Mabel Adams

Ortho gel is known for picking up weaker D antigens than some tube reagents. I know that Quotient/Alba anti-D blend reacts more like the Ortho gel but the Immucor Gammaclone doesn't pick up those (mostly) weak D types 1 & 2 at IS. They will show up positive at AHG phase with Immucor. John Judd published a paper, which many follow, of considering anything 2+ or weaker in gel as Rh negative. I assume if you take the tube testing through AHG you will get a positive. Doing that will help troubleshoot the situation. None of this probably has much to do with the transfusion reactions. Rh typing of weak and atypical D antigens is a complicated mess both serologically and the terminology. If these are young females, we try to send them for molecular D typing.

Does anyone have a good, current information sheet for patients regarding risks/benefits of transfusion that they could share?

We have sent out a test for the antibody plus ARC wanted us to do a high sensitivity test for the antigen so we are doing that. One of the providers wondered if she should wear a medical alert bracelet. I was a bit ambivalent because I wouldn't want anyone to be afraid to transfuse her if she really needed it. I said the wording should be to avoid transfusion unless life-threatening emergency and prepare for possible anaphylactic reaction if transfusion needed. Of course, this is only if she has the antibody and maybe then it is excessive. Thanks for your input. I welcome additional information.

I felt that the section on segments surely applied only to RBCs. Do you think that means the whole standard does? To me it implied that the other parts applied to non-RBC containing products but I'll be happy to assume it is for RBCs only.

We have just learned that we have a 32 week pregnant IgA deficient mom admitting tomorrow for observation for the next 2 weeks with plans to deliver at about 34 weeks by C-section because of placenta previa and vasa previa. There is no record of anti-IgA testing that we can see. This is not her first pregnancy--G3P2. She is about 30 years old and was identified as IgA deficient 5 years ago. She is donating 2 autologous RBC and FFP units. I assume there is no extra risk for the baby. We are 3.5 hours' drive from our blood supplier. Any advice appreciated as we create a plan for dealing with possible hemorrhage.

I moved them to Hem at my prior workplace but not at the current one. Hoping the Hem analyzer someday has flow cytometry method for it so then it will go. The more adult cells you count, the more accurate your result should be but otherwise the math is proportional as mentioned above. We use a Miller disk (like for manual retic counts).

Epic/Beaker/SafeTrace Tx. There are some quirks of moving specimens between our facilities and outpatient orders that Epic and STTX sort of fight over. We had to make some special settings in our interfaces to make them play well together. We are using BPAM and scanning blood is working pretty well. We are still working the bugs out of scanning for MTPs--mostly user error. It works well in OR but the humans have trouble getting it all right in the ED and ICU sometimes. Also, some MTPs are so fast they can't keep up with the documentation in real time. Lastly, BPAM in an MTP pretty much requires 2 nurses to manage transfusions and not every place has that many people to use for just the transfusions.

This makes me look at Std 5.11.4 "Retention of Blood Samples: Patient samples . . . shall be stored at refrigerated temperatures for at least 7 days after transfusion." Do you still have the specimen drawn on day 1 of admission 7 days after platelets were transfused on day 15 of admission? We keep our specimens 17 days after last use due to our pre-op policies but I have never looked at their storage with FFP or platelets in mind. I doubt that we think we are "using" the specimen when we issue platelets so we don't move it forward to the current day's rack so it gets saved for 7 more days. Besides regulatory nit-picking, what is the risk to the patient if we no longer have the specimen (that we collected and typed early in the admission) 7 days after the platelet or plasma transfusion?

"Establishments must be registered and products listed within 5 days of beginning operation, and annually between October 1 and December 31. Blood product listings must be updated every June and December." is from https://www.fda.gov/vaccines-blood-biologics/biologics-establishment-registration/blood-establishment-registration-and-product-listing. Does anyone know what we were required to do in June? If nothing changed in our product listing was I supposed to have done something on the CBER site in June?

Our supplier won't rotate WB. We would have to schedule our shipments for probably every 2 weeks which means the units have only a few days before expiration by the time we get replacements (after accounting for testing days before they can be distributed plus transport time). Trying to use these up as packed RBCs with only a few days left will likely mean they are given to any blood type. If we stock them on our helicopter they won't be settled when we want to pack them. I have seen some smaller refrigerated centrifuges that look like they will spin blood units. Has anyone used a Rotina 420R from Helmer for blood units?

Can you keep a thermometer on it to make sure proper temperature is maintained? Or validate that it is in range? Those old serology/RPR rockers used to have a motor that got hot in the middle so we had to put a rack on it to keep the platelets away from the motor (this was probably 30+ years ago).

That's what we do with age 50 for women. A bit of confusion now with extended gender choices in Epic but we haven't got a way to identify MTF trans patients adequately. We don't change to type specific (other than matching Rh) until we have crossmatched blood but that is because of the fear that they will think uncrossmatched is always universal donor so don't think they need to check ID when they hang it. I keep hearing people express that thought. "What, you need patient ID for me to pick up blood in a massive transfusion?!?" "Yes, this is crossmatched blood." This is on a day when we had multiple MTPs underway. KISS principle here. Some exceptions include a young female A neg when we have used all of the O neg units.

We don't worry about Hgb S in neonates except for exchange transfusions for which we request it. I've heard the same about the LR filters but don't have true evidence.

I'm reactivating this topic because it has come up again. The AABB Guidelines quoted above are over 15 years old and the only reference in them that says not to use for platelets is to a specific blood warmer's operation manual. Does anyone know of any studies with modern rapid infusers like Belmont RI-2 and Level 1 regarding infusion of platelets and cryo? It seems like they should be safe and it really helps with the workflow to use them but we need evidence.

Some of the success of WB may be due to the reduction in crystalloid rather than the whole blood itself. I look forward to more good studies being published.