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  1. 7 points
    SMILLER

    Titers

    I just read what I posted yesterday and would like to officially submit that post for longest sentence of the month. Scott
  2. 6 points
    Ward_X

    Give E and c negative units?

    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.
  3. 4 points
    Mabel Adams

    Give E and c negative units?

    I think how rural you are also plays into this. We are the only lab that does antibody IDs in a region of rural Oregon the geographic size of a small Scandinavian country. Our blood supplier is 3.5 hours away over a mountain pass and it snows here. I am not 100% convinced that we should do this but the logic behind our policy to avoid causing production of anti-c is because 5 small hospitals with no ABID capabilities would preserve the ability to select Rh negative blood in an emergency and have very good odds of it being compatible in a patient with a known anti-E, but once they have anti-c that option is gone. We can screen for the c antigen here but if we need to find 6 units our odds get ugly and we would rather get them from the supplier--but they are not exactly across town.
  4. 3 points
    This is what we have done for well over 10 years and have not seen any problems from it. For those repeat Rh negative trauma patients, even Rh incompatible blood carries oxygen and transfusion reactions are seldom intravascular so are usually survivable. Also, patients often have hemorrhaged out a lot of antibody as well as blood. You can fill them back up with Rh neg after you ID the antibody. We had to knowingly give e+ blood to a trauma once and she did fine other than having a positive DAT. We only gave a few e+ units and got in some e negative to fill her back up with. I think she got 2 units of each.
  5. 3 points
    Ensis01

    Give E and c negative units?

    I was told, by a very senior tech, that this convention began pre-automation when instances where an anti-E was identified but occasionally weakly reacting anti-c was missed. This resulted in a change in hospital policy so when the patient has an anti-E and is c= give E=,C= units. I then assume this practice spread as techs gained seniority and moved to different hospitals. The improved reagents, panel cells and especially automated methods over the last few decades, plus increased pressure with time and costs may either make this policy redundant or (remain) implemented based on your patient population and experience. Thoughts anyone
  6. 3 points
    Scott, you are kind of contradicting your self here. In one sentence you are advocating avoiding the production of anti-c which can only be accomplished by screening units and transfusing c= units. Then you say it would be nice if you did not have to screen for units. I see a conflict here. Bottom line, it's a gamble. Either you screen for c= units now to prevent anti-c or you take the chance they won't make anti-c and if they do you start screening units then. The latter was always my choice.
  7. 3 points
    I wouldn't dispute the findings of Peter Issitt vis-a-vis transfusion reactions, but I was talking in terms of HDFN, and would still say that an anti-c in pregnancy can be extremely serious. In terms of an emergency situation, I agree with the Technical Manual.
  8. 3 points
    With regard to PI with platelets, it is true you do not need to test the PI products but Babesia testing still needs to be done for RBCs collected in the 13 states of interest. Regarding test strategies, some hospitals,eg Johns Hopkins, has opted to do secondary bacterial testing on day 4 rather than the PGD test. Attached is a recent study covering the cost effectiveness of the approaches believed to be acceptable by the FDA. However, as noted the Guidance is not Final. This paper is a good starting point though. platelets Cost effectiveness methods bacteria testing Transfusion 0419.pdf
  9. 2 points
    They most certainly DO NOT throw them out. They are an altruistic gift from our donors. The units are not marked as K+ (the hospitals are aware that the antigens that appear on the unit are those for which the is negative (except for D, D, E, c, and e) and so,if there is nothing to say that the units are K Negative, they are assumed to be K Positive. In this case, according to our Guidelines, the units should not be given to females of child bearing potential, who are not themselves K+, or to patients of either sex and any age, who are either already transfusion dependent, or likely to become transfusion dependent, unless they themselves are K Positive. That having been said, K Positive units are more likely to reach time expiry in hospitals, than are K Negative units, as might be expected.
  10. 2 points
    Baby Banker, there are hundreds of blood group antigens. You cannot match for the all, and studies in both the UK and USA have shown that, even using units from donors who have been tested at a molecular level, it gets more and more difficult, and more and more expensive, to match more than a few antigens. It follows the Law of Diminishing Returns. As I say, I have some knowledge of hyperhaemolysis myself, and, as you quite correctly say, the best thing to do is to stop transfusions. However, as I said above, there are some situations in which this is clinically impossible, at which time, covering the patient with high dose IVIgG and methylprednisolone during transfusion is one of the very few options - and this would have to be done at other facilities, as well as your own, even if the family are silly enough to go elsewhere under such circumstances.
  11. 2 points
    SMILLER

