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  1. There is going along to go along and then there is accepting ample amounts of data from extremely reliable sources. It's not about "sales" it's about trying to serve the population in general, based on the best knowledge we have currently and being willing to accept that. If what you are doing works for you in your little corner of the world, that's great but making light of advancements because it doesn't fit your paradigm and accusing some of the best professionals out there of being uncaring is.......... I'll stop now. I've been in this group for more years than I care to count and don't want Cliff to ban me.
    6 points
  2. Yes, that is valuable for the treatment advice. For the transfusion decisions, my plan is to say, "don't unless necessary", then, if there are enough compatible units and Ab titer is very high, start with a couple of compatible units. Once antibody has been bled out, then use random units and, if you can guess when the last few units will be given, make them the more compatible ones to reduce the RBC destruction in the coming days. If titer is lower or there are few to no compatible units, start with random units and try to fill the patient up with the (more?) compatible units at the end. Maybe with sufficient immune suppression as your article suggests, we wouldn't have to try to guess when the last few units will be transfused. We could keep the compatible ones for single unit transfusions over the ensuing days.
    3 points
  3. Cliff

    Elutions

    If you haven't done it in a while (staff will catch on), check cells.
    2 points
  4. This is almost certainly NOT the paper that you wanted referenced, but it may help in an emergency. Win N, Needs M, Thornton N, Webster R, Cheng C. Transfusion of least-incompatible blood with intravenous immunoglobulin plus steroids cover in two patients with rare antibody. Transfusion 2018; 58: 1626-1630. (DOI: 10.111/trf.4648).
    2 points
  5. Did you know that in the UK they would be appalled that we might give K+ blood to a female with childbearing potential in the US because we don't routinely K type either the units or the patient? D isn't the only immunogen out there (although it is certainly very immunogenic, and the number of positive donors outnumber the number of K pos donors). Still, there are other risks than making anti-D that some are equally concerned about.
    2 points
  6. I'll add that this policy is in keeping with the guidelines of the AABB and Red Cross. If, in the US, we used O neg instead of O pos, we certainly would not have enough O neg left for known Rh neg patients or those with anti-D. We are on allotment for O neg and can't get more than our quota without the supplier's medical director approving a medical release. No change in sight. We can't trade the certain harm to those patients for the potential harm for the trauma patients who are 85% likely to be Rh pos, usually male, unlikely to make anti-D, and usually not likely to require emergency transfusion more than once in their lives. I'll admit that I am having some of the same qualms with the new policies to use O pos whole blood for traumas of any age and gender. Their arguments about the modern treatment of HDFN are probably right, but they are harder to accept for me. We had to start keeping O pos on our helicopters last year because we couldn't manage the O neg rotations anymore. Same risk as the whole blood argument. The only young female transported got the unit of liquid plasma and not O pos red cells.
    2 points
  7. I've said it before, inertia is the strongest force in the universe. From my 35+ years as a blood banker and supervisor of both donor services and transfusion services, I have come to the conclusion that, as a general rule, blood bankers are extremely slow to change when not resisting it completely. This appears to be especially true if they are not actively involved in the change or keeping up on the literature. I saw a great may changes during my tenure and not all of them were comfortable at first. Giving O Pos blood to massive bleeds was just one of them. The data supports it, no matter what our long held concerns and fears try to tell us. Many of those long held fears and concerns were primarily theoretical, especially in how prevalent and disastrous the outcomes would be. I have a number of stories to prove my point but I think I'll stop now and step off my soapbox.
    2 points
  8. O negs are still used in excess of their numbers in the general population. I've worked on both the donor side and the transfusion side. The pressure on O neg donors is huge. They are asked to donate as often as possible. We owe it to these donors to be good stewards of their donation.
    2 points
  9. We give O pos for all uncrossmatched blood orders for males and females over 50. We've done it for a couple of decades. We avoid it if the recipient is known to have anti-D already. We have seen very few make anti-D.
    2 points
  10. On the contrary - The quality IS there and we are saving lives better than before. Statistics show that: 1) - most "Trauma" MTP patients are male... So, making anti-D is the least of their worries - like our team always says......they have to LIVE to have a problem. And, 2) - it is not nearly as likely for RH neg females who are bleeding excessively and get Rh pos units to make anti-D as you may think........and the quality of care for the few females who do get pregnant after an Rhpos transfusion AND make anti-D is so much better now. Again - they have to LIVE through the traumatic episode to make anti-D and then get pregnant and have a baby. IF all that is possible after their trauma experience I think they'll be thrilled and having anti-D will be a non-issue. You might want to read the articles I posted above in this thread. They're really helpful.
    2 points
  11. I just answered this question. My Score PASS  
    1 point
  12. AB123

    Thawed FFP

    Did the advise in the attached screenshot from this site change? And if so which standard, document or reference etc details this requirement?
    1 point
  13. I just answered this question. My Score PASS  
    1 point
  14. I just answered this question. My Score PASS  
    1 point
  15. I just answered this question. My Score PASS  
    1 point
  16. exlimey

