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  1. Cliff

    Cliff

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  3. Malcolm Needs

    Malcolm Needs

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Popular Content

Showing content with the highest reputation since 01/29/2024 in all areas

  1. I don't think the AABB comments are evidence based. Washing with 37 degree saline is extremely unlikely to cause false negatives with clinically significant antibodies, and I'm unaware of any evidence that this is so. Any such antibody would be very low affinity to be washed away by saline at any temperature, and unlikely to have in vivo/clinical significance. As argued persuasively above by Malcolm Needs, anything that doesn't react at 30 degrees or above in typical serologic testing isn't going to cause clinical problems. Patients are neither at 30 degrees nor centrifuged :). Our serologic techniques are overly sensitive, in general, for clinically insignificant agglutinins. No need for cold panels ever, with rare exception, and more for intellectual curiosity than clinical decision making. Perhaps a mini-cold screen someetimes just to confirm you are indeed detecting a weak cold agglutinin in 37 degree testing, which disappears with prewarm technique. Like Malcolm, I've never seen a patient with an hemolytic reaction due to an antibody that disappears with prewarming, in close to 50 years of clinical practice. I know there are in vitro examples of clinically significant antibodies that weaken or disappear with prewarm, but I've never seen any clinical consequences.
    4 points
  2. And here we are after just one week. Getting very close!
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  3. I just answered this question. My Score PASS  
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  11. Ward_X

    Give this a try

    Your score is 86.28, higher than 89.25% of the people who have completed this task Every word I thought of I could somehow trace to another word I had already logged! Very tricky
    1 point
  12. Cliff

    2024-02-15 Birthdays

    The person on the top is very special to me. Happy birthday
    1 point
  13. Exciting news, we're only halfway through the month and have achieved the initial goal! We have 56 responses. If you have not completed the survey yet, please consider doing so. We'll review the data at the end of the month, post the results, and then start working on some of the suggested improvements. Thank you!!!
    1 point
  14. Anemias and Myeloid Malignancies Anemias and Myeloid Malignancies https://academic.oup.com/book/24332/chapter/187167821 Submitter Cliff Category HemeLabTalk Submitted 02/12/2024  
    1 point
  15. 🩸 Join Dr. Melanie Bodnar from Canadian Blood Services for an insightful session on ABO Discrepancies! 🩹 Explore advanced ABO blood group techniques 📚 https://immunohematologymadeeasy.com/abo-discrepancies-case-studies-from-donor-testing-learntransfusion-seminar/ #MedicalEducation #ABOAnalysis #ProfessionalDevelopment
    1 point
  16. 5.14.4 A new sample shall be obtained from the patient within 3 days prior to transfusion in the following situations: If the patient has been transfused in the preceding 3 months with blood or a blood component containing allogeneic red cells. If the patient has been pregnant within the preceding 3 months. If the history is uncertain or unavailable. Day 0 is the day of draw. 5.14.5 In patients with a history of previously identified antibodies, testing shall be capable of detecting and identifying the presence of newly formed clinically significant antibodies. Standard 5.14.3.1 applies. 5.14.3.1 When antibodies are detected, additional testing shall be performed to identify antibodies of clinical significance. Source: AABB Standards for Blood Banks and Transfusion Services, 33rd Edition, effective April 1, 2022 (Published: 12/21/2023 )
    1 point
  17. Just a thought but you may want to check the AABB Standards instead of the Technical Manual. Your question is more of a standards question than a technical one. Since I no longer have access to the Standards this is the best I can do.
    1 point
  18. I just answered this question. My Score FAIL That's embarrassing!!!!!!!!!!!!!!!!!!!!!
    1 point
  19. I have no supporting references but for me, common sense dictates that in a space that small you could not get the probes far enough apart to get any significant temperature variations. Having said that, regulations, requirements or other such problems seldom involve anything resembling common sense. Much like common courtesy, common sense is seldom common.
    1 point
  20. SbbPerson

