RichU

Just an observation.... When I worked in a reference lab in the UK we tested the patient's cells against AB serum in parallel when performing IAT typing. This was part of the testing protocol and there was no DAT required. I would only think about doing a DAT if this negative control was positive. Is there a charge for running a monoclonal control with monoclonal typing reagents?

We use NHSBT 10 cell panel in Cellstab as our secondary. They also do enzyme treated version. (and 3% NISS version). We have to attach our own barcodes to use them on the IH500 and you might have to talk to BioRad to ask if they can install software to let you use the cells. Scottish NBS also produce a panel I believe.

Don't whoever makes your gelcards produce reagent cells too? When I worked for NHSBT we used BioVue cells on BioVue cards and BioRad cells on BioRad cards.

No products/components since 2016 (see my previous post) TO OUR KNOWLEDGE. Being a small island nation, patients quite often get treatment in the UK which we don't know about and vice versa - very helpful. So he may have had D pos platelets. I think it unlikely he had D pos red cells for a planned procedure. We did XM 4 units (O neg) in 2016 but none were required. Thanks all

Thanks for your input. Patient came in this time for Laparotomy. The only other product we have issued is Beriplex (prothrombin complex to reverse Warfarin) in 2016 when he had an AAA. (Antibody screen neg) Cheers

Hi Guys, Has anyone seen the following scenario before and , if so, how common is it? 2002 male O neg patient transfused 4 units of Oneg and 6 O pos. 2012 and 2014 antibody screen negative. Now using the same methodology (DiaMed IAT), we have a strong anti-D. No D positive units transfused since 2002. Why is anti-D now apparent 20 years after the transfusion of D pos cells but not 10 years ago? Cheers, RichU

I think it depends on individual circumstances. I would not keep K- units as a requirement for these patients once therapy has ended and no antibodies are detected. I would always give c-, E- units to an R1R1 patient with anti-c whether or not anti-E had been detected. @Malcolm - as I've said before, there are always caveats with serology! (even that statement)

UK units are all K typed. We don't give K+ blood to females <50years, children, anti-CD38 patients, chronically transfused (eg Sickle) or anyone with anti-K. Anyone else is fair game.

Thanks srichar3. I know about 5.3, hence our 45 minute stipulation, but there is no max?

The BioRad panel sheets only usually give + or 0 for P1 whereas NHSBT give numeric scores which is much more helpful when the antibody only reacts by IAT with strong examples. A cold panel helps with any ambiguity too. (and P1 type on the patient, but who stocks anti-P1 at a hospital?)

Hi all, Can I have your opinions/policies regarding the following please? We currently have 15 members of the on call rota, 12 of these are not transfusion staff. Therefore we only get 2 sessions a month and sometimes wont be performing any serology for weeks. Everyone does have to do 10 days in here per annum. More people want to join the rota and the pathology manager thinks this is a great idea. I am concerned that, especially the ones new to transfusion, won't be particularly competent with that level of experience. Thanks, Rich

We use BioRad gelcards. There are different ABD-Confirmation cards for Donors and Patients. The Donor one detects DVI, the patient one does not. The D status of all donors found negative by the ABD conf card are confirmed using a monoclonal anti-D by IAT. Is re-grouping of units, sent from the blood bank, at the hospital a thing? Sorry for the late post

What are the post delivery time constraints for a sample to screen for FMH? We require maternal sample taken at least 45 minutes post delivery, but is there a maximum limit and where are the regulations for this? I can't see anything in the BSH guidelines (for UK bods) We had a delivery sample which we had to reject (minimum data set not met), so we issued 500IU anti-D and requested a repeat sample which did not get taken until the day after. Would foetal cells (with prophylactic anti-D, already sensitising them) be being removed from circulation, would this affect the dosage required or are we only interested in removing what remains? Cheers. p.s. my spellchecker wants me to change some spelling. It can go and ........!

