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What needs to happen now is a thorough investigation of WHY this issue happened - not to apportion blame, but to ensure that it can never happen again due to an error in the lab

Am I being obtuse? What are you using the scope for?

Also ticks the box for safety when the second type (for none type O patients) comes from a second separate sample.

We do not require another tech to perform another verification of blood type just to use the computer for crossmatching. The computer is set up to require two ABORh's. Our policy is that we require two separate draws by two different phlebotomists when we have a patient that our computer system has never seen. The first ABORh is performed by our automated platform on one of the samples and then a technologist performs the second ABORh on the second sample. Our computer system, and I would hope yours too, keeps that historic information for the next time the same patient visits. The second time that patient arrives in our institution, we only draw one sample for testing and perform the ABORh. At this time, our computer recognizes the historic blood type and the current (i.e. Two ABORh's are present for computer crossmatching). If the patient meets our other criteria, then we are able to perform computer crossmatch. FDAEXM_Guidance.pdf I am not aware of any regulatory or accreditation requirements that state testing needs to be performed the way you describe your current process.

Clinical management of the patient can be tricky - and sometimes no matter what's done, there's not a good outcome. We advise following liver function and renal functions. Much depends on if the potential Ag/Ab reaction causes intravascular hemolysis. We'd particularly watch LDH and creat. We may recommend hydration/Lasix to keep those kidneys flushed. If hemolysis is severe, and LDH is high, we may recommend a red cell exchange. Which may or may not help. By the time you're seeing brisk hemolysis, most of the donor cells have been destroyed and there's little to exchange. Plasma exchange is also an option. But many times in an ABO mismatch, these things can happen quickly. The sooner the BB med director knows, the sooner he/she can help guide clinical management.

Still liking my Helmer cell washer. Very glad we switched from the Sorval. Earlier Sorvals were great but the re-branded CW2+ was awful. The Helmer may cost more up front but it is worth it because we have no problems, no parts to buy and no hair pulling.

The baby has not been proved to be D Negative, as the DAT is positive. Until the cause of the DAT is fully understood (you are correct in saying that it could be as a result of an ABO incompatibility, or an antibody directed against a low prevalence antigen, but it could equally be anti-D, or a combination of any of these causes), or that the baby is expressing a weak or Partial D, which cannot be proved or disproved while the DAT remains positive. Under such circumstances, the mother should be offered anti-D immunoglobulin (as a belt and braces exercise), and if the offer of anti-D immunoglobulin is accepted by the mother, you are duty bound to make certain that the standard dose is sufficient. If this is not sufficient, a calculation should be performed to ensure that a sufficient dose is given. THERE IS NO ROOM OR EXCUSE FOR GUESSING IN ANY AREA OF BLOOD TRANSFUSION.

But since you have learned about novel antigens, maybe in your spare time you could write a (wait for it!) NOVEL!

Human source commercial antisera like anti-Fyb have shown weakening antigens after DTT treatment in our hands . Others have not found this. We wish we could figure out why our reagent cells sometimes lose their Fyb antigens. Donor units that we have treated have not seemed to lose reactivity.

Wow, can't remember the last time I read a 4 page thread from start to finish! Txlabguy82 this is definitely one of those "s....tuff happens" occasions. Personally I see nothing in your process that would concern me, Actually there is a fair amount to commend you for. As far as this possibly being a sample problem, I think not. I've used short sample EDTA tubes far more often than I care to admit. I guess, just to join in on the questions, could the sample have agglutinated as opposed to clotted? Just a random thought and not real sure where it's going but it did come to mind as I was reading. When I was supervising blood banks and transfusion services I never got overly excited about the random one time occurrences, especially those where no real cause could be pin pointed. The corporate Transfusion QA group hated it when I would remind them that as long as humans were involved in a process there would be the occasional human error. Now, whether or not this particular case was human error will probably never be determined. Bottom line; the patient received her dose of RhIG because the process discovered a problem. Why the problem occurred will, most likely never be truly determined so don't let this eat at you over much. My recommendation, find employment as a dedicated bloodbanker and enjoy the rest of you career.

If there were 2 populations of cells, and if the fetal cells were ABO incompatible with the maternal sample however D positive, the fetal cells could have been hemolyzed in vitro by the time the sample was retested 10 hours later. Since the fetal cells were no longer intact, the repeat testing would have been on exclusively maternal cells and tested as D-negative. I realize your initial forward type did not detect/report the presence of mixed field agglutination. With monoclonal ABO antibodies and using tube testing, it is often very difficult to detect mixed field reactions with small populations of other cells. It seems the monoclonal ABO antibodies are so avid, the agglutinates seem to "trap" the other population of cells in the agglutinate rather than remaining free to be resuspended. This was demonstrated years ago when the AABB offered "damp" workshops where samples were provided for testing, registrants reported their results and results were tallied and presented to attendees. During the time when the older polyclonal ABO reagents were still in use and the monoclonal reagents were just being introduced, the results indicated a significant difference in the detection of mixed field agglutination in the forward ABO testing between the groups using polyclonal reagents (MF detected) vs. monoclonal reagents (MF not detected).

Has anyone had any problems with the the inside cover of the cell washer "chipping"? It looks as if the paint is chipping off and I'm wondering if it is due to the weekly bleach cycle. The cellwasher is only 3 years old. I don't remember ever having this problem with the older cellwashers, but of course, I sometimes don't remember what I had for dinner last night.