Mabel Adams

Can anyone explain the justification for irradiating liquid plasma (never frozen) used for trauma patients when we don't irradiate the red cell units they get? I know the RBCs are leukoreduced so don't contain many viable lymphocytes but there were cases of GVHD if LR units weren't irradiated. Our liquid plasma is made using a hard spin so I would think that there aren't many WBCs in it but no one seems to be able to tell me how the number of lymphocytes in liquid plasma compares to the number in a LR red cell unit. Maybe this is because the big places irradiating their plasma have their own irradiators. For us, it would nearly double the price of the plasma unit so I need justification.

Does anyone know an estimate of the number of viable lymphocytes in liquid plasma compared to red cell units? Our liquid plasma would have been made from a hard spin, I think, as ARC does not make whole blood platelets. I think that should mean that most of the WBCs go with the red cell unit and then most are removed by leukoreduction. We don't give our trauma patients irradiated red cells; do liquid plasma units have some order of magnitude more lymphocytes then leukoreduced red cell units that would require irradiating the plasma but not the red cells?

This process coats the vial #4 cells with a monoclonal antibody, not human source anti-D so, to us, it seems like just making it look like you did QC rather than really testing anything besides the camera and algorithm. I agree with Joanne that you have proved with the screen QC that the IgG gel cards work, the camera can read and the computer can interpret. If it didn't make the DAT cell suspension properly, the algorithm would flag that. We continue to jump through this hoop because our TJC inspectors probably will expect it and Ortho told us to do it initially.

We had a melanoma patient on Nivolumab = Opdivo who apparently has hemolytic anemia but his IgG was only microscopically positive and his complement was negative. Hgb 5.5. Retic % slightly elevated, absolute retic normal, immature fraction retic very high. Bili and LDH normal. Hpt <14 and responded to steroids. They blamed this drug so I hunted up this article. This was new to me so I wanted to share it. Clinical Trial Am J Hematol 2019 May;94(5):563-574. doi: 10.1002/ajh.25448. Epub 2019 Mar 13. Clinical and laboratory features of autoimmune hemolytic anemia associated with immune checkpoint inhibitors Rebecca Karp Leaf 1, Christopher Ferreri 2, Deepa Rangachari 3, James Mier 3, Wesley Witteles 4, George Ansstas 5, Theodora Anagnostou 6, Leyre Zubiri 1, Zofia Piotrowska 1, Thein H Oo 7, David Iberri 8, Mark Yarchoan 9, April K S Salama 10, Douglas B Johnson 11, Andrew D Leavitt 12, Osama E Rahma 13, Kerry L Reynolds 1, David E Leaf 14 PMID: 30790338 DOI: 10.1002/ajh.25448 Free article Abstract Immune checkpoint inhibitors (ICPis) are a novel class of immunotherapeutic agents that have revolutionized the treatment of cancer; however, these drugs can also cause a unique spectrum of autoimmune toxicity. Autoimmune hemolytic anemia (AIHA) is a rare, but often severe, complication of ICPis. We identified 14 patients from nine institutions across the United States who developed ICPi-AIHA. The median interval from ICPi initiation to development of AIHA was 55 days (interquartile range [IQR], 22-110 days). Results from the direct antiglobulin test (DAT) were available for 13 of 14 patients: 8 patients (62%) had a positive DAT and 5 (38%) had a negative DAT. The median pretreatment and nadir hemoglobin concentrations were 11.8 g/dL (IQR, 10.2-12.9 g/dL) and 6.3 g/dL (IQR, 6.1-8.0 g/dL), respectively. Four patients (29%) had a preexisting lymphoproliferative disorder, and two (14%) had a positive DAT prior to initiation of ICPi therapy. All patients were treated with glucocorticoids, with three requiring additional immunosuppressive therapy. Complete and partial recoveries of hemoglobin were achieved in 12 (86%) and 2 (14%) patients, respectively. Seven patients (50%) were re-challenged with ICPis, and one (14%) developed recurrent AIHA. Clinical and laboratory features of ICPi-AIHA were similar in DAT positive and negative patients. ICPi-AIHA shares many clinical features with primary AIHA; however, a unique aspect of ICPi-AIHA is a high incidence of DAT negativity. Glucocorticoids are an effective first-line treatment in the majority of patients with ICPi-AIHA, and most patients who are re-challenged with an ICPi do not appear to develop recurrence of AIHA.

Can anyone give my a ballpark price on purchase of an X-ray irradiator? Probably not the Raycell unless their parts and service TAT have improved and they have a smaller footprint. I need an idea if it is $50 or more like $500K. Thanks.

Also, why do all of the methods I can find still include the 37C reading? AABB Tech Manual, John Judd's book, Harmening, Blaney & Howard all reflect this (some may be older editions). Even Immucor's instructions for their screen cells include it. Quotient/Alba screen cell instructions list it as optional.

So why did we read tube screens at 37C in the old days. I vaguely remember reports of anti-E that reacted only at 37 and not at AHG. I am wondering if that was back when the enhancement was albumin.

What have you all decided will have the most impact on your usage of O red cells as we must dial this back significantly, it appears.

Thanks for the heads up. Our meeting is at noon. Oh my!

Our Red Cross says there will be an announcement tomorrow and that our rep will be available to "answer our questions". Does anyone know any rumors whether it is a national thing our just our region?