    gel diluent qc

    Except that the QC manufacturer's diluent used to make a control antibody solutions is not used in any phase of patient testing--it does not need the be QC'd--it is QC. I would think the point is that the gel diluent is being controlled (which it should be), by showing it does not produce a positive reaction as a negative control. When patient or unit cells are being tested in gel, you use that gel diluent to create an 0.8% suspension--so for a positive gel control, if you are creating your own 0.8% suspension, again you want to use the manufacturer's diluent. Scott
  12. 2 points
    exlimey

    Give E and c negative units?

    Unless you have the right contacts......
  13. 2 points
    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.
  14. 2 points
    True Scott, but these people don't exclusively make anti-D; they could make virtually any specificity, even if D Negative blood had been given. For example, if they had made an anti-c, they would be in equally in the deep and nasty, if they have another emergent situation in the future, and are given rr units!
  15. 2 points
    I'm sure Malcolm can give you the hard numbers and details but keep in mind that not every D- person responds the same when given D+ RBCs. Some will develop anti-D with as little as 100 microliters of cells or less while others will never develop anti-D no matter how many units of D+ RBCs they receive. Then everyone else is scattered around in between these 2 extremes. Then throw in the males and women who are beyond child bearing and it becomes even more complicated. I fall into the category believing that try to prevent the formation of anti-D after a transfusion event, especially one of multiple units is counter productive and an effort in futility.
  16. 2 points
    Dansket

    positive dat w cord blood

    An important aspect of this conundrum to remember is that physicians do not treat newborns just because of a positive DAT, they treat infants who are anemic or hyperbilirubinemic regardless of the DAT results.
  17. 2 points
    Neil Blumberg

    Neil Blumberg

    And to give credit where credit is due, whatever I have achieved has been with the invaluable contributions of my collaborators, including physicians, scientists, medical technologists and nurses. In particular, my most important collaborator has been my wife, Dr. Joanna Heal MBBS, MRCP, whose brilliance and dedication to patient care made all the difference. That's her in the picture :).
  18. 2 points
    Malcolm Needs

    2nd ABO

    I agree that, in the case of an emergency, of course group O blood should be given - I have never argued against that and would be completely mad to so do. No, my argument was purely that, in a normal situation, a second sample should be taken from ALL patients.
  19. 1 point
    LisaMarie

    delayed reaction

    Thank you very much Malcolm. Very detailed explanation. I am waiting on the molecular testing results now and yes she has been transfused and we are issuing Rh negative of course.
  20. 1 point
    Me too! And guess who always gets to come in during a blizzard - no snow days for me .
  21. 1 point
    AMcCord

    Validation

    We came up on SafeTrace Tx in May. Haemonetics offered validation with a 'partner' company, but we chose to have our system validated by BC Solutions. Using a totally independent company seemed like a better idea.
  22. 1 point
    Ally

    Welcome Ally

    Happy to join a professional team like pathlabtalk. I read lots of interesting topics
  23. 1 point
    Ward_X

    2nd ABO

    We've caught misdraws twice the last month from samples that required a 2ABORh/didn't abide by proper electronic collection... it's safe to say the hassle is beneficial!
  24. 1 point
    pbaker

    2nd ABO

    We use the 2nd person to identify, knowing full well that it is not very reliable. We recently had a safety fair, prior to TJC arriving, and used an armbanded model as our patient and laid the collected specimen next to it. The names were similar, but different, MRN were different and DOB was similar but different. Only about 50% of the nursing staff caught the discrepancy. We then explained to them that the specimen was labeled properly only from the wrong patient. Since blood bank does not see the patient or the armbands (we use a BB armband), we would have accepted the specimen and resulted the testing for the wrong patient. Some understood and were scared, some just wanted the stamp on their paper to get their CEUs. Please don't ever put me in the hospital!!!
  25. 1 point
    Mabel Adams

