Mabel Adams

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.

MaryJo, I am still an Oregonian at heart and hope to return someday. Where have you moved to?

There used to be a thought that you could switch back to the original type from O as long as the patient still reverse typed as his own type. No one ever made real clear whether one should take the reverse through AHG looking for those high-titer O donors but with the small volume of plasma on Adsol units, I would think it would not be necessary. One other thought: if you have a situation where chaos reigns (maybe multiple traumas all with the same last name), keeping on with the Os just due to the risk of mistransfusion is worth a thought. John Staley made me think of this once with regard to units shipped in helicopters with patients. The flight crew was going to assume the units in the cooler/box were for their patient--but what if someone handed them the wrong cooler with type-specific blood (for someone else) in it.

I know of a place that did a test on all cord specimens to verify that they were entirely cord blood and not partly maternal blood (a fetal hgb test of some sort--kind of like the old APT). A mixture of mom and baby's blood could also give some interesting results at times. I bet it's pretty rare. I hope my techs are paying attention to the mom's blood type--certainly in RhIG situations and if DAT is pos.

Cliff, I just tried to cut and paste the pertinent part, not do it as an attachment so that is why I failed I'm sure.

The most recent thing I read said to bank it with a public cord blood bank as a donor and not with the private cord banking companies. I believe that Presbyterian Hospital in NY was one of the pioneers. Their website probably has info.

It seems to me only one manufacturer makes the C3d alone. We use the combo.

If the mom is O and the baby is AB with a pos DAT, I guess there could be more than the usual circulating antibodies involved--both anti-A and anti-B (or more probably anti-A,. I guess it's more a matter of the same antibodies having more antigens to attack and the techs wondering if there is a specimen mix-up. Also, a baby can be homozygous for an antigen the mom has antibodies to if she is not the genetic mother. That's about all I have ever heard of about it. It might be more difficult to find units for an exchange transfusion that are compatible with the baby as well as the mom's antibodies--but that happens with genetic moms sometimes too.

I'm just glad that most of the antisera I keep are monoclonal and don't require AHG testing. Sidesteps the problem for all but anti-Fya. (We only keep common antisera.)

Thanks. This is what I was remembering about it being rescinded. I tried to paste the content of the FDA letter here, but it won't let me--probably because it is a pdf file. You have to scroll down the page of the geocities site to find the FDA letter link.

We do a visual check of our MTS diluent daily. We had a dispenser get contaminated with yeast--very hard to eradicate. We replaced it. Now we clean the diluent dispenser weekly with sterile DI water and a few other tricks to minimize contamination. We run a pos and neg plasma sample with a unit made up in the diluent so it mimics the reagents used in patient crossmatches.

A ballpark price I got for the Echo was ~$95,000.

I agree this is not a problem for tranfusion services but is for donor centers. Do US donor centers always do DAT or Auto control as part of donor testing?

I thought the FDA rescinded that. There was a big discussion of it on here or the AABB site a few years ago and someone got to the bottom of it with the FDA, I thought. Where is Bob Currie when we need him? Out playing with his trains I guess.

I have only heard of cases where the baby has a blood type that makes it appear that it can't be its mother's child. For us it would be so rare that it is only worth a mention in the Notes section of the SOP.

http://www.shamrocklabels.com/ They have an online catalog that you might be able to get label samples from. The expiration labels on it are JAN 2010 so might work for frozen red cells or if your system doesn't limit future expirations.

We thought about doing it but determined that the adhesive didn't stick well at refrigerator temperatures so we decided to attach the label with a tie-tagger and leave the backing on it.

Our panel sheets have outlived at least 3 computer systems. Sometimes there is detail there not available in the computers. I still have panels from the 1970s in our files--and sometimes we get a patient that hasn't been in again since then. This community has a very stable population. We have space for this degree of overkill, but I agree that 5 yrs is adequate.

We do it when it comes out of the water bath.