Brenda K Hutson

Report as "Unable to determine Rh at this time." Brenda Hutson

When I was at the Red Cross Reference Lab, we once had a donor who had donated 13 times as an O NEG.....then was determined by the regional donor testing lab to be a very weak subgroup of A (not sure of all of the testing they had performed to detect this and why it would not have been detected before this....but it was confirmed). Someone above suggested perhaps a weak A (or B subgroup)......maybe there is something to that?? Were all of the patients you tested against this unit, group O? Just a thought Brenda Hutson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So the Director of Nursing is asking me if the 2nd person (that performs the blood check at the bedside with the transfusionist) has to be a Nurse? So does it have to be 2 Nurses? AABB Standards just states: The transfusionist and one other individual (or electronic system) shall, in the presence of the recipient.....etc. etc. Thanks, Brenda Hutson, MT(ASCP)SBB

Patient 52 years old (and now I will quit responding to my Post)..... Brenda

Ok, a little more information..... The Tube Testing was repeated (incubated at RT for 15 mins.) and this time I got to the cards before they were discarded. What I found was: Anti-A= 4+ Anti-B = shakes off roughly; is very strong agglutination microscopically (not Rouleaux) A1 Cells= Macroscopically NEG but microscopic Rouleaux B Cells= 2-3+ Antibody Screen not yet performed.....so picture still confusing. Thanks, Brenda

Sorry Malcolm...in response to your question about acquired B....I am re-reading inserts but what doesn't make sense to me in considering that is: 1. No evidence of acquired B in Tube Testing 2. Tube testing seems to indicate a straightforward group A patient (though GEL does not); with exception of the fact that the reverse typing with B cells is weak....only becomes 2-3+ if incubated at RT 3. No Reverse Type in GEL Testing (would expect strong reaction with B cells) The insert for the Liquid Anti-B does state that "The Anti-B reagent derived from the cell line LB3 does not recognize this 'pseudo B' antigen. Anti-B of GEL Card is from Line LB-2 (and states that clone was selected because it does not react with acquired Thanks, Brenda Hutson

Ok, here is the rest of what I know at the moment (still trying to reach patient for more information; came in as just a WELL patient getting a flu shot and wanting a blood type): ProVue Anti-B well= 2+ (Anti-A= 4+); Reverse Type= NEG Manual Ortho GEL= same as ProVue Erytra GEL= 4+ in both wells Anti-A and Anti-B; Reverse Type= NEG So all of our GEL Testing is similar results.....whether automated or manual Tube: Anti-A= 4+; Anti-B= NEG (but shook off roughly; Tech threw tubes away before I could view under microscope.....so being repeated at the moment); Reverse A1cells= NEG, Reverse B cells= 2+ (on incubation at RT) Ok, clones (sorry, not sure if this is what you are looking for but is what I can get from Manufacturer's Insert): The liquid reagent for the Anti-A tube testing is ALBAclone (Murine Monoclonal IgM); Cell Line LA2 The liquid reagent for the Anti-B tube testing is ALBAclone (Murine Monoclonal IgM); Cell Line LB3 We are also doing an Antibody Screen (though not ordered) just to see if there are any other surprises that might help us out (and/or make things worse...who knows) This is SUCH a mystery to me.....I have never seen a discrepancy between methodologies for a blood type like this. Could definitely use some assistance. Thanks again..... Brenda Hutson

So we are still playing with this, as well as waiting for history and a new specimen on the patient, but in the meantime, thought I would throw this out (have not seen something like this before). On automation (ProVue): Anti-A=4+, Anti-B=2+, Rh OK, Reverse Type (both cells) NEG In tube: Anti-A= 4+, Anti-B= 0, Rh OK, Reverse A1 cells= 0, Reverse B cells= 1-2+ Any thoughts/ ideas? One thing I am going to do is Manual GEL to see if that matches the ProVue (so if at least, GEL matches GEL). Thanks, Brenda Hutson, MT(ASCP)SBB

We have been told not to use the Ortho Panels (or Reagents) with Grifols GEL Cards....you can get erroneous results. We have also always used the Immucor Panel (and apparently that is ok for Grifols GEL), and Grifols has just come out with a 2nd panel. They asked my opinion of the cells on the panels and I honestly told them I was not excited about the panels (not enough homozygous cells; NO K homozygous cell; etc.). I have also requested that they designate cells on one of their 2 panels that can be used as a modified panel for Passive D (as both Ortho and Immucor do). They are working on all of these issues. What is good about Grifols is that they are very open to suggestions and recommendations for improvement and seem to be quick to act upon them. So speak up to your Grifols Rep! Brenda Hutson, MT(ASCP)SBB

Yes, that is the tough part about the Safe-T-Vue 6 when it comes to units going to OR (at last minute.....of course if OR is next day, you could put them on ahead of time....but it is those last minute ones or having units added on that creates issues). And while I know some places use Safe-T-Vue 10, you are correct that blood sitting in a cooler in OR for an "in case" transfusion, is considered Storage (that is my understanding anyway) and therefore should be monitored with Safe-T-Vue 6 monitors (I do not know whether FDA cites people for monitoring at 10C or not......I have chosen not to find out and just use the Safe-T-Vue 6). The comment above regarding the Institution being allowed to decide whether something is storage or transport, is surprising to me (and it is the FDA that has the requirement anyway, not AABB). While there may be some gray areas when it comes to storage vs. transport, some areas are not gray (and I do not think a cooler sitting in your OR for a "possible" transfusion, is a gray area).....but as I said, I know there are some places that monitor those at 10C instead of 6C; but they answer to their FDA Inspector and I will answer to mine (though consistency and clear guidelines by the FDA for this issue, would be really, really helpful ). What I instruct my staff to do in this situation is: 1. Your best shot of getting Safe-T-Vue 6 to stay white is to put them on the units while they are still in the refrigerator.....before you ever take them out; that is when they will be the coldest (we also do this when setting up our emergency units when our pre-tagged units were just taken by ER or OR) 2. Then when you take them out to pull segments (i.e. if performing an actual serological XM), or to perform electronic XM), place them on coolant polar packs (we always keep refrigerated packs available). Works best if you can even sandwich between 2 coolant bags. 3. Do what you need to do outside of the refrigerator, quickly (i.e. barcode scan in computer, pull segment, etc.) and get it back in the refrigerator as quickly as possible. 4. Once all serological and computer work completed, Tag units. For Issue, I would again place on coolant packs. We do very well if we follow that protocol. But if you try to take the units out of refrigerator and do whatever you need to do "first;" then try to put on monitors, you will have a very hard time getting them to stay white long enough to even get them out of the dept. Just some thoughts..... Brenda Hutson, MT(ASCP)SBB