Mabel Adams

I have a feeling a lot of ORs would quietly exempt themselves with a pair of scissors!

The Tech Manual says to use saliva from known secretors and non-secretors as controls. It also lists under "Reagents", "Human (polyclonal) anti-A and anti-B. Note: some monoclonal reagents may not be appropriate for use, therefore, apprpriate controls are essential." Saline is also run. The anti-A used is diluted till it produces a 2+ agglutination. For testing the A substance only, I would have 4 tubes: 1) known secretor's saliva +Anti-A, 2) known non-secretor's saliva + anti-A, 3) saliva being tested + anti-A, & 4) saline + anti-A. After these incubate, A1 cells are added to each tube to see if the A substance in the saliva neutralized the diluted anti-A. Now that I have thought it through, only the non-secretors would produce agglutination so in a way that is actually the positive control--at least in my brain.

OK, I am reading the secretor procedure in the Tech Manual. I don't have anti-Lea nor anti-H lectin, but I suppose we don't really care about anything but A substance for this experiment. My only source of polyclonal anti-A would be a patient or volunteer. I can come up with a positive control secretor, but not sure I could come up with a negative control. The other problem I have is time. Does anyone have any of that to loan me?

Shily, your question about the A substance is interesting. Marilyn, is it possible that the A substance in the serum used to dilute the anti-A1 lectin could adsorb out the lectin in addition to the other cause of weakening that you mentioned? Maybe I could do some experimenting because I am married to one A2 that is Lea and Leb neg and I gave birth to another. I am A int and Leb pos so my daughter could be a secretor. I am not sure I have time or materials to do secretor studies on them, but I could probably provide someone some samples. I could do the A1 lectin dilution with my husband's A2 (possible non-secretor) serum/plasma and see if reactivity drops off like it does for everyone else.

"American Association of Blood Banks" lends some recognition or credibility to a regulation or other information for a layperson. "AABB" tells them absolutely nothing! There has got to be a better way to be global and inclusive than to make your name meaningless. How about "All-around Association of Blood Banks" or even "All-star" or "All-the-world" or "Amalgamated" or just about anything else. Or change the letters to GABB-Global Association...

Marilyn, I heard you had retired. Glad to see you aren't just tending roses or touring Europe but have stayed to keep all of us blood bankers educated.

Bob, this simply won't work. What are you going to do with your repeat patient who has had his forehead blown off? Where is your chip then, huh??? Name me a body part you can attach it to that will never be injured or surgically removed. You can't even imbed it in the brain, as we all know of some people that seem to lack that organ. Keep trying. I am sure you will think of a sure winner yet.

Almost all blood that leaves our lab goes via pneumatic tube in plain zip-locks (they are way cheaper than bio bags in addition to their not mistakenly labeling the blood as biohazardous). So far the few units still picked up go out "naked", and probably still will--until one breaks.

We haven't seen any software police yet.

OSHA actually lists tested blood products for transfusion as specifically exempt from the Biohazard designation...or did last time I checked. Bob, when was that we were looking that up? Last year sometime? I can't find it on the AABB site where I think I posted it.

Did the audioconference touch on any ways to meet this requirement without doing 2 blood types on separate specimens or adding a high tech or barrier system? In other words if you have a good system--even if that is only that your phlebs do a consistently good job--so that you can give some evidence of a sufficiently low error rate will they accept that?

Also, do you use monoclonal anti-A reagent? How strongly does it react with A3 cells? Is it as weak as with human source anti-A?

Shily, you do great with English! It seems like the only things we have trouble understanding are things that are done differently in your country--not your English. Even if some syntax isn't perfect, you get the main ideas through clearly. I am impressed by your willingness to join this forum as a non-native speaker. You are educating us about ways things are done in other countries' blood banks. Thanks.

We treat the cells with EGA to remove the antibody, then proceed with the weak D test. We haven't had to do one for a long time.

If we only have to do this in "non-emergent" cases how are we defiining this? Are all stats emergent? I believe from the debate about computer crossmatches, it was established that we can charge for the second blood type, right? Seems like it will be time-consuming to verify that the techs are actually doing the second type on all patients without historic types and non-emergencies (and AB Pos ladies over 104 years old with red hair...or whatever else CAP dreams up).

