David Saikin

The only thing I am aware of is the collection of low volume units.  300-404mL WB collections with anticoagulant not adjusted - you can use the rbcs but no other components can be prepared.  There are also low volume collections for autologous, where you may adjust the volume of anticoagulant based on the donor's weight.  There is no defining statute regarding minimal volumes for transfusables that I am know of.

The only thing I am aware of is the collection of low volume units.  300-404mL WB collections with anticoagulant not adjusted - you can use the rbcs but no other components can be prepared.  There are also low volume collections for autologous, where you may adjust the volume of anticoagulant based on the donor's weight.  There is no defining statute regarding minimal volumes for transfusables that I am know of.

When my supplier has a dearth of O Negs, if I get an O Neg patient who looks like they may be a big user, I contact the Medical Director.  I also talk w the provider.  Depending on my inventory I may ask to immediately switch to Rh+ units.  We only stock 6u (overstock hosp); we have to have 2 for females of child bearing potential.  A big user can totally deplete all my O's.

 

When my supplier has a dearth of O Negs, if I get an O Neg patient who looks like they may be a big user, I contact the Medical Director.  I also talk w the provider.  Depending on my inventory I may ask to immediately switch to Rh+ units.  We only stock 6u (overstock hosp); we have to have 2 for females of child bearing potential.  A big user can totally deplete all my O's.

 

Malcolm, my very 1st AABB inspection came about 2 months after taking the Blood Bank supervisor job.  After it was over I contacted AABB and told them that I would never let that inspector in my facility again and if they tried to send her I would drop our AABB membership.  YES, the inspection/inspector was really that bad and luckily I never had to carry through with my threats/promises.  

Personally, I never minded inspections/assessments.  My blood bank and transfusion service were "visited" no less than twice every year by inspectors.  Either FDA (we were licensed to ship blood interstate at one facility I supervised), AABB, CAP or JCHO.  Being inspected that often meant we never had the opportunity to let things slip unlike other areas of the lab that were inspected less frequently.  On the other hand it did become very expensive paying memberships as well as buying materials required to stay current on the requirements of each agency.  When cost cutting measures were called for reducing in this area was always discussed but for some reason was never acted upon.

 

I'd be in favor of keeping both CAP and AABB.
If one of them is doing your CMS inspection, then the other can be used as "practice".

This has been an ongoing Immucor issue for a couple months for us, spanning a couple lot numbers. The reactions are still macro positive at IS, so there isn't actually an issue per the package insert, but yes, they are weaker than normal. We haven't had to incubate anything that wouldn't normally be incubated. 

We had that problem with lot 134046.  I contacted Technical Support and shortly after that we got a Technical Communication that we were not the only ones with the issue.  It worked if we incubated at RT for a while.  We stuck it out because we knew our new shipment was due in a couple of days.  We got the SAME lot number!!  Immucor suggested confirmation of A1 reactivity by other methods and consulting your quality department and/or medical director.  We just continue to incubate at RT.  When it's colder in the lab, it works better 

@AuntiS - as far as running the last wash with A1 and B cells - my thought is that it serves as a negative control for your possible (although VERY unlikely) ABO specific antibodies that may be left.  
We run a panel and A1, B cells with ALL our eluates except cord blood eluates.  For them we run screening cells and x3 A1 or B cells depending on mom/baby ABO incompatibility (we prefer rapid acid over LuiFreeze for cord bloods)
For our last washes we run screening cells and A1,B cells
In the end it comes down to how the protocols are written for each facility.

In New York State, we also are inspected by the state.  FDA, NY State, AABB, CAP.  You can make a sound argument that this is wasteful and duplicative.   Obviously we don't have any choice about FDA and NY State.  CAP and AABB, as accreditation organizations, will accept the results of each other's inspections, which is a plus, but you are still dealing with two sets of requirements.  My advice to smaller facilities is to pick one if you can do so, and not duplicate your efforts and expense.  Both organizations are essentially trade organizations, not scholarly/research societies. They both provide important educational opportunities, but you don't need both to keep your staff current, in my view.  With the shortage of medical technologists, reducing non-productive non-clinical effort is a priority to prevent staff burnout and keep everyone focused on the main mission, patient care.

My current hospital lab is JC and FDA inspected. My prior lab was CAP, with the hospital being JC. I honestly don't see a difference without the CAP inspection here, as we follow all AABB standards anyway. We used to be AABB inspected in BB, but dropped it in 2004 or 2005, before I got here, due to costs and not much gain for a hospital transfusion service that doesn't irradiate, wash or pool. My two cents: you don't need inspections by 4 organizations, just pick one.

We send titers out to the ARC ref lab now. We were doing a lot of prenatal panels and doing the titers for the clinically significant antibodies for those patients. It got to be a burden considering our work volume and staffing levels, plus maintaining competencies for the procedure was becoming difficult. We have plenty of other work to do, so I don't miss doing them.

