Ensis01

I have transfused 400u to 2 patients one night (2 traumatic aneurysms with different etiologies).  Another night a patient w an 8000cc bleed in the OR.  I had never seen folks get so much blood and survive.  All 3 walked out, though one guy was missing 2 limbs.

I agree with Auntie-D.  I issued well over 100 units to the police dog handler blown up in the "Harrod's Bomb", and he also survived.

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I am in the resolve the Backtype at a minimum of once for every patient.  I have had two Bombay phenotype patients in labs I have worked in. 

If the problem is that the reverse group is too weak to allow for a safe IS cross-match, DO NOT ALLOW AN IS CROSS-MATCH.  It is simple.

Let me ask the basic question is this necessary?  If the weak back type agrees with the front type, you know everything you need to safely transfuse the patient.  Why bother with serologic make work?  It has no clinical relevance that I can think of.

There was a study done here by ORBCoN in Ontario, Canada.  It showed that most (I think it was 99%) babies were delivered from people under the age of 46.  So yes, not all.  But most.
Best of luck on your journey to conceive.  I had mine at 40.  So I'm always tired, but love her to bits.

Four drops of plasma to resolve back type ABO discrepancies (with an auto control) has been part of procedures in all places I have worked. My concern is that your techs are using a technique that is not part of your labs procedures. 
WRT ISXM: if you resolve the backtype using 4’C (RT) incubation do your procedures require you to do the ISXM at 4’C (RT)?

Someone one time tried something once and achieved the results they were looking for and told someone else.......  That's usually how it appears to work and in all my years working in blood banks and transfusion services I have discovered that inertia is the most powerful force in the universe!

Four drops of plasma to resolve back type ABO discrepancies (with an auto control) has been part of procedures in all places I have worked. My concern is that your techs are using a technique that is not part of your labs procedures. 
WRT ISXM: if you resolve the backtype using 4’C (RT) incubation do your procedures require you to do the ISXM at 4’C (RT)?

This is Shrodingers D - Treat the mum as if the baby is D+, treat the baby as if they are D-

We also wouldn't as we keep 6 packs for our NICU babies to reduce donor exposure (and also the amount of work needed for us when there are maternal antibodies) - Irradiation would mean we would need to recrossmatch every week

The paedipacks supplied by NHSBT, or, rather, the donors are also tested for unusually high levels of potassium ions, as a result of findings a few years back where babies had been affected by fresh, rather than stored blood from such donors (natural hyperkalaemia).

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

True, but who is going to perform tests, such as ADCC, that cost a certain amount of money, as well as time, when M Negative units are generally easily available?

Agreed.  We don't use the ADCC, we just give M negative.  Even a little, sub-clinical hemolysis probably isn't good for patients :).

What a waste of expensive phenotyped blood.

For many hospitals; once an anti-M is identified, at any phase, M neg units are required. This is usually due to reluctance, or inability to over-ride the BB LIS especially if the BB is primarily staffed by generalists. 

I whole heartedly agree with the pint!
 

Best suggestion yet!!!!!!!!!!!!!!!!!!!!!!

Malcolm we can do this for ever!!  The antibodies CAUSE the hemolysis by activating the compliment. 
Here's my analogy, without my finger pulling the trigger the gun doesn't go off and I don't get a bird in the bag. When I do pull the trigger did I kill the bird or did the lead shot kill the bird?  Or did the gun kill the bird? To address the hemolysis of autologous cells with the same analogy. Occasionally 2 birds are close together and both are killed with the same shot.  One was intended the other was not but I still pulled the trigger.  
Take one of the factors out of the equation and the end result does not happen or is significantly altered so the answer to all the questions is YES.  I think what we have here is a case of semantics.  Every step could be said to have CAUSED the end result.  
This is fun.  Let's discuss it over a pint some day.

That is true John, BUT it is STILL the complement (specifically the Membrane Attack Complex of C5b, activated C6, C7 and C8 molecules and about 6 activated C9 molecules) that causes the haemolysis, which is why autologous red cells are also destroyed.

I may be mistaken but I seem to recall being taught that it was the ABO antibodies interaction with incompatible RBCs which caused the activated complement so without the ABO antibodies you don't get the hemolysis.

We require a confirmation on anyone requiring transfusion of any product.  Our thinking is that if they are receiving plasma or platelets, they will probably require red cells also eventually. It is a no charge test so the patient only has to lose about 3 ml of blood and no money.

Hi @Clarest,
The IgG is already in the card. It is that tiny amount of clear liquid at the top of the card. Rest assured, it is an AHG test.