Ally

Here's one paper that involves extended cold storage of room temperature platelets.  They actually seemed more functional.
Xu F, Gelderman MP, Farrell J, Vostal JG. Temperature cycling improves in vivo recovery of cold-stored human platelets in a mouse model of transfusion. Transfusion. 2013 Jun;53(6):1178-86. doi: 10.1111/j.1537-2995.2012.03896.x. Epub 2012 Sep 24. PMID: 22998069.
 
 
Background: Platelet (PLT) storage at room temperature (RT) is limited to 5 days to prevent growth of bacteria, if present, to high levels. Storage in cold temperatures would reduce bacterial proliferation, but cold-exposed PLTs are rapidly cleared from circulation by the hepatic Ashwell-Morell (AM) receptor, which recognizes PLT surface carbohydrates terminated by β-galactose. We cycled storage temperature between 4 and 37°C to preserve PLT function and reduce bacterial growth.
Study design and methods: Temperature-cycled (TC) human PLTs were stored at 4°C for 12 hours and then incubated at 37°C for 30 minutes before returning back to cold storage. PLTs stored at RT or at 4°C (COLD) or TC for 2, 5, and 7 days were infused into SCID mice and the in vivo recovery was determined at 5, 20, and 60 minutes after transfusion.
Results: PLTs stored for 2 days in COLD had significantly lower in vivo recoveries than RT PLTs. TC PLTs had improved recoveries over COLD and comparable to RT PLTs. After 5- and 7-day storage, TC PLTs had better recoveries than RT and COLD PLTs. PLT surface β-galactose was increased significantly for both COLD and TC PLTs compared to RT. Blocking of the AM receptor by asialofetuin increased COLD but not TC PLT recovery.
Conclusion: TC cold storage may be an effective method to store PLTs without loss of in vivo recovery. The increased β-galactose exposure in TC PLTs suggests that mechanisms in addition to AM receptors may mediate clearance of cold-stored PLTs.

A Negative is the type of choice next.  The most recent type of A positive is from the transfused units. They will eventually go away.  Patient true type is A negative and should get A or O negative.  Patient might also develop Anti-D.  Diving A negative will help the cells survive longer.  If the patient is a female of reproductive age, it might be good to suggest giving  Rhogam to the medical Director. 
 
 

For us it would depend upon the patient's age and child-bearing potential.  If that is unknown or unclear, routine transfusion after MTP would be A NEG.  Additional massive bleeding A POS.  

First question, is the patient actively bleeding?  If not and they just want to "top them off" then A neg is the choice.  If they are and your A negs are very limited then stay with the A pos blood.  As far as RhIG goes, as mentioned above, forget about it.  All it will do at this point is cause more problems.   That's what I would do.

RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first.
Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. 
Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow. 

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

I just had this conversation with the CAP .... 
Here's may question and CAP's response:
My question -- RE: COM.04250 Comparability of Instruments/Methods I need clarification on this for the Transfusion Service. Since antibody screen and antibody identification TESTS both use the same METHOD do you have to perform correlation on both TESTS or just on the METHOD? In other words do I have to do the CAPTURE antibody screen and compare it to the PeG screen and then also do CAPTURE antibody identification (which is the same method as the screen, just with more cells) and compare it to a PeG antibody identification (which is the same method as the screen, just with more cells)?
 
CAP response -- If you compare the antibody screen methods, you are correct, that covers the antibody identification as well.
Sincerely,
Kathy Passarelli
Technical Specialist, CAP
The intent is to compare METHODS so if your antibody ID on the instruments are performed by the same METHOD as the antibody screen then you do not need to perform an antibody identification as part of your instrument/method comparison....just the antibody screen will suffice.
Ditto for comparing your manual method, if your manual antibody identification is performed by the same method as your manual antibody screen then you just have to do the antibody screen and compare it to your instrument method.
 

We also compare DATs since we perform them in gel (newborn) and tube (hemolytic anemia)

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year.  It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK.  Sorry if this sounds egocentric, but I am very excited.

My experience has always been that blood products given during an MTP were a stop gap while the cause(s)of the bleed were dealt with, continuing for as long as it takes. As described above this can involve a huge number of products.
What situations during a MTP can cause more harm than good?

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

We use combo gel card IgG/C3 In case the result negative is great. if the result positive then we do tube method IGg and(C3b,-C3d).

Congratulations!!!! Malcolm well deserved.

Agree with previous replies, when you have screen, panel and AC all 4+ the first thing to think about WAA. I suggest to do Adsorption in order to rule out alloantibodies. Also you might have warm autoantibody demonstrating D specificity in this case transfusion of antigen negative rbc is Not required BUT antigen negative blood may increase cell survival.
Did you do DAT? 

I worry about donations if people get sick in large number and they can't donate we might  experience blood products shortage.

We use  an ABORh from the current admission to cover all possibilities. Stem cells patients or using someone's else insurance. For FFP and Platelets. 

Yes, Rouleaux interference is  common in gel testing. Make sure to follow what's recommended for time and speed when you spin your specimen.  if you have negative results on IgG phase I do agree with Ensis  do saline replacement if it's negative resulted as such and add a comment.

Hi Malcolm, I am a new member and just read this topic and I like to say that is honorable to be recognized for your contributions to transfusion medicine. It is exciting no need for apology
Very glad I joined  the society of transfusion medicine.

Happy to join a professional team like pathlabtalk. I read lots of interesting topics