David Saikin

I have seen a few responses to this question in the past . . . I use the HemoTemp II indicator. I validated them once. Someone suggested that they should be validated with every new lot, or once a month, or with every shipment . . . ad nauseam. I am not about to do that. I agree that validation has been taken to the utmost extreme of absurdity in many instances.

Most antisera for C and e are not AHG reactors so your auto would be negative. Since you did your ID in gel (and your titer in tubes?) I am not surprised at the difference in reactivitiy. Maybe the antibody is IgG4 subclass, so you would not get hemolysis . . . stuff like this is what makes BB so interesting . . .

Are you using gel or capture? I find it hard to believe that a tube reaction of 3-4+ (at AHG?) would only give a titer of 1:2 (unless your ID is using the newer technologies). To answer your question - you can only explain the data you have discovered. The patient has antibody directed at her own Rh antigens. Maybe you should find out her PCP and give the info to that individual rather than the OB doc. I have not seen autoab only associated with pregnancy. Is she Rh(o)D+? How is the Rh control? If the Rh control is negative, you should have been able to type her without a pretreatment. But this is also a moot point. Not much help to you, but I always find these autoabs very interesting.

Peg - we have validated antigen typing in gel using either the IgG or buffered gel cards (depending on the type of antisera used). Only the anti-Lea did not work, probably becuae it was outdated for a few years.

Larevalo - how did you f/u you IS saline replacement? Did you add serum for 37C/AHG testing?

Pick an antibody (anti-D is the easiest). Sensitize some Rh+ cells (or you could try using outdated check cells). You want the cells to be DAT+ but not agglutinate until AHG phase. This may take a few tries to get down (if you have a procedure for making check cells it should work). Give it to your techs.

A quality plan is usually not a small document, esp if you follow AABB guidelines and their quality essentials. Remember you will need to fine tune whatever you use to your own operation.

Ned - we are talking anti-Complement activity here. I run the patient and the C check cells at the same time in the buffered gel. I do a 5 minute incubation prior to the centrifugation step. I also use the anti-IgG card for that portion of the DAT. We stopped running an auto control with our routine absc. The only time we run an auto is if we are doing an antibody ID. I have had good luck with eluates following + IgG DAT in gel.

I still run the complement control cells. I used to run my patient and control cells with just the diluent also (so that I would feel better in case there was something non-specific going on). I am still kind of new to gel. However, after a year of doing so I am no longer running the control cells with the diluent. My complement DAT is pt and control cells with anti-C3b,-C3d and my patient with diluent only (negative control).

2+ diluent is indicated for specimens not obtained in EDTA, which would include donor retypes. I don't know if this is your solution, but it may help to use the correct diluent (unless you validated yous the dil 2 for all your work).

I use the diluent as my negative control (with the patient ceills). I originally ran the C check cells with diluent too but am removing that after 12 months of experience. I like the complement testing with the buffered gel card.

Pick some topics and let your staff present the CE program (10-15 minutes lecture). It is good for them. Provides valuable speaking experience and blood bank info at the same time . . . build it into their performance programs.

Why doesn't your peer review program deal with the outliers for transfusion? If they won't, you should bring it up at your JCAHO/CAP/AABB isnpections. Once you are cited for non-compliance, compliance should improve. Or - - - you could always have the Medical staff approve new criteria for component transfusion.

I need to amend my previous post - in gel we just use mf, but if tube testing, we grade the reaction with the mf superscript.

Patient probably is missing part of the D mosaic and has made antibodies to the missing portion(s). I have a pt who is a D(VI) with anti-D.

The standards require timer checks on analog timers, not digital. Digital, if battery operated, always runs until insufficient power - no decrease in timing. If plugged in, there should be no problems at all. Digital is based on osciallations of quartz at a certain frequency (I think) - it does not vary as long as powered. We never check digital timers, never been cited (AABB/CAP/FDA)- quote the standard. Further, I have had CAP inspectors who "thought" that I should be doing as intimated above . . . CAP Central agreed with me.

I always had to beat the plt donors away from my door. We had a small, hospital based donor service and great donors. When we started doing automated plts they beat the door down (and sometimes each other) to line up. I don't have any good ideas for you.

I qc my panels using weak antibodies when they come in. My interp for antibody detection cells is the screening set. Detection vs identificiation. I think some panel qc in indicated by the feds, not necessarily day of use.

Depending on the "why" for the FP, there are also factor/activated factor concentrates that are available (from the pHarmacy), esp if you are only giving plasma to ameliorate anticoagulation.

The Circular of information is a good source for info on all the blood products.

I think that only analog timers need to be checked. Digital is usually exempt . . . because of the nature of digital.

If you are transfusing the plasma within 24 hrs you do not need to relabel it, only change the expiration date. If you use it as thawed plasma with a 5 day expiration, you do need to relabel. You only need a 2nd tech involved if that is your policy . . . there is no standard demanding such (AABB or CAP).

Get the CFRs . . . they're cheaper.

Cliff has pretty much hit the nail on the head . . . it is Blood Bank trivial pursuits (at least when I took it a few decades ago) . . . I had the good fortune of having the practical portion too; I think now they have patient management questions instead of performing actual blood bank serology. I studied Mollison, Pittiglia, the Tech Manual, Garrity & Petz plus made flash cards of blood group systems. Even if you don't pass, you will gain a tremendous amount of blood bank knowledge. Good luck!

Look at the testing you perform. Are new employees expected to be able to do everything after their training? If yes, doucment that on your traiining form. If no, doucment what entry level performance should be; don't forget 6 month re-eval and also when the employee should be able to perform all testing (if appropriate). On another level, new employees who are experienced vs new employees out of school is an entirely different take (the competencies are the same, but how you demonstrate it may be different). Good Luck!