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I have been on the bone marrow donor registry for 25 years and in May I got a call that they wanted to do more testing to see if I might be a match for a 20 year old male with ALL in Germany. Now all of the additional testing is done and they say I am the match! We are now waiting for the recipient to be ready but they think that it should happen in about a month. I'm so excited! I hope it goes through as planned.

We still use the labels even though we've had an LIS which prevents release of un-typed units for two decades, our blood supplier already double types them, and we keep unprocessed units in an entirely different refrigerator. Anytime I discuss getting rid of them there's intense fear and paranoia. "What if there's a downtime? How will people know the units on the shelf are REALLY retyped?" I'm hoping to hear from more incredulous people who didn't even know others still used them to inspire me to forge ahead and suffer the backlash.

Just check the release date/version number of the insert - if that hasn't changed then nothing in it has.

I wondered if Brits celebrated this, maybe as good riddance day.

Our plan for the patients is to do a preliminary type and antibody screen, along with a full phenotype, before they begin treatment. Once they begin the medication, we will perform elutions on the patients. This should allow us to identify any newly formed antibodies that wouldn't be detected with the DTT treated cells.

I hope they aren't making RhIG from someone who can make anti-D as well as anti-c. She would have to be r'r', right? She needs to be donating Red Cells, not plasma for RhIG. I get the point though that the idea of a passive antibody is always worth keeping in mind.

I certainly appreciate everyone's feedback. Old habits are so hard to break and some techs are so nervous about this change. You would think it would be a relief given that over 2000 units a month are transfused!

I just walked into this in my new position . . . WOW. I think we are doing a f/u on all transfusions to determine if the patients were definitive candidates for leukos or not. This is my task starting tomorrow. Waiting for a complete list from the blood supplier.

Happy Independence Day to all my friends and colleagues in the USA.

I can understand your reasoning Brenda, and can quite see your point, but I think that the fact that your units of blood will have been "on the shelf" for a while, the chances of there being sufficient viable T lymphocytes in them, and for these to remain in the patient's circulation long enough to cause TA-GvHD is unlikely - not impossible, but unlikely.

Thank you Malcolm; that does help. So it brings up that gray area I am struggling with.....in an emergency. It is true that Massive Protocol is always an emergent situation, but my struggle has to do with the fact that if you have the time to switch from uncrossmatched to crossmatched (still Massive Protocol), is the assumption then that you also have time to meet special requirements (we do not use electronic crossmatch yet....so there is a little time involved)? I am leaning towards writing in my SOP that "if time allows," we will Irradiate units for patients on crossmatched MTP who require Irradiated; but that if time does not allow, to obtain a variance from the Medical Director. I will run that by the Head of Oncology and Trauma Docs to make sure they are ok with that. My concern here (and it may just be a lack of understanding on my part) is that while I understand the theory behind the decreased risk of antibody formation say in giving Rh POS to Rh NEG (etc.), I am thinking that the issue with Irradiation is the opposite....that the reason we give Irradiated is because the patient already has a weakened Immune System and yet Irradiated products are still required to prevent the risk of GVHD. So in my mind, I would think this would put them at a greater risk of GVHD (giving non-Irradiated to a patient massively bleeding) if we are only considering the Immune System status of the patient (i.e. since the problem in GVHD is the cells you are transfusing attacking the patient.....which I am sure you know), but perhaps the excessive bleeding, also does not give the transfused cells a chance to mount an immune response against the patient?? That is the part I have never really thought about. In getting feedback from some other Hospitals, there are some that do state that once they are on crossmatched massive protocol, they give Irradiated Products (if required) and only get a variance if they cannot keep up with the need. Obviously, if the choice comes down to a patient bleeding to death vs. giving Irradiated products, we would opt to give non-Irradiated products (at least I have that part clear in my head ). Thanks again........ Brenda Hutson

I had a trauma surgeon tell me one time that in a true MTP situation that they want us to give them whatever ABO compatible products we can give them as fast as we possibly can. He mentioned that in a traumatic situation the body's immune response system shuts down because the body is sending all of its defenses to help it make itself through the trauma situation. If the patient survives the MTP episode then it might be time to worry about antibodies, irradiation, etc. And he also mentioned that the blood is passing through so quickly that he doubted very seriously if the patient would even have time to respond to foreign antigens.

I think those pesky labels are a "left over" from a time before we had LIS's.

Your new Pediatrician should treat on symptoms, rather than laboratory results, but order laboratory tests to prove the symptoms. It would be a lot cheaper, and would also show that the "Pediatrician" actually deserves the title.

Actually, this has been done. It was a poster presented at BBTS ASM some years ago now at, I think, but don't quote me on this, Bournemouth. I can't remember who were the authors, although one of them was certainly Dr Fiona Regan, and it won a prize (sorry to be so woolly about the details, but I am working from home today, and so don't have access to all my books, reprints, etc). Anyway, the bottom line was that the equation used for the Kleihauer test result relies on the woman being a Standard British Issue in terms of weight, height, etc, and, of course, all women average out under a bell-shaped curve (meaning some will fall outside the Standard British Issue woman, but still be within the "normal range", and some humans (including me) will fall well outside the average (in my case, not because I am exceptionally tall or short, or because I am under weight - which leaves one alternative!!!!!!!!!!!!!!!).