Neil Blumberg

Agreed.  The ONLY time we might perform anything like a post-partum screen is if the baby's DAT is positive, and the baby has clinical signs of HDFN, but the mother has not been shown to have an alloantibody in her circulation during the pregnancy.  In such a case, we may well test the maternal plasma (or an ABO adsorbed and eluted sample of the plasma) against the paternal red cells (if available) to see if the antibody is directed against a low prevalence antigen expressed on the paternal red cells.  Having said that, however, this would only be useful in a further pregnancy with the same male, as providing the present baby with a unit for top-up or exchange would be easy if the antibody is directed against a low prevalence antigen

Our policy is to not transfuse to patients with the corresponding antigen (obviously  ) and to wash the unit with Plasmalyte (our standard washing solution).  I realize most places do not have the capability for washing or even centrifugation to remove most plasma.  In that case, I would simply not use it for a patient. If you don't wash it, you then have to make sure the patient isn't transfused with an antigen positive unit later in their course, or at some other hospital.  Too much opportunity for misadventure to my way of thinking.

Our policy is to not transfuse to patients with the corresponding antigen (obviously  ) and to wash the unit with Plasmalyte (our standard washing solution).  I realize most places do not have the capability for washing or even centrifugation to remove most plasma.  In that case, I would simply not use it for a patient. If you don't wash it, you then have to make sure the patient isn't transfused with an antigen positive unit later in their course, or at some other hospital.  Too much opportunity for misadventure to my way of thinking.

Our policy is to not transfuse to patients with the corresponding antigen (obviously  ) and to wash the unit with Plasmalyte (our standard washing solution).  I realize most places do not have the capability for washing or even centrifugation to remove most plasma.  In that case, I would simply not use it for a patient. If you don't wash it, you then have to make sure the patient isn't transfused with an antigen positive unit later in their course, or at some other hospital.  Too much opportunity for misadventure to my way of thinking.

Our policy is to not transfuse to patients with the corresponding antigen (obviously  ) and to wash the unit with Plasmalyte (our standard washing solution).  I realize most places do not have the capability for washing or even centrifugation to remove most plasma.  In that case, I would simply not use it for a patient. If you don't wash it, you then have to make sure the patient isn't transfused with an antigen positive unit later in their course, or at some other hospital.  Too much opportunity for misadventure to my way of thinking.

Okay, so as long as the said antibody is tested each and every time, to ensure that the antibody specificity has not "broadened", but also that the thermal amplitude has not changed, so that, "this time" it may be a clinically significant "cold-reacting antibody", rather than a clinically insignificant "cold reacting antibody".

Sadly, it is not even THAT simple (if only), but it depends upon the specificity of the antibody and, to a certain extent, the ethnicity of the patient.  "Cold-reacting" anti-M, for example, is known to be much more clinically significant in people from the Far East (particularly Japan) than in any other ethnic group, as far as I know.

However, if you take the "antibody" out of the computer system, so that it no longer flags, there is the very real possibility that a formally clinically insignificant "cold-reacting antibody", that has developed into a clinically significant "cold-reacting antibody" may be ignored - not "not detected" (far from it) but ignored, because "it was okay last time"!

All that having been said, I have NEVER understood why time and money is spent on determining the specificity of a genuine cold-reacting antibody, rather than just determining the thermal amplitude, to determine the clinical significance, and bothering to provide antigen negative blood, when there is zero chance of a haemolytic transfusion reaction!

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

Transfusion Medicine in our institution includes the Blood Bank/Transfusion Service, Donor Service and Stem Cell Processing Laboratory.  Outside each facility we have the relevant signage.  Some places it includes Therapeutic Apheresis, which in our institution is both physically separate (so is our Donor Room) and located in the Dept. of Medicine (Cancer Center).  As long as the facilities are well defined, I'm not sure the overall name matters much, except on stationery, which no one uses much anyway :).

"The bottom line was, if the treating physician wanted to use up the entire inventory trying to save a life, we could not deny them the blood, even though it places other patients at risk. "
I would call this some combination of cowardice and insanity, speaking purely personally.  Taking responsibility for difficult decisions is why physicians get paid well, and avoiding decision making is irresponsible.

"The bottom line was, if the treating physician wanted to use up the entire inventory trying to save a life, we could not deny them the blood, even though it places other patients at risk. "
I would call this some combination of cowardice and insanity, speaking purely personally.  Taking responsibility for difficult decisions is why physicians get paid well, and avoiding decision making is irresponsible.

"The bottom line was, if the treating physician wanted to use up the entire inventory trying to save a life, we could not deny them the blood, even though it places other patients at risk. "
I would call this some combination of cowardice and insanity, speaking purely personally.  Taking responsibility for difficult decisions is why physicians get paid well, and avoiding decision making is irresponsible.

There are no data suggesting a particular limit.  Survival is very unusual after 30-50 units of red cells, but everyone has exceptional cases like those mentioned above. We have discussed futility of care many times, and our practitioners are quite amenable and forthcoming.  We have stopped resuscitation in a young man having a liver transplant go badly, when there was no surgical path to hemostasis after about 250 units, but this is unusual too.  Bottom line, a case by case decision as to whether care is futile and/or the patient's needs endanger the well being of other patients needing transfusion.  Those are the key issues in each case to my way of thinking.

No AABB standard requires a crash cart.  Donors do not develop anaphylactic reactions, but this type of reaction is why offices or facilities that administer transfusions or IVIgG (and similar products) need to be able to administer epinephrine emergently.  Most of the rest of the stuff in a crash cart would never be needed and certainly not for blood donors.   So no crash cart unless you are administering human blood products or drugs that can cause anaphylaxis. 

No AABB standard requires a crash cart.  Donors do not develop anaphylactic reactions, but this type of reaction is why offices or facilities that administer transfusions or IVIgG (and similar products) need to be able to administer epinephrine emergently.  Most of the rest of the stuff in a crash cart would never be needed and certainly not for blood donors.   So no crash cart unless you are administering human blood products or drugs that can cause anaphylaxis.