Of course not Malcolm! To clarify - we only release for patients that are IS or electronic XM able, and only if the patient is stable with no impending procedures, and has a Hct above our threshold of 7. Patients with antibodies that require AHG crossmatch keep their units reserved for them for the life of the sample (3 days). 

We only type for the specific antigen but we do perform an Rh phenotype when we find a clinically significant antibody.  I used to have all the relevant antisera but, as was defined so succinctly by Malcolm's bean counters, it was too expensive. 

We only type for the specific antigen but we do perform an Rh phenotype when we find a clinically significant antibody.  I used to have all the relevant antisera but, as was defined so succinctly by Malcolm's bean counters, it was too expensive. 

We only type for the specific antigen but we do perform an Rh phenotype when we find a clinically significant antibody.  I used to have all the relevant antisera but, as was defined so succinctly by Malcolm's bean counters, it was too expensive. 

When I was working in the Reference Laboratory at the NHSBT and, come to that, when I was working for a short time in a Hospital Blood Bank, we would ALWAYS test for the C, c, E and e antigens, together with the K antigen, both for patients and donors, and we would also test for the antithetical antigen, as well as the cognate antigen (in other words, as in your example, the Jk(a) and the Jk(b) antigen.  We ALWAYS did this, except when the grouping reagent was exceedingly rare (e.g. anti-Dib) or the antibody AND the antigen were extremely rare (e.g. anti-Kpc).

The reason we did this, particularly in the NHSBT Reference Laboratory, was because we wanted to identify very rare phenotypes, such as Kp(a+b-), or even rarer (in most cases), null phenotypes, but there was also a paper that showed that people who were transfusion dependent, such as sicklers and thal patients tend, once they have made an initial atypical antibody (particularly anti-C, anti-c, anti-E, anti-e or anti-K) to make all sorts of specificities (I'll try to look up the paper and get back to you on here).  Other papers comparing their findings actually agreed with them.
I say ALWAYS, but then, of course, the Bean Counters, who know nothing about Blood Group Serology, or about Patient Requirements, and care even less, came along, and we were banned from doing this as, apparently, IT COST TOO MUCH MONEY, except in special circumstances, such as patients from the Black populations, where we were privileged to be able to test for both Fya AND Fyb, in case they were Fy(a-b-) - and, of course, most of those who were found to be Fy(a-b-) had the FYB gene, so would very rarely produce an anti-Fy3,  as they were homozygous for the GATA1 gene mutation.
Unfortunately, what these "suits" seem to forget, despite counting beans for a living, is that, if the patient goes on to produce other, clinically significant, atypical alloantibodies, they will occupy a hospital bed for longer while suitable blood is identified, including, sometimes, cryopreserved units, ALL OF WHICH IS FAR MORE EXPENSIVE THAN THE INITIAL TYPING WAS IN THE FIRST PLACE - but what do we professionals know!

RANT OVER!!!!!!!!!!!!!!!!

Yes, I agree with you Malcolm. We use child-bearing potential in our policy.

I am uncomfortable with the use of the term "child-bearing age" because, if the bit in the brackets isn't properly interpreted, a four-year-old D Negative female (for example) might be given D Positive blood because she is NOT of child-bearing age, but is, of course, of child-bearing potential.

We are similar to others, male traumas and women over 50 get O pos immediately, children and women under 50 get O neg until we have a type, but still no more than 10 units of O neg if they are on MTP. A critical shortage could be handled the same way. Place a limit on how many O neg units each patient should get, based on your available inventory, and write this in to your policies, both internal BB and the hospital versions. 

We have the same for MTP and Emergent Release (we use 50 as the cutoff age).  For routine transfusions we still require Path approval.

You can decide how long you want to keep units in crossmatched status.  This is probably dependent on the validity of your specimen.  There is no reason you can't release after 24 hrs. 

An interesting case/issue. I agree with your premise: doing anything to make the saline control nonreactive (warm-washing, CDP, acid-elution) will probably make the test with anti-IgG negative, too (assuming the positive saline control is due to IgM-coating of the patient cells, causing direct agglutination).
Perhaps a DAT with an anti-IgM reagent could be arranged ? Did you try a DAT with polyspecific antiglobulin reagent or a monospecific anti-Complement reagent ? But even results from these could be "invalidated" by reactions in the so-called negative control.

I have, unfortunately, seen two ABO transfusion reactions, both of which were fatal.  In both cases, the DAT was negative, BUT, when the blood samples were put under the microscope, the reason was only too evident.  There were hardly any red cells in the samples, presumably because the complement system had haemolysed both the transfused red cells, but also the "innocent bystander" autologous red cells.

That having been said, your explanation is perfectly logical.