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I work at a reference lab as well and we get roughly 3-4 DARA patients a month. More often than not, half are repeat customers. It seems strength varies from patient to patient, but definitely increases as the treatment continues, but nothing more than a 2+. We treat screening cells with DTT every time. We also treat a second set with trypsin to help rule out Kell group system antibodies. So far we haven't had much viability with cells lasting longer than a full shift.

I vaguely remember that one. There are lots of anecdotes of funky results that were ultimately blamed on the saline in use at the time. More recently, there have been reports of excess ozone in "blood bank saline" causing inactivation of the S antigen. Apparently ozone is bubbled through saline to sterilize it. In colder months the warehouse is cold and the ozone does not dissipate as quickly. In the summer months it's not so much of a problem.

I work at a reference lab and I have personally worked up many Dara patients. I have had to DTT treat reagent cells only once to remove the reactivity caused by it. Every other instance I have been able to complete rule-outs/rule-ins in LISS. Maybe as these patients are on the drug for longer we will have to start DTT treating cells more but as of now it hasn't been as big of an issue as it was thought to be last year when this all started(at least for us). Has anyone else noticed this too? Could be we are just lucky with our patients.

I don't remember the name of the hurricane that destroyed much of south Fla in the late 80's/early 90's. I used Dade's blood bank saline. it was noted at the time that somewhere, somehow in its manufacturing process it was neutralizing the reagent anti-D. Dade never remanufactured that product after the plant was destroyed. Otherwise I guess I am a lucky guy - never had to use "normal" saline, but it was always an option.

Wow, David, you must live a charmed life if you haven't been tripped up by "bad" saline sometime in your career. Certainly in the vast majority of cases the actual pH of saline has little impact, but there are lots of examples where changing the pH of a test system has deleterious effects. Most manufacturers of blood bank reagents and test platforms now specify pH ranges for saline, essentially requiring the use of buffered saline.

30 yrs ago, we used plastic tubes at Dana Farber. They are not as clear as glass, but maybe have improved in the recent years! One big problem was static - labs are typically very dry and when you used a pipet to drop spec/reagents into the plastic tube, the drop would "jump" out and not go in. We had to wipe the tops of the tubes with saline dampened gauze to get things into the tubes. Hard plastic tubes would still be considered "sharps" and need to disposed just like glass. If there's a choice, I'd advise sticking with glass.

Here is what I wrote for our purpose: Compatibility testing is all pre-transfusion testing performed on a potential transfusion recipient and the appropriate donor blood, in an attempt to ensure that the product will survive in the recipient and induce improvement in the patient’s clinical condition; the electronic crossmatch is performed with the ABO compatibility truth tables built in a computer system. The electronic verification of donor/recipient compatibility has many advantages. In addition to the major benefits of increased patient safety and decreased unnecessary work, the electronic crossmatch has advantages that include time savings, job simplification, increased throughput, decreased turnaround time, reduced patient sample requirements, and reduced handling of potentially hazardous samples, as well a avoidance of false-positive and false negative reactions associated with serological crossmatches.

What is a computer crossmatch? How does the computer do a crossmatch? I think you mean electronic issue?

Hi all, Wanted to let you know that there's a blog (one of a series) on Malcolm Needs on Canada's Canadian Society for Transfusion Medicine website. BloodBankTalk is also mentioned. http://www.transfusion.ca/Resources/CSTM-Blog/January-2017/I-will-remember-you-Malcolm-Needs

We have the HemoSafe in our OR area as well as three BloodSafe controlled small refrigerators with kiosks and magentic locks distributed throughout our facility for massive transfusions. We are very happy with their performance. A word about the "coolers as storage" idea: When we had our AABB assessment in 2009, the assessors threw that at us as well. I knew it sounded wrong, (not to mention the fact that our assessment was prior to the effective date of that standard) but at the audioconference for the changes, which unfortunately didn't take place until a few weeks later, Debbie Kessler made it very clear that blood sent to the OR in coolers is "transport", not "storage", as long as the time period doesn't exceed what the cooler is validated for. She said "the cooler is transporting blood out to the OR and back to the transfusion service with a pause in the OR". I made very detailed notes about this so that we could respond to the variance. That said, I would still recommend the HemoSafe if your budget allows. You are able to maintain tighter control over your inventory and keep detailed logs about their disposition.