Does anyone know of a list of what's changed between the old AABB quality system and the new PROPOSED Quality Systems Framework? I don't have the old requirements memorized to know what is new in the proposed version. Or are they just wordsmithing with no substantive changes? Thanks hive mind.

ABO antigens are present on many other tissues besides red cells. I wonder if they serve additional functions in some of those tissues.

We use the Safe-T-Vues but people have to learn that they are not out of temp until the whole circle is completely red. They also have to learn not to handle them too much when applying them, especially the hot-handed people. How are you meeting the requirement for alarms on your coolers? If you are recording the temperatures at least every 4 hours, I guess that might get you by. I consider holding blood for days in a cooler to be storage not transport so alarms are required (or Q 4 hour temperatures).

When our air ambulances give blood, it is wrapped into the charges for their service. I don't believe they charge by line-items. We bill the flight service for any units used. I don't know how it would work with a ground ambulance. We have contracts with the flight services that covers this. If they use the blood we supply to them to fly a patient from a scene to a different hospital, they tell us who the patient is (Name, DOB at least) and we enter them into our BBIS (SafeTrace Tx) even if they have never been registered in our HIS. We have a protocol to assign them a fake MRN to keep STTx happy. This might not work with Meditech because the BB module doesn't have separate patient registration capabilities as I recall. If the patient has a record in our HIS, we use their established MRN but create a visit in STTx. We manage final disposition for all of their units. It is in the contract that any recall will be sent to them for follow-up with recipient. This has never been needed.

Thanks for this. It took me a bit to realize that I could choose 2 shifts by holding the Ctrl key. The wages only allow one value, but I was able to put the wage range in the body of the description so it worked.

We state that they should start the transfusion within 30 minutes, but that is not a "must", just a recommendation of good practice. If they ask us, we will say that the blood should be infused within 4 hours of issue, but they probably use 4 hours of start of infusion sometimes. I think this falls under the practice of medicine, although it might matter what the SOP says you are to do.

The prediluted cells from Ortho contain the antibiotic nitrofurantoin as I recall. I think that contributes to why they are to be kept in the dark as that drug is always dispensed in a brown bottle. Patients make antibodies to the antibiotic and thus react in the prediluted cells. Diluent 2 lacks preservatives because we can't store the suspensions over 24 hours so 3% cells suspended in it don't react with antibodies to the antibiotic because the antibiotic isn't present. In my experience, the antibiotic doesn't seem to wash off of the cells but rather adheres to them. What you are doing is a great way to prove that this is the problem rather than a cold antibody etc. Most of our patients who have this, continue to have it for years to come.

I am so sorry for all of your losses. I hope life gets a bit easier in the coming months and years. You provided much help and support on this site for a long time. We are glad to have you here if you choose to join us.

Does anyone know a source for rubber (or similar) weights for balancing centrifuges used to spin units. I seem to remember round circles of different thickness of rubber from decades ago. Thanks.

Was this the case that was written up once in the CAP survey educational information 15-20 years ago? I've always remembered that it was a B pos patient. Although I think in that story the receiving hospital typed him as B (didn't notice the mixed field or assumed it was O given to a B patient) and kept giving B blood until he expired.

Years ago in a hospital far away we had a blood refrigerator in the OR central core. I received a stat T&X specimen from OR and proceded to complete the work. I got a blood product request from from OR before the workup was complete so I phoned to notify them that I would not send the blood until the crossmatch was done (of course they could have requested uncrossmatched which they didn't). Not much later I got a call from the nurse anesthetist and her voice had terror in it. She said that she had spiked a unit that was in the fridge to hang on the patient (O pos) I was still testing and then she checked ID against the unit and discovered it was for a different patient (A pos). then she called me fully aware of how close she had come to hanging A blood on an O patient. The OR had a bad habit of not returning units to the blood bank from surgeries at the end of the day and the A pos unit was for a patient who had surgery the prior day. They were the only units in the fridge so she assumed htey were for her patient. The OR desk must not have relayed the message about the delay. There are ways and processes for making remote fridges safer (although TJC recommends against them) but that hospital promptly removed the fridge from OR and we started issuing blood in coolers with the patient ID on them that could be taken to each room. They were much better about returning unused blood and we were aware if a cooler had not been returned so could call for its retrieval.

To save time in my verification process, I am looking for what settings others use for spinning down a blood unit in a Hettich refrigerated 420R centrifuge. Thanks.

I read an article a few years back that showed that blood really didn't do anything terrible if it got a few degrees outside of our range for a bit. That gave me comfort for dealing with these slight deviations. That said, we once had a nursing unit return a unit of plasma that they found in their meds fridge a month or so after we issued it.

Our lab manager wants to have blood bank share a refrigerated centrifuge with Micro that we use for occasionally spinning down units to remove the adsol before adding plasma for neonatal exchange transfusions. Micro would have their own buckets (with lids) and they would use it to spin down AFB specimens. We have to replace our old one because it won't hold temp anymore. This bothers all of us blood bankers but I can't find a regulation to give her to say we need our own centrifuge. Any advice or leads on a regulation I can quote?

Wow! We are having trouble getting enough applicants to our lab jobs. Half of our Micro department decided to retire this year. Other lab scientists are moving to be closer to family. Pandemic effects maybe?