Leaderboard

Our hospital IT people created a "uncrossed-emergency-MTP" order (actually just a notice) that can be entered into the hospital system that sends the patient's registration to the BB system. That way, we can order whatever on our BB system when a MTP is started. The "order" also serves to document a physician's order for using uncross-matched blood. Scott

Currently I do not work in such a Facility so have Generalists that rotate, but most of the Hospitals I have worked at in my career, were large Medical Centers that fit your description and they always used Blood Bank dedicated staff. I think you need that specialization to be performing high level testing. Also, it would be a lot to ask of Generalists who have to rotate between all depts. that they would be that specialized in the Blood Bank, but also be able to be knowledgeable and competent in the other areas as well. You need a certain depth of Blood Bank knowledge to be training interns; to do high complexity serology; to know how to handle difficult trauma situations. Just my thoughts.... Brenda Hutson

Thank you all for your input. With regard to the comment that the post was long....I tend to like to explain things thoroughly so readers have all of the information I have, and know what my thoughts are up to that point. Sorry, just my style. ABsub did also occur to me, but in all honesty, I have only rarely seen this in my 30+ years (just lots of AsubB). Also not sure if it was just weak due to age so would not want to "label" them as ABsub if 6 months from now, they typed 4+ with Anti-B. So was a little nervous about coming to that "official" conclusion. So we did make the recommendation that if they really wanted to know, they could try submitting a new specimen in about 6 months. I agree that there could be a different Low Incidence Antibody that caused the transfusion reaction (we only tested what we could get from our panels). We are sending pre and post specimen plus leftover platelets to the Red Cross to see what they come up with. They may or may not elect to run a panel of some Low Incidence Antigens from their frozen inventory; but of course they can't test every Low Incidence Antigen so it would just be a "hit or miss." But I guess what is still just odd to me is that the DAT was negative before the transfusion (just that morning; was just sent because the patient was being seen by their Oncologist and has been using blood products steadily, so they wanted us to have a specimen available should they need to transfuse more RBCs in next few days); then clearly positive right after the transfusion; and there was definitely an Anti-Lua coating the cells (but also a mystery as to why the strength of the DAT would so obviously weaken in just a few hours, if no evidence of hemolysis). Also, with regard to the comment from BankerGirl about why we were calling it a hemolytic transfusion reaction. We had called the Red Cross Medical Director right after we discovered the Positive DAT and he instructed us to do that; however, our Medical Director did not state that on the Transfusion Reaction Report; but in fact, stated that the reaction may not have even been related to the transfusion; could have been coincidental timing (but that still doesn't explain a Negative DAT becoming Positive from Pre to Post). So is the suggestion then that while we eluted the Lua.....that had we performed an eluate on the negative DAT cells from the morning, we may also have eluted it then but it is just that it is not present on enough cells to have resulted in the Positive DAT (i.e. as an explanation as to why the DAT changed but no Anti-Lua was identified in the platelet plasma)? I am still trying to make sense of that part; that if it was not the cause of the reaction and was not in the platelets, the assumption would have to be that it was already present and coating the cells prior to the transfusion; just not enough to cause a positive DAT; but enough to come off in a concentrated eluate? The patient had received numerous red cell transfusions over a long period of time; so there certainly could have been a small population of transfused cells that were Lua POS to which the patient's Anti-Lua attached? Also, Antibody Screen Negative, so no "free" Anti-Lua (unless low titer). If Red Cross comes up with anything more concrete, I will pass that along; but I really appreciate your input on this mystery! Brenda Hutson