    Kell & Antibody screening

    If by this you mean that you are negative for the antigens Kpa and Coa then that is of no more importance than if you have blue eyes. Antigens are structures that antibodies recognize and attach to. They could be on the flu virus in a vaccine or on a strep bacteria or on red blood cells. We in blood banking deal with those on red blood cells. Being negative for Kpa and Coa is just a genetic difference in your red blood cells and a very common one at that. If you have made antibodies to these antigens which you lack then that could cause some potential problems with your pregnancies or transfusions but they are manageable. Your children will not have any special risks in their pregnancies because of this.
  26. 1 point
    Mabel Adams

    2nd ABO

    In your case, all scanning would be correct so the technology won't save you. Thank heavens for phlebs also asking patient to verify ID. I've seen several registration errors that could have had negative downstream effects.
  27. 1 point
    Mabel Adams

    Give E and c negative units?

    So the same logic applies as for E & c--avoid stimulating anti-V/VS during more routine transfusions to save yourself the option to have a compatible crossmatch during a crisis when you may be giving V/VS+ blood to save a life. If the patient has already made anti-V/VS you can still choose to ignore it and give incompatible units because it is a lesser evil but we would mostly feel better if we could avoid giving crossmatch-incompatible blood because it would be hard in the moment to prove that there wasn't an additional antibody directed against a different low incidence antigen. That's why we do AHG crossmatches I'd say. Same argument against it of using a precious resource before the patient has made the antibody.
  28. 1 point
    It can do emergency release w no type (or screen done). HCLL was the BBIS I was purchasing for.
  29. 1 point
    exlimey

    Give E and c negative units?

    They may indeed "cause very mild delayed transfusion reactions", but to a multi-transfused (Sickle Cell Disease, SCD) patient, with often a multitude of other alloantibodies, what would be a typically mild reaction in a "normal" patient can be serious, even fatal in SCD patients, especially if it induces a hyperhemolysis event. SCD patients understandably have very fragile immune systems. It doesn't take much to upset the apple cart. They sure do, especially since many laboratories routinely use the super-sensitive assays like PEG-IAT or CAT (gel/bead technology) for crossmatches.
  30. 1 point
    Jennifer Castle

    2nd ABO

    We use a separate BB wristband, perform electronic crossmatch, and require a second draw on patients for whom we have no type history. (We may also use a separate draw, ie. CBC if available). Last year, a patient was registered incorrectly (same name, different date of birth - so all bands, charts and labels were incorrect). It was caught by the phlebotomist performing that second draw. If I had ever questioned our process, I certainly did not look back after that near miss. We have to remember that patient identification IS the number one safety goal, because everything stems from that.
  31. 1 point
    Malcolm Needs

    Give E and c negative units?

    Anti-V and anti-VS have only ever caused very mild delayed transfusion reactions, and only ever caused a positive DAT, rather than clinically significant HDFN.
  32. 1 point
    Yes Mabel, all free and accessible to anyone. just be aware that all courses are based on Australian guidelines
  33. 1 point
    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.
  34. 1 point
    We give O= unxm only to females of child bearing potential (<50 yo).
  35. 1 point
    Malcolm Needs

    Titers

    I agree entire;y Scott, but some people think that the frozen sample has to be "identical" in terms of a titre, otherwise the new titration is unacceptable (I know, I know)!
  36. 1 point
    We do the same for our traumas. I think its a common practice. Scott
  37. 1 point
    My lab (for trauma I center) does just that: our MTP prep. work includes having sets of O+ aside for male traumas, and O= aside for female traumas. For these untyped pts in emergency situations, the Rh is essentially determined by their gender. For platelets, male/women BCBY do not require Rh= receipt. You're right @Kari Reichenau in saying that giving O= to everybody really burns the inventory...
  38. 1 point
    I think you need to worry about the quality of the cards before they are used. We also have had some bad cards shipped to us earlier this year (we do manual gel). Bad as in no liquid on top of the gel. According to Ortho, the gel goes bad in situations like this, so "fixing" them by re spinning doesn't seem like a good idea. They should just be rejected. Scott
  39. 1 point
    SMILLER

