David Saikin

I wonder what company's gel you are using? In the USA there is only one vendor. I know that in Europe there are at least 3 different suppliers. I have validated typings in gel using either the buffered gel cards or the anti-IgG cards available here. The only difficulty I encountered was with Lea typing (probably had to do with the antisera being outdated for a few years more than the gel). I did not need to use enzymes. Are these recommendations based on your personal validations or from your gel manufacturer(s)? Thanks for your valuable input.

Jewtt hasn't been the same since they were bought out (by Puffer Hubbard I believe). I think the Helmer products are currently the best on the market.

We use the PeG autoabsorbtion . . . it is fast and reliable. I've never had any success using WARM (though I do use this to destroy Kell ags). and PeG sure beats the old enzyme pretreatment and heat and the hours this took.

I treat all these lookbacks from reactive donors the same, whether it is HIV, HCV or whatever. We comply with the CMS guidelines on lookback. In my experience, having mulitple ways of dealing with events leads to misapplications somewhere down the road. K.I.S.S. is my best guideline. It can all be done the same way as long as you use the most stringent requirement for all.

I try to do at least one/month. I have a pretty basic audit tool; even the housekeeper could do the audit using it (I think). Our CMS inspector likes to see at least one audit per year.

I worry about the paperwork "after the fact" when transfusions are uncrossmatched in emergent transfusion situations. The transfusions are documented on the chart and the team is not going to bother with the paperwork, as they are more interested in the patient at those times.

AABB does not recommend in this situation. Classically, an antibody may be ruled out with one non-reacting homozygous cell, an enzyme pretreated heterozygous cell (when applicable) or when using PeG. These rules have sufficed for years. As I am converting to Gel Technology, I will allow rule outs with heterozygous cells based on the sensitivity of this methodology. Why the uncertainty of the homozygous cell r/o and place yourself in a scenario (occasionally) where you cannot meet your own SOP? But, that's what makes America great!

We routinely use the PeG autoabsorption. It is very efficient, however, if the antibody is very strong (3-4+), it may take several passes to remove.

ok, I'll bite - Were any blood cultures done? If so, were they positive? I would guess that some bacteria that is producing an acetylating enzyme is transforming some of her "B" cells into "A-like" cells (kind of like a reverse aquired . This bacteria has gotten into her blood stream and is responsible for the ABO effect you are experiencing. Don't keep us waiting too long.

I guess that a tp is the removal a determined volume of whole blood. It requires a physician's order. You do not need FDA registration to perform this procedure. I have used syringes, vauum tubes, and donor bags to accomplish these procedures. Some docs only want 250 cc removed, some want "a unit".

I was fortunate enought to be the LAST group that had a "practical" exam. On our written test the board included 5 patient management questions. This type of question was going to replace the practical. The entire scenario was very subjective and fortunately, for me, it was not graded. The exam is made to be demanding, and it is my opinion that it is designed for those who attend formal SBB training programs. Experiential knowledge is not enoiugh to make it through. There is the "trivial pursuit" aspect to portions of it. But it can be done. I had a tech ask me if I thought she should take the test. I told her "yes, even if you don't pass, look at all the knowledge, practical and theoretical, you will be exposed to." Anyway, take it again if you want that credential. A lot of times, SBB blood bankers will band together and have an area wide training session for local testees. Our local ARC rep is very active in this process. Good Luck!

Having supplied a few answers on this site, I have found it to be most helpful and informative. I work in a small, but very active insitution in northern NH. We do reference work for some of the smaller facilities around here and, hopefully, are raising the blood bank consciousness of the folks we interact with. There is life outside the metropolitan areas and a GREAT quality of life is important, esp to me. Dave Saikin Littleton, NH

Roxanne - where in Vt are you? I am in NH. This site is excellent - been a member for a while. dave saikin

If you try hard enough, you can usually autoabsorb an auto ab (unless the pateint has been recently transfused), then you can issue crossmatch compatible, antigen negative red cells. I have a problem with "least incompatible" - it's like being "a little pregnant". Usually, with an warm auto situation, I tell the docs that the patient will handle the transfused cells as well as they handle their own, ie, they will be coated with antibody and removed.

I do not believe you are responsible for how nursing handles the product, except that once manipulated, you may not receive it back. I am assuming that the component is being transferred into a (labeled?) syringe, but otherwise, no other mandated criteria is attached. As opposed to you distributing product in a syringe, which would require it to be compliantly labeled. It might make an interesting quality monitor, but then your institution might be mandated into some form of regulatory action based on your review of this procedure. Do they have a policy/process that addresses blood administration in the manner in which they proceed?

Yes, the flower needs to be activated. You can keep a bolus in your bact incubator - if you are going to use them a lot. I put mine on the bb heating block with a box of slides on top for 1 - 2 minutes, since I only use them sporadically. If using the block method, make sure the flower doesn't sit directly over a hole.

We used to get tickets for the NASCAR races in Bristol. For the 2 weeks prior to the race, anyone who registered to donate was eligible to win these. Our donations went up about 300% during that time frame. The community relations folks felt it was better to do all the registered donors vs only those who actually donated. The down side was that we registered a lot of donors who were deferred during the History/phsysical.

You can validate your prewarmed crossmatch to verify that it will detect ABO incompatibility. You can also validate it with your enhancement media.

Is anyone aware of where 25% NSA (12.5 g/50mL) may be purchased?

We use an "anti-D due to RhIg" code in our BB Computer. We result this as anti-D, possibly due to RhIg administration on _ _ _ and also recommend a repeat antibody screen in 8 -10 weeks in order to differentiate passive vs active immunity.

I've been in places where it is both ways . . . bb techs or RNs. In all places, it was a bb operation - scheduled and performed by.

We do not routinely wash our segment blood prior to crossmatching. If there is a problem, that is one of the first options to perform. Also, dependent on the rare reagent antisera package insert, the suspension may or may not be washed.

I think that your new tech needs to follow your protocol. You do have a protocol, yes? If you do, then you must have a reason for having it . . . the tech needs to comply. Or - you can do it your new tech's way. By allowing this current process to continue, you are sending conflicting and possibly confusing information to your Medical staff.

The fetal bleed screen will usually be macroscopically positive on these weak D pts. There is no alternative but to screen for fetal hgb in order to detect fetal-maternal hemmorhage. You could do a weak D test . . . if positive do you give RhIg?

Why do so many organizations want a "massive transfusion" protocol. I don't have one either, but, since we do immediate spin xm's (for the most part), it seems to satisfy that need.