Jsbneg

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

Thank you all very much for your responses. I'm glad to hear that this is not a common practice and I do agree that the risk of mistyping would be extremely rare. This was my first time as well seeing this kind of practice. Definitely worth an SOP change.

Hi everyone, Please forgive my ignorance regarding this question, but I'm still confused about why antigen typing (as part of antibody workups) cannot be reported within the last three months of pregnancy, at least according to the practice in the blood bank where I currently work. I'm assuming this is to prevent mistyping in cases of a fetal-maternal hemorrhage. I'm curious if this is a common practice in other places and if there are any AABB or CAP regulations addressing this issue. Thank you in advance.

That is correct Mabel Adams. Thank you for clarifying that. Transfused cells are more heavier that autologous cells, and therefore they reside at the bottom of tube after centrifugation. The probe in Erytra analyzer picks up the cells 2mm from the bottom of the tube.

Hi mpmiola, I apologize for my late reply. Grifols just confirmed the phenomenon that was described in the discussion above as the cause of the ABO discrepancy. They stated that the probe in Erytra analyzer goes down to 2mm from the bottom of the tube to pick up red cells. in this case, the transfused cells (group O) are more heavier (more dense) than the patient's own cells (group A) and therefore they occupied the bottom of the tube after centrifugation. Since the probe only takes cells from the bottom of the tube, it only picked up the transfused cells (group O). Hope this makes it clear to everyone.

Hi mimi03, Sorry if I didn't make it clear. it was actually the opposite of what you said. The patient was truly group A, but after receiving 3 units of group O RBCs (as emergency) , the front ABO type on Erytra was coming out as group O on multiple runs post transfusion, while the same samples were correctly typed as group A by tube testing and manual gel. The explanation of this phenomenon was provided above

Thank you all so much for your explanations. I agree with jayinsat regarding the importance of transfusion history in this case, but I would have expected mixed field on the instrument, which was not the case. The concept of the density difference between the autologous RBCs vs the transfused RBCs and its impact on the probe sampling is very fascinating. Thank you all for sharing the papers that explain this phenomenon.

This is very interesting. The patient was in fact transfused 3 uncrossmatched groupO RBC units before the T&S testing was performed His baseline Hgb was very low (3.7g/dL). I will investigate this by repeating the manual gel testing using the upper RBC layer. Thank you.

The patient was admitted into our ER for severe anemia likely due to GI bleed. His HgB was 3.7 g/dL when admitted. Received 3 emergency Opos RBCs units. The type and screen on Erytra was performed after the transfusion of the first 3 units.

Quite concerning indeed. Luckily the mistyping is from groupA to groupO....We did contact Grifols technical support and provided all the results and lot numbers. We haven't gotten an explanation yet from their end.

Hi all, We had recently an ABO discrepancy on one of our patients (front typing groupO; back typing groupA) using the automated gel instrument Erytra (Grifols). When testing was done by tube method and manual gel (same manufacturer of gel cards and antisera reagents), the patient typed as straightforward group A (anti-A reacted strongly 4+ by both tube and manual gel methods). The same results were obtained again with a different sample collected from the patient. Testing on Erytra was repeated for first and second sample, again same results. it goes without saying, all the daily QC of the gel cards on the instrument were fine and we had other patients that were typed corrected as groupA, except for the discrepant sample. The patient does not seem to have a subgroup of A (at least based on the results of tube and manual gel methods). I wonder if anyone else has had similar ABO discrepancies by gel. Thank you in advance.

Very interesting. Thanks for sharing this. I've never seen such phenomenon.

Thank you Jayinsat. This was very helpful and I wish you the best of luck with your PhD dissertation. I hope we can see in the near future a more substantial change in the scope of practice of DCLS or PhD CLS graduates in the clinical laboratory. But I'm sure the path won't be without resistance as pathologist's interest will be at stake.

Hi Everyone, Has anyone in this group pursued a PhD program related to blood banking, if there is any. After getting my SBB and MS, I still want to pursue a more advanced degree, but the options seem to be very limited. I considered the DCLS program (The Doctorate in Clinical Laboratory Science), but not sure how the new graduates of this program are fitting into the clinical laboratory practice. Thanks everyone in advance for any insights.

it is usually unadvisable to assume anything in blood banking, especially when it comes to how antibodies behave. I don't have experience on how anti-G react with RhD vs C antigen positive RBCs, but I have seen many anti-e (allos and autos) giving stronger reactions with R1R1 vs other e+ phenotypes. I would go ahead and do anti-G studies to confirm whether is an anti-D or anti-G....I'm curious to see how other would think of this.