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Mabel Adams

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Posts posted by Mabel Adams

    On 8/1/2024 at 10:26 AM, jshepherd said:

    With BiologID, there is an option to add an interface so that your BBLIS data adds to Biolog's data, which means that once you assign the units to the patient they were removed for, it will also show up in Biolog. We still have to issue the units in our BBLIS, they're not connected in that way. Our ED charge nurses call the BB with the patient MRN, we give them a code to access the fridge, and they take what they need. Yes, we basically emergency issue the units in Softbank with that MRN we are given, and use Biolog to know exactly which units were removed from the fridge for that patient.

    I am actually working with Biolog to set up a system to remove that phone call to us, so that the RNs can enter the patient MRN on a tablet, it will give the fridge access code, and there is more streamlined access to the blood products, but we still get all the info we need for our tracking and systems. 

    Does the access code change every day or hour or...?

    Resurrecting this old thread to ask what problems you all find with either a simple blood fridge in ED or with a Haemobank.  We plan to get a Haemobank eventually but if we would just have the same problems with it that we would have with a simple fridge in ED with a few units in it, then the cost benefit ratio is poor.  I am most concerned with keeping nurses trained to use it in a not terribly busy level 2 trauma center.  We have an MTP that uses over 6 RBC units about once every 3 months.  I worry that they will take out O neg for males, take units out for too long then put them back or waste them, not label the units for the patient (with Haemobank) and that it will keep the units far from us so we can't use them up on other patients (mostly 5-day plasma for this concern) without a trek to the ED to swap them.

    Posted

    Yes, this again.  OR wants to use it; the circular still says not to.  Does anyone have any definitive data that allows the use of Lactated Ringers solution in blood infusions?  I see one small study out of Canada in 2009.   I'm not sure how it could be allowed when the Circular of Information specifically says never to use it.

    4 hours ago, jtemple said:

    I haven't seen a rebuttal but the FY system is reported to be a problem with storage. It was reported by :

    Williams D, Johnson CL, Marsh WL. Duffy antigen changes on red blood cells stored at low temperature. Transfusion. 1981 May-Jun;21(3):357-9. doi: 10.1046/j.1537-2995.1981.21381201813.x. PMID: 7233520.

     

    We had to purchase a set of screening cells from a different vendor for DTT treating cells for Darzalex patients because when we validated it, the Duffy antigen we were testing didn't survive the process consistently.  It was fine on Alba cells but not on Immucor cells.

    Posted

    Some of you more "experienced" people will remember the little saws that we used to score the microhematocrit tubes so we could break off the part with the immature red cells for antigen typing someone who had been recently transfused.  What the heck were those saws meant for originally?  I feel like they came with something else in the lab.  Were they for general chemistry glass tubing?  Also, what tool works well now for scoring the plastic-coated glass microhematocrit tubes since those little saws aren't available?  I found a few centimeters of staples (ready to be put in a stapler) could work.  Hack saw blade?

    Posted

    What's a high frequency antigen that might be weakened on expired reagent cells, reacts in Ortho MTS gel testing (about 1+), including when 3% cells are converted to 0.8% to run in gel but not in PEG? It does not react in MTS gel on 2 expired 3% reagent cells converted and run in gel but did react with 3 in-date cells converted to 0.8%. It does not react using 30-minute PEG with any cells in a 16-cell panel.  DAT is neg.  No recent transfusions; 51 y.o. fe with a lacerated spleen from being thrown from a white-water raft onto a rock. Hgb staying stable enough. O pos. "Race: Other White" and she is from Arizona. I would think it was antibody to the gel diluent in prediluted reagent cells but then the converted cells using diluent 2 should not react.  I am tempted to trust the PEG results but thought I would ask.

    Posted

    Someone online said that anything not in an FDA-approved kit or reagent system purchased from a vendor is a lab developed test and thus subject to the new FDA rules, including all those ancient procedures that are in the methods section of the Technical Manual. I could argue that the titer procedure is really just specimen treatment, not a test different from any other tube AHG test.  Generally, the tube AHG tests are defined in the manufacturer's instructions.  Is saline replacement a test?  I wonder what the Lab regulatory bodies will say about the new rule in regard to BB tests.  Anyone have any extra knowledge about this for BB?

