David Saikin

i don't know what you mean by mismatched rbcs (i do understand about plasma/plts).  RBCs need to be abo compatible.)

Same as Magnum

Same as Magnum

i don't know what you mean by mismatched rbcs (i do understand about plasma/plts).  RBCs need to be abo compatible.)

I used this case study as part of my Higher Specialist Diploma in Blood Transfusion.
The IBMS have asked if I would like to give my PowerPoint presentation ('What the f?') at the 2023 Congress.
Thank you to all the contributors - I will certainly big up PathLabTalk if I do get to do it.
Rich

It's a state law issue. Each state sets its own regulations about who can order what, if I recall correctly.  It sometimes may be an institutional issue.

That is not a process for any regulatory agency I know of.  Must be the inspector's personal opinion.
 

Personally, I would go for the all electronic documentation.  Just have some form of backup procedure for down time.  You may have to justify it to some inspector but you have a good case for it.  If the inspector still insists on citing you then take it higher and contest the citation.  It the only way to get things changed.  

I agree with John.

Vacation???? I'd settle for a day off without being called in because we have no staff coverage in the blood bank. 

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.

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. 
 
 
 
 

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. 
 
 
 
 

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. 
 
 
 
 

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

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

I'd get a few of the blood bank vending machines.  One for the OR and one for the ED.

It is all over the place, to be honest.

It is Caucasian, rather than caucasian,  It is group O, D Positive, and group A, D Positive, rather than either group O Positive or group A Positive (see the early editions of Peter Issitt's book).
It is Oh (with a subscript "h"), and not "Bombay".  The FUT1 gene, or, rather, the lack of a functional gene through various different genetic mutations, leads to the "Oh" phenotype, but this should NOT be called the "Bombay phenotype".  Although this phenotype was first described by Bhende YM, Deshpande CK, Bhatia HM, Sanger R, Race RR, Morgan WTJ, Watkins WM.  A “new” blood-group character related to the ABO system.  Lancet 1952; i: 903-904.  DOI:  10.1016/S0140-6736(52)92356-8, Another example of the Oh phenotype can be seen in the rare recessive condition, Leukocyte Adhesion Deficiency Type II where, to all intents and purposes, the patient will have a normal H gene, and yet the red cells are of the Oh phenotype, and anti-H can be found in the plasma. the phenotype has been identified in many different parts of the world (and is not just confined to mutations in India or even Asia (Hidalgo A, Ma S, Peired AJ, Weiss LA, Cunningham-Rundles C, Frenette PS.  Insights into leukocyte adhesion deficiency type 2 from a novel mutation in the GDP-fucose transporter gene.  Blood 2003; 101: 1705-1712.  DOI: 10.1182/blood-2002-09-2840).

The other thing is, of course, that "Bombay" no longer exists - it is now Mumbai!
I APOLOGISE FOR BEING A COMPLETE PEDANT!

If you have any, you could try D Negative Cord or Neonatal red cells, which express the LW antigen comparatively strongly (certainly compared with adult D Negative red cells).

While the Ogata-Matuhasi phenomenon has been recognised since the early 1960's, it is, that notwithstanding, a very rare phenomenon to actually come across in practice.
With all due respect to you Bet'naSBB, if you "see this quite a bit", I would be a bit worried as to why.

Have you considered that your patient could be a particularly low-grade weak D, a partial D of some kind (such as an RoHar), which would explain the anti-D in the eluate as a result of the RhoGam, or that what you are detecting in the eluate is not an anti-D, but is an anti-LW?
I also assume that the last wash is totally negative?  Sorry to ask this.

Yes John,  With higher dose anti-D immunoglobulin, the DAT of a D Positive baby is quite often positive.  In the UK it is now quite common to give a dose of 1, 500 IU of anti-D immunoglobulin at 28 weeks of gestation and, as a result, many babies have a positive DAT, but I have never heard of clinically significant HDFN as a result,  Physiological jaundice is also quite common in newborns, whether the mother was given anti-D immunoglobulin or not, and whether the baby is D Positive or D Negative.

Sickle trait cells do not sickle under physiologic conditions compatible with life.  Purely a theoretical construct.  Oxygen transport is also normal under physiologic conditions compatible with life. The evidence that sickle trait cells present any risks to any patient through transfusion is exactly zero.  Patients with sickle trait rarely, if ever, have any problems attributable to sickle trait. The epidemiologic evidence is likewise weak, if not zero.

Over my many years I have come to realize that inertia is the most powerful, driving force in the universe and the most difficult to over come!!!

@exlimey if a Lewis antibody is identified - we type the patient......  it's just how our protocols are written.  The only time we would be required to provide Lewis antigen matched units would be if the antibody demonstrates hemolysis at AHG otherwise just XM compatible.  Do I know why?  not really - I've just been doing what I was told......for almost 35 years.