Ensis01

Hi all
I was a member here several years ago but had not been able to access my account due to signing up with an NHS email address - duh! I'm now back... I'm no longer in the lab - Covid broke me!
I broke out of the lab (and lab quality management) into HSC Transplant, specifically ATMPs and CAR-T QM. I thought MHRA/UKAS was bad - Jacie - WOW!!
I've recently moved to a national occupational health company - I thought I would have a quiet life; no such luck! I'm now doing a QMS rebuild (Q-Pulse) and preparing for ISO9001/27001 in March, and also ISO 13485, IQIPS (based on 15189) and SEQOHS. Exciting times - I get to build Q-Pulse exactly how I want it... I'd rather switch to RADAR but that's a long term plan.
I've also found out I may not yet be out of the lab. They are thinking about opening a brand new lab and mobile POCT units - which I will project manage. Major change control done right
Exciting new role for me with lots of challenges ahead.
I'm glad to be back

If you don't follow the manufacturer's instructions you have to validate, instead of verify for use - easier to use theirs...

I worked in a rural lab for some years - with a recruitment and retention premium of one pay band higher

I don't think you can go wrong following the manufacture's directions/recommendations!  Besides, it's easier than inventing your own.  The only time I would consider otherwise is if the manufacture's directions/recommendations are way over the top and burdensome.

Keep paper long enough to ensure correctly billed from supplier. 

Just another thought (and I'm sure you also considered this), we see a positive DAT which doesn't seem to make sense a few times a year that is resolved by washing the cells an additional 3-6 times or by obtaining a capillary specimen on baby.

I had this very scenario about a year ago and it turned out mom had an anti-Dia. It was not on any of our in lot screening or panel cells. I did as I suggested and ran a select panel against mother's plasma using expired panel cells and identified the Dia. The eluate on the baby was eluted the Dia also. 

If the baby is not anemic and has no evidence for hemolysis, I'd just leave it at that.  There are variant plasma antigens that can elicit antibodies and these can be hard to identify using red cell serologic techniques. If the eluate is negative against panel red cells, this is high probability.  Perhaps mom is sensitized to a paternal immunoglobulin variant and these immune complexes are adhering to red cells.  There are no standardized tests for such anti-plasma protein antigens, to my knowledge.  Not very satisfying, but the clinical findings are the most important issues here, not the serologic issues.

My 2nd job is only per-diem, but I have been working almost everyday on my days off from my 1st job.  We are so short of staff, the Lab Manager has to fill in for several evening shifts herself. That means, she does her day shift work and then continues on to evening shift and goes home at midnight almost everyday. They are so happy to see me on my days off from my 1st job, because they sorely need the help. The only upside to all this is I am getting so much overtime $$$. That's about it.  

I just answered this question.

My Score PASS  

If the candidate has commercial lab experience running HPLC or LC/MS/MS they will have direct transferable skills and experience with following SOPs/procedures, running QC and tight deadlines. So they would definitely be trainable. However you would have to teach them everything BB as BetnaSBB described above. Do you have the time for that commitment? 

??  Maybe mom has an antibody to a low incidence antigen that could not be detected with routine testing ?? 
That would be my first thought, at least.

There could be a number of reasons for this. My first thought is mom could have an antibody against one of the low frequency antigens (Cw, V, Diego, Bg, etc). If you really want to figure it out, you could perform an eluate on the cord blood and a select cell panel on the mom's plasma. You will need to run the cord eluate against that select panel as well. 
Of course, by select panel, I mean finding panel cells that are positive for the low frequency antigens.
That's my thoughts
 

I agree with both Bet'naSBB and jayinsat in that it is probably an antibody directed against a low prevalence antigen.  The problem with identifying the specificity of such an antibody is that there are so many!  To make certain that it is not a "fool's errand", it might be worthwhile trying to get a sample of blood from the putative father, if he is available and/or known.  As the baby is, like the mother, group O, there is a 50% chance that the father will also be group O, in which case it is simple to see if his red cells can be sensitised by a maternal antibody.  If he is not group O, everything is not lost as, as jayinsat suggests, an eluate from the baby's red cells should be clear of all anti-A and/or anti-B.
If the putative father's red cells are compatible by all methods, either there is another explanation for the positive DAT, or he is not the father (or both).

