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My favorite transfusion reaction work up resulted in closing the blinds on the window to keep the sun from beating down on the patient resulting in a rise in temp. True story.

Hello, Great discussion. I just set up a comparison study using DTT made with different pH buffer and here is the data (a copy of poster to be posted at 2017 AABB meeting). Hope it help answering some questions here. to print DTT poster AABB 2017.pdf

And remember when the "blood warmer" was a few minutes on the radiator/heating vent ? Good times.

Our Policy states that it is the responsibility of the Physician to "call" a Transfusion Reaction. Sometimes, they will call us and try to get us to tell them if it is a Transfusion Reaction (i.e. should they initiate a Transfusion Reaction) and I have advised my staff that this is NOT our call.....we do not know the patient, we do not know what their condition was prior to the transfusion, and we are not Physicians. When a Nurse suspects a Transfusion Reaction (and I have assisted Nursing education with the PowerPoint presentation on that for which Nurses must complete the assignment annually), they are advised to notify the Physician and let them make the call (they can also notify us, but we will not tell them whether or not to call a reaction; and they are required to notify us if they have decided to call a Transfusion Reaction). Yes, there are times they call us and based on what they tell us, we may think they should be calling a reaction (but we will not make that decision), and then they end up not calling a reaction (i.e. the Physician decides not to initiate a transfusion reaction). Those times can be disconcerting, but all I can do is continue to educate staff (and even though the symptoms may sound to us like they should initiate a reaction, that is exactly why we do not advise.....it is possible that the patient has been having those symptoms and the Physician knows that....so they are the ones who have the "big picture" of what is going on with the patient, not us). There is a Hospital Procedure which I wrote, which clearly describes various symptoms of transfusion reactions; what to watch for. But they made that call. Brenda Hutson, MT(ASCP)SBB

These days we don't use glycerol to freeze rare red cells, but glycigel (for the recipe, see the library, user submitted, SOPs), as we find the preservation better and easier. As far as your findings are concerned, I agree that it is probable nothing to do with the actual age of the red cells. It is much more likely to be the formation of ice crystals in the red cells over and over again, with successive freezing and thawing episodes. Essentially, the glycerol acts as an "anti-freeze" (rather like you would find in the water in the radiator of your car). This glycerol affects the temperature at which water freezes (fairly obviously, from what I have just said!), but also affects the way the water crystals form and how they affect the red cell membrane (they are not as "sharp", for want of another way of putting it). The use of glycerol does not make the crystal formation absolutely "blunt" however, and so each time an aliquot of red cells is thawed, and then refrozen, there will be more and more damage to the red cell membrane, and this is cummulative. So, there may be very little haemolysis seen in a sample that was frozen down once, 15 years previously, but only thawed for the first time now, whereas a sample frozen down say, two years previously, but frozen and thawed several times may show gross haemolysis. All of that having been said, however, the age of the red cells when they are first frozen down can affect recovery (the fresher the cells when frozen, the better the recovery), as can the type of the red cells being frozen down. For example, Rhnull individuals normally have a well-compensated haemolytic anaemia because of membrane abnormalities leading to stomatocytosis, and these red cells have a "fragile" membrane from the "word go", and so such red cells never recover quite as well as "normal" red cells.

Well, not quite sure how it ended up this way in that we spoke to the Medical Director at the ARC twice (he had said to report it as a hemolytic transfusion reaction); I sent them copies of ALL of the work we had performed, as well as a copy of the Transfusion Reaction Form showing the symptoms and work-up; and I attached a letter, summarizing everything that had transpired, and what our additional thoughts were (i.e. Antibody to a different Low Incidence Antibody being just one other thought). I received an e-mail back from the Medical Director a couple of weeks later, and here is what was written: I received this report of a potential TRALI reaction from your hospital, and after investigating the sex of the donor involved in this case--a man--I have decided not to investigate the case. The reason for not investigating the case is that the donor in TRALI cases are previously pregnant women with HLA antibodies, and male donors do not have HLA antibodies. You also had a concern for TACO, but TACO is not associated with any donor or blood component characteristics. I am going to send you formal follow up letter with this decision. So I e-mailed him back, reminding him of our conversations (we never mentioned TRALI or TACO as a possibility for many reasons), and mentioned that I had also attached a letter (which may never have reached him; I can't say.....so I attached it again to my Reply e-mail). I have never heard back from him.....so I guess it is a closed case. We went as far as we could with a work-up.....so if ARC is dropping it at this point, I guess we are also. The patient has subsequently been multiply transfused w/o incident, but we may never know what actually caused this 1 reaction for the patient. Brenda Hutson, MT(ASCP)SBB