David Saikin

I studied Mollison, The Technical Manual, Garrity and Petz, and the Pittiglia Blood Bank Book plus made flash cards for the blood group systems.  If you are just looking for a book to study to pass the test . . . well I think that is the wrong attitude.  I had a tech who wanted to know if she should take the test.  I told her that if she could afford to lose the $$$ go ahead 'cuz look at all the knowledge you'd gain studying for the thing.

As Malcolm posted if you don't believe the IRL results why send it. The IRL gave you a B pos result, which aligns with the other history you obtained. That being said your policy may need to be scrutinized to determine if the B pos result is valid for the entire admission or needs to be confirmed for each new sample. I would suggest getting this clarified for future admissions, get your pathologist involved as they may have strong opinions on this and once clarified document clearly in your LIS the process.

Well, I would almost agree with you, except that it is not necessarily a low-frequency antibody; it is MUCH more likely to be an antibody directed against a low-frequency (low prevalence) antigen, and some of these (for example, anti-Wra) are found quite regularly, if you are daft enough to go looking for them!!!!!!!!!  You are, however, absolutely right in saying that, if it was an antibody directed against a high-frequency (high prevalence) antigen (for example, anti-Vel) then there would be agglutination with all the panel cells (with possibly one being negative, just be sheer chance).

We used and continue to use:  INCOMPATIBLE. 

We always felt that least incompatible is like saying someone is a little pregnant . . .

The classic WAA case - an autoantibody that prefers the presence of a normal e antigen on its target red cells. May or may not be compatible with e- (R2R2) cells, but often shows weaker reactivity, especially in it's early stages of development. By the time the autoantibody gets to the 4+ stage (complete, solid agglutination), there are rarely any weaker cells.
The question: Do you transfuse e- (R2R2), i.e., the "least incompatible" ?
From a rarity/inventory point of view, in the short term that may be manageable, but probably unsustainable long term. The decision gets more complicated when the patient is E-. One could argue that there's a significant chance that by transfusing "double-dose" E+ cells, you'll cause the patient to make anti-E. Oops. Next time around, the R2R2 option may be off the table.
And ultimately, as Petz opines, there's scant evidence to support that "least incompatible" cells (e- in the above case) survive in vivo any better than random cells.

We always felt that least incompatible is like saying someone is a little pregnant . . .

We always felt that least incompatible is like saying someone is a little pregnant . . .

We always felt that least incompatible is like saying someone is a little pregnant . . .

We always felt that least incompatible is like saying someone is a little pregnant . . .

I had a corporate transfusion service medical director who was uncomfortable with the term "CMV safe" so we were required to use the phrase "CMV risk reduced"!  I know it doesn't add anything to the discussion but when I read Ann's post the memory made me smile at the lengths some folks would go.

I recently switched everything (over a couple of years) to Bio Rad because the Ortho rep wasn't responsive and they were more expensive for us.  We're not automated because we don't have the power and space but hopefully one day!  

Years ago the Ortho rep told me if I didn't buy anything he wasn't coming back.  (I had requested prices which were never forthcoming).  I told him good bye.  Ortho called and told me he was their top salesman.  I told them not to send him back.

Either the units were Jk(b+), rather than Jk(b-), or, perhaps, the patient has produced another specificity?

I would treat this like any other lookback or non conforming product notification from my supplier. I would generate a risk management occurrence report and submit it to our medical director. Our medical director and the patient physician would figure this all out. 

I would expect the blood center to put an expiration date on that product.  You should not have to alter that as it would be a licensed/registered product in compliance with regulations.

When using Immucor Solid Phase I have Rapid ID, Extend I (all Rh+ cells w 5-6 c neg and e neg cells), Extend II (all Rh neg cells w 1 Rh+)
3% panels:  Immucor Panocell (10 cells + 1 rare cell).
Used to use Ortho 0.8% panel A and Panel B
BioRad has 3% and 0.6% panels

When using Immucor Solid Phase I have Rapid ID, Extend I (all Rh+ cells w 5-6 c neg and e neg cells), Extend II (all Rh neg cells w 1 Rh+)
3% panels:  Immucor Panocell (10 cells + 1 rare cell).
Used to use Ortho 0.8% panel A and Panel B
BioRad has 3% and 0.6% panels

When using Immucor Solid Phase I have Rapid ID, Extend I (all Rh+ cells w 5-6 c neg and e neg cells), Extend II (all Rh neg cells w 1 Rh+)
3% panels:  Immucor Panocell (10 cells + 1 rare cell).
Used to use Ortho 0.8% panel A and Panel B
BioRad has 3% and 0.6% panels

When using Immucor Solid Phase I have Rapid ID, Extend I (all Rh+ cells w 5-6 c neg and e neg cells), Extend II (all Rh neg cells w 1 Rh+)
3% panels:  Immucor Panocell (10 cells + 1 rare cell).
Used to use Ortho 0.8% panel A and Panel B
BioRad has 3% and 0.6% panels

Once you've called a critical value of something that doesn't change rapidly, like a very low platelet, red cell or white cell count, you don't need to keep calling every subsequent value, since the ordering physician/NP/PA has the responsibility of checking lab values for studies they order.  Not the lab.  Plus it's a waste of everyone's time and annoying :).
Not a big fan of critical values in general, particularly for non-emergent metrics like cell counts, creatinine, BUN, etc.  Usually the clinical situation is vastly more important than any laboratory number, including for the CBC and chemistries other than electrolytes.  One of the big time wasters in laboratory and clinical medicine.  Only unexpected values that need action within minutes to hours need to be "critical" and called in my view.  Blood cell counts aren't among them in my view.  There's nothing critical about a white cell count of 500 or 100.  Presence of blasts is another story.

We found that certain specialties were not interested in our standard critical values and instituted their own for their patients.  Not a big deal because there were not many.  One in particular was Oncology.  I don't remember their values but I do remember they were considerably lower than our standard critical values.  They also indicated that they only wanted follow up notification if the values dropped significantly and they told us what a significant drop was.  I'm sure you are aware that critical values is not a "one size fits all" and it is a case where flexibility can be your friend.  Talk with them or better yet have your medical director talk with them and see what they would work best for them.  I found over the years that a doctor to doctor conversation was often much more productive.  Of course that assumes your medical director is willing to go to bat for you.

In 2016 we paid around $250K for a Rad Source 3400 Blood X-ray Irradiator with installation and earthquake bracking plus we pay around $13K for annual PM and services calls (parts, tech and travel included).  They're service is top notch and we're never down for more than 24 hours and it's a workhorse that can irradiate 12 units at once (2 per canister with capacity to irradiate 6 canisters at once).  Oh and you can irradiate blood and platelets at the same time just not in the same canister.  The newer models have a much smaller footprint than the one we have.  https://www.radsource.com/  
No I'm not a spokes person I just really love our irradiator!!
 

We keep cords and placentas for 7 days post-delivery.

If you use the specimen for testing, retain it for the same time period as other tested specimens. I am not aware of any requirements for specimens collected 'in case we might need them or get orders later'. However, the antisera reagent inserts specify how long a specimen is OK for testing, dependent upon the tube/anticoagulant used for specimen collection. That should be addressed in setting your policy.