Leaderboard

We don't recheck antigen typings here in our hospital in Canada. The typings that have been performed at Canadian Blood Services, are embedded in the barcode on the bag, with all negatives printed on the End User Label. Every unit is antigen typed for K so if it isn't printed on the bag the unit is K Pos. Antigen typings we do are all linked to the unit through barcode. The reason of, "We were typing a lot of units and may have mixed them up", is not acceptable in a blood bank setting. Go work in a different department if you can't organize yourself. Anyway, there is also a full gel or whatever you use crossmatch at the end of that phenotyping, as long as the antibody is reacting, an anomaly could be discovered there. You have to have a little faith that people before you are doing their job properly, or you can cause yourself a lot of undue stress.

Lots of users on this Forum are in the same place and I'm sure they have some good advice on how to approach this issue. However, I would be cautious of implementing an optional process that potentially calls into question the quality of previous work.

I'd also like the phlebotomist to identify me correctly and label my pre-transfusion sample correctly with MY name.

It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT). Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct. In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups. They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.

My previous boss always said they had to come up with new rules to justify their jobs. When they can't find the "low hanging fruit" because we all try hard to do the right things and follow the rules, they start digging deeper and come up with stupid stuff. As long as they keep coming up with new rules, they keep their jobs.

I believe the primary action of CDP is as a mild acid, thereby eluting bound IgG (reducing DAT) and denaturation of HLA/Bg antigens (removal of "unexpected reactivity"). Perhaps the prolonged treatment time removed some of the sialic acid on the red cells and has inadvertently created cells that are easier to agglutinate, i.e., the equivalent of enzyme-treatment ?

We are inspected by FDA, NY State, AABB, CAP and FACT. Lots of opportunities for self-important, obsessive folks to make useless work for the people trying to take care of patients. The stories I could tell. We've also had many rational, balanced, thoughtful inspectors who clearly are only focused on the important stuff, to be fair. But a significant portion of our profession(s)' people do not realize that getting staff to focus on minutiae that will not affect patient outcomes distracts staff from doing the important things well. A well known psychologic/cognitive fact. Keep it simple and avoid worrying about unimportant stuff. The notion that documentation is more important than anything else is the most pernicious piece of rubbish in medicine, and driven by the administrative/legal model (and billing of course). And people proudly spout this nonsense as if it actually helped anyone but those in accounts receivable. I'd personally like the technologist doing my pre-transfusion testing to get the ABO and antibody screen correct as a trillion fold more important relative to them documenting what time, date or temperature all of that was done. Not to mention what that person had for lunch or dinner before the crossmatch (coming soon to an inspection near you). For the record I'm a Gemini, which I assiduously and loyally document in every interpretation and progress note I write.

@Neil Blumberg Exactly. We've all had the odd cases that survive when it doesn't seem they should, and I agree that it's certainly case by case and dependent on hemostasis and coagulation like @Auntie-D said above. We use TEG for coagulation eval as well. I think my trauma surgeons are looking for a prompt to make them aware of how many products they've used, so they can evaluate the futility of continuing versus stopping. Anesthesia is the group transfusing these products, and they can easily lose track as well, so we're looking for an estimate of when the blood bank staff might give them a nudge to let them know they've hit a threshold, and to evaluate the entire picture of the patient with that knowledge, rather than being tunnel visioned into fixing the damage only. I have heard 30-50 units of red cells is the sweet spot as well. We consider more than 30 units of red cells to be a super massive transfusion, so that would jive.