    gel diluent qc

    We use diluent to make up the negative and positive control solutions for checking the screening cells. That seems adequate. Scott
  40. 1 point
    The only test I know of is PGD (Pan Genera Detection) test by Verax. We have not completed our validation yet because the logistics of implementing the test are extensive because I work in a children's hospital and we split our apheresis platelets into really small syringe aliquots for our NICU and CVICU so we use our platelets for the full 5 days. The test takes about a 1.5 mL of platelets per test per 24 hours. We have not implemented PAS platelets yet due to the fact that our primary vendor doesn't collect them yet and I have to build and validate them in our computer system (I am the only one who can build in our computer system and I am the manager and technical specialist as well). I hope to build them into our next computer upgrade next year. So the only plus I see from using the PGD is the potential to extend the expiration date of the apheresis platelets to 7 days but I haven't even looked at what that validation is going to require. Verax is very good at providing all the information you need, however.
  41. 1 point
    Cliff

    BACTERIAL TESTING FOR SD PLATELETS

    It is still in draft, and has changed (significantly) a couple of times. It is rumored to be finalized next month. This will create significant changes for all of us, I suspect we'll get a year to implement, same as the new Babesia testing requirement. Our testing vendor isn't ready to offer it to clients yet.
  42. 1 point
    Don't see anything wrong with that. Unless someone offers an anti-D (RhIg only) survey - which I believe no one does. If you can do an antibody ID you can identify anti-D, I would presume. Some inspectors just don't get it.
  43. 1 point
    Because your blood counts will generate "patient Data" they fall under CLIA. Proficiency testing, competency assessment, training, and operator qualifications all apply. You can meet the requirements by having a qualified laboratorian general supervisor, oversee all of the instrument maintenance, calibration, linearity and QC review. The laboratory Director will need to follow some of these things as in traditional patient-based lab. Who will be your "CLIA assessor" for this activity, AABB, CAP, Other? If you are going to be AABB accredited then AABB will assess your operation against the CLIA regulations. The laboratory Director can be responsible for ordering the CBCs. However if this research is clinical, the physicians sending their patients should complete the orders. All of this should be specificed into your research protocol and IRB submission.
  44. 1 point
    AMcCord

    positive dat w cord blood

    I had a similar experience when a Family Practice Dr, who was chair of the OB committee at that time, brought back the Immune Anti-A, -B test. The only 'reference' he offered was his experience with his children. We wanted to ask if those tests affected how the infants were treated, but refrained....tongue biting was involved. The pediatricians say they don't need the test.
  45. 1 point
    David Saikin

    Specimen Expiration

    3rd day at midnight; draw day is day 0.
  46. 1 point
    Malcolm Needs

    Neil Blumberg

    A fairly short, but very interesting interview with Neil Blumberg in the July 2019 edition of AABB News, as he his one of three new inducts into the National Blood Foundation's Hall of Fame. Congratulations Sir and, from what I know and have read, thoroughly well deserved.
  47. 1 point
    Neil Blumberg

    Patient Blood Management

    Patient Blood Management is a comprehensive, multi-modal approach to reduce/prevent anemia prevalence and reduce transfusions to only those that are life saving or absolutely essential. While the AABB has some materials and interest, they are relatively less likely to explain to you that the primary rationale is that anemia and transfusions are mostly harmful to patients in current practices. The pre-eminent organization in the USA in this matter is SABM. The founders of PBM include anesthesiologists such as Aryeh Shander at Englewood Hospital and Tim Hannon at St. Vincents, who saw that (1) Jehovah's Witnesses who refused transfusions actually had better outcomes than similar transfused patients and (2) transfused patients had dose dependent increases in nosocomial infection, thrombosis, multi-organ failure and mortality in the literature and their own practices. In other words, less is better. None is best when possible. Needless to say, the initial reaction in the blood banking and transfusion medicine community was lukewarm at best when these ideas were first put forward a couple of decades ago. But preventing anemia by doing fewer lab tests, and less frequent lab tests has begun to catch on in some places. See: https://www.sabm.org/patient-blood-management-programs/ Good place to get some initial education and join if of interest. A typical PBM program will include a part-time medical director (often an anesthesiologist, intensivist or hematologist, but also surgeons, transfusion medicine physicians, and other specialties) and one or more full-time nurses or medical technologists who focus on educating practitioners about current practices. You need a clinical champion at the bedside who other practitioners respect and will listen to. Changing practices is arduous and sometimes rather unpleasant work. When Bernard Fisher showed that the Halstead radical mastectomy for breast cancer was harmful to patients, the initial reaction was anger, disbelief and pushback. So it sometimes is with PBM. Physicians change their practices slowly or not at all. At our institution, PBM is heavily weighted towards collaborations between specialties, including, for example, an anemia management program prior to cardiac surgery, advocating restrictive transfusion practices where there is evidence (and there is tons of evidence that liberal practices are lethal at worst, wasteful at best). Happy to answer further questions.
  48. 1 point
    sgoertzen

