Ensis01

For donors; molecular testing provides a full predicted phenotype which becomes their historical phenotype. To send out labelled antigen negative units they need to be serologically confirmed. If there is no anti sera it will be labelled to that effect I.e. “historically negative by molecular methods”. This will efficiently provide the supplier more combinations of antigen negative units. Though they will proberbly still screen for the Rh and only send out if good. Another very important and useful part of the information molecular testing provides is the antigen variant information for both donor and patient (several other threads on this!). Also If the volume sent out is high enough it may be less expensive and provide more information than the usual full serological phenotype.

For those that do elutions; do you use the cord blood or get a new specimen?

If Panel A has one cell with a 1+ reaction and all other cells are negative, I would call it positive. The iffy/suspicious screen cell that may or may not be an artifact becomes irrelevant. The patient would remain on full cross match forever due to the positive panel A cell. Trying to prove the reactions to be artifact at this stage may be very time consuming and still not resolve the issue. It seems more efficient to just do the full cross matches while the screen is being run.

Forever.

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I agree with Cliff and AMcCord. I suggest to first determine if your lab can afford the time, i.e. do you have enough techs to work-up warm autos that require allo adsorptions in addition to your current work load. If you can and do then look for the answers to your list.

Any comparable unit.

Agreed

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I have never taped on both sides as When we are talking small drops, which are blotted, the blood/reagent does not soak through so taping one side works OK. If the spill is big and paper is wet then it is better to put in clear folder and photocopy. For a policy: probably better not to say both sides as it would be irritating to always need to check and especially get dinged by an inspector for that.

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Klsmith’s original question is regarding concern of missing an anti-f if the patient has an anti-e. I am trying to make the points (and failing it seems) that firstly giving e neg units side steps the f issue. Secondly his blood bank policy should state the normal clinically significant antibodies that need to be ruled out and how to deal with the others. This site is a great way to clarify any confusion created with respect to “the others” or if the policy or logic is not clear.

My main point I was trying to make is that your policy/SOPs should explicitly define what you MUST rule out, like anti-e and what you rule out if it happens to be present on the cell. To put it another way if a patient has a negative screen but none of the screen cells have the f antigen, does your policy require you to find a select cell that does?

In this context "re-identifying" an antibody refers to documenting you have 2 cells (or 3 depending on policy) that are positive for that antigen and 2 (or 3) cells that are negative for that antigen plus testing the patient for the corresponding antigen. Once the antibody is identified "re-identification" is not needed but one positive cell shows it is still reactive if all else is ruled out. So for example I will choose select cells that are negative for previously identified antibodies that will allow me to rule out all antibodies I am required to by policy. I will also ensure there is at least one cell positive for that antibody to see if it is still reactive (closes the work-up with a bow). I will also double check all positive cells (probably on the screen) to see if there are any other antigens that are not ruled out, for example Jsa, Kpa, Lua, V, f etc., if there are then another cell is needed to rule it/them out. So on a practical approach: you run the screen, chose cells to rule out all clinically significant antibodies spelled out in your policy and issuing non-reactive units covers the rest. If you are still concerned I suggest you closely read your policies and SOPs to ensure, to your satisfaction, that it makes sense and nothing was missed. There are many threads on this site delving into the more esoteric, unusual and complicated antibodies and how different transfusion services deal with them and why. With respect to your example: an e negative unit will be f negative as the f antigen is only expressed if both the c and e antigen are present AND they are in the cic position; therefore either c negative or e negative units (patients) will be f negative. Hope this helps.

The easy answer on a practical note is as long as the Emergency Release order has been signed by the physician who placed the order all is well in the BB. My understanding, from when I worked at a level I trauma center, is that once the patient is in the OR; the anesthesiologist is in charge and is not required to finish the transfusion orders of the ER physician. If the anesthesiologist wants to transfuse the remaining uncrossmatched unit they cancel the ER order (if electronic) and place their own when things calm down. This has to do with billing, transfusion criteria and removes ambiguity. As long as your policy ensures that any physician ordering/transfusing Emergency Release products is documented in case they need to justify their decision.

I like this as a rise in temperature can be due to the temperatures being taken by different methods or locations (oral, rectal or armpit). SMILLER's phrase ensures this is incorporated into the evaluation process.

Firstly kudos for taking the initiative and getting outside opinions to the changes you are experiencing and are uncomfortable with. The above comments (from way more experienced blood bankers than I) indicate your new supervisor is not wrong but needs to clarify the new process in context for you all. I suggest following AMcCord's advice and pulling some past work-ups (or invent them). Include patients with a new and previous single antibody, also patients with new and previous multiple antibodies. Then get the supervisor to walk through how he would resolve them and explain how each work-up would change with a negative and positive DAT. Running a DAT with each work-up is fine as long as it is clearly laid out what you are to do with the results and why. Once you have "proved" an antibody according to policy, running only negative cells for that antigen is normal practice because it is efficient (especially for the anti-e mentioned above). This is however assuming you have manual gel, as Dansket said only full panels can be run if automated. Hope this helps.

My understanding is that when collecting the blood from the donor; several tubes are collected and sent off for testing at a BIG lab, this includes the ABO/Rh (as well as bacteria, diseases etc.). The donor center would only test ABO/Rh if the BIG lab determined a serological discrepancy or if the ABO/RH was a historical mismatch for the donor (these would be resolved by a tube not segment). The only time a donor center would need to confirm an ABO/Rh by a serological test from an attached segment AFTER labeling is if the donor center's reference lab was working as a transfusion service for a hospital.

WOW; a real can of worms! Just for fun and off the top of my head here is my opinion. PPE is by definition to protect the techs. The lab lay out should allow a transition location to don lab coat. When entering lab proper; add gloves and safety glasses (ask anyone who has had their head in the eyewash for 15min). Gloves should be changed when visibly soiled and periodically as they loose their impermeability over time (I remember reading either vinyl or latex in ~20min). Wash hands when changing gloves. Put face shields in key locations. Small reagent/blood smudges on paperwork are taped over, if larger spill occurs put in plastic folder and photocopy. If this is followed the tech is protected and contamination throughout the lab minimized/contained. Gloves are prohibited but lab coats required in labeled "Clean" areas of the lab that are used for issuing blood products and manager/Sr. tech paperwork. Blood products worked on in the lab are handled with gloves but products are issued without gloves and placed in Ziploc bags so that if dropped leaks are contained. The RBC will be taken out of the bag and hung by an RN wearing gloves. Yes I know that it is purely semantically that if working on a RBC I wear gloves but when issuing the same unit I do not. It does however provide a clear distinction as far as writing and interpreting policy. The last thought is that whatever you decide is your policy; it must be practical and enforceable or will not be followed by the techs and therefore only an academic exercise.

Congratulations Malcolm!!!!