Except for the new CAP item (50575 or something) that seems to strongly suggest reyping patients. On the AABB site I asked if anyone was planning to meet this requirement by doing anything other than retype the patient and no one answered. This CAP requirement is the one I have to meet. I may choose a method that also meets the electronic xm requirements because we may want to go to it anyway if we have to do all the work. As for other techs doing the blood type--they already have full-time jobs and we are understaffed as it is. It isn't whether they are capable opf learning, but whether we can further disrupt the workflow of the whole lab to pull them into BB. Not that this is impossible, but we will be begging if management and the other depts don't buy into the necessity.

Bob, whose CCC do you use? Mine are apparently at least partly Rh pos so don't work well in your recipe--it comes up weak pos to 1+ at IS with anti-D. The other recipe is, as we would expect, rather more mixed field, but workable. Thanks. My supplier sends out their donor testing so doesn't have many weak D samples either.

I am trying to figure out a way that a small place can do anything meaningful with the new retyping rules. We seldom have more than one tech working BB and on nights have at least some time when there might be only one tech in the whole lab. Weekends occasionally have only one tech trained to do BB on duty for at least a few hours. Do I try to have the second type done by another tech maybe hours later--maybe flag the units that they can't be issued till the repeat is done??? Or do I just meet the letter of the law and have my same tech toss the cell suspension and repeat the type himself? I don't really want to have separate rules for different shifts, but I also want extra work to provide some meaningful benefit.

I inspected a hospital lab for CAP last Friday. They only store and issue blood that is crossmatched remotely. All the crossmatch questions were in their checklist, yet it said it was a customized checklist. They were missing the donor and tissue and parentage sections as I recall. (Or maybe parentage is separate now anyway.) BTW, we inspected on Friday and the end of their 6 mo. inspection period would have been this Mon or Tues.

I am so glad to see that St. Baldrick's is a legitimate charity (over 88% of funds go to programs per Give.org). I was afraid it was someone's spoof on Cliff's appeal for the heart association. The internet seems to have fostered a culture of mean-spiritednes--often hidden by anonymity, but there is no call to decrease civility and plenty of reason to increase it! Even if we disagree we can be kind and civil about it, no? OK, off my soap-box.

What system are you on? We did manual BB billing, first entered straight from a free-standing BBIS billing print-out to the billing computer--then manual entry into Meditech. Now we have the BBK module of Meditech so I have built it that way too. It was pretty labor-intensive to do manually and required someone that understood the system.

My impression of the customized lists is that they are not very narrowly customized. I do nothing to modify products but pool, aliquot and thaw but all the other unit prep stuff is always on my list.

On another student mock sample need: does anyone have a good recipe for faking weak D blood?

Hi, Nonaof 2, Although it would be unusual for someone working in the donor center to know your blood type as soon as you donated, maybe it is in your records and he was referring to that. I will take a guess at what he was referring to. There are subgroups to the A blood type; the more common ones are referred to as A1, A2 and A3. There are also some others. The link below has some information on subgroups. If that doesn't help you, I'd suggest calling the blood center where you donated and asking to talk to the lab. A Clinical Lab Scientist there should be able to answer your questions. There is no need to worry about needing a transfusion if you have a rarer subgroup of A. You can be given O blood and possibly A as well. Thanks for being a blood donor! Post again if you can't find what you need. http://www.owenfoundation.com/Health_Science/Blood_Group_A_Subtypes.html PS BBers: this is a pretty decent site I just posted the link to.

Sometimes by adding requirements, be they bands or identifiers, we just create more things to check and more ways to make mistakes. Case in point: we recently ceased providing a transfusion slip with our units. Now we don't have to check that against the unit when we "dress" it or issue it. Nursing makes up their own forms for the chart with the info that used to be documented on the slip. We no longer get back a copy of anything and the computer puts the units in as "presumed transfused." The nurses were kind of confused by not having more paper to check at the bedside with another nurse, but I think it puts the focus in the right place--does this unit match this patient? Sorry, bit of a tangent. Hope someone besides me can see how it relates.