Mabel Adams

Have any of you changed reaction reporting forms or protocol to try to better capture cases of TRALI and appropriately manage them when you find them? We have used a protocol that divides reactions into classes based on initial signs/symptoms or on our testing results. Class I is allergic, class II is FNH, class III is hemolytic. The signs of TACO and TRALI are kind of vaguely lumped into class III but it doesn't make sense to do a huge serological workup for TACO or TRALI. Do I add a Class IV or just go to a flow chart? I need to make this easy for nursing as well as techs and our generalist pathologists. Has anyone already invented this wheel? Thanks for any procedures or info you can share.

Scientists discover a new chemical process conducted by hemoglobin. Science Daily (11/6) reports that researchers have "discovered a previously undetected chemical process within the oxygen-carrying molecule hemoglobin," according to a study published in Nature Chemical Biology. Investigators discerned "how hemoglobin, through a catalytic reaction that does not change its own chemical properties, converts nitrite salt to the vasodilator nitric oxide." They also noted "how the nitric oxide activity harnessed by hemoglobin escapes the red blood cell to regulate blood flow and how the process...relies on the oxidized...form of hemoglobin, previously associated only with diseased states." Previously, researchers knew that "n the bloodstream, iron-rich hemoglobin consumes, on contact, any free nitric oxide released by the blood vessels, so the idea that hemoglobin participates in forming nitric oxide had seemed implausible." There is quite a lot of information on Hemoglobin research to be found at the Science Daily site. http://www.sciencedaily.com/releases/2007/11/071105091931.htm

Thanks for trying John. I guess I knew this was impossible. I think I have figured out a way to make the new expiration print an extra time on our compatibility label on a small extra label so it will be harder for the techs to forget to use it to cover up the original exp., more legible and not prone to tech's not knowing what day it is. My current techs are more reliable than some of the dregs of techdom we were forced to hire a few years back so maybe I should be more trusting.

You must be a subscriber? It won't give me access to the article--just the abstract. (I suspect that many of us senior members need to get out more.)

Would it meet regulatory requirements if an attached tag stated the new expiration of FFP after thawing but the original expiration wasn't changed or covered up on the bag label? I was thinking I could word it so it would establish that this was a changed expiration for the transfusion-ready product, but my computer uses the same tag format for red cells as for FFP so it would have to be a statement applicable to all products. I will not be able to print new labels after the ISBT conversion. I understand that we can just change the expiration if we are only thawing FFP for our own use, but I am afraid techs will occasionally forget to change it and I wanted to make it pop out with the tag we already attach to the unit. I'm guessing this is a pipe dream but I thought I would ask.

For those of you that get pre-pooled cryo, does it come labeled as ABO only or both ABO and Rh?

Could you get a more precise count of red cells in the pheresis units from the blood center and calculate the RhIG dose more precisely? Every time the red cell dose approaches 15 ml of red cells, she would need another RhIG dose, right? The persisting RhIG from previous doses should add some "cushion" for imprecision and patient variation. You might even take the patient's size into consideration and talk to a pharmacist. Still, if you can give it IV, it won't do her any harm. Hopefully the titer of anti-D wouldn't cause significant compatibility problems if she got a BM from an Rh pos donor. I wonder how high you could get her titer to go? Also, does she get mostly Rh neg pheresis, so the 7 pos ones could be spread out over several weeks?

I was under the impression that they just dumped the units into the dialysis machine and let it circulate through the system. You are right that if anything was amiss, the whole unit is already committed. I should check with our dialysis unit for sure about how they do it, when I find time.

Do Europeans not use a separate Blood Bank banding system ever? Not everyone in the US uses one, and there are a couple of permutations of the concept (one band number per admission vs. one band number per specimen), but I would guess a small majority do use such a system--especially since the Joint Commission on Health Care Organizations came out in favor of them a few years ago. BTW, we call it a Band Only.

