Mabel Adams

Do you find gel DATs to be a lot more sensitive than tube? We certainly pick up a lot of auto controls in manual gel but the sample tested by tube DAT (IgG) is negative. I would not be thrilled to do eluates on all those that are recently transfused unless it was going to provide me some pretty meaningful information. This is why I have hesitated to use gel IgG cards for DATs.

Anna, I think the language issue is a nuance. We might say we did "doubling dilutions" but I hadn't heard the verb form that I can think of--it seemed an understandable extension, so I knew what you meant after a second's thought. Of course, I am an old blood banker who was taught things like ASO titers in school. One of the nice things about this forum is that it is open to us as well as generalists and those from different backgrounds. I enjoy your unique perspective.

I wonder if so much testing for a baby that isn't even yellow can be a justified use of resources. I think more limited testing was recommended in the Perinatal Guidelines book that AABB put out.

Apparently the database from Hematrax that my supplier uses has 7 day plts as "pheresis" while the ICCBBA database has them as "apheresis", but the FDA has switched its policy and, even though the blood supplier's labels had been given FDA approval it is now acceptable for certain label changes (like from "pheresis" to "apheresis" ) to be made without resubmitting the labels to FDA for new approval. I am a little vague on this, so you will want to clarify with FDA if this affects you. Anyway, we can have all the new labels say "apheresis" which is the ISBT way, according to my email from the FDA matt person and clarification from my blood supplier.

One other reason that the FTOW fails is that management expects we can all keep doing our regular jobs (usually short-staffed) and still have time to invest in this project. I remember a teleconference on Six Sigma that talked about training leaders and assigning them to that work for a period of time, but our boss wanted to do it on top of everything else we were doing. The resources must be provided or the process simply won't work as advertised.

Our blood supplier switched to ISBT last week. We are getting "transitional" labeled units from them now and they say that as long as they could import a codabar unit, we could continue to see them. There are 3 permutations of transitional labels, one very short-term and the other two for imports--either that they then modify or not. Whatever the original unit number, it stays on the unit. An ISBT unit number may be added as well. The product code stays codabar unless they have to modify the product. I am trying to settle the nightmare now that one ICCBBA database for label priniting (not the product code database that I have looked at) lists 7 day plts as "pheresis" and 5 day plts as "apheresis" and I have to get my pre-pprinted labels printed the right way. I hope to get some answers soon. If anyone out there knows the answer, let me know.

I think CAP started requiring a repeat ABO on the post sample in the last couple of years, regardless of the nature of the reaction (other than allergic).

Sounds like it would be mostly used for antigen "typing" donors but would also be good for sickle cell patients--you could get a complete genotype even if they had been transfused. It might be good for testing dads of babies of sensitized moms because you can get a genotype, not just a phenotype--or even the cord blood when indicated. The turn-around-time is too long for routine use in a transfusion service, I would think. Correct me if my understanding is wrong.

I personally still consider 50 a young female--until next year when I will consider 51 to be young.

Have any of them mentioned problems with the fact that MT can't keep the division information of a divided product if it is further modified (like irradiating an aliquot or thawing apheresis FFP that is a divided product)? I can get by at my hospital because it will only affect rare FFP that the supplier makes into 2 products because it is high volume, but places that order in aliquots or need to make aliquots and then irradiate the aliquots are having fits with this. My center switched to ISBT last Tues. and we are starting to get units--some with transitional labels and some full ISBT. I guess I will see soon if I thought of everything in all the preparations.

And computer systems sometimes have a hard time dealing with exceptions. Likewise, if you use the Hollister banding system that has "band cards", it might have been discarded unless you take pains to avert that. The whole thing becomes an outlier if you don't have a regular policy for extended times. It is very hard to keep all of the pieces in the right place for such exceptions.

I saw anti-D,C & E from plts in an adult male with lymphoma some years back. Recently we have an elderly female O neg patient that got about 6 apheresis units of Rh+ plts before we ever had to crossmatch her. She has a 4+ anti-D and a weak anti-C, but she may well have had them for years. Other than adding some delay and costs of IDs and antigen typing (not for D), it doesn't cause the patient much harm. It isn't like it is hard to find compatible blood for them. We reserve RhIG for young females.

It's a microarray using molecular methods, I think.

They can't very well use pre-printed expiration dates .

http://www.kingbiomed.com/ This one takes donors it looks like. Best of luck.

Haematologic Technologies, Inc., 57 River Road, Unit 1021, Essex Junction, VT 05452 USA Tel: (802) 878-1777 Fax: (802) 878-1776 Email: hti@haemtech.com Web: www.haemtech.com You can talk to these folks. Maybe they would have info for you. They make factor deficient plasma from normal plasma so I don't know if they need any deficient donors.