    2nd ABO

    Someone above commented that a 2nd sample is only required in the U.S. for computer crossmatch (which used to be true). But with the 31st Edition of AABB Standards (effective April 1, 2018), this requirement was moved so that it now applies for all pretransfusion testing for allogeneic transfusions including all types of crossmatching (IS, AHG, and Computer crossmatching). This is more in line with CAP requirements and makes more sense in order to detect possible Wrong Blood In Tube (WBIT) events. AABB Standards for Blood Banks and Transfusion Services, 31st Edition 5.14.5 Pretransfusion Testing for Allogeneic Transfusion There shall be two determinations of the recipient’s ABO group as specified in Standard 5.14.1. The first determination shall be performed on a current sample, and the second determination by one of the following methods: Testing a second current sample. Comparison with previous records. Retesting the same sample if patient identification was verified using an electronic identification system or another process validated to reduce the risk of misidentification. Standards 5.11 and 5.27.1 apply. Personal Note: If you intend to retest the same sample (by a different person or the same person), be prepared to show the AABB assessor your validation proving that your "another process" is actually validated to reduce the risk of misidentification (i.e. WBITs). CAP Checklist Requirements: TRM.30575 Misidentification Risk The facility has a system to reduce the risk of mistransfusion for non-emergent red cell transfusions. NOTE: Mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her. The laboratory is expected to have implemented a plan to reduce these risks through implementation of a risk-reduction system. Among options that might be considered are: (1) Verifying the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including the recording of the result in the institution's historical record); (2) Utilizing a mechanical barrier system or an electronic identification verification system that ensures that the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. Other approaches capable of reducing the risk of mistransfusion may be used. The laboratory should participate in monitoring the effectiveness of the system that it implements. The laboratory should also consider improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion. TRM.40670 ABO Group and Rh(D) Type Verification The recipient's ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory's records. NOTE: Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system. For laboratories that employ computer crossmatching, serologic crossmatch techniques must be employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum reactivity, apparent change in blood type post hematopoietic stem cell transplant).
  49. 1 point
    MAGNUM

    2nd ABO

    We instituted the practice of retyping the patients if their histories could not be proven. To do so, we instituted the practice of performing the retypes on a different specimen collected at a different time within the previous 24 hrs or within 1 hr of the blood type verification in the LIS. The histories are checked on every patient in the blood bank, if they do not have a historical type, the phlebotomist is sent to the patient room to collect a new lavender top tube. It does not matter the type of the patient, if they have no history, they get retyped. This practice ties into CAP TRM.30575. We have actually "caught" incorrect collections by the RN's that collected the incorrect patient and labeled the specimen with the wrong patient information. This is our practice and we are sticking to it! The other Scott
  50. 1 point
    Dansket

    2nd ABO

    Testing the same specimen twice may detect some internal testing errors, but will not detect WBIT (Wrong Blood In Tube). You need to gather some data to show how many patients would be impacted by collecting a second blood sample. Ask these questions, "How many patient admits annually?", "How many patient admits required blood bank testing?" (at my facility the calculated percentage was 11%), "How many patient samples type as Group O?" (at my facility the calculated percentage was 55% and we don't draw a second blood sample on these patients), "Of the non-Group O patients, how many had an independently collected blood sample in Hematology that could be used for the second ABO blood sample" (in our facility that was calculated to be 16%). So for every 1000 patients admitted annually, 100 (I'm using 10% for sake of simple calculations) would require blood bank testing of whom 45 (100-55) would be non-group O, 7 (45 x 0.16) would have a blood sample in hematology, leaving 38 (45 - 7) or 3.8% (38/1000) patients requiring a second sample to be collected. Using this kind of data will give you a much better grasp of the impact of routine performance of a second ABO determination on all patients for whom a Type and Screen or a Type and Crossmatch is ordered.
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