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Showing content with the highest reputation on 04/18/2019 in all areas

  1. For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so..
    2 points
  2. I have heard a couple of different clones coming from Seattle Hospitals (Hu5F9-G4 and ALX148). Watch out for the clone numbers when you work on patients on anti-CD47. It might make a big difference whether or not you can use Immucor anti-IgG to rule out your underlying alloantibodies.
    1 point
  3. We just got our first anti-CD47 out here in the sticks on a patient who went to Seattle for a clinical trial. That drug is Hu5F9-G4. No other name yet. It interfered with her reverse as well as all gel testing. We did a 30 minute saline screen and it was 4+ at 37C but negative at IAT using Immucor's anti-IgG which doesn't react with IgG4. She was antigen typed before starting treatment so we got that information and gave her K and Fya negative units (lucky she is positive for most antigens). We called them incompatible because we have not validated the Immucor anti-IgG as our test of record, the screen was 4+ at 37C and because the drug causes the patient's H&H to drop so I wasn't sure that the units would be certain to have normal survival. I didn't expect to get one of these for a few more years since we aren't in a big teaching hospital region. It would have been nice if the big center had sent her home with information that she was on this and instructions to tell the blood bank. We lucked out finding clues in Epic's Care Everywhere so we called the Seattle blood bank.
    1 point
  4. We use Sunquest as well. Our MTP does not drawn anything. All it does is print the order in Blood Bank. The BB Staff orders what is needed (Prepare Orders, etc.) and informs the provider IF a BB Sample is needed (often times we already have a sample). I suggest you get the order for TS out of your MTP order. We, too, put MTP on 'Downtime' protocol. Our Unit Tags are 3 parts: White Top copy, Yellow middle copy and card stock back copy. When issuing blood 'routine', the white top copy is discarded, yellow copy is kept in BB and card copy stays on the unit. For 'Downtime', the white copy stays on the Unit Tag and they use this for their dual checks, etc. Message me if you'd like more information.
    1 point
  5. Most developing clinically significant alloantibodies still react at 37oC, and so trying to detect them at room temperature is more or less futile as, in most cases, all you will detect are antibodies that you do not want to detect, such as cold-reacting anti-M, anti-N, anti-P1, etc, which would be a waste of time, reagents and, most importantly these days it would seem, money. Most polyspecific or broad-spectrum AHG reagents these days are a mixture of anti-IgG and anti-C3d (particularly in the UK). They do not contain anything but the merest hint of an anti-IgM (certainly, they would not be CE-marked for anti-IgM). The other thing is that I am prepared to bet quite a lot of money that your laboratory is using EDTA-anti-coagulated samples. This means that the Ca++, Mg++ and Mn++ ions are all chelated from the plasma, which means that the complement pathway cannot be initiated in vitro, so, even if the de novo antibody was capable of "fixing" complement, the anti-C3d would not detect such an antibody anyway. Therefore, as the number of recently transfused patients who are developing antibodies not yet detected by normal serological techniques who have been fatally affected by a further transfusion hasn't been great (zero in fact) and the same applies to pregnant ladies, stick to trying to detect clinically significant antibodies at 37oC using monospecific anti-IgG. GOOD QUESTION THOUGH - SHOWS YOU ARE THINKING!
    1 point
  6. In that case, I strongly suspect that Anna's (galvania's) suggestion about an antibody to a bacteriacidal additive used to suspend the screening and antibody identification panel red cells is correct. Way back, I experienced this myself, and even if the cells were washed about 4 to 6 times, I could still not get rid of the positive reactions. I always used to suspend my red cells in Dil2, until I was told to stop it by one of my bosses on the grounds that it was too expensive. After that, we saw it more and more, and, of course, it actually cost us more to sort out the problem, than it would have done if we had continued to use Dil2. Bosses who wear suits, rather than white coats, always know best though!
    1 point
  7. Mable, if you can figure out a way to convince your providers to skip the O Pos moms, let me know! Our OB/Gyn practice is OK with not doing the O Pos moms (and they delivery 90+% of the babies here), the pediatricians are Ok with it. Our problem is one family practice provider and he's not budging. We offered to make it an optional order - he wants it, he can order it, but that didn't work either.
    0 points
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