Mabel Adams

I was hoping you would share your experience. Thanks.

The Blood Group Antigen Fact Book says HDFN risk of Anti-Kpa is mild to severe. Apparently ACOG says this antibody causes only mild HDFN. Does anyone have any references or know why the book includes "severe"? Our patient has a titer of 32 and we want to manage it like anti-K, but maybe it doesn't affect the red cell precursors like anti-K does.

For gel 2+ or less, we ask provider to allow us to send out for molecular typing if patient has childbearing potential. Otherwise, we usually interpret them as D positive but add a note that their type is weak and atypical so they may sometimes be reported as negative and other times (other places) as positive. If they have anti-D or some other reason (anti-C & anti-E?) we will choose to call them D neg.

If we get in a directed donor unit with a D00 at the end of the product code, and we want to give it to a different recipient than originally intended, do we relabel it with a V00 product code or can we leave it as D00 and cross it over to regular inventory?

I think AABB requires that stored blood products be maintained in a way to reduce errors. The old tradition (maybe there are still rules) of keeping specimens below blood products suggests that specimens spill in the refrigerator. I can't recall every seeing that happen. I've seen a few doozy spills out on the workbenches but not in the refrigerator.

Update: apparently AABB is changing this standard to an interim standard. Proposed Interim Standard Focusing on Sterile Weld for the 33rd edition of Standards for Blood Banks and Transfusion Services (aabb.org) If the integrity of the weld is complete, and the compo­nent is in a container approved by the FDA or Competent Authority for storage, then the original shall have an expiration date/time shall apply, consistent with the storage requirements for the blood or blood component. assigned in accordance with the FDA- or Competent-Authority-approved package insert for the storage container. Standard 5.1.4 applies. Regardless of the integrity of the weld, if no storage time limit is specified in the package insert or the package insert is not available, the component shall have an expiration time of 4 hours after transfer from the original container. Confused yet? I am.

I just got information back from Fresenius (now maker of Fenwal transfer packs) that their bags are good for red cells through the unit outdate but that they are not approved at all for platelets. Do you know if Charter Medical says that their bags are approved for platelets? We use their 60 ml syringes and they are listed as okay for platelets so I assume their 150 ml syringes would be but wasn't sure about their bags.

One thing we require, before using a pre-warmed technique, is proof that there is room temperature reactivity. You had this with the reverse type but that is often lacking in group O patients. It's not perfect for the anti-Vel etc. but it prevents the habit of doing a pre-warmed technique just to make reactivity disappear. It is a saline method so less sensitive, after all. Using it when you are pretty sure you have a cold can be a reasonable risk to take. Using it when you don't have a cold antibody, means taking an unnecessary risk.

Does anyone know a manufacturer of transfer packs that stipulates expiration times? I find nothing online for Fenwal bags and the box doesn't list expirations. Four hours isn't even enough so the product is still in-date at the end of the usually allowed 4 hour infusion time.

What is the expiration used for platelets that are divided into a transfer pack/bag using a sterile welder (closed system)? Do you use the original expiration or does the plastic of the transfer bag not allow oxygen transfer like a platelet bag so they have to have a shorter expiration? If the latter, how long of an expiration is permitted?

Do you know if they assessed the results based only on recipient blood type? I would think that group O patients would be much more likely to get ABO-incompatible platelets. Group O patients are known to have different bleeding tendencies for other reasons. I would like to be sure they accounted for this possible confounder, or understand why it doesn't matter.

If IS XM can be a test on the Vision, I would think it could go through the interface like the AHG XM does. Might depend on your BBIS.

How is your final product labeled? I didn't notice that in the document.

I think Texas is studying this. I have heard that the cold-stored platelets are already activated so are thought to work well for rapidly bleeding patients. I don't think activated platelets last well in your average oncology patient.

IS XM in Ortho gel uses the neutral card, while IAT XM requires the IgG card. We don't currently stock the neutral gel cards. Our small hospitals are gel-only so any IS XMs needed there are done by using the neutral wells in the ABD/Reverse card that were intended for the reverse type. They do these maybe once a year at most.