Brenda K 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

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

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

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

Better late than never.....just saw this Malcolm.  Congratulations and thanks too for your contributions (many) on PathLabTalk.  I have learned a lot from you.
Brenda Hutson

Thanks for all of the resources Malcolm (and yes, I did also point out it would not be following Manufacturer's instructions).  You remind me of a former Pathologist from "years" ago that I have always stayed in touch with and ask questions of from time to time......he is like a walking library for resources that back what he tells me.  I will pass yours on to my new supervisor .
Brenda

We give O POS to males and women over 55 yrs old.  We give O NEG to women <  55.  That being said, if we have an ID before taking a cooler to ED and the patient is historically Rh NEG, we would start out with 4 O NEG and determine switching depending on gender, age and usage.
Brenda Hutson

Malcolm,
So I read through the PowerPoint and I can only say my friend, I think I am afraid to Post on this website anymore!  But points taken.
Brenda Hutson, MT(ASCP)SBB

Malcolm,
So I read through the PowerPoint and I can only say my friend, I think I am afraid to Post on this website anymore!  But points taken.
Brenda Hutson, MT(ASCP)SBB

Many years ago when working at ARC, I asked Dr. Garratty with some assistance with a patient who had a Warm Auto-e and was hemolyzing.  So we were giving e NEG RBCs, but the patient was still hemolyzing.  He spoke with the physician and suggested he stop transfusing (the guy was down to like a 4 Hgb at that point and probably would have died had we kept transfusing him).  Plus, that then sets them up for making the alloantibody.  I have always been taught that as a general rule, you do not honor a warm autoantibody with specificity unless there is evidence of hemolysis due to that antibody.....but still, transfusing these patients "at all" then, seems to make the situation worse.  Plus donor facilities do not tend to want to let their e NEG units go for a warm autoantibody; they need them for the patients with allo anti-e.
On another note, our protocol for patients with Warm Autos is that if we can get them in an untransfused state (last 3 months), we do a complete phenotype (major antigens only; do not include M) and then going forward, give them matched units as long as the warm autoantibody is demonstrable.  That is for no other reasons than turnaround time (our Reference Lab is about 5 hours away)  and cost of a work-up (though depending on their type, getting matched RBCs can be the more expensive option).  We also started doing that on patients with Darzalex (which at any given time, we have about 3 patients).  If a patient's phenotype is too difficult for ARC to supply just based on us not wanting to send a work-up, they will tell us they cannot provide that and we will then submit them for work-ups when necessary...but for the most part, they have been able to.
Brenda Hutson, MT(ASCP)SBB

I have to disagree with the presumption that as long as you are following what is in your SOP, you are fine.  The SOPs still have to be accurate.
Just sayin.......
Brenda

I have to disagree with the presumption that as long as you are following what is in your SOP, you are fine.  The SOPs still have to be accurate.
Just sayin.......
Brenda

Reminds me of a donor we had once when I was a reference lab sup.  He had donated 12 times as O NEG.  The next time he donated, they picked up weak typing with Anti-A,B and with further testing, turns out he was a very weak subgroup of A!  Unbelievable.
I agree with A subgroup.  I see a lot of people want to automatically classify the subgroup....but without further testing, that is actually erroneous.  Best to just leave it at subgroup.
Brenda Hutson, MT(ASCP)SBB

Reminds me of a donor we had once when I was a reference lab sup.  He had donated 12 times as O NEG.  The next time he donated, they picked up weak typing with Anti-A,B and with further testing, turns out he was a very weak subgroup of A!  Unbelievable.
I agree with A subgroup.  I see a lot of people want to automatically classify the subgroup....but without further testing, that is actually erroneous.  Best to just leave it at subgroup.
Brenda Hutson, MT(ASCP)SBB

Reminds me of a donor we had once when I was a reference lab sup.  He had donated 12 times as O NEG.  The next time he donated, they picked up weak typing with Anti-A,B and with further testing, turns out he was a very weak subgroup of A!  Unbelievable.
I agree with A subgroup.  I see a lot of people want to automatically classify the subgroup....but without further testing, that is actually erroneous.  Best to just leave it at subgroup.
Brenda Hutson, MT(ASCP)SBB

