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Thanks. Finally found a great journal article about this phenomena - just takes googling the right keywords to find something. Here is a link for those interested. https://onlinelibrary.wiley.com/doi/full/10.1111/vox.12909

No I would use PEG for tube testing and Albumin for certain situations. We dropped NHANCE several years ago

There were time when we would use NISS, rather than LISS, when the auto-antibody was really strong. Remember, before LISS, NISS was what we used all the time, and not everyone who received blood in those days keeled over and died as a result!

We have Epic 2018a with Sunquest v8.0. They are working well together but always a work in progress. Nursing is using Epic BPAM so they are doing barcode scanning of the units at bedside so we are now able to issue blood product without any paperwork other than the patient/unit identification tag on the unit. We are in the process of piloting the same process of blood transfused in the OR given by Anesthesiologists. Next up is creating process for rapid scanning during Massive Transfusion.

I'm afraid that I have to disagree. bbguy.org is not good - IT IS BRILLIANT!

Dosage addresses the expression of ag on the red cell.and its reactivity with antibody. Homozygous intimates a single expression of the gene. Let's say we/re talkijng about the K ag. KK is homozygous for K, Kk is heterozygous for both K and k , kk ia homozygous for k. Dosage occurs when the antibody reacts less strong when the gene products are heterozygous, i.e, the homozygous expression will display stronger reactions. The systems which express dosage are the Rh, MNSs, Kidd, and Duffy. The texts tell you the Kell system ags do not express dosage but I have found the reality is that they do. When ruling out antibodies it is generally considered good practice to not rule out based on a negative result with a heterozygous cell. There are modalities of testing which enable the use of heterozygous cells for rule outs: enzyme pretreatment (not for Duffy or MNSs); I've also considered PeG to be valid for this. Hope this helps