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Might be a rare IgG anti-A1 - you may not see in in the Reverse (presumably IS or buffer-only gel card), but is detected when you do anything with an antiglogulin reagent. You could try doing the Reverse by IAT. The DAT may just be a red herring, but it might represent a weird autoantibody that favors group A cells.

It COULD be that the patient is a secretor, and is secreting sufficient A substance, which is then adsorbed onto the group O red cells, for some very strong anti-A reagents to detect this adsorbed A substance (remember that the patient will still secrete A substance throughout his life, as the secretion is not affected by the bone marrow transplant). This is a bit of a long shot, but I have seen it happen on very rare occasions.

We don’t charge.

I believe that you cannot charge for the 2nd type. Cost of doing business.

I may be wrong, but isn’t washing the reason for your 24-hour outdate. Irradiation itself doesn’t abbreviate to 24 hours.

You could still be looking at an additive/preservative issue. You state that Gel testing performed by your site was Grifols and the Reference Lab was Ortho Gel with Immucor reagent red cells. Immucor does not make reagent red cells for use in gel systems so the Reference lab would have had resuspend the 3% cells to 0.8% for use in gel. If I remember correctly that involves taking an aliquot of the red cells, adding saline to make them easier to decant to a "dry" button and then adding MTS Diluent. So you are essentially washing away the additive/preservative in the reagent cells and thereby removing that as a potential problem. The fact that the crossmatch performed in Grifols gel was negative also points to the reagent cells as being the issue. I would suggest that you try rerunning the specimen in Grifols with "washed" reagent red cells to remove the additive/preservatives and resuspend them in the same diluent you use for the donor cells and see what you get. As to the C3d being positive. Have you checked patient's meds list? Some meds cause the DAT to be Complement Positive e.g. antihistamines containing brompheniramine, phyenyltoloxamine

We would issue with 15 minutes left on the type and screen. And, per the AABB's 2010 Ask the FDA and CLIA Transcript: Question 34: The Circular of Information, for the Use of Human Blood and Blood Components, in the Instructions for Use section, item number 13 states: "Transfusion should be started before component expiration and (be) completed within 4 hours." What is the FDA's interpretation with regard to this instruction? For example, is it acceptable to start a component at 23:45 on the expiration date and allow the unit to be transfused for 4 hours (until 03:45 the next morning)? MS. CIARALDI: Our regulations in 606.122 state that administration should start within four hours of entering the product. To us, this means that transfusion must be started within the shelf life of the unit. The length of time to hang a unit, specified in the Circular of Information, is four hours. We are aware that this may sometimes result in the transfusion ending after the unit has expired; however, we do not object to this practice.

As stated above, we use IS XM for ABO compatibility check only when the computer is down. We have passed several TJC and AABB inspections since starting this. Here is a quote from my crossmatch procedure: Whereas: Sensitivity: Immediate Spin crossmatch will not detect 100% of ABO incompatible units due to low titer of antibodies or weak expression of the antigens. Specificity: Immediate Spin crossmatch gives some false positive results (cold agglutinins, rouleaux etc.). Cold antibodies can cause false positives with immediate spin crossmatches, presenting a quandary on how to manage a unit that is incompatible at IS and compatible at AHG. Warming the sample to avoid the cold antibody might reduce the reactivity of the ABO antibodies as well. This false positive could happen even with an O unit when ABO incompatibility is not even possible. The BBIS contains algorithms that verify the ABO compatibility of all products selected and our validation shows this to have 100% sensitivity for detecting ABO incompatible units and 100% specificity for avoiding false positive results—both an improvement over immediate spin testing.

We only perform an eluate if +DAT can't be explained by an ABO incompatibility, known maternal antibody, or circulating RhIg. We will perform at physician request. but I don't recall that ever happening. We only routinely perform cord blood testing on Rh negative moms & those w/ clinically significant antibodies. Occasionally a pediatrician will request a cord DAT if a mom had a previously affected infant.