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At the beginning of the testing process, ProVue warns the user with a disclaimer displayed onscreen that hemolysis, icterus and turbidity (wbcs, lipemia) may interfere with reading of a sample. ProVue takes an image of the gel well and does a gray-scale analysis. The presence of turbidity, hemolysis and icterus would darken the image and prevent analysis due to lack of contrast. Byfaith was asking if her current criteria is too restrictive and for options for sample rejection criteria when using automated gel testing. My suggestion was to let the machine determine sample acceptability. Using a visual color chart comparision process that was probably developed for manual tube testing ignores the machine's capability to do sample rejection that is more consistent and appropriate for the machine.

Transfusion reaction workup is a whole 'nother animal. If I get a post-transfusion specimen that is hemolyzed, the first thing I do is ask the phleb if the draw was difficult. If it was, I send up someone else to obtain a new specimen. If we can't get a clean specimen, then that information is part of the documentation and taken into consideration with the interpretation of results.

Oh, I agree Malcolm. And we do accept slightly or even moderately hemolyzed samples in our lab, depending on the test. My point was, in the case of a possible transfusion reaction, when one has to document pre- and post- appearance of the plasma, it is completely pointless if the pre- specimen is hemolyzed to begin with. Anyway, this thread seems to be more concerned with automated ananlyzer requirements regarding hemolysis. I have found a few papers online, but it seems like they are only verifying that analyzers only begin have problems with at least moderate amounts of hemolysis. Not being experienced at all with what Byfaith is working with, I would guess that if the manufacturer doesn't have a problem with lesser hemolysis, they may be nothing to worry about. Scott

True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab. My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used. I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though. I have learned never to respond in the heat of the moment if it isn't absolutely necessary.

The Echo won't like a specimen w/ hemolysis at 3-4+ when graded. That's actually quite a lot of hemolysis, so the specimens we reject for hemolysis are few and far between. The majority of our hemolyzed specimens tend to come from IV starts collected by nurses - they are 'supposed' to be saving us time by collecting specimens that way.

There is older literature referring to the concept of hemolysis as a positive reaction interpretation. I believe this is relavant only to tube testing. There is also the fact that using EDTA samples complement does not come into play and therefore no hemolysis of test cells? I believe our cutoff is random, going along with our chemistry laboratory cutoff.

Thank you for your comment, John. My statement is also not popular with my Laboratory Director, but it is true none the less.

Not sure how I missed this discussion when it first came out but here's my 2 cents worth. It is the physicians responsibility to inform the patients of ALL risk / benefits of every aspect of their treatment to include transfusions of any and all blood products! Granted, this is not always possible due to the situation but that does not absolve the physician of the responsibility! In no way should this responsibility ever be dumped on anyone else.

You were right about "although I have my doubts about that being a coincidence." It was not a coincidence. The Sanger sequencing on this lady indicated that the patient is cisAB.01/O.01. In Geoff Daniel's Human Blood Group text book, page 43, described that sera from cis AB people almost always contain weak anti-B. This is a great learning case indeed! Have anybody tried testing acidified anti-B with known cisAB cells? I am wondering if acidified anti-B would be non-reactive with cisAB in addition to A(B)?

In the UK, we have this (relatively new) saying, "Why give two, when one will do?" This is NOT for someone who is bleeding out, of course, but for your "Average Joe" who needs a transfusion. It is predetermined what Hb level the patient needs, and a second (or subsequent) unit will not be released unless the patient's Hb has been checked. If the Hb has reached the predetermined level, the unit will not be released. This is not something that is decided by the Consultants at the Hospital; this is something that is decided by the Chief Medical Officer (nobody above him/her except the Minister for Health)!

In Massachusetts, it's the physicians. We audit a small percentage of transfusions every month, and consent in one of the things we look for. We've stopped "letters from the committee" as they are ignored. We report No Consent directly to Patient Safety/Risk Management. The hospital lawyers then contact individual MD and their chiefs. This is also reviewed at Medical Executive meetings. Very rarely now do we miss a consent. The higher up the food chain you report, the better the results.