AB123

Current UK guidelines stipulate "Unless secure electronic patient identification systems are in place, a second sample should be requested for confirmation of the ABO group of a first time patient prior to transfusion, where this does not impede the delivery of urgent red cells or other components." As per the recommendation only ABO type is required to be repeated, repeat antibody screen is not required. In any case of urgent blood request group O blood is usually used if the 2nd sample is not available. When this recommendation came in in 2012 it did cause a lot of discussions regarding the increased use of group O blood at the time.

When we did plasma exchange and had a single SAHARA we used to have to start thawing overnight to get it ready in advance, they claim 6 bag capacity but in reality I found it was hard to fit 6 in. One site I worked at that was a major trauma center and did heart and lung transplants and ECMO had 2 for this reason.

I have used the Sarstedt SAHARA III for many years and they are very good, with regards to limitations I am not aware of any as such, they use dry heat to thaw the plasma and I don't ever remember one breaking down in the 3 different labs I have used them in. Maintenance is limited to wiping down the unit every week and cleaning out when you get a burst bag but they have a tray in the bottom to catch any leakage, I would take one any day over any water bath options. My current lab has an Helmer, I find it very slow compared to the SAHARA.

Are BPL still going? I gave up on them in the end, so many supply issues over the years, the only real advantage of BPL over the other suppliers was the fact they did a 250iu then they stopped producing that to concentrate on the 500 and 1500's. Plus the fact it was a lot cheaper than the CSL product.

Worth noting not all preparations can be given IV, it depends on the filtration methods used. One of the main suppliers in the UK (BPL) could only be used IM, Rhophylac by CSL Behring can be administered IV.

http://grifols.com/documents/10192/4198468/brochure-mdmulticard-en/fc571fca-f5e0-4b8c-97de-502b9a75f947

Hi Malcolm I was aiming my comment at blood centers in other countries where PRBC's may be the only option, I don't believe we can order whole blood from our center here in the UAE and reconstituting PRBC's is the only option we have. I wish every blood service was a capable as NHSBT.

I remember when I was in the UK a rep showing me a device they have for such a purpose, would have either been from Immucore or Ortho but cannot say for definite which one. If I remember correctly he said they were aimed at countries that require bedside checking of ABO prior to transfusion so there must be some countries out there where this is a requirement and there is a market for it. The device he showed me looked very much like the Diamed malaria strip test, a Elisa in a clear plastic case that gave bands for the positive reactions.

When investigating grouping errors when antibodies with wide thermal range are present such as Anti-M reacting at RT and 37. What lengths do you go to to confirm the reverse group, for example if the screening cells are incorrectly positive I,e group B forward group reacting in the B cells and confirmed Anti-M reacting at room temp, do you just assume the Anti-M is responsible for the false positive reaction or do you go out of your way to find M negative group B-cells to confirm negative reaction in the back group. I go with the latter but all my staff seem to think I'm mad asking them to confirm this, just interested to see others approaches. Thanks

If you PM me your e-mail address I would be happy to share our SOP with you. We don't wash the red cells though we only remove the supernatant then reconstitute with FFP.

Hi Malcolm, according to the red book whole blood is used in the UK for exchange TX with removal of some plasma to increase the HCT. Is this not the reason why reconstituted PRBC are not been used as the end product is the same? But for labs that don't have access to whole blood reconstitution would be required to remove the additives and correct the HCT.

When performing double exchange is the additive solution and anticoagulants not an issue? Plus removal of any potential residual AB antibodies if using group O unit with non group O patient? This was always my understanding of the justification for reconstituting.

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No you can buy inline filters for post storage leukocyte reduction, our blood supplier does not offer leukocyte reduction of platelets unless they bare apheresis units but they are not always available so we sometimes have to resort to using these filters. https://www.terumobct.com/imugard "MUGARD III-PL for Platelets The IMUGARD III-PL filter is a hard-housing filter designed to remove leukocytes and microaggregates from platelet preparations. Each filter system is equipped with a spike, clamps and tubing. The filter housing material is semitransparent to make monitoring the filtration process easier. Available in lab and bedside versions, the IMUGARD III-PL features a bypass line on the lab version to remove air from the transfer bag. The bedside version features a drip chamber and a roller clamp below the filter to adjust flow to the patient. Filters platelet concentrate for volumes equivalent to platelets produced from six Buffy Coats Offers greater than 90 percent platelet recovery" The efficiency is reported to be not as good as pre storage with these but this is not an option we always have. My issue is currently we are giving the filters to the nurses to do at the bedside which I don't feel is the best option and I would like to bring it into the lab, mainly because of training as its much harder to train all the nurses to do it properly than it is for the lab and of cause the lab can QC the process which would be impossible at the time of administration.

