Kelly Guenthner

Also, were any of the transfused units antigen positive? This is the quickest way to get a negative indirect antiglobulin test ;).

Your policy (to draw and test your own specimen) is the strictest interpretation of the standards (and one that most blood banks likely follow), but I do believe you'll find systems that share MRNs, share LIS, share policy & procedure (may even share technical staff) that will use pretransfusion results performed in blood bank A to transfuse the patient at location B by technical staff in blood bank B and are doing so within AABB and CAP standards.
All that is to say, I don't think you'll find a standard that explicitly says you have to draw and test your own specimen at your own physical location. We come to that conclusion because of all the other standards.

Your policy (to draw and test your own specimen) is the strictest interpretation of the standards (and one that most blood banks likely follow), but I do believe you'll find systems that share MRNs, share LIS, share policy & procedure (may even share technical staff) that will use pretransfusion results performed in blood bank A to transfuse the patient at location B by technical staff in blood bank B and are doing so within AABB and CAP standards.
All that is to say, I don't think you'll find a standard that explicitly says you have to draw and test your own specimen at your own physical location. We come to that conclusion because of all the other standards.

I think this is the key: Is initial testing at that ED is under one patient identifier/armband and the testing at your facility under a completely different patient identifier/armband?
It's less about the testing, more about the patient identification.
From CAP:
TRM.40230
Specimen Labeling for Pretransfusion Testing
Phase II
 

All blood samples used for pretransfusion testing are labeled at the time of specimen collection in the presence of the patient with:
1.       Patient's first and last name
2.       Unique identification number
3.       Date of collection
4.       A method to identify the individual collecting the specimen.
NOTE: Blood specimens collected for pretransfusion testing must be positively and completely identified and labeled before leaving the patient. Acceptable practices for positive identification of patient and blood specimen labels must be defined in the procedure manual and may include visual inspection and/or an electronic system to read the identifying information contained in bar codes or radio-frequency identification (RFID) microchips or the patient's wristband. Acceptable practices for generating specimen labels must be defined in the procedure manual (refer to GEN.40490) and may include electronic devices utilizing information encoded in bar codes or RFID microchips. There must be a dependable method to identify the individual who collected the blood specimen, such as initials or another identifier on the tube, or an electronic record.
Evidence of Compliance
✓        Properly labeled blood specimens AND
✓        Records identifying the individual collecting pretransfusion testing specimens
 

You can also contact the FDA and ask, I have always found them to be very helpful.
Worst case, report it (again, I don't think it's reportable) and they will reject it and let you know why.  That is safer than not reporting it.
I understand a lot of facilities are reluctant to report, but I came from a large facility and we reported about 50 - 75 events a year and never got in "trouble" from the FDA.

Was the patient transfused? If not, hyper hemolysis is less likely. Sounds like mechanical causes are most likely.

I am retired now and will never forget the sound they make when they are dropped on the floor.
 

In the UK, the Guidelines would (quite correctly in my own opinion) NOT allow us to perform electronic issue on any sample, whatever the pathology, on a patient where the forward ABO type does not match the reverse ABO type (apart from Newborn babies).

The FDA Guidance on Computer Crossmatching calls out that patients with an ABO typing discrepancy should not be allowed to qualify for computer crossmatches. 
" If ABO typing discrepancies exist, you should not rely on a computer crossmatch. This is particularly important if there is mixed field red cell reactivity, missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation. Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques." 
I wrote our policy to include any non-straightforward ABO types for any reason will be required to get an IS or IAT crossmatch. 

The +s stands for strongly expressed.

The expression of the P1 antigen varies considerably from person to person, but the reaction strength with anti-P1 is an inherited trait (i.e. the strength of the expression on the red cell surface).

"I apologize for this dumb question."  BBnoob69, NO QUESTION IS A DUMB QUESTION, IF YOU DO NOT KNOW THE ANSWER.  If you don't know the answer, the dumb thing is to not ask the question in the first place.  NEVER be afraid to ask a question on here,

We use a hands-off process where the floor faxes their request for blood, the blood banker sends the unit via the pneumatic tube and the floor faxes/sends back the signed copy of the unit tag.
I am finding it difficult to come up with a routine transfusion scenario that does not involve 2 people at issue (one on the floor, one in the blood bank).  
I can come up with a couple of CAP requirements that you could cite, though they don't explicitly say 2 people at issue, you could certainly argue that your way of satisfying the requirement is to have one person from the floor, one person in the blood bank at issue.