    Paypal

    Thank you Cliff! Sorry, I didn't see this reply sooner. Thanks again
    1 point
  21. Hello All! I know this subject has been discussed extensively. It continues to be a source of confusion in my TS, due mostly in part to the lack of solid Blood Bankers (all generalists who rotate through). Currently, our SOPs for working up suspected cold agglutinins include a "cold screen" at 4 degrees using Immucor Panoscreen I and II, and patient autocontrol. If Cold Screen is indicative of a cold Autoantibody, a Tube Pre-warm screen is performed, and subsequent panel, if warranted. This is so confusing to my techs. Last night I received a call at home from my 2nd shift tech, saying she had a patient coming in for transfusion for one unit of red cells, with no prior history with us, was found to be A+, Negative antibody screen in solid phase on Echo, BUT positive Immediate spin crossmatches. She then proceeded to tell me she "prewarmed the crossmatches and then they were fine." She wanted to know how to result the Cold Auto!!!!!!!!!!!!!!! After swallowing to remove my heart from my throat, I explained that this was not a conclusive "work-up" for a Cold auto. I talked her through the possibility of Rouleaux (She said she only saw "clumps" not "coins" microscopically); the possibility of an A2 or subgroup, but she assured me the reverse reactions were consistent with A. I then told her the series of procedures to follow for a suspected cold agglutinin, all of which are in our SOPs. I suspected Rouleaux, and asked her to follow the saline replacement procedure, explaining that if it was true agglutination, saline replacement would not "correct" it. She performed saline replacement and the IS crossmatches were as smooth as silk. I guess my question is, does anyone have any suggestions for making this more clear to our staff? Also, what are your procedures for identifying a cold agglutinin, or autoagglutinin, both specific and non-specific? How about a flow-chart to make it easier for techs to determine what to do next? Any info, SOP, chart anyone is willing to share will be so appreciated right now, and worth its weight in GOLD!! Dawn
    1 point
  22. I attached a few SOPs and a flowchart. Please let me know if you need other items. E-1-5_Identifying Cold Antibodies.docxE-4-6_Cold Autoadsorption.docxE-4-5_Cold Absorption Using RESt®.docxE-10-3_Cold Antibody Workup Process Flow.docx
    1 point
  23. The following references may be of interest: Leger RM, Garratty G. Weakening or loss of antibody reactivity after prewarm technique. Transfusion. 2003 Nov;43(11):1611-4. doi: 10.1046/j.1537-2995.2003.00563.x. PMID: 14617322 From the abstract of the above publication: "Results: PW PBS-IAT and PW LISS-IAT showed that 40 and 47 percent of antibodies were weakened, respectively, compared to LISS-IAT; reactivity for 14 percent of antibodies was completely lost by each PW method. By PW PBS-IAT, 34 percent of antibodies were weakened compared to PBS-IAT. PW PEG-IAT showed weakened reactivity by 56 percent of antibodies compared to PEG-IAT; reactivity of seven out of seven PEG-dependent antibodies was completely lost. Of 67 antibodies, 19 percent were defined as low affinity. Of 64 samples tested by the PW method and for low-affinity antibodies, only 6 of 30 that showed decreased reactivity by the PW method appeared to be due to low-affinity antibodies; only 6 of 12 samples that appeared to contain low-affinity antibodies also showed decreased reactivity by the PW method. Conclusion: Antibody reactivity of potentially clinically significant antibodies can be decreased or missed by PW methods. Antibody enhancement media does not ensure antibody detection by PW methods." Other publications of possible interest: Storry JR, Mallory D. Misidentification of anti-Vel due to inappropriate use of prewarming and adsorption techniques. Immunohematology. 1994;10(3):83-6. PMID: 15945800. Hopkins C, Walters TK. Thermal amplitude test. Immunohematology. 2013;29(2):49-50. PMID: 24094235. Dupuis S. Use of the prewarm method for detecting clinically significant alloantibodies in the presence of cold autoantibodies. Immunohematology. 2018 Dec;34(4):148-150. PMID: 30624948.
    1 point
  24. Cliff

    Average age

    or 12. As I mentioned, it is imperfect data, but overall, I think it likely reflects our staffing ages.
    1 point
  25. John C. Staley

    Average age

    Thanks Cliff, that is some interesting data. When I was working in Utah there was a push for licensing Clinical Laboratory Scientists every couple of years in the state legislature. What I found most interesting, surprising and some what alarming was that the most strident lobbying opposition came from physician groups. My assumption was that they did not want to have to pay for qualified people to do the testing in their office and clinic labs.
    1 point
  26. Cliff

    Paypal

    That's odd. I was under the impression (possibly false) that PayPal was only required for me. Anyhow, I just added Stripe payment processing. When you get to the checkout, you can choose Stripe or PayPal. I appreciate your support!
    1 point
  27. We have been using pre-warming in the UK since before I started in Blood Transfusion (circa 1973) and we have never had a clinically significant transfusion reaction caused by warming away an antibody in all that time. Yes, there have been occasions when, for example, an anti-S has disappeared by pre-warming, but, if you look in most text books, and all reliable text books, anti-S is only rarely clinically significant - and certainly none of those that we have "warmed away" have caused any transfusion reactions at all. There was one case of an anti-Vel causing a fatal transfusion reaction, BUT, that was not missed through pre-warming; that was missed because EDTA plasma was used, and the anti-Vel could only be detected in serum (confirmed by the IBGRL), and so I think that the worries about pre-warming are vastly over estimated. It is vital to keep up with competency for this technique, as with any other technique, but probably more so with this technique.
    1 point
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