I always assumed that factor-deficient plasmas were made by absorbing out the factors from pooled normal plasms, not from factor-deficient donors. But I guess I don't actually know. Any coag experts out there?

What might be the mechanism that makes a DAT interfere with the Fetal screen test? The indicator cells are coated with anti-D, not anti-IgG, right?

Our system will truncate the name on the patient's hospital armband and addressograph "chip" but have the whole thing in the computer and usually on the specimen order labels. Usually our phlebotomists call down to ask what they should do. I will accept either the patient's full name or the truncated version, although it is a significant part of the picture to know that the name has been truncated and that the phlebotomist recognized this. We use the name, Medical Record number and a specific BB armband number for ID. My theory is that the reason we reject spelling errors is because we feel they suggest an error in ID of the patient. This case is not an error, just the best we could do given the limitations of the computer. At least that is my take on it.

I've checked with several companies and just placed an order with Shamrock for preprinted product code labels. Once they make my custom labels they will become stock for the rest of you. They got mock-ups emailed to me within a day and I should get the labels in 2-3 weeks. It was painless because I only had to tell them the product code (E4024 etc.) and they made them to their usual format. Price was the best I found too.

I have now done pretty extensive research on pre-printed product code labels and have just placed an order with Shamrock for several custom labels--which will become stock now that someone has ordered them. For me they had the best price, because almost anyplace I got them I was getting a 20+ years' supply so the price per label was less important than the capital outlay at the moment. The only ones I needed were for irradiated products. They got me mockups of the product codes I wanted emailed to me within a day. I should have the labels in about 2-3 weeks. All I had to do was tell them the ISBT codes and they plugged them into their usual format. Someone in our little Meditech hand-holding group pointed out that even those with the ability to print them might still need some for downtime. The divided product labels should be a real joy--maybe an inkpen will do till the computer comes up. Someone with a free-standing printer should go into the business of printing off batches of 20-50 labels for small places. With so many different possible codes we will use up fewer of each. Maybe there is more to it than I think, but I wonder why so many label companies are so expensive.

We had a patient this week that was in a couple of years ago. At that time, She had a remote transfusion a couple of years prior, then she had been transfused about 7 units about 3-4 months prior, and then 2 units only about a week before. We found a 2+ DAT (IgG), reactivity resembling anti-D in gel (she is O pos) and an eluate with a panagglutinin. (I find that a lot of autoantibodies in gel prefer D pos cells.) The place that transfused her just prior had found similar results and had antigen typed her pretty extensively and gave her D neg units. She is negative for K, C and Jkb. Now she has a negative DAT in tube (still weakly pos Auto control in gel) and her screen is postive. ID showed reactivity only with 3 Colton B pos cells and one other cell besides the screen cell (which has not been tested for Cob). All the usual suspects could be ruled out with multiple double-dose cells. Has anyone ever seen an anti-Colton B by itself (well, with another Ab to a low-freq). I'm sure it is possible--especially if a screen cell is Cob pos so you can find it. Here's what my fertile mind is stewing on: what if she made an anti-Jkb plus the currently detectable antibodies, but its titer dropped too low to detect. I can't really quite make a case for giving her Jkb- units on this basis, but I would appreciate knowing other's more extensive experience with such cases. She came through surgery okay and is unlikely to be transfused during this visit.

AABB published Guidelines for Perinatal Testing (or some similar wording) which is based on Judd's work and makes a very clearcut case for policies in this area. There also was an article by Judd in Transfusion several years ago that covered most of the same territory. The only other point I would throw into the pot, and it is also not sure-fire, is that massive FMH could leave an anemic baby. Not always, as FMH can be more of a slow seep than a gush so the baby has time to make replacement red cells so is not anemic. So, if you get this picture with an anemic baby, you might feel the possibility is weighted toward FMH more.

The fetal screen is positive because the mom has a weakly pos D antigen. The neg Kleihauer tells you that there really are not fetal cells present. The fetal screen measures D antigen, while the Kleihauer measures fetal hemoglobin. Determine the dose based on the Kleihauer. If you use the formula in the Tech Manual you will round down to zero and add one dose, which says to give the patient 1 dose. Two doses shouldn't hurt her. Anyone that is recommending RhIG for weak D moms needs to have a policy addressing these cases so techs don't go nuts. Even if you give up doing weak D tests on moms, you still need the policy because you will find out they are weak D pos when you get a pos fetal screen and a neg Kleihauer.

"Hello to everyone again. I have relocated to Portland, OR as of September 07, from the Detroit MI, area. Good to be in the wild West again where I can see mountains, as I'm a native Coloradoan! Just checking in to see if there's anyone else on the board from this neck of the woods. MJD :D" Are you at OHSU or one of the other Portland Hospitals? I trained at the med school.