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Thank you all for responding to this topic. Fortunately, the patient survived probably due to bleeding at that moment. Both poly- and mono-specific DATs were done and they (i.e. poly DAT, IgG, complement and saline control) were all weakly positive. An eluate was tested against A1, A2 and B cells and reacted with A1 and B cells, not A2 cells. The reaction strength with A1 cells was stronger than B cells. The possible explanation for eluate reacting with B cells is that the anti-A,B in this O patient's plasma coated on the A donor cells got eluted and reacted with group B reagent cells.

I would wash the red cells in saline and test the DAT (I have occasionally found stronger reactions). You can also try washing the red cells using cold Elu-Wash as that can help bind any weak antibodies to the red cells. In this case I would do an eluate including A1, A2 and B cells irrespective of the DAT results. Lastly I assume you can call the transfusion reaction irrespective of DAT results if hemolysis is evident in the post sample? The only hemolytic transfusion reaction I worked-up was clear cut and involved uncrossmatched blood given to a patient with history of an anti-Jk(a), against the BB tech’s advice. As Malcom stated above not many red cells were left, including the patient’s as the hemoglobin went from a 6 to a 3! I could not tell where the plasma ended and red cells begun.

We did this exact process. We paid Haemonetics to extract the data and put it in the format that Soft needed. They were extremely less than helpful, so I feel your pain! Our internal lab IT team ended up having to modify so much of what Haemonetics provided us, we may as well have done it ourselves. Even though we were paying Haemonetics to do the extract, they took FOREVER to complete each part of it, requiring our LIS team to modify the files into the Soft formatting at the end, so we could stay on track with the project. Also, lesson learned: SafetraceTx filed all of our cord blood tests as a valid blood type, and these were all included in our extract. We started electronic crossmatch when we went to Softbank, and found out a few months in that cord blood types were being counted as a historical type.....so we are now in the process to remove those from the Softbank BSA, a process we are having to pay Soft to help us with. Our LIS team told me to make sure you review any files that Haemonetics extracts for you very carefully. There were formatting issues all over, and Soft's format for the upload is VERY specific, and a bit odd. Our LIS team says if you're not already familiar with the Safetrace tables, it might be more difficult to do this yourself. They also recommend getting Soft involved early, to ensure that the formatting is correct and the data you're intending to pull is valid. Our LIS thought they could have done this project themselves, in retrospect, but they also are very adept at Crystal report pulling from the SafetraceTx tables, so knew where to find the info. The concern was how long it would have taken them to do the extract themselves. Let me know if you have specific questions, we may be able to help guide you if you go it alone!

Those 25% that appear order abuse or CYA could just be physicians erring on the side of caution. Alternatively many ER departments have check-list protocols; when curtain symptom boxes are ticked orders are automatically generated (or required). It may be worth while seeing if this is the case.

I have, unfortunately, seen two ABO transfusion reactions, both of which were fatal. In both cases, the DAT was negative, BUT, when the blood samples were put under the microscope, the reason was only too evident. There were hardly any red cells in the samples, presumably because the complement system had haemolysed both the transfused red cells, but also the "innocent bystander" autologous red cells. That having been said, your explanation is perfectly logical.