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Both. Not all reactions are caused by IgG immunoglobulins. Reactions with, for example, anti-Vel can sometimes only be detected by complement coating on the red cells.

In that case, we had a bombing that happened to be at shift change, so we had two shifts worth of techs. You didn't want too* many techs at once, because then it turns into a "too many cooks in the kitchen" sort of deal, but plenty from the first shift stayed, and the second shift was arriving. They didn't call in many extraneous people because they had no idea how long it would last, and you'd need staffing for after the initial rush. That being said, there were plenty of staff, and the supervisors were helping on the floor. Our blood supplier even called and offered to ship blood. In reality you only need 2-3 people to handle an MTP if your inventory is set, but in a situation where you have dozens of bleeders and the inventory needs to be maintained, everyone has a job to do. Again, large trauma hospital here.

that's the way should deal w a known antibody. You don't have to prove it is still there because you are going to respect its presence regardless. Running ag negative cells to r/o other specificities is the way to go. (At least it's the way I've gone for the past 30+ years).

If we've done a type and screen pre-delivery, we only test the mom for a feto-maternal bleed on a post-delivery specimen. We don't repeat the antibody screen in those situations. If there was no type and screen done pre-delivery, we will do the complete workup post-delivery. If that antibody screen is positive and matches the pattern of anti-D, we check with the nurses to see if the patient received ante-natal RhIG and when. We report out the positive antibody screen and comment that the positive results are probably due to Passive anti-D from RhIG given (date). We also comment that the antibody will be identified if requested by the physician. No physician has ever requested that we do an antibody identification on these patients. I did an inspection once where the blood banker was working up a patient who had anti-M. She choose only selected cells that were M negative to do the panel on in order to see if the patient had formed any other antibody. This is not currently our practice, but I was interested in that procedure. That would be the same as testing those cells marked with @ on the panel to see if anything besides anti-D was present, I guess.

Just from a man-power standpoint, you don't always have the time to "extra" antigen type. I've seen pts with anti-E that receive products on a weekly basis (that happen to be cancer pts) that have yet to make the anti-c. What about the extended billing for antigen typing? It just seems like a gross assumption to believe a pt with an anti-E acquiring a unit of red blood cells will form an anti-c from it (going back to Malcolm, who initially replied that the anti-E could have been made for reasons other than transfusion). I agree with the serological science of why these are seen together, and why the anti-E can lead to the anti-c, but I have trouble justifying the cost of tech/time, reagents, and billing, to go off a hunch that the anti-c is probable.

I am the blood bank supervisor in a 233 bed acute care facility. I am a working supervisor. We are not a trauma center. Most days, I am the only blood banker on the shift, so there is no one to call. If I am lucky, the chemistry tech might be available to help. I can also get the manager to issue blood, but that's all. We rarely have MTPs - a ruptured AAA or OB bleed, but they are few and far between.