The other thing that springs to mind is that, even if there is an antibody directed against a low prevalence antigen, as you have not identified a specificity using your standard panel, and should the baby develop a clinically significant case of HDN (it is too late for HDF) and require a transfusion, acquiring crossmatch compatible blood, suitable for the baby, should be a simple task.

Personally, I'm ready to start traveling.  Did a short stint a few years ago.  I'm getting tired of the regulatory environment.  Just be a tech for a few more years and let someone younger deal with the reg folks.  I really like Blood Bank work. 
 
 
 
 

You can give them the lit on giving type A plasma for traumas.... Yazer had a good paper. But honestly, they should be following SOP, and if they're not, they need discipline!  If you have good SOPs that direct them to use the best possible option of first expiring units, they need to be following it. We attempt ABO compatible as much as possible, but it's not always feasible. 

Thanks  for your sharing, Malcolm.
In the course of reading the cases above, I encountered  many problems which  resolved  by checking on books. This is a very  impressive way to absorb new knowledge. As a hospital blood bank worker, I rarely have chances to get access to thoes cases.  
 

nurse practioners and pas can order blood components.  At least any place I've ever worked.

We are currently bringing in 3 techs with H1B visa sponsorship. We've had one or two at a time a few times in the past with a generally good experience. We've been so short for so long that this was a necessity.

It is a phrase we use in the UK when we are using swear words, but do not actually want to swear in public.  I have ABSOLUTELY NO IDEA why her doctor told her to get rid of her card.  We had issued it to her, and we were not very happy when we heard what her doctor had told her (particularly as the antibody was against a high prevalence antigen!

If the candidate has commercial lab experience running HPLC or LC/MS/MS they will have direct transferable skills and experience with following SOPs/procedures, running QC and tight deadlines. So they would definitely be trainable. However you would have to teach them everything BB as BetnaSBB described above. Do you have the time for that commitment? 

Our situation is even worse now than when I originally posted this thread. We are taking candidates with bachelor's degrees in sciences and no lab training. We cannot keep qualified blood bankers. Everyone is burnt out. I am burnt out. The crisis is here.  

In a sense our hospital is somewhat unique in that we used to have a hospital based MLS program.  I was the BB instructor. Because we had about 9 openings we were forced to be "creative".  We started pursuing BS grads who met the criteria for our MLS program when it was still in existence.  Because I was the BB instructor - I still had ALL my lectures which I had since recorded for our Pathology Resident program.  After at least 2 interviews each - giving them information about basic BB'ing that they had to study to answer questions during future interviews -  we have hired some of these BS grads,  Their 1st month is "School"  where I basically teach them BB as I would have taught my students.  They are not working the bench at all - just student samples, etc.  I also give them ALL my tests.  Once they complete our internal BB program - they move on to training at the bench.  After working in our BB for a year, they will be eligible to sit for the BB(ASCP).  Our first 2 came in February and the 2nd 2 started in August.  So far 3 of the 4 seem to be doing fairly well.  The 4th isn't "bad" - they just came for working in the research environment and their research perspective isn't really a good fit (although we hired them because we thought that would be a great asset!)  but it's getting a smidge better day by day.  
We did have 9 openings at one time with at least 4 on 3rd shift.....we are now looking at 2 openings for which we are being "picky" and are looking specifically for techs with at least 1 year BB experience.
We are a very busy - very large transfusion service and also do just about all of our own reference work.  Really the only thing we send out is genotyping.

@Baby Banker - sign on bonuses - unfortunately - are NOT the answer.  Our hospital offered a $10k sign on bonus and $1500 moving expenses.....ALL of the people who were hired for our BB in those positions are all gone.  They worked their "required" time to get all their $$ and then they were gone - not to mention the people it attracted were less than ideal candidates for our BB - but we had so many openings we pretty much couldn't NOT take them.

If necessary, I am prepared to justify vote.  I hope you are willing to justify your (or the wife's) incorrect nomenclature!!!!!!!!!!!!!!!!!!!!!!!!!!