David Saikin

Just because an antibody is avid, it does not mean that it is high titre; the two are not identical.

I've also seen this in an elderly K- male patient - he had never even been hospitalized in his life, much less transfused, until we saw him with his positive DAT and anti-K.

I had a patient who had anti-K.  He was transfused fairly regularly (2-4u/month) for years.  Always K neg rbcs.  Always had a +DAT.  Only anti-K in the eluate.   

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

The front and back label bar codes are identical.  It maybe that when you bring the unit into your LIS system the double zeros and check digit at the end of the unit number are not used but when the vision scans the label for ABO conformation they are, thereby creating this discrepancy. 

I'd look at what a manufacturer of an agitator designed specifically for platelets provides.
Here is one from Helmer - https://www.helmerinc.com/products/pro-line-platelet-agitator-pf15-pro
"Variable agitation speed (40-80 cycles/minute) helps meet the needs of local regulations and other specific applications"

I would be interested in knowing how many antenatal RHIG doses the mother received. While it is possible for RHIG to cross the placenta and cause HDFN, seems to be extremely rare. The probability increases with each antenatal dose. That said, I agree with you that the baby's own cells should have sequestered any residual RHIG in circulation though I probably would not change my policy. I would just document the deviations when necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877609/

I had a patient who had anti-K.  He was transfused fairly regularly (2-4u/month) for years.  Always K neg rbcs.  Always had a +DAT.  Only anti-K in the eluate.   

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

I've experienced remote alarms that were monitored by facilities crew.  Even though the lab was 24/7.  Facilities even did the alarm checks.  Seemed to work pretty well though I had to tweak that system while I was their temp manager.  Alarm probe in freezer in the air - they wanted it to be sensitive, well it was.  The chart looked like a supernova explosion.  I told the medical director if I was inspecting they would be tossing everything out.  Once we put the probe in 50% glycerol the system worked pretty well.  I still did weekly checks on the documented temps for both refriges and freezer.  Otherwise, I agree, if you are 24/7 there is no need for a remote alarm.

That has always been my impression as well.
On a related topic, the u in Du stands for Underwood.  The first patient who was discovered (or at least the first one written up) was named Underwood.  Frances Wideman told me that at a CAP Transfusion Medicine Seminar ages ago.

In this paper from 1985, "The Lui elution technique A simple and efficient method for eluting ABO antibodies c. s. FENG, K. c. KIRKLEY, c. A. EICHER, AND D. s. DE JONGH, TRANSFUSION 1985; 25:433-434.", the authors thank A. Lui. MT(ASCP)SBB, who introduced this technique to them. Therefore, I believe Lui is the name of the MT who invented this elution method. 

I've experienced remote alarms that were monitored by facilities crew.  Even though the lab was 24/7.  Facilities even did the alarm checks.  Seemed to work pretty well though I had to tweak that system while I was their temp manager.  Alarm probe in freezer in the air - they wanted it to be sensitive, well it was.  The chart looked like a supernova explosion.  I told the medical director if I was inspecting they would be tossing everything out.  Once we put the probe in 50% glycerol the system worked pretty well.  I still did weekly checks on the documented temps for both refriges and freezer.  Otherwise, I agree, if you are 24/7 there is no need for a remote alarm.

I've experienced remote alarms that were monitored by facilities crew.  Even though the lab was 24/7.  Facilities even did the alarm checks.  Seemed to work pretty well though I had to tweak that system while I was their temp manager.  Alarm probe in freezer in the air - they wanted it to be sensitive, well it was.  The chart looked like a supernova explosion.  I told the medical director if I was inspecting they would be tossing everything out.  Once we put the probe in 50% glycerol the system worked pretty well.  I still did weekly checks on the documented temps for both refriges and freezer.  Otherwise, I agree, if you are 24/7 there is no need for a remote alarm.

As have I, but I STILL don't understand the need to try and determine the specificity of an antibody causing a WAIHA, when almost all of them, if not actually all of them, are only mimicking specificities only, and so, to give truly compatible blood would mean giving something like Rhnull units, or En(a-) units - and why would anyone waste such precious units on such a case?  Indeed, as so many were proved to be anti-Rh17 or anti-Rh18, or, indeed, anti-Wrb, why even wasted such rare red cells proving that the wheel has already been invented?  Sorry, but I just don't understand this obsession.

So, why, pray tell, does the alarm even sound at a nursing desk?  This is quite unnecessary and obviously inconvenient for all involved.  If the reason is, as usual, "that's the way be been as long as anyone remembers", it's time for a change.  Hopefully you can get this easily rectified.  Good luck.

If this is the case, I would propose you do not need remote monitoring.

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

If you have enough of the unit left, you could use blood culture vials along with an initial gram stain.

In the blood banks that I have worked at, all used the screen cells to test the last wash except for the ARC IRL which had a very different method of testing the last wash.

I like the not black or red ink logic; all other colors clearly indicate an original document and not a photocopy. As long as it is permanent and waterproof any other color or shade of ink works. I personally like weird blues

How can you prove anyone did anything?  Unless you watch.  Inspectors cannot impune your work is bogus based on your process, unless something seems amiss.  I would immediately contact their regulatory agency and ask for the official stance on such and/or a replacement inspector. 

In the UK, unless a piece of work (such as running positive and negative controls) is signed and dated by the person carrying out the work, it is regarded as not having been done in the first place.  While I am not, by a long way, in favour of everything suggested by either  "Internal Quality", or "External Inspectors", in this I stand four square with them.  On the other hand, when they prescribe what colour ink we should use, they can go take a running jump, as far as I am concerned.

I never considered keeping the opened segment used for the crossmatch.  While I can understand the idea behind it I personally consider it over the top in our blood bank paranoia.  Each segment in the line can be positively linked to the unit transfused and that should be all you need.  

I've never heard of that practice though I understand the concept.