Sounds like the Chinese definitions of D variants might be more useful. Here, Weak D is the term used for any antigen detectable only by an antiglobulin technique, regardless of whether it is partial or complete but just with less antigen on the cell. From serologic testing we can't tell the difference for certain unless they have made anti-D. Thirty years ago, these people were called Du positive (they were called Rh neg, Du pos by some techs and Rh pos, Du pos by others). Then they were called Rh pos (or D pos), Du variant for awhile. Now the preferred term is weak D, but even that isn't clear-cut as some places are choosing to treat anyone reacting less than 2+ (tube) as Rh neg. What we need are antisera that give us positive only with the people we want to treat as pos and neg with those we want to treat as neg. We would probably have to have different antisera for donors than for recipients. Maybe genetic testing will resolve this dilemma.

OK, fine, but what am I going to do when I need those obscure OSHA or FDA regulations that you always had on tap? Can I still email you for them? That would be easier than hunting them all up online through the government morass. Like everyone else, I will miss your unique contributions.

I think different decisions might prevail in different circumstances. Cord blood DATs, vs. testing donors, vs. transfusion reaction workups, vs. antibody ID in the recently transfused, vs. possible AIHA. In some cases the extra sensitivity would be good and in some cases not so good.

David, I assume you run the complement check cells as a parallel positive control in another microtube. You aren't using them as "check cells" somehow in gel are you?

John R. Pawloski, Jonathan S. Stamler (2002) Nitric oxide in RBCs Transfusion 42 (12), 1603–1609. doi:10.1046/j.1537-2995.2002.00278.x

http://www.wtop.com/?nid=106&sid=1263417 Here is the source in the lay press in case you missed it. There was also an article in Transfusion a few years ago on the function of Nitric Oxide, that stayed on my nightstand for 2 years hoping I would eventually understand it.

http://www.dukemednews.duke.edu/news/article.php?id=38 This link is from 2001 but has some good background info.

Since the Nitric Oxide issue has hit the lay press has anyone got a lead on a good resource for answering patient's and clinician's questions?

IS xms allows you to "get the screen cooking"; then you can do the type and xms during the incubation (barring antibodies of course).

We have a SOP called "Rack setup" that defines it so it isn't repeated in all the other SOPs. It defines labeling and how type and xm tubes should be set up in our rack.

Sheri, I think there was something in the MT tutorial mentioned above about how MT would continue to create aliquots using the A, B suffixes, but you can control whether they print or not, I think. Maybe it wasn't in the tutorial but was in a DTS to fix how it printed aliquots. I am sorry I don't have the DTS number at home. I will try to look Monday. I remember thinking that it meant MT wasn't really going to ISBT, they had just come up with a band-aid. Richard, For the 6 times a year we would print bar codes the printer would have to be really, really cheap.

We store our cards in the fridge except for a rack or two in use. Spinning before use is okay. It helps get splashed or condensed liquid back into the column. We only do it if visible problem with cards.

For at least the 26 years I have worked here when we turned out an antibody ID, we included statements about the % of units compatible, whether it is clinically significant, and , if an appropriate patient, whether it is known to cause HDFN. In the old days this was a form letter from the pathologist, so you could argue that it was a true "path interp." I guess. It got turned into canned comments when we went to a computer system. Does anyone else do this? I wonder if it is time to stop except in unusual cases where more explanation is needed.

Are you just aliqouting into pour-off tubes, or saved reagent vials or what?

We are having a terrible time this month. I think I am even seeing some non-specific reactions with our panels which usually live in the fridge. At least, several samples on which I have done additional tests using 3% cells made into 0.8% lost all the fuzzy weak reactions and only kept the real anti-K etc. These could be antibodies to gel constituents but they don't react in all pre-diluted cells. I am about ready to go to diluting up our 3% cells ourselves every day. Sheesh!

Back in the day, alarm probes and thermometers in blood fridges were always placed in 10% glycerol. I seem to remember reading that this was no longer considered necessary. What solutions are being used and why. Is anyone adding anything to keep down the growth of microbes?