals. My question was only in relation to fetal-maternal bleed screens (rosette test). If we have an RhIG evaluation ordered and the mom is D negative and does not have immune anti-D, we will give RhIG. If the baby is less than a certain gestational age, we will just give 1 RhIG without checking for any additional bleeding. Over a certain age, we will do a rosette test and follow up with a Kleihaur-Betke if needed. My question is what that age should be.

Hi Kelli, I'm so excited to hear you are writing an article for Transfusion. Finding time to write is a challenge. I wouldn't worry about a professional reviewer as the Transfusion staff will edit your article to comply with the Transfusion Style Guide. As one of the former Technical Editors for Transfusion, I'm very familliar with the process. The journal's website which you can access through AABB.org, has instructions for authors that will cover how they would like you to organize your paper (Case Review or original work, etc) and the steps for electronic submission of the file once you are ready for the peer review process to start. The peer reviewers are only supposed to look at content and how you drew conclusions from your results. They will submit questions back to you if it is felt there is more explanation or data needed. This is meant to be a supportive, collaborative process so please do not take any of the comments personally. They are meant to help you look good as an author. When content is settled, the technical editing staff for the journal will will work on your paper to make it comply with the Transfusion Style Guide and send you proofs before anything is printed. They do all the heavy work as far as grammar and formatting are concerned. They will make sure your data is presented in the clearest way possible and that your intended message is delivered correctly. You will be involved in the process but not completely responsible for it so don't worry! Any questions or concerns, I'm happy to help.

We wrote in our policy that we don't expect 100% concordance, cited several publications regarding the differences between the methods, and made a note that the blood bank supervisor and medical director will both review the results to determine the significance of any observed discrepancy.