 

My facility is not AABB accredited, just Joint Commission and FDA, and I have an individual membership. I am the supervisor, and we are a large level 1 metropolitan trauma hospital. I have gained so much from my membership. Everything Cliff mentioned about resources is true, and I can't tell you how many times we've taken advantage of the discount on books for my pathologists (none of whom are transfusion medicine specialists). 
AABB membership also opened up all the subcommittees and sections, and I now sit on 9 subsections and lead one of them. I am also a mentor in the program Cliff mentioned above. 
I would say it's worth it for at least one year, so you can try it out and see what you get from it. Pro tip: if you love it, they do offer a 3 year membership option that knocks some of the cost down.  

In this context two people means that one person is from the floor or OR (an RN for example) who brings a transfuse order, a physical piece of paper, for a specific patient to the lab. One person in the lab issues the relevant product to the RN. This issuing process therefore involves two people representing the two involved departments comparing the name, MR#, product type and product # and any other requirements (Irr, antigens etc.) prior to formal issue.  This theoretically ensures no errors. That being said I have had an RN bring a valid transfuse order for a different patient to the one she wished to transfuse. 

The good news is none of this makes any difference to clinical efficacy or safety. These temperatures are almost totally arbitrary and have no scientific basis.

Seems like a bit of insulation should take care of it. Not exactly sure what that would look like though. But something to slow down that temperature change. I usually sandwich mine in a couple of refrigerated cooler bags. 

We use Ortho Panel A (gel) as our primary method; Immucor/Werfen panocell as supplement (diluting to 0.8% and using gel; will also use PEG/LISS IAT as warranted).  Additionally, we save a couple months worth of expired cells to use for selected cells, when our in-dated cells don't have the right antigen combo.

We use Ortho Panel A (gel) as our primary method; Immucor/Werfen panocell as supplement (diluting to 0.8% and using gel; will also use PEG/LISS IAT as warranted).  Additionally, we save a couple months worth of expired cells to use for selected cells, when our in-dated cells don't have the right antigen combo.

Column agglutination technology is an excellent technique, but does have a tendency to detect antibodies that react at temperatures well below 37oC, even after fairly prolonged incubation at 37oC.  However, the fact that the blood group, including the "reverse grouping" is clear of atypical agglutination suggests that this may not necessarily be the case for this patient.

Just to be on the safe side though, and if you can, I would either treat the plasma from the sample with rabbit erythrocyte stroma (which will adsorb out most "cold" agglutinins), treat the plasma with 0.01M dithiothreitol (which will denature the J-chains of IgM molecules, meaning that, although they can still sensitise the red cells, they are no longer able to agglutinate the red cells) or, and my personal favourite, is to pre-warm the plasma and red cells to 37oC before mixing, perform the IAT at strictly 37oC in glass tubes, wash with saline warmed to 37oC and use monospecific AHG.  If any, or all, of these techniques lead to negative results, the chances are that the antibody is a clinically insignificant "cold" IgM antibody, such as an auto-anti-HI (given that the patient is group A, and the test cells are all group O)..

Failing the above, send a sample to a red cell reference laboratory.

I hope that helps a little bit.

We will dilute the 3% to 0.8% and run in gel but with 40 min incubation.  We found when we validated the process, it was imperative that the cells be diluted according to Ortho's "recipe" to dilute cells.  While validating, we saw some false negatives when the dilution was "eyeballed" and/or when only incubated for 15 minutes. We might take to another media in certain cases, but PEG is our first choice....we will take to tube in a few situations...Patient on DARA, apparent antibody to gel itself or, antibody to preservative in gel cells (everything pos, auto neg).  In cases of the last scenario, we will often try diluting a 3% screen from a different manufacturer and run those cells in gel to see if it's the cells, or the gel.......usually if the AC is neg, it's the cells.
We are a large academic med ctr, and are the "reference" lab for other smaller sister hospitals so we do have the advantage of having access to screens and panels from multiple manufacturers.  

We do that.  You could also use LISS (or PEG) to complement your SIAT.  Make it more sensitive. sandra

Can you convert the tube panel cells from 3% to 0.8% and test in gel?  We primarily do that to run selected cells that are not already diluted to 0/8%

Andrew Hadley and Peter Soothill (Editors).  Alloimmune disorders of pregnancy.  Anaemia, thrombocytopenia and neutropenia in the fetus and newborn.  1st edition.  2002.  Cambridge University Press.  ISBN: 0 521 78120 5.

Failing that, send them back to Nursery School, because it is THAT simple!

We also do titers on the Vision.  We keep an aliquot of the previous titer, but only test it in parallel with the current if there is a significant difference to the current (titer jumps/drops 2 or more dilutions [The increase of 2 or more is our alert/critical value]).
We titer against screen cells, which are QC'd daily and do not do any additional titer QC.

If I remember correctly, back in ancient times, we did not include any control with the initial titer. (Probably because no one thought of it!) For any subsequent titers we would use a frozen sample from the previous titer.  

Discarding your tips is also the AABB standard practice: