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Brenda K Hutson

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Brenda K Hutson last won the day on June 26

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    Blood Bank Technologist

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  1. Well, not sure the wiggle room is "right" since no one has said anything specific, other than run positive and negative controls. So just throwing out some methods I have used in various places throughout the years. If you use the antisera method, you could easily run a positive and negative control cell for the antigen you are trying to detect or rule-out. In the other method, the cell with the known antibody would be your positive control and the rule-out cell would be your negative control (provided it was in fact negative). Brenda
  2. People have long used expired antisera and panels. You just need to run controls. Which brings one to the question....what are appropriate controls? That has never been clearly defined. Some people antigen type the cells tested for the antigen(s) for which they are using the cell (i.e. if using it to rule-out Anti-E, they type it for E to make sure it is still reactive). I was taught a variation on the theme. That is, to run a Positive Control Cell, which is a cell that is positive for the suspected/ known antibody and which reacts then at the same strength. For example, let's say you suspect the patient has Anti-Jka (that is what another panel seems to indicate) but you need to run a cell on another panel to rule-out Anti-E (so a Jka-E+ cell).....your control cell would be a cell that is Jka positive and it should then react at the same strength as the Jka positive cells you have run on another panel. So, a couple of possible options.....again, CAP just says controls have to be run, but does not clarify what those controls should be. Brenda Hutson, MT(ASCP)SBB
  3. Hello Malcolm, I am the same Brenda Hutson that used to Post on PathLab Talk, but my e-mail address changed and I forgot my Password, so when I tried to login, it said Brenda Hutson was already in use, so I had to put my middle initial. Glad to be back. Brenda
  4. Hello All, I am the same Brenda Hutson that used to Post on PathLab Talk, but my e-mail address changed and I forgot my Password, so when I tried to login, it said Brenda Hutson was already in use, so I had to put my middle initial. Glad to be back. Brenda
  5. So we know that at times we add extra plasma to increase detection of weak antibodies. But my question is, has anyone done this with GEL testing? The instructions clearly state to use 25ul of plasma so just curious as to whether that is even an option with that technology? Thanks, Brenda Hutson, MT(ASCP)SBB
  6. Our new supervisor wanted me to see what others are doing with regard to questionable, weak blood types. Specifically, if for example the forward type is strong but the reverse is weak (say <2+) and there was no obvious explanation for the weak reverse type (immunodeficiency; elderly; etc.), would you still call out the blood type, or would you call it inconclusive based on not having an explanation for the weak reverse type? i.e. Anti-A=4+ Anti-B=0 A1C=0 BC=W+ Without an "obvious" explanation for the weak reverse, would you report the patient as group A or would you report it as inconclusive and transfuse group O RBCs? Thanks in advance for replies, Brenda Hutson, MT(ASCP)SBB
  7. I know there must have been discussions on this topic, but in my search, only found it as it relates to young children (which is not our patient population). We are moving towards a 2nd blood draw/ blood type on patients with no historical blood type. I would be interested in hearing how others are managing that as far as workflow and hospital staff buy-in. 1. For Pre-Ops, when do you get that 2nd specimen? 2. For Outpatients, when/ how do you obtain that 2nd specimen? 3. For Inpatients they want to transfuse, what is the protocol? 4. Do you require it just be a different time of draw, or does it also have to be a different phlebotomist? 5. etc. etc. ANY/ALL Feedback would be much appreciated. Brenda Hutson, MT(ASCP)SBB
  8. This refers to New Lot Confirmation and Acceptability. It states that "New reagent lots and shipments are checked against previous reagent lots or with suitable reference material before or concurrently with being placed in service. " Currently, we perform Lot to Lot Testing for the Fetal Screen Kits only. Is anyone interpreting this CAP question to also be applied to Commercial Reagent QC Kits?? Do we now need to perform Lot to Lot Testing on those also? Thanks, Brenda Hutson, MT(ASCP)SBB
  9. This refers to New Lot Confirmation and Acceptability. It states that "New reagent lots and shipments are checked against previous reagent lots or with suitable reference material before or concurrently with being placed in service. " Currently, we perform Lot to Lot Testing for the Fetal Screen Kits only. Is anyone interpreting this CAP question to also be applied to Commercial Reagent QC Kits?? Do we now need to perform Lot to Lot Testing on those also? Thanks, Brenda Hutson, MT(ASCP)SBB
  10. This is not an "exciting" question....but just wondering, does anyone out there know of a commercial label for Antigen Typing (to place on the unit) that has a space provided to write the Unit#? We could get some specially made, but that would be expensive; so just curious. I know we had one at a previous place I worked at many years ago, but not sure if they made those themselves? Thanks, Brenda Hutson, MT (ASCP)SBB