Are there any sites that receive platelets non Leukocyte reduced and then perform the leukocyte reduction on site? If so do you do this in the laboratory prior to issue to the wards, or do you provide the nurses with the filter for them to perform at the bedside? Thanks

But what temp do you consider acceptable for return? what evidence did you use to validate this? If you state it must still be at 1oC to 6oC, you may be throwing units away that are still fit for use. As CAP are asking for a validation then it needs to be evidence based, opting for 1oC to 6oC would be the easy option but I dont want to be throwing away units that we can still use. Are there any standards from AABB regarding this? I have a copy in the post but not sure it will come before our CAP inspection next month. Thanks Steve

But what is the acceptable temperature limit for a 30 minute excursion? If it was in a validated transport box with a logger inside that remained between 1oC and 6oC then it wont be considered to have left cold storage hence the 30 minute rule wouldn't apply. We have transport boxes validated for 8 hours that we send to OR. So that fact that a limit to "30 minutes rule" exists suggests that the unit does not need to be kept at cold storage temperatures, but what would be acceptable? temperature for the unit to reach for 30 minutes? For example UK guidelines state that a unit of PRBC can be used with temperature excursion of up to 10oC for up to 5 hours. Some interesting info in this document for the UKBTS reviewing the evidence of various studies, https://www.transfusionguidelines.org/document-library/documents/change-notifcation-no-33-2016/download-file/Change Notification No 33 2016 - Removal of red cells from a controlled temp.pdf Ramirez-Arcos and colleagues from the Canadian Blood Service reported on two studies using red cells in SAGM. In the first study, a single five hour exposure to room temperature showed no immediately significant effects on the in vitro quality of the red cells, although six days after the exposure ATP and K+ levels were significantly lower than in unexposed controls[22]. In the second study, units were exposed to room temperature for 30 minutes on each of five separate days, and no significant effects on in vitro red cell quality markers were reported[23]. Steve

I have always used total number of outgoing RBC's for that month, used + wasted. The issue with using the number received is that some months you may receive a large quantity for that month but due to expiry they wont expire till the following month where your received stock may be less than the month before hence this will skew the figures giving a higher % waste for this month. Using total outgoing RBC's gives a better indication of the waste against use for each particular month. My previous lab had a stats program built in that was based on MHRA and UK BSMS requirements and this always reported waste as a % of total outgoing RBC's. Steve

Just found this from the BBTS; https://www.bbts.org.uk/downloads/bbts2016/presentations/15.00_wed_qs_3_kate_aplin_bbts_2016.pdf/

This was my point exactly, without a full on viability study, the likes of which would be far out of the realms of possibilities for a hospital lab, I cannot see what validation can be done. Just proving temperature does not mean that one that exceeded say 10oC for 10 or 15 minutes is still not a viable unit. Studies have been done on this matter, what is the point of individual labs trying to validate it, should we validate expiry dates too? of cause not we have to go with what the suppliers have validated them for and trust the information we are given.

With regards to cap standard TRM.42470 What levels of validation are people performing? I can see this from 2 angles, 1 is the risk of bacterial growth should anything already be in the bag, the second is the risk of reduced blood viability from 30 minutes extra of been out of storage. The latter I would imagine would be extremely difficult to validate, in the UK the 30 minute rule is an accepted standard on which we have never been required to validate this. Is a simple temperature check ok? should quarantine of the unit be performed with microbial culture? as has been suggested by one of my staff, however this would remove the unit from use for 3 days and possibly result in waste of the unit anyway. TRM.42470 Acceptance Back Into Inventory Phase II There is a written procedure, validated by the laboratory, for accepting blood/blood components back into inventory after they have been issued. NOTE: The procedure must include steps to verify the integrity and appearance of the blood/ blood component and maintenance at appropriate temperatures. The steps and criteria defined in the procedure for acceptance of units back into inventory, such as the use of transport containers Thanks Steve

Hi Does anyone use the bartender bar-code software from seagull to print ISBT128 format blood bag labels? Thanks

Do you know how the treatment would differ say for DAT due to anti-D compared to ABO incompatibility? I can see the benefit of knowing prior to delivery as they can asses the risk based on what antibody is present and at what titre but post delivery surly monitoring Bilirubin and HGB will give them far more information about what the neonate needs than what antibody is bound to the cells. That seemed to be the response from out pediatricians when I asked them. Steve

Recently I started working at a lab in the UAE and here the process for all positive DAT's on neonates is to do an Elution and antibody ID, from my experience in the UK this practice is unheard of and I have not come across any site I've worked at before doing this. However I appreciate different parts of the world have different standards that they follow. As here we follow CAP I wondered what other sites in the US are doing with DAT positive babies? As a side note I asked the lead pediatrician if the antibody ID is useful to them and was informed they treat all positive DAT's the same regardless of what antibody it is. Thanks Steve

Hi Kaytee Thank you very much for you help with this, that description seems to match what we need and I will look into getting the request made. Regards Steven Richards