carolyn swickard

We do an eluate only if the Dr orders one, and we haven't had that in years.   We only do the cord bloods of O and all Rh neg moms anyway.  An O mom with a B baby can frequently be seen to have  a more aggressive HDN - but usually treated just with Bili lights and hydration, occasionally they also don't let the mom breastfeed.
Any ABO HDN eluate workup really doesn't yield anymore useful information than you already know - Mom's are usually O and the babys are A or B  - DAT mystery solved.
On the rare clinically significant antibody - try to find whatever it is mom has and phenotype the baby (if possible) if the DAT is positive -  might be worth sending out if you can't do any of that.  Do you have to send out AB Titers if they are monitoring the pregnancies?  Do you usually know in advance, the moms with positive antibody screens or do you get little prenatal work? That might effect what you need to do.
On the very rare(!): Dad has a rare antigen and mom has the corresponding antibody -  good luck even remembering that if shows up.  The only real way to work one of those up is to have specimens for Mom and Dad and crossmatch Mom with Dad's cells.  If Mom had a negative antibody screen (frequently) but is incompatible with Dad and the baby - send that out for information to use on the next pregnancy - if there will be one.  Otherwise - the current infant will have to be dealt with as well as possible - Bili lights, hydration, maybe exchange transfusion with units compatible with Mom's specimen.  
That is what we would do.

If this works - this is, I think, a proposed observational study to determine how standard Blood Bank practices may affect the transfusion of infants.  Someone is looking at the age of irradiated units and what it might mean to infant safety.  Interesting. Does red blood cell irradiation and/or anemia trigger intestinal ...
https://bmcpediatr.biomedcentral.com › articles       by T Marin · 2018 · Cited by 6 — Our overarching hypothesis is that irradiation of RBC units ... The majority of premature infants receive transfusions for anemia of ...

1. The AABB Tech Manual, the AABB Standards, Harmening's book is good, Issit's "Applied Group Serology" is excellent; Mollison's "Blood Transfusion is Clinical Medicine" is excellent;  Blood Bank Guy - a very useful site; this forum - always useful.  The AABB website.  National websites (AUS, New Zealand Canada) for their blood services.  ARC and UBS (now Vitalent) - our big national blood suppliers.
2.  Get a set pattern of working set up that you can follow (within the ways your Blood Bank likes to do things: tubes, automated, computerized, etc.);  ALWAYS do the work the same way - keep things in the same order always - your tubes, your results, your units as you work with them and label them.  I have trained people who I watch do things in a completely random order, especially as they load the centrifuge - then they had to straighten out every thing to read it and enter it in the computer.  Waste of time and very confusing - it will get you in BIG trouble someday when you are in a hurry.   At the same time - things will change overtime - new computer, new instrument, etc. - be adaptive to change.  If you need to set up a new pattern because it is more efficient or works better with a new instrument (especially computers) - be willing to change and adapt.
3.  Always keep an eye on processes - make sure they follow the Standards and are being done correctly.  Watch for inappropriate procedural drift - don't just change the procedure to "your" way just because you think it works better - it may be the other way for a good reason.  If not - talk it out and see if you can initiate change.  Blood bankers can be slow to change, but they follow rules for VERY good reasons.
4.  You just always wish you knew more.  Patients don't always follow the "rules" and situations can be very fluid in trying to get the right products to the right patient at the right time - and YOU will be the one holding the line on staying within safety rules (and yes, they do scream at you sometimes.)  Most Drs and many RNs do not know a lot about Blood Bank - you will answer many questions.  Always try to keep learning.  Remember always  - there is a patient at the other end of that conversation and they need your help.  You may be the only one with the right and safe answer, but you have to find a way to help the patient 1st.
Best of luck - enjoy the adventure.
 

I tend to work them the way "galvania" works them too.  I just start with the high frequency antigens and work down to the low frequency ones.  That is the way we screen too - eliminate the high frequency antigens and screen only the negative units for the lower frequencies as you get to each antigen.  (mostly we just call our distribution center (Vitalant, El Paso) for units like that - they are doing an outstanding job getting units for the "messy" patients!!)

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

What about RH pos plasma products or platelets?  Though they don't tend to cause an anti-D, they can "spike" one that dropped below detectable levels, I believe.  And that far back, if any platelet concentrates were given, they would have had more RBC exposure than they do now with platelet pheresis units.  Just a thought.

I was also thinking about 'why not drop the unit retesting' after all of the donor centers went to computerized donor labeling/retesting and I hadn't seen a labeling error in years (you did use to see a very few go by) and then realized that with so many places going to computerized "compatible unit release" - the retesting done by the receiving facility is the only chance they get to check that the RBCs in the unit do indeed match the label on the bag.  Without, at least, an Immediate Spin crossmatch check of the unit vs. the pt - there would be NO other physical check done if unit retesting was dropped.  So there we go, the inspection agencies will want the unit recheck for forever!  If the UK's figures were studied and accepted by the FDA/CMS/AABB, etc. - we might eventually see a change, but it probably won't be soon.  (my 2 cents )

I tend to work them the way "galvania" works them too.  I just start with the high frequency antigens and work down to the low frequency ones.  That is the way we screen too - eliminate the high frequency antigens and screen only the negative units for the lower frequencies as you get to each antigen.  (mostly we just call our distribution center (Vitalant, El Paso) for units like that - they are doing an outstanding job getting units for the "messy" patients!!)