  11. So we have had 2 patient mysteries in the past week. One of them probably has a simple solution....but is just not something I have ever seen in over 30 years. The other one is more of a mystery. 1st case: We received a Cord Specimen on the baby from an A NEG mom to evaluate for Rhogam. The baby typed 4+ with Anti-A, but 1+ with Anti-B. We did wash the cells many times. We also obtained a heelstick but obtained the same results. I am used to seeing weak A typing on newborns; but not used to seeing it with Anti-B (but then statistically, I have seen many more A's over the years than B's); especially when it was so strong with the Anti-A. Have any of you seen that weak of typing with Anti-B on newborns, or are there any other thoughts on what is occurring here? 2nd case: 62 year old male with diagnosis of COPD, Dyspnea, GI Bleed, Chemo (as recently as yesterday). So ongoing problems. He has had MANY transfusions of RBCs and Platelets over the past year; including past 3 months. The patient is A POS. Yesterday, he was transfused with an O POS Platelet (we only keep 2-3 in-house at any given time so just have to give what we have, and do so by outdate). Anyway, after receiving only 151 cc's of Platelets, he had Chest Pain, Respiratory Distress and Vomiting. He was transferred by ambulance the 1 block to the Hospital ER. All of our clerical check was fine. Our Policy for giving Platelets is that we just have to have a historical type on the patient; it does not have to be a current type. However, the Cancer Center had drawn a HOLD specimen that morning so as it turned out, we did have a pre-transfusion specimen (just had not been tested yet). Upon testing both the pre- and post- specimens, the only issue we came across was that the pre-transfusion IgG DAT was Negative, but the post-transfusion IgG DAT was 3+. When we spoke to the Medical Director of our Donor Facility, he said to report it as a hemolytic transfusion reaction. Problems with that are: After whatever treatment they gave patient in ER, he was sitting up and feeling just fine. Also, no indications of it being TRALI. So we became concerned that perhaps we had a platelet with a high-titer Anti-A,B. We performed an Eluate on the post specimen and tested it against screening cells plus A1 and B cells. All testing was NEG. Now we were really stumped. We had the patient re-drawn and now, several hours later, the IgG DAT had dropped to 1+. Not a dramatic drop in Hgb.....from 7.4 before transfusion, to 7.1 after transfusion, to 6.9 this morning. So my last "guess" was that perhaps he was just really unlucky and the donor of the platelets had an Antibody to a Low Incidence Antigen, and the patient just happened to be Positive for that Low Antigen?? So we are testing just the Lows that are on our panels (Cw, Kpa, Jsa and Lua). Of course there are a lot more Low Incidence Antigens that it "could" be if that is what caused this. But that decrease in strength of the DAT, in light of not really seeing evidence of hemolysis, is very confusing. And if it is an Antibody to a Low Incidence, due to his many transfusions of RBCs, is the Antibody attaching to his own cells, or to donor cells he previously received which may have been Positive for a Low Incidence Antigen? Any thoughts/ suggestions. Also, as I am completing this, my Tech. just brought me a gel card with the results from 2 of the Low Incidence Antigens. It looks like the card spun at an angle so I want it repeated, but it appears that the eluate is reacting with the Lua+ panel cell. But I wouldn't expect an Anti-Lua to cause a severe reaction in a patient like that. Anyway, will keep you posted on our serological results.....but if you have any other ideas/ thoughts, would love to hear them. Thanks in advance for your input, Brenda Hutson, MT(ASCP)SBB
  12. For those of you who have switched to either the Erytra or Vision, I would be interested in hearing the Pros and Cons of your particular piece of equipment. I know there have been some separate listings (usually equipment-specific), so would just like to see it all laid out; which has the least problems (or the more manageable problems) as it seems they both have their pros and cons. Thanks, Brenda Hutson, MT(ASCP)SBB
  13. I am trying to create the conditions by which we can perform our Cord Blood Testing via automation. As we all know, cord blood specimens are not great. We were using a sterile screw top tube that they had used years ago, but in my efforts to see if we could automate it, we were able to locate sterile pink EDTA tubes for them to collect in. However, still getting them with clots. They found that if they filled them only 1/2 full (so quicker to get cap back on), the clotting was not as bad or frequent....but still no consistency. Our automation will run testing on Cord Specimens (Erytra), but we will not start it until when and if we can get them non-clotted (or at least where we can use an applicator stick and maybe just be taking out 1 small clot). Anyone out there successfully performing cord blood testing via automation? I can't imagine any analyzer would accept a clotted specimen so if you are, please share with me what your success is in getting non-clotted cord specimens. Thanks, Brenda Hutson, MT (ASCP)SBB
  14. Ok, so I posted a very brrroooaaad post yesterday that was titled "Multiple Questions".....but had responses to none of the questions. So, let me narrow it down a little (sorry about that ). What I most want to know about is what all of you are doing with your pregnant patients that type 2+ with Anti-D? Are you sending them out for molecular testing? Or do you have a lower cut-off for that? Just curious because I currently have one. Thanks, Brenda Hutson, MT(ASCP)SBB
  15. Actually I want to run a few "totally unrelated" things by you: What is your cut-off grade of D Reactivity for considering a patient a Rhogam Candidate? At what strength of D Typing do you say the patient is Rh Positive and is not a Rhogam candidate; vs. what strength do you say she may be a Partial D so you give Rhogam to be on the safe side (or do you have testing performed to confirm one way or the other; molecular testing)? We have a current patient who is 2+ which I am inclined to just report as Rh Positive....but that is the strength at which we have our machine flag our Rh Types as questionable. On a totally different subject.....validation of new Platelet Rotator/ Incubator. Clinical Engineering did all of their checks and we are doing Alarm and Temp. checks. I am also trying to procure expired platelet apheresis to "load" the rotator and ensure it maintains temp. with a full load. Anything else anyone out there does for this validation? And on yet another note.....with your Donor Center Contracts, how many of you state such requirements as: % if Standing Order that can be cut/ month Requirement to never allow you to go below Minimum Levels of any given blood type % of RBCs that must be fresh (i.e. no >8 days old)? % of group O RBCs that must be fresh (may be higher than overall # for all RBCs above) What other restrictions do some of you list? Thanks, Brenda Hutson, MT(ASCP)SBB
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