[Emergency Released RBC]

That’s a really good point Ward_X.
 

Emergent events documented in the EMR should be enough to justify our actions in the case of unXM’d blood. I have never thought of the possibility that that would suffice as documentation for this purpose but requiring docs to sign papers really does seem a little archaic after thinking of it in terms of all the information that is available to us in the EMR to prove who requested it, but we in the blood bank are so used to having >complete documentation of everything. But this also can never be assumed as not everyone is so meticulous....

[BloodBankTalk: Clinical Aspects of Transfusion Reactions]

I just answered this question.

• My Score
  PASS

 

[BloodBankTalk: Antibody/Antigen Reaction]

I just answered this question.

• My Score
  PASS

 

[BloodBankTalk: Allergic Reaction]

I just answered this question.

• My Score
  FAIL

 

[BloodBankTalk: Antibody/Antigen Reaction]

I just answered this question.

• My Score
  PASS

 

[Emergency Released RBC]

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.

Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

[Blood Group Discrepancy]

srichar3, do let us know results of other tests and if the patient was treated as AsubB for transfusion. I’m curious as to why the patient would have such a strong reaction with A reverse cells if they are a subgroup (I have only seen 1+ in reverse with A cells in subtypes but of course YMMV) and wonder if perhaps there is some pertinent clinical information causing false positive results with anti-A in gel, such as pH- or reagent- dependent reactivity. Especially since it was just BPos in tube method.

[Ag typing procedure discussion]

Following the manufacturer’s IFU (Ortho; tube method), when performing antigen typing for CEce, we test IS, followed by RT incubation, mix, centrifuge, grade.

For Jka/b, Lea/b, K and P1 (procedure is the same, except these have no IS read prior to incubation), we incubate, do not mix (as mixing after incubation is not mentioned in the IFU), centrifuge, grade.

So, per manufacturer’s instructions, we mix before and after RT incubation for CEce testing but not for the other direct agglutination reagents, where we only mix before incubation at RT and spin without mixing.

Does this not mess with anyone else’s head? I understand that sensitization occurs during incubation and that any mixing after an incubation is futile (I think I’m correct on that?).

Thus,

Question 1: What would be the point of mixing our tubes after incubation in any Rh antigen typing procedure?

Question 2: I am under the impression that unnecessary mixing can break up weak hemagglutination, so wouldn’t post-incubation mixing carry with it the distinct possibility of false-negative reactions (yes, I know MOST donors react strongly with CE/ce)?

[Probably a silly question...]

On 1/30/2020 at 9:29 AM, kaleigh said:

I'm sure I should know the answer from school.

Oh gawwsh I wish we could count on school to teach us the intricacies of immunohematology but it seems these things are truly only taught by 1) loads of experience; 2) engaging with those who have loads of experience; and 3) reading seriously in-depth reference texts.

A bit off topic, but traditionally MLS schools teach immunohematology as one, one-semester course with lab plus clinical rotation. While the clinical rotation solidifies the theory a lot more than the class, I believe our graduates would benefit from a second “Immunohematology II” class covering practical basics such as the types of things similar to OP’s question and things related to more in-depth troubleshooting and discrepancy resolution, and in addition, advanced theory for selection of appropriate components for transfusion for problematic patient needs and emergency situations. Sorry for the slightly untimely ramble....but chemistry, hematology and microbiology get the dual-course treatment, BB should too.