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Our primary method is gel. If we get =/< 2+ reactivity (on someone pregnant or with childbearing potential), we repeat with tube reagents to see if it reacts at IS. If not, we incubate @ RT for 15minutes. If tube reactivity is not 2+ or more, we tentatively call the patient Rh- and request an order for Rh genotyping from the physician. The vast majority do come back as being a variant that can be treated as Rh+ for transfusion/RhIg purposes. There have been a couple that we were told have the potential to make an anti-D. I uploaded one reference to the library under Educational Materials. There was also a good article in Transfusion Volume 55, March 2015

Repeat testing to make sure that plasma was added to the panel.

We had graduated to doing ABO/Rh and DAT only on babies born to Rh neg moms. Then...........a new Family Medicine doc came to town and became the head of the OB committee and now we are doing ABO/Rh and DAT on babies born to all O moms as well. The new pediatrician head of the pediatric committee is perfectly OK with testing only the babies born to Rh neg moms - all our newborns are scanned for evidence of elevated bili before discharge, so a high bili is not going to be missed. We are hoping he can eventually win the day and we can go back to testing only the Rh neg babes. One category that we don't automatically get cord bloods on is the moms with clinically significant alloantibodies. I would like to see that change. If a pediatrician doesn't order a DAT on those babies, I find a hemo sample and run one - if it's positive, I would take that info to the medical director for followup with the attending.

As long as a new specificity is detected in the plasma, I wouldn't UNLESS the patient requires a further transfusion. in which case I would do an elution and test it against red cels that do not express the antigens against which the plasma is known to contain antibodies (including the de novo specificity).

It would be interesting to hear exactly why the new paediatrician wants to go back to this testing regime, considering that it has been known for decades that the DAT in a case of ABO HDN can be negative for a couple of days from birth, and only then become positive. May I respectfully suggest that this new paediatrician relies on his or her ability to look at the baby's symptoms, rather than his or her ability to read laboratory results. This way, more babies may survive.

We do something extremely similar to your daily executive safety huddle. We previously had two individuals for laboratory quality/compliance, one for all lab and the other for blood bank specifically. Now we just have the one individual who covers the whole lab.

Here is the quick and dirty for the stroma preparation procedure: We used three units of red cells (R1R1, R2R2, rr; one homozygous for Jka, one for Jkb, one for S, one for s; not more than one unit positive for K). Each unit was treated with 10 cc of 1% ficin (freshly prepared) in a waterbath for 15 minutes. Test after incubation with glycine soya to ensure 2+ reaction. Incubate longer if needed. Wash 3 times in a Cobe 2991 with no red cell override. Add 75 cc of digitonin, mix, and incubate in the processor for 5 to 15 minutes. Do three manual washes with superout set to 300cc. Add 75 cc of digitonin, mix, and incubate in the processor for 5 to 15 minutes. Wash until stroma is white (a minimum of 2 liters saline - watch the waste bag, it can't take this much!) Spin times at least 3 minutes gradually increase the superout as the hemolysis is reduced. Additional digitonin may be added if the stroma is not the desired whiteness. Be sure to wash thoroughly afterwards. Test the supernatant with red cells to see if all the digitonin was removed. The stroma may require extra washing before it is used if these cells hemolyze. After wash is completed, add about 200 cc saline. Aliquot into tubes and freeze at -70C Use within 6 months. Credit the staff at Florida's Blood Centers Reference Lab for this procedure.