Reminds me of a donor we had once when I was a reference lab sup.  He had donated 12 times as O NEG.  The next time he donated, they picked up weak typing with Anti-A,B and with further testing, turns out he was a very weak subgroup of A!  Unbelievable.
I agree with A subgroup.  I see a lot of people want to automatically classify the subgroup....but without further testing, that is actually erroneous.  Best to just leave it at subgroup.
Brenda Hutson, MT(ASCP)SBB

Thank you all very much for your responses....they are very helpful (and enlightening).  Not surprised at people trying to short-cut the process at times (we see that for other things, right)?  I know there will be pushback but we will get there eventually.  I really like the idea of the computer being able to initiate that 2nd blood draw (but don't think we have that capable of a system); that would be ideal.  I also appreciate seeing some things we should "watch out for."
Thanks again for your assistance....let the fun begin!
Brenda Hutson, MT(ASCP)SBB

I gave a talk at a seminar on this once many years ago.  I KNEW many of my peers were not reporting things that I was reporting (things that clearly were supposed to be reported).  They would try to make it sound like they didn't think it fell into that category, but I knew they knew better than that.....it was a choice. My comment to them was that "we all know that there are a lot of types of errors we could make, and the FDA would never know unless we reported it (for example, let's say you sent out a non-irradiated unit and it was caught by nursing......even so, when it is returned, it is FDA Reportable because the Blood Bank did not catch it.....but how would the FDA ever know that occurred unless perhaps Nursing wrote an occurrence against the lab)?  It is a system largely based on honesty and integrity.  So one time, I asked an FDA Inspector, are you more concerned about places that report a lot of BPDRs, or those who report none?  Of course a LOT cannot mean a LOT.....but they were more concerned about those that never reported in that as we all know, EVERYONE makes mistakes.
Brenda Hutson, MT (ASCP)SBB

Wow, this is sad; I am replying to my own e-mail! In this same Edition of the Technical Manual, page 294 also "clearly" states: thawed single and closed-system-pooled cryoprecipitate concentrates should be transfused within 6 hours of thawing.
This is all very conflicting and very confusing! Maybe by the time I get pre-pooled Cryo., they will have it figure out!
Brenda Hutson, CLS(ASCP)SBB

I can only reply in this way:
1. The Guidance I cut and pasted in previous responses, came directly from the AABB and FDA Regulatory divisions.
2. Both the AABB and FDA state that the wording needs to be clarified
3. Until both regulatory agencies clarify their wording, it is up to you all to decide if you want to choose 4 hours, just to be on the safe side. I only passed on what I was told.
Brenda Hutson, CLS(ASCP)SBB

See my responses which direct you to the Technical Manual. While the Technical Manual is not a regulatory book per se, it was trying to elaborate on regulations for this. As the reply from the FDA/AABB stated, the FDA wrote their regulation before their were pre-pooled Cryos. so they need to revise theirs.
Brenda Hutson, CLS(ASCP)SBB

In looking at that Standard, you are correct in stating that it only discusses a single unit of Cryo. and Pooled Cryo. However, I guess that I am wondering (in light of the reference I made from the Technical Manual), if the issue of "pre-pooled" Cryo. being thawed, just was not differentiated in the Standards??

I don't know what to so; it just seems to me that the way the Technical Manual reads, it does differentiate between Cryo. that was pooled prior to thawing, and that which was pooled after thawing.

I think I will look into that some more; espeically given that this Hospital I used to work at, does receive pre-pooled cryo. and does give it a 6 hour expiration.

But, let's find out the truth! I will call the AABB for clarification.
Brenda Hutson, CLS(ASCP)SBB

I gave a talk at a seminar on this once many years ago.  I KNEW many of my peers were not reporting things that I was reporting (things that clearly were supposed to be reported).  They would try to make it sound like they didn't think it fell into that category, but I knew they knew better than that.....it was a choice. My comment to them was that "we all know that there are a lot of types of errors we could make, and the FDA would never know unless we reported it (for example, let's say you sent out a non-irradiated unit and it was caught by nursing......even so, when it is returned, it is FDA Reportable because the Blood Bank did not catch it.....but how would the FDA ever know that occurred unless perhaps Nursing wrote an occurrence against the lab)?  It is a system largely based on honesty and integrity.  So one time, I asked an FDA Inspector, are you more concerned about places that report a lot of BPDRs, or those who report none?  Of course a LOT cannot mean a LOT.....but they were more concerned about those that never reported in that as we all know, EVERYONE makes mistakes.
Brenda Hutson, MT (ASCP)SBB