    Posted

    If the Kleihauer calculations are for seven (or more) 300 mcg vials of RhIG (assuming persistent fetal Hgb and weak D have been ruled out), are there precautions for giving that much?  Is it effective?  Is there a number of vials that is just too many? I have heard of concerns for hemolysis, which are sometimes mitigated by spreading out the IV doses and by giving steroids.  I vaguely remember the idea that over a certain number of doses it may be hopeless.  Is the approach different if due to transfusion rather than a FMH? Does anyone have any actual guidelines or evidence?

    5 hours ago, Malcolm Needs said:

    In that case, I think that you would have been justified to have given "straightforward" D Positive blood in terms of a transfusion.  This is based on two papers from experts on the subject.

    Sandler SG, Flegel WA, Westhoff CA, Denomme GA, Delany M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD.  It's time to phase in RHD genotyping for patients with a serologic weak D phenotype.  Transfusion 2015; 55: 680-689.  DOI:  10.1111/trf.12941.

    Sandler SG, Chen LN, Flegel WA.  Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype.  British Journal of Haematology 2017; 179: 10-19.  DOI:  10.1111/bjh.14757.

    My own mentor, Joyce Poole told me that Weak D Type 1 individuals rarely produce an anti-D after transfusion with D Positive blood - although she had come across about three or four cases WORLDWIDE!!!!!!

    Can not even Weak D type 1 patients be consistent in their ability to make anti-D?!??!  I still don't know why we got such different results than previously in gel. I verified that Ortho didn't change the anti-D clone in their gel cards between November and now. I guess this patient just wanted to mess with us.

    1 hour ago, applejw said:

    I have experienced ABO mismatch accidents three times in my career.  Twice the recipients were Group O with reduced isoagglutinin titers and received between 2 and 4 units of Group A RBC.  The other was a middle aged male that was A Pos receiving 8 units of Group B RBC during heart surgery.  The Group O patients experienced an immune boost of their anti-A titer and quickly removed the incompatible RBC from circulation.  The A patient who received 8 units of Group B RBC developed DIC intraoperatively but survived.

    I have also experienced a situation where the Group O inventory was reduced to less than 5 units during a liver transplant and major trauma.  It seemed that every patient that needed a transfusion was Group O that day and we ended up harvesting blood from the liver donor and processing it to transfuse to the liver recipient to save the remaining units for other patients.  Fortunately, we restored the Group O inventory quickly.  It did not happen in the face of mass casualties or the level of shortages seen during the COVID shutdown. 

    These experiences are very useful for anyone considering this as a possible deviation from normal processes in a dire emergency.

    Maybe some of these references are helpful. 

    7. Selleng K, Jenichen G, Denker K, et al. Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: A prospective, single-centre, observational study. Lancet Haematol 2017;4:e218-24.

    8. Frohn C, Dümbgen L, Brand JM, et al. Probability of anti-D development in D– patients receiving D+ RBCs. Transfusion 2003;43:893-8.

    9. Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, et al. Prospective evaluation of a transfusion policy of D+ red blood cells into D– patients. Transfusion 2008;48:1318-24.

    10. Tchakarov A, Hobbs R, Bai Y. Transfusion of D+ red blood cells to D– individuals in trauma situations. Immunohematology 2014;30:149-52.

    11. Yazer MH, Triulzi DJ. Detection of anti-D in D– recipients transfused with D+ red blood cells. Transfusion 2007;47:2197-201.

    12. Burin des Roziers N, Ibanez C, Samuel D, et al. Rare and transient anti-D antibody response in D(–) liver transplant recipients transfused with D(+) red blood cells. Vox Sang 2016;111:107-10.

    13. Yuan S, Davis R, Lu Q, et al. Low risk of alloimmunization to the D antigen in D– orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion 2008;48:2653-5.

    14. Schonewille H, Haak HL, van Zijl AM. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion 1999;39:763-71.

    15. Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010;134:202-6.

    From this: Association Bulletin #19-02 - Recommendations on the Use of Group O Red Blood Cells (Revised) (aabb.org)

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