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This is where having a transfusion service director who knows something about clinical medicine and hematology comes in very handy. It shouldn't be the medical technologists' job to triage requests. Many transfusions do more harm than good, so it's not that difficult to figure out which patients urgently need transfusion and which can wait, but this requires a knowledgeable and tenacious physician to handle the individual requests and screen them. As a field, pathology has paid little attention to the need for those who can do such tasks, as compared with surgical pathology skills, cytopathology, etc. You may need to involve your institution's hematologist(s), intensivist(s), surgeons and anesthesiologists to help make these decisions if your lab physician(s) aren't up to the task.

The vast majority of trauma patients only need TEG/ROTEM as these are the only assays shown to improve clinical outcomes when used to drive transfusion therapy. For patients who don't respond well (keep bleeding), it's important to have the fibrinogen level, platelet count, PT, PTT as well. The individual factor assays are largely irrelevant and unneeded. Hemophilia A and B are vanishingly rare diseases, and vWF is usually mild to moderate in most patients so individual factor analyses would be needed very uncommonly. A test of platelet function such as the closure time (PFA-100) might be a useful thing to have too, but less relevant in trauma patients.

Personally, I would consider this extensive QC and not validation. There really is a difference. There truly are things that can not be reasonably or realistically validated in the clinical setting, antibody panels and antibody screens are just 2 of them and for the same reasons. I think I'll stop there.

Dang! I should have slipped in "probably is an A1 individual". (You are very alert for a Monday morning!) Donna

This is what I thought also, as the cells had been re-spun maybe it changed the proportion of adult to fetal cells.

I believe newborn and maternal red blood cells do not have exactly the same density. So, on 2 different sampling even from the same tube of packed cells, you may have diff. proportions of maternal vs newborn red blood cells. It is the same in case of transfusion, as transfused cells are heavier, depending on the way RBCs are sampled (bottom/middle/top of packed cells) you may have diff. results/pictures (DP, no DP...).

With attention to blood utilization, the overall red blood cell usage has gone down. Consequently blood suppliers have had to pair down the number of overall units they collect in order to avoid out dating products. Since we are drawing a population, the proportion of desired units in that population (All Rh negs and all group Os) has not changed, but the absolute number of the desired we can acquire units has dropped. Transfusion practices are still demanding nearly the same number of desired units as before blood utilization practices were implemented. About half of the Rh neg units distributed go to a non-Rh negative recipient, often because hospitals do not want to "waste" them. Perhaps if before making that decision to transfuse the blood bank contacted the blood center and asked if there was an immediate need to transfuse an Rh negative unit to an Rh negative recipient, we could better utilize the resources we have. Also I believe the merging of blood centers has contributed to the problem. Where the community blood center was usually able to manage the blood needs of the local hospitals, many are selling blood by contract to facilities miles away. This has decreased the amount of ad hoc blood available for export. The "low-titer group O" craze is also taking a toll because of the demand for repeat donors to fulfill the need to have Whole blood units with a 21-35 day out date, available for emergencies. Most blood centers are trying to recruit blood donors by blood group now in order to avoid out-dating Apos and Bpos units. This means that Rh negative and group O donors are approached to give 2-3 times more often than donors of other blood groups. The desired donors are complaining that they are being approached to give red blood cells too frequently and are starting to ignore our requests. All of these issues (and perhaps others) are contributing to the nation wide blood shortage of the most desired units. Importing products is also difficult. If they are available at all, did you know that in order to import four group O negative units a blood center might have to also purchase 50- 100 group A Pos units? Platelet utilization seems to be increasing. Where do platelet donors come from? Usually whole blood donors. Sometimes the blood center needs to decide whether to take a group O product or obtain a platelet product based on the needs of the day. Thank you to those who are excellent stewards of the products you receive! Blood centers are not shorting you because they are incompetent. Frequently it is extremely difficult to obtain the most desired products any where at any price. You can help your blood center serve you by being honest with your inventory.