We require the RNs (or another aide) to bring a small pickup slip with the patient admission label on it.  This label includes the pt's full name, MR# and Acct# (financial #) and the BB ID band number when they are picking up RBCs.  We do not require a BB ID band # for plasma transfusions.  They also must bring a copy of the current "consent to transfuse" form - filled out correctly.  
Outpatient RNs bring a copy of the transfusion order and the consent form - with the Pt's BB ID band # if picking up RBCs.
O.R. is required to bring one of the small pickup slips with the Admissions label and and the BB ID band # if requesting RBCs.  They are not required to bring a copy of the consent form.
E.R  - in an emergency situation, uses an Emergency Release form (handwritten by us) based on information in the computer or that the E.R. fills in.  They do not have to bring a consent form until everything is caught up and the TS is completed and the pt is off Emergency Release protocols.
Because we still use and require a unique BB ID wristband for blood (RBC) transfusion - both the floors and the O.R. have to prove we are all working on the same patient.  Until we get some kind of system that fewer people (I won't say none!) can screw up - I prefer the use of an independent BB ID wristband where the Draw - to XM -  to Transfuse circle has the best chance of not being corrupted.  We also require a second specimen (independent draw) for all ABORH confirmations.  Doing the best we can to not make a mistake.

A little personal experience here.  As I've mentioned in the past, my wife was a labor and delivery nurse so you can guarantee that any pregnancy she had would be complicated.  When she was pregnant with our son, baby #1, we were not following her closely because of the Anti-K I had detected while still in school because I am K neg.  She had donated some blood for me to test during one of my blood bank classes.  It was the result of previous transfusions.  Anyway, back to the story.  Jason was delivered 6 months prior to the start of antenatal RhIG injections so that never happened.  The delivery was via C-section and the physician thought there was very little bleeding so only one vial of RhIG was issued post delivery.  At the time the facility she delivered at, where she worked, did not routinely perform FMH determinations.  I worked at another facility was I was not involved.  Fast forward to a couple of years later.  I had been using blood from Janice for students.  Her anti-K was a little unusual in that it showed up at room temp, went away at 37o and then returned at the AHG phase.  A student submitted his workup indicting an anti-D as well as the anti-K.  Needless to say I was surprised and repeated the test twice using 2 different panels and confirmed that the anti-D was there.  She had fallen while skiing when she was about 6 months along so our best guess that she had either received her RhIG injection to late or to little was provided.  The anti-D became a bigger issue 4 years later when our daughter was born but that's a story for another time.

I know that some of the early work on ABO-mismatched solid organ transplantation, viz-a-viz ABO antibodies was carried out by Professor Patrick Mollison and his co-workers, and he showed that, whereas inhibition of IgM ABO antibodies is reasonably easy by, in the early days, transfusion of FFP to adsorb the antibodies in vivo, the same is not true of IgG ABO antibodies.  He and his co-workers found the inhibition of these antibodies was much more difficult, and this was almost certainly because only 40% of IgG antibodies are intravascular, as so they "rebound" when inhibited or removed from the intravascular area, whereas almost all of the IgM antibodies are intravascular, and so "rebound" is less likely.

I was also thinking about 'why not drop the unit retesting' after all of the donor centers went to computerized donor labeling/retesting and I hadn't seen a labeling error in years (you did use to see a very few go by) and then realized that with so many places going to computerized "compatible unit release" - the retesting done by the receiving facility is the only chance they get to check that the RBCs in the unit do indeed match the label on the bag.  Without, at least, an Immediate Spin crossmatch check of the unit vs. the pt - there would be NO other physical check done if unit retesting was dropped.  So there we go, the inspection agencies will want the unit recheck for forever!  If the UK's figures were studied and accepted by the FDA/CMS/AABB, etc. - we might eventually see a change, but it probably won't be soon.  (my 2 cents )

Well, unless they are K+k- and have made an anti-k!!!!!!!!!

Just a thought, I have not seen anyone mention in this thread, testing the current sample in parallel with the previous sample.  We would start with the very first sample and freeze what was left after the initial titration.  We would then thaw and run it in parallel with the next sample.  This was an attempt to mitigate the, hopefully, minor differences in technique between techs and give us an accurate picture of any increase in antibody levels.

