Ensis01

Would be very interested to know what antibodies were detected.

Well, you can see the reasoning with patients with rare, weird antibodies that never show up on even a 3 cell screen.  Match your practices to the needs of your patients - it isn't a one practice fits all kind of service we do.

I think that after you use them for a long time.....running panels and seeing which "positive" reactions pan out to be something, and which do not; you start to get an "eye" for what is a true positive vs. a few red dots that are not going to give you anything (or, you learn the "look" of a cold agglutinin; rouleaux; warm auto; vs. clinically significant antibodies).  I think it just takes time and experience (going after the questionable reactions long enough to know "when" to go after them)  to feel comfortable (and in the end, you could still be wrong; but there is also a good chance that if it is so weak that you can't decide whether to call it Positive or not, you probably won't find anything anyway).  Just my opinion.
Brenda Hutson, MT(ASCP)SBB

seems like a great deal of expense for what end?  To determine if a patient is a RhIg candidate? OR WHAT.
I was a member of  a TAC for one of the BB vendors last summer.  We discussed Rh molecular testing.  The company thought it was  valuable, the committee members thought it was not worth the bang for the buck.  Unless the price has come down significantly.

Found early mornings and evenings are best.   A martini in hand doesn't hurt either.

Great answer @AMcCord! I would just add - if you are just getting used to the echo or NEO - everyone has forgotten once and then they are really careful not to do it again; so don't beat yourselves up! I know I still check by ringing the vial like a bell at the beginning of my shift just to make sure! - Because - if the vial doesn't have the stirball and the person before you loaded it; it is stills works for the first couple hours or so until the red cells start to settle to the bottom of the vial!  

Catching these patients untransfused is difficult.  Submit a sample for full molecular phenotype.  At a minimum, try to determine Rh and K type.  If your antibody screen is negative, select crossmatch compatible units.  If positive, the next step is to 0.2M DTT treat your panel cells to help distinguish that the observed reactivity is due to daratumumab.  The reactivity that we've seen is usually variable in saline techniques, resembling what use to be referred to as "high titered, low advidity" or HTLA antibodies. The 0.2M DTT works very well, but I would not recommend any micro reads.  Most common antibodies can be ruled-out with 0.2M DTT treatment, but not antibodies directed at the Kell system antigens.  (There are other antigens "destroyed" by the DTT treatment, but they are not pertinent to this immediate discussion.)  As such, if no underlying antibodies were detected, our transfusion recommendation is to select K- units if the patient has typed K-.   While some recommend phenotyped matched units, we do not.  Having a full phenotype does not absolve a blood bank from determining what the reactivity is due to and if any new antibodies have developed.  Requesting phenotyped matched units, without the presence of antibody is a waste of a potential resource, drives up costs unnecessarily and may result in a delay that is longer than resolving the actual work-up if the patient's type is rare enough. 

I had a hematologist once that wanted all of her patients to get "double-filtered" products.  I asked her to provide me a reference to bring to Transfusion Committee; she couln't find one.
Request denied!  LOL

Any blood supplier making and distributing LR products must be rigid product qualifications.  The wbc reduction is must greater than bedside filters. 
I would be concerned about someone instituting a blood administration process that BB hadn't been involved with to assure it does follow manufacturer's instructions, isn't having some deleterious affect etc.  If it was observed by an AABB inspector and it was not kosher, you are going to be the one getting a non-conformance.

Why?
From my brief stint in components at a blood supplier, I remember leukoreduction methods being QC'd fairly well. Physicians should be pre-medicating patients and requesting irradiated blood as needed, not double filtering products to some unknown end. How do they even know it's doing anything qualitatively substantial?

Sounds like a waste of resources to me

Nope.  I think it's a great idea to have different methods and different manufacturers.

I am in China, I don't know the rules or regulations in the USA.
I will keep tube as a backup since gel method sometimes are too sensitive and easy to be interfered by some factors, such as cold antibodies, proteins or sickle cells.

That's because I just made it!  Maybe I should put it in the library!

The military does use "walking" donors - other soldiers who have been tested within a time frame, and are available for donation.  Field hospitals are definitely much more sophisticated now than even 10 yrs ago.  Field hospitals do have plasma and platelets as well as red cells available. 
TXA (tranexamic acid) is being used extensively in urban trauma centers.  Recombinant activated FVIIa  (NovoSeven)is less in vogue at the moment due to many bleeding episodes. 
Many of our trauma surgeons are ex-military - or active army reserve - and they are big advocates for simulated whole blood.  Some of our trauma surgeons will be publishing soon on experience with simulated WB being almost as good as WB.  They know nothing is as good as fresh WB, but understand that's an unrealistic goal.
 

We do not use cord blood specimens for any crossmatching purposes because the cord blood specimens are labeled with mom's armband label and are not always labeled at the time they are collected.  When any Packed Cell is ordered, the computer automatically orders a type and screen with the crossmatch.  We have the NICU draw us 1 ml of blood in EDTA, and we do the type and screen (in gel).  If the screen is negative, we can result on that specimen until the baby is 4 months of age.  We do not do any crossmatches on the baby unless the antibody screen is positive, and in that situation, a new specimen is needed every 7 days until the antibody screen is negative and a crossmatch is performed.  If we need to test using the mom's plasma, we would enter results and add a result comment that the antibody screen was performed on mom's plasma.