Thanks Malcolm, I was hoping you would reply. I didn't fall asleep but had to reread a few times! I left their employ 4 years ago. I don't recall selecting M- units if the anti-M was not detected by IAT. I did wonder if the policy had changed since I left, but from what you say it was already in place. The unfortunate thing for us is that we produce our own red cells, which are compatible and (probably) safe for these patients, but we have to import M- units from the UK due to the RCI report. This means we have to pay for the units and the cost of air freight for blood which we are unlikely to use for the antenatal patient.(To cover delivery). (Rant over) Having said (all of) that, we have a not insignificant number of residents of Thai stock who may fall into the category of been at risk of severe HDFN from a non-detectable anti-M! So maybe we will have to accept it.

We have an antenatal patient with previously detected anti-M. We referred the booking sample to our RCI lab who did not titre the anti-M as it did not react by IAT. The report we got back recommended we select M- units for cross-matching by IAT. This is contrary to the British Society for Haematology guidelines which say M- must be selected only if detected at 37oC. When I queried the advice I was told this is their policy. Any thoughts?

Wow. I didn't realise how lucky we are at my hospital. We process around 7,000 samples a year, so not a large facility. It is not a lack of expertise that stops us doing elutions/titres/adsorptions rather that it would not make financial sense for us to. We have 4 full-time transfusion specialists for routine (9-5) hours. Outside of these times is covered by multidisciplinary on-call. Any biomedical scientist in the pathology department can join the rota. On call samples are processed in haematology, transfusion, biochemistry and a few micro tests by the lone worker. Training in transfusion for the on call staff is much longer and more in depth than for the other labs. Each rota member has to work and train in BT for 10 days a year and be signed off as competent for all aspects. The 4 transfusion scientists are available to process Ab ID and FMHs if need arises. This means that more than 50% of routine hours every year are dedicated to training on call staff.

I just answered this question. My Score PASS  

We have a system called bloodtrack. Basically crossmatched units for named patients and 2 O neg units for emergency use (labelled with dire warning about uncrossmatched red cells) are kept in a locked fridge. To access this fridge the user who comes to collect units has to scan their barcode then the barcode on the blood pack(s). Bloodtrack saves the information regarding personnel, unit details and time removed from temp. controlled storage. There is an audit form with the emergency units which the medic has to fill in and return to the lab. so that we know which patient has received which emergency unit. We keep a line segment from these units if case we need to retrospectively crossmatch (eg. for transfusion reaction investigation). So, in conclusion, we rely on a paper based system to inform us that a specific emergency unit has been transfused to a certain patient.

All paediatric units produced by NHSBT in the UK are HbS negative.

Sorry for the delayed reply mrmic. We received 3 requests for bilirubin level but 2 were insufficient. The first was within normal limits. We have had no follow up samples from baby and I do not expect one. I assume, due to our lack of knowledge regarding an ongoing situation, that the baby did not require any medical intervention. Thanks

Thanks for still cogitating on this. How strong would an antibody have to be to block antigen sites? ( Difficult to answer given the lack of cases, I assume) Also, given the presumed whoppingness(!) of the titre, wouldn't you expect at least some sign of HDFN? Cheers p.s. I have had to postpone the presentation due to circumstances beyond even World leaders.

There's always a caveat with serology! Sometimes when things are so ingrained it's easy to take them as read.

Sorry, it's not that I don't recognise the significance of a titre of 32, just that I wished to illustrate that a rising titre is significant during any pregnancy but if you don't do any titrations, due to detecting an antibody in a previous pregnancy, how would you pick it up?

I always understood it was the change (especially upwards trend) in titre throughout pregnancy which indicated whether there might be a problem for the current fetus (and likely antigen status) rather than just a historic or latest result. A change of titre from 2 to 32 is more alarming than a titre which is 32 at booking but remains at 32.

Forgot to mention that all our transfusion lab samples must be handwritten at the bedside with no amendments or missing details and signed/dated/timed with matching printed form. As you can imagine we reject lots of samples.