    Elutions

    First step is to determine what are you trying to prove. Do you want staff to merely have a productive/reactive eluate, or do you need them to identify the specificity, too? As Malcolm says, if you're in a blood center/centre, with access to whole units of plasma containing IgG antibodies of various specificities, it can be relatively easy to sensitize red cells with the appropriate phenotype (from your RBC inventory). Using D+ cells with anti-D is the simplest approach (or use Check Cells). This would certainly satisfy the mandate for a productive/reactive results. But, if you want the added challenge of antibody ID, using the same cocktail of reactants each time will lessen said challenge (as Cliff commented). But, back to basics.....make sure you have a specificity which is IgG in nature, reactive only by IAT. It should be relative strong WITHOUT LISS or PEG enhancement - use the standard/original saline-IAT to chose your antibody source. Always incubate your sensitization phase at 37C. You may need to vary the ratios of packed cells to serum to get optimal results (typically at least 2 volumes of antibody to one volume of packed cells). The shelf life of the sensitized cells may be increased by suspension in a red cell storage solution/preservative.
    1 point
  17. jshepherd

    Elutions

    My old supervisor would antigen type a patient sample for something AHG, like Fya. Once we had patient sample that was Fya positive, she'd remove all the plasma, and add a ton of Anti-Fya sera (usually stuff that was about to expire). Let it sit in the fridge for several days so the Anti-Fya antisera bound to the patient cells that were Fya pos, then she'd check that the DAT was coming up pos at IgG, and make us do an eluate on that sample. The caveat here is that it's not a very stable sample, and it only worked well sometimes. Also, what I describe above comes from my memories of 10 years ago, so I may have missed a step. I haven't had to attempt to make this myself in my current facility. I need a whiz like @Malcolm Needs to check that this could work in theory......
    1 point
  18. I just answered this question. My Score PASS  
    1 point
  19. I just answered this question. My Score PASS  
    1 point
  20. 1 point
  21. We would indeed!!!!!!!!!!!!!!!!!!!!!!!!!!
    1 point
  22. I've seen anti-D come stronger or weaker in the same patient, and when we've sent them for molecular they come back as some form of weak D usually. We use Immucor reagent here, so tube typing, and it's the same reagents on the instrument as in our tube, but we do see some variability from the two methods, likely because of the RT incubation the instrument does on all blood types. The weaker D can "unbind" it seems, and the instrument will call something Rh negative when in tube we get weakly reactive or 1+.
    1 point
  23. It's pretty likely it's her blood because baby has a weak D Rh type but, yes, we thought of that.
    1 point
  24. "Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago. Thanks for your words of comfort." You are STILL not giving ANTI-D Kym; you are giving D Positive red cells. The other thing is that, within the White populations, but more so in the Asian populations, there is a very good chance that giving group O, rr blood will stimulate the production of an anti-c (IF any Rh antibody is stimulated), and that can be just as "dangerous".
    1 point
  25. Not sure I can help your argument, as we give O pos immediately to all males and females over 50, for any amount of emergency products. If you're wanting to argue for O negs as the first products when the blood type is unknown, it may not be received well, as this is very much becoming no longer the norm across the country, as far as I know.
    1 point
  26. Yes, when there isn't a true massive, it is more likely the patient may make an antibody. That said, we have the same procedure here as you Kym: we give O pos to males and women over childbearing age for ANY emergent release red cells. If they only get 1 or 2 units, then so be it. This is part of the battle of using inventory appropriately and calling a code/massive appropriately....and never the twain shall meet.....
    1 point
  27. It varies from no reaction to lethal hemolysis. Anti-D is not entirely predictable in causing severe hemolysis. But mostly bad stuff happens :). This is true to some extent for anti-A and anti-B, although these are more dangerous as they fix complement in vivo better than anti-D in general. Joe Bove (my original mentor) reported a case of a patient receiving multiple units that were ABO major incompatible with no reaction. Not typical, but illustrative of the variability.
    1 point
  28. Even without a transfusion reaction, the haptoglobin drops with transfusion of red cells. Lots of non-viable cells and free hemoglobin in many red cell transfusions. If you cannot see red urine, red plasma and a drop in hematocrit/failure to rise, it's not a hemolytic reaction. Haptoglobin plays almost no role in assessing hemolytic transfusion reactions, and, as mentioned, unless you measure it on the pre-transfusion sample as well, tells you almost nothing. LDH pre and post would be more useful in most cases. Don't bother with haptoglobin in most cases.
    1 point
  29. We give Rh pos WB to any patient over 50kg that they call MTP on and keep it as the primary resource in our adult ED refrigerator. That being said, I have attached two articles concerning this very subject should you like to read about some studies done. Anti-D in Trauma Patients.pdf Rh negative risk with Rh pos RBC.pdf
    1 point
  30. Exactly what Malcolm and Dr. Blumberg said - we've been doing this (in the states) for more than 10 years at my facility, rarely do we see an Rh neg trauma patient, and even rarer do they make an antibody to D if they survive, which for us is a significant percentage of trauma patients we see (98% survival rate). The key is giving the mismatch during a massive bleed, not just a onesie twosie transfusion. This is also why we give type A plasma to unknown type trauma patients, instead of AB.
    1 point
  31. we use these........... They're kinda pricey but make refrigerators "clean and neat" and they last forever!......we can fit 40 units per shelf - max...... 4 rows of 10u each, there are other "storage solutions" available that would force them to put less on the shelves......
    1 point
  32. The rate of alloimmunization in massive transfusion trauma patients who receive D positive red cells appears to be quite a bit lower than seen in healthy adults exposed to D positive red cells many years ago in the original trials. Perhaps as low as 1-2%, not 40% as seen in healthy recipients of test doses.
    1 point
  33. Well i guess quality just not there anymore. Like all things. Not caring we are endangering future life. Going with the odds. You are right. Only things matter any more are cost and convenience. No wonder they don’t really train any more theory etc. it’s all technician work now. 🤷‍♀️
    0 points
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