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Tests on the adsorbed serum (with ZZAP-treated cells) give confidence that the are no underlying alloantibodies to common antigens. However, the use of allogeneic cells risks removal of a cold-reactive alloantibody to a high incidence antigen, e.g. anti-Vel, -PP1pK. A low risk, but still concerning. Does you facility also test the ZZAP-treated patient cells (now presumably DAT-negative) back against the patient's own serum ? This is ultimate proof that the cold-reactive antibody is an AUTOantibody and adds more confidence in the results of the adsorption with allogenic cells. I may b

My personal system was virtually identical to yours except for the the reverse type I used JH-RA and JH-RB. In the facilities where I was the Transfusion Service or Blood Bank supervisor my tube labeling requirement for the staff was that anyone in the department could set down an take over the testing and know who and what was in each tube.

If you are talking about tube tests, I label A,B,D,Dct, a,b. ABSC: 1, 2, 3. With the pt initials underneath.

OK, not Rh, but D. We were using solid phase technology and recently switched to gel (IH-1000). We've had a policy for many years, if you test less than 2+, we call you Rh Neg. Now with gel, people who were 1+ are testing 2 or 3+. This is concerning for OB patients. Do we give Rh immune globulin or not? We've sent a few of these out for genetic testing to determine if they are capable of forming an anti-D, but if they've just delivered an Rh pos baby, and we don't get the results back for weeks, it's too late. We are a big organization and have a very active labor un

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Thank you for the reply. The ZZAP'd cells were allogenic. At our institute if the DC is positive and the DAT is also positive due to IgG. We ZZAP the patient's cells and repeat Rh group. I was surprised the IRL did not do that.

We validated using Anti-C3 in a Neutral Gel card.

There are many plasma proteins that can cause allergic reactions. Transfusing washed cellular products frequently prevents additional reactions. In addition, there have been several case reports of a donor consuming an allergen (peanut butter is classic) before donating. The recipient who is sensitive subsequently has an allergic reaction. One that comes to mind was well documented in the NEJM. And of course don’t forget the controversial IgA deficient patient allergic reactions.

Yes.

We use combo gel card IgG/C3 In case the result negative is great. if the result positive then we do tube method IGg and(C3b,-C3d).

With the COVID pandemic, my institution demoted me and resulted in a significant pay cut. I decided to leave and go where I feel welcomed and valued for my 30+ years of experience in BB and as a generalist, LIS and manager. I have been on call, even during my vacations for over 5 years, coming in the middle of the night, holidays and weekends. I am leaving a no one is trained to do elutions, Ob titers, Dara protocol and master log review. I feel bad, but administration seems to realize nor care that I am just leaving an empty opening in the schedule! I have read all the previous postings from

When I first joined the wonderful world of blood transfusion, with particular reference to blood group serology, at the International Blood Group Reference Laboratory, when it was in London, my mentors were Dr Carolyn Giles and Joyce Poole. In those days, yes, we did use microscopes (albeit with very little magnification) and, given that we were using human-derived antisera, and the fact that I was anxious not to miss anything, I often got Joyce to check my sightings down the microscope. These were invariably "kissing cells", as you suggest, and Joyce christened them "Malcolm weaks", a term

I don't believe that an optical aid necessarily refers to a microscope. In my pre-retirement years we used the agglutination viewer when an optical aid was required. Example: https://www.fishersci.com/shop/products/fisherbrand-tube-agglutination-viewer-5-watt-bulb-w-magnifying-mirror/22363560

Plus we should remember the goal of each test. In the case of prenatal Rh typing, identifying the patient who should get RhIG to prevent possibly making anti-D whenever possible is the goal, not generating a binary pos/neg answer. Unfortunately the reagents available aren't perfect for this but we need to be able to defend our decisions to the woman who makes anti-D and never has another healthy pregnancy.

After a lot of reading and deliberation, here is what we ended with. Testing of Male Patients and Female Patients ≥ 56 Interpret according to Rh Tube Test SOP. Follow discrepancies as outlined for women below, except for sending for molecular testing. Testing of Female Patients < 56 For newly tested women less than 56, if result is 0, testing is complete. If > 0 but < 2+, interpret as Rh neg and perform Rh molecular testing. Notify a supervisor to have molecular testing performed. If ≥ 2+, interpret as Rh pos. This is for all women less than

I too think it is 16% for pregnancy Mabel. The lower number is because not all foetuses will be ABO compatible with the mother, and so her ABO antibodies will destroy the red cells in a small FMH, and, of course, not all pregnancies result in an FMH. In transfusions, however, the units given will be ABO compatible (or so we would hope!) and so the dose of D Positive red cells will be a great deal bigger than an FMH, and will not be destroyed by the recipient's ABO antibodies, so they stay in the circulation a lot longer.

I would just like to add one 'grain of salt' to this debate. You cannot detect all D variants - whether D weaks or partial Ds by serological methods alone. Neither D weaks or Partial Ds behave in a way that allow one to say that all D weaks or partial Ds react with such and such a strength. You will always miss some. You will miss some D+ donors because their D antigen is so weak that it is not detected by even the most sensitive of routine serological tests - or because despite using at least two different monoclonals the donor has an extremely unusual variant that is detected by neither.

I would have got her RHD gene sequenced earlier in her pregnancy, so that I would have a better idea as to whether she required anti-D immunoglobulin. If she turned out to be (potentially) a Partial D, or a Weak D other than Types 1, 2 or 3, I would give a double dose of the normal dose of anti-D. Anti-D immunoglobulin is still derived from humans, which means it is a "soup" of different anti-D specificities against the 36 odd epitopes, some of which would be expressed on the lady's red cells, and some of which would not. Therefore, some of the anti-D specificities would be adsorbed ont

It was a bit of a troll question. It seemed to me that if we can't trust the reactions we get in gel then what's the point of using it. As far as I can tell regarding the IFU's Dansket is right. I realize the importance of precision and care being taken in the blood bank, but I think a lot of times we fall victim to an overabundance of undue caution.

The patients should be genuflecting to the FDA inspectors. I know I would were I a patient who required a transfusion!

We have dedicated blood bankers on each shift. This was suggested to us by an FDA inspector. We supplement with generalists on evenings and nights.

Staffing in NYS labs right now is reaching catastrophic levels. Can't even find generalists.

Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages, We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB. The only real "dedicated" techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area). On second

I validated anti-C3b,-C3d using buffered gel cards. We use 0.8% patient cells and we make the commercial Complement Check cells 0.8% too. We spin after a 5 minute incubation at room temperature. The check cells are always 3-4+. As for the sensitivity problems being discussed - negative tube vs + gel . . . why are you using gel? Up front we all know it is more sensitive. I don't think you can ignore a + gel result just because you repeat it in tubes and it is negative. My ped docs are enthralled with the increased DAT sensitivity. I have found 3 anti-Jka in gel that were negative with t