We purchased bins from VWR International. They are manufactured by AKRO MILS if you want to check their website: https://akro-mils.com/ They are inexpensive and come in various colors: Red, Blue, Clear, White and many sizes. We got Item# 75854-808 ... a case of 12 clear, 4" tall x 11.625" deep x 6.625" wide. 6 fill one of our drawers (3 in front, 3 behind them) very nicely. If you message me, I'll tell you the price (very reasonable). They sell dividers for them, too ... again, in the same colors. We also use them for our reagents. We stole the idea from Chemistry, by the way, so I can't take all the credit for this idea.

We test both panels with the same diluted antibody and make sure the results are the same.

Sorry to resurrect an old thread but as my question has already been discussed in this thread I thought it worth continuing here. I want to know if anyone has a technical explanation as to how a large amount of maternal contamination of a cord sample can occur? In the UK in my experience at all labs I've worked its always been practice to perform APT (NAOH) test on all cords that give the same blood group as the mother, I've always seen this as one of those tests you just do but seems a bit of a waste of time as its never positive. Last night we had a cord sample giving group O Pos result but with weak reactions in the B and AB wells. I advised the staff member to wash the cells and repeat, this then showed a strong mixed field, O and B. We requested repeat venous blood which was B Positive the mothers blood group is O Pos. APT test showed the first sample was not, or at least not all Neonatal blood. I've done a bit of a google search and although there are a lot of papers discussing contamination there isn't much that describes exactly how it occurs. I'm assured the samples are taken by double clamping then taking the blood with a syringe and needle. Thanks

If you mean you use the panel cells as positive and negative controls for your grouping antisera, no it doesn't, as these reagents are MUCH more avid than most human antibodies.

What I was saying is that, if a "mixed-field" ABO reaction was regularly due to there being a mixture of maternal (presumably group O) blood and baby (presumably A, B or AB) blood, then if a Kleihauer test were to be performed on these samples, you would see a substantial number of ghost (maternal) red cells in the film, in which the HbA has been destroyed - and you don't. This proves that, in most cases where a "mixed-field" ABO reaction is seen with cord blood, all (or the vast majority) of the red cells are from the baby, with HbF intact, and staining with the eosin. I've just re-read this, and I think I could have written this more clearly, but the problem is that "I know what I mean"!!!!!!!!!!!!

not on a routine basis - only for need.

Yes thanks Terri, she's back home now and feeling fine - although I suspect that once the shock wears off, it will be mighty painful. Have no fears for me - she will never read the post about the dinner. If she does, PathLabTalk will have one less member!!!!!!!!!!!!!!!!!!!!!!!!!!

Oh no...hope your wife is OK, Malcolm. And I hope for your sake that she does not EVER see your comment about your dinner.

Actually, I have to disagree L106, as, if the anti-A1 being used is Dolichos biflorus, this lectin will also detect Tn activation and Cad polyagglutinability - both highly unlikely, but both possible. Sorry!

I only use the A1 lectin if I am dealing with a reverse grouping discrepany (grA backtypes as an O).

Certainly, in the UK, this is not, to say the least, a routine procedure.

I'm SO glad we don't have one of these. OK: chart/alarm shows temp stayed within range, temp was recorded once during the day. Keep the blood. Not OK: chart/alarm shows temp stayed within range, temp was not recorded once during the day. Throw away the blood. I kind of like Dave's point "Better to eat them and use the incident as a means for better compliance with regulations." However, I don't see a difference in how the blood was stored in the 2 scenarios, aside from a note on a logsheet, so I side with goodchild and kirkaw. The real issue, as Dave continued, is that the units could have been taken out of the fridge, sat and cooked for half a day on a counter, then put back in. In either scenario you wouldn't know it. There's my non-answer. Throw them away if you want to make a point to the OR, but I see no difference in safety whether someone recorded a random temp or not.