Can I make some comments about this type of reaction 'from the other side'.  It is easy to forget that reagent red cells come from real donors who have complicated antigens on their red cells.  The donors will be tested for as many antigens as possible, and the presence or absence of those antigens will be noted on the accompanying antigen sheet.  However, it is impossible to test for all those low frequency antigens (LFA) out there.  And unfortunately, antibodies to LFA are often far more 'common' than you would expect.  So, if you're getting an unexplained positive reaction with a reagent red cell it's probably due to an antibody against a LFA.  And the manufacturer is not going to be able to identify it; all they can do is withdraw it from use for the future.  these results are not false positive but unidentified (and probably unidentifiable) positives.  Your reference lab might be able to identify it if they have a good sample from the patient together with a sample of the cell.
As for reagent red cells with positive DATs when used in gel (Frenchie) - you will sometimes see positive reactions in IgG or poly AHG in cards if you put the reagent red cells on to the cards without any plasma, due to the fact that the cells are not meant to be used in that way.  Usually if you repeat with neutral plasma, the 'positive DAT' disappears.  If it doesn't, either there is a real problem with the cell (unlikely) or it has become contaminated in your lab.  And - Frenchie again - I would advise you against diluting 3% cells for use in cards.  You could be creating more problems than you think you are solving.
Another reason that you might see unexplained positives is antibodies to Bg.  As far as I know all manufacturers test their cells with a panel of anti-Bg antisera.  However, we all know how variable Bg can be.  You can test a cell with 20 anti-Bg and maybe only 1 of them is positive; and vice versa someone with a known anti-Bg won't react with all Bg+ cells.  So if you are seeing a fairly high number of unexplained positives, especially in pregnant women, then you shuld suspect Bg.
 

We just ID the antibody. Usually, if there is a problem, we'll contact the nurse and let them know why it's taking longer than usual but that's about it.

What makes you?  If it is your computer programme, I would urge that you change your computer programme so that it only makes you when the anti-A1 genuinely reacts at 37oC (pre-warmed, etc).
A computer in the laboratory is there to aid the staff; not to make things more difficult.

The only caveat I would add...consider your staff. I have all generalists. I require them to use a microscope because they are not all equally skilled with shaking off and seeing weak reactions in the mirror. Without the scope, we would miss some things we need to see. If I had a dedicated blood bank staff, I would give you a different answer.

Scott asked me to expand on my one liner above!
In the UK, much of what we do is "governed" by Guidelines issued by the British Society of Haematology (BSH).  For some time now, they have advised that group O, D Positive red cells be given, in an urgent situation to all males and to females over 50-years-old.  As far as I know, this has resulted in no clinically unfortunate sequalae, and, also as far as I know (and I am one of the people who writes these Guidelines) there is certainly no plans to reverse this decision.
I am equally unaware of any problems encountered where the patient has been readmitted to a different hospital and the transfused O Positive red cells causing any problems; indeed, there used to be problems the other way round, when we used to give D Negative blood to D Positive patients, who were then thought to be D Negative.  However, in most cases, these patients are either too ill to be moved to another hospital (don't forget, you would only give uncrossmatched blood in extremis) and, sadly, some of them do not ever get the chance to go to another hospital (remember also, that a huge percentage of patients who receive a transfusion of ANY kind are dead within six months (because of the underlying pathology, I hasten to add, not because of the transfusion!).
We do not issue any cards, apart to those patients who warrant an antibody card.
I hope that helps Scott, at least, even if it doesn't help you Christiane (that was tongue in cheek, in case anyone thinks I was being nasty to either of you)!!!!!!!!!!!!!!!!!!!!!!

I know it's happened, but the number doesn't seem to be very high.  (I'm going strictly on memory and not actual numbers).
The problem with that is, most of these type of people tend to be traumas, not the chronically transfused people you see often.  Once they've been discharged, we may not see them again or it may be years later. 
It may sound crass, but for it to be a problem, they need to survive the event which is causing them to bleed to death.  Developing an antibody (ANY antibody) is the least of their problems.

Bg antibodies are antibodies directed against HLA Class I antigens.
These antigens are expressed quite strongly on virtually all nucleated cells, but are poorly expressed on red cells.  This is purely down to the number of antigens sites on the various cells.  For example, a T lymphocyte will express some 100, 000 such antigens on their surface, whereas a red cell will only express from 40 to 500 such antigens.
It was originally thought that Bg antigens on red cells were adsorbed onto the red cell surface from the plasma, but it now seems that these antigens may be intrinsic, having been formed during the time when the erythrocyte precursors actually had a nucleus, but, that notwithstanding, they can easy be removed from the red cell by chloroquine treatment.
Bga is analogous with HLA-B7, Bgb is analogous with HLA-B17 and Bgc with HLA-A28, but there may be cross-reactivity with other HLA antigens.
Bg antibodies are very common in pregnancy, having been stimulated by the foetal HLA antigens, but have never been implicated in clinically significant HDFN, so neither you, nor the expectant mother need to worry (they are "nuisance" antibodies).
For more information, try Geoff Daniels, Human Blood Groups, third edition, 2013, Blackwell Publishing Ltd. Chapter 32 (pages 512 - 514) - so there is not a lot to read!

Typically expiration dates are established by the manufacturer. They perform stability testing for the duration of the assigned expiration date to support it with data. Data shows the product is capable of performing up until the claimed expiration date. It may continue to function they just do not have data to support it.
This should be done to support any "reagent" made that is not at least qualified in some way each day of use. Assigning an expiration date based upon the shortest dated component is not very good science. The different ingredients could be compatible with each other or could have a negative impact to on another. From a pure scientific and quality aspect one would prepare a reagent and place it on a stability schedule and test it periodically for performance. This data is then used to support the use. Any assessor should accept this science.
A simple analogy I like. If you made a cake today with milk that had a use by date of tomorrow does that mean the cake is not good after a day. Of course not, since it is now in a different form and could be stored in a different way. 

Our policy states one must be the transfusionist (RN) and the other must be "a qualified individual".  There must be documentation that they have been trained to do the bedside check to be considered "qualified".