OK i dont really understand this, but i asked for more specifics - and our backup computers are evidently attached to the network but in a weird limited fashion where they get a solitary incoming dump every four hours, of BB data, but otherwise do not receive network activity, and have no "outgoing" channel. when we were hacked, one was due for a dump and got hacked, the other was instantly quarantined off-line and so had almost all (except the last few hours worth) of BB data.
also was just told it is also now stashed in some quarantined part of the cloud?  this is waaaay over my head in terms of IT though. sorry i cant explain it any better :-(

To answer your first question - Yes, we have seen several antibodies On ECHO/LUMINA) that we can not see in the titers (saline only / 2 fold dilutions/ 30 min inc).  Especially Anti-E.
I once talked to a reference Lab about titers  (we had an anti-G - such fun) and they felt it was most important to try and replicate the In-Vivo condition in the mother for clinical significance - therefore - no enhancement medias and heterozygous test cells, where possible.   That is what we have done since and we just have the Med Director answer any questions they might have (after a through briefing, of course!).  Hope that helps.  
Titers in gel are always higher than titers in tubes (see CAP results for the various titer methods if you can).  
Consistency in method and full disclosure on method and clinically significant ranges should be the most important part of titers.  We restrict ours to only daycrew techs with proven competency testing (and still hope for the best!).
There was an article:  W. John Judd for the Scientific Section Coordinating Committee of the AABB, Practice Guidelines for Prenatal and Perinatal Immunohematology, revisited Transfusion 2001,41:1445-1452, that answered a lot of my questions - if you can find it.  It was supposed to be revisited each decade, but I never found anything in or around 2011.  May have missed it...

To answer your first question - Yes, we have seen several antibodies On ECHO/LUMINA) that we can not see in the titers (saline only / 2 fold dilutions/ 30 min inc).  Especially Anti-E.
I once talked to a reference Lab about titers  (we had an anti-G - such fun) and they felt it was most important to try and replicate the In-Vivo condition in the mother for clinical significance - therefore - no enhancement medias and heterozygous test cells, where possible.   That is what we have done since and we just have the Med Director answer any questions they might have (after a through briefing, of course!).  Hope that helps.  
Titers in gel are always higher than titers in tubes (see CAP results for the various titer methods if you can).  
Consistency in method and full disclosure on method and clinically significant ranges should be the most important part of titers.  We restrict ours to only daycrew techs with proven competency testing (and still hope for the best!).
There was an article:  W. John Judd for the Scientific Section Coordinating Committee of the AABB, Practice Guidelines for Prenatal and Perinatal Immunohematology, revisited Transfusion 2001,41:1445-1452, that answered a lot of my questions - if you can find it.  It was supposed to be revisited each decade, but I never found anything in or around 2011.  May have missed it...

The suggestion I got was to make it a routine maintenance task. Connect your backup computer once a week to the network and load the backup file. I talked with our IT people and they said they could set that up so it was a matter of accessing a file on a server and downloading it. The hows and whys are all magic to me, but the IT analyst I talked to wasn't at all concerned about any difficulty doing it. Then, of course, the computer has to be totally disconnected from the network or you risk exposure to bugs and hackers. WiFi shut off and/or cable disconnected.

To answer your first question - Yes, we have seen several antibodies On ECHO/LUMINA) that we can not see in the titers (saline only / 2 fold dilutions/ 30 min inc).  Especially Anti-E.
I once talked to a reference Lab about titers  (we had an anti-G - such fun) and they felt it was most important to try and replicate the In-Vivo condition in the mother for clinical significance - therefore - no enhancement medias and heterozygous test cells, where possible.   That is what we have done since and we just have the Med Director answer any questions they might have (after a through briefing, of course!).  Hope that helps.  
Titers in gel are always higher than titers in tubes (see CAP results for the various titer methods if you can).  
Consistency in method and full disclosure on method and clinically significant ranges should be the most important part of titers.  We restrict ours to only daycrew techs with proven competency testing (and still hope for the best!).
There was an article:  W. John Judd for the Scientific Section Coordinating Committee of the AABB, Practice Guidelines for Prenatal and Perinatal Immunohematology, revisited Transfusion 2001,41:1445-1452, that answered a lot of my questions - if you can find it.  It was supposed to be revisited each decade, but I never found anything in or around 2011.  May have missed it...

Quote: "We will sometimes use no enhancement media to avoid warm autos (and colds), using 3-4 drops serum, a 60 minute incubation,..."
We also use this technique as the only way we can attempt to see under Solid Phase/PEG warm autoimmunes here. We have used the procedure for years and can routinely see the known alloantibodies, if still present. Since our Reference Lab (I will put in a plug here for the finest reference lab I have worked with - Gulf Coast Regional in Houston, TX - fast, accurate and nice to work with) is a plane flight away, sometimes we have to do the best we can with what we can do on site. Allo and Auto Absorbtions haven't been doable here for some time, so we use the one hour, saline enhancement procedure for "looking under" warm autos. We will back down in sensitivity through Peg and LISS first, but if the warm is still interfering, we will go to 1 hr, saline enhancement as our last resort. We have had allo and autos (still!) show with this routine. The method has been validated with several known antibodies and was originally recommended in a AABB seminar from another reference lab, but I don't remember who or when.
I appreciate so much, all of the help and advice and shared knowledge found on this site, especially from some of the senior posters such as Malcolm. I too objected to your tone and responses. Try validating the SOP yourself, you will find it does work and you may find you appreciate the method.