Mabel Adams

I know we sometimes transfuse plts to inpatients that are "comfort care" only because their constant nosebleeds otherwise interfere with their ability to visit with family. I would guess there are times when red cells are given to keep the person from feeling too faint or having chest pain while waiting for the cancer to finish off some other organ system. Also, our hospital does Hospice and Home Health in the same dept. so maybe it is really a home health patient. They have very rarely transfused blood from our facility. There are issues of the nurses staying proficient, the time necessary for the nurse to stay with the patient both during and after transfusion and recourse if a reaction occurs.

I studied on my own and took the exam 10 years ago. I remember people saying it would surely have a lot of regulatory stuff on it, but I studied according to the content guideline (available on the ASCP website if you dig hard enough) and the test definitely followed it--lots of BB serology at that time. In those days you didn't know if you passed when you left the test and I was totally sure I had failed. The test questions change depending on how you answer the early ones so I am sure the test always seems difficult. I still believe my passing score was divine intervention.

For the daily QC of reagent cells (screening cells) we run a known negative patient (gel) and a commercial positive QC antibody that will react with all 3 screen cells. We don't use all typing sera every day so we just test known antigen-negative and (weak or single-dose) positive cells against the antisera when we use it.

We were due by Oct 4 and were inspected 9/17.

I seem to remember an article in Transfusion in the past 10 years where someone defined paramaters for anti-Fya titers.

We started reflexing them (after proper one-time notification, of course) because our OBs were getting annoyed that we were waiting for them to order them.

http://www.cbbsweb.org/enf/2003/fmh_antenatal.html Here is a link to the CBBS page noted above. Is there someone that could see that this info gets into the next Tech Manual near (or in place of) the "20 weeks gestation" entry?

Watch out for static electricity too.

If you are in the USA, the rules above may not apply. It is essential to be honest with the blood center, even when it is sad that you can't continue to donate. Maybe someday the US rules will be changed also.

As I recall, many babies will type as A subgroups even if they will be A1 as adults because the ABO antigens are not completely developed at birth. At least we had to wait till my daughter was a few months old before testing to see if she was an A2 like her dad or an A int like me (no, we didn't poke her just to find this out, and she is A2). For it to cause HDFN, it would have to be IgG so it can cross the placenta. Do you have examples of anti-A1 that are IgG?

Let's see if I can remember this from the days of leukoreduction decisions. There are different sets of HLA antigens (A,B,D,DR etc. I think). Plts only have the HLA A & B antigens, but wbcs have them all. In order to make antibody to the HLA A & B antigens, the recipient had to be exposed to the DR (I think) antigens as well, which meant that white cells were required. Once the antibodies were made, they could react with the plts causing refractoriness, but the wbc was necessary for the stimulation of the antibodies initially. Does anyone else remember if this is what the story was and whether it has been disproved or refined?

It is probably wise to build with your newest, least comfortable, most distractible tech in mind--whatever solutions you choose. Sometimes it is more about productivity than making a mistake, but that is probably a rare problem with today's staffing issues.

Is the antibody you are testing something with a known specificity or a new one, never before identified? I am curious what antibody you are working with.

The blood bank world should collect data on the number of patients with newly detectable antibodies within 4 days of a confirmed negative antibody screen. Particularly interesting would be any that had not been transfused during that 4 day period, but maybe had been over the 3 months prior to the first specimen being drawn. If we ever get any nationwide data collection system (like biovigilance or error reporting) there should be a way to also collect data on some rare events like this that no one facility would see too many of by themselves.

We don't get many folks from China and Switzerland on the AABB site. That adds to the fun here.

Is anyone using the CAP Competency Assessment Program? Is it time-consiming for generalists to keep up? Is it demanding of the person in charge of managing it, both in time and learning curve? In general has using it been a good experience? Is it worth the price? Could you also tell me how big your lab is? Thanks.

Our blood bank remodel 10 years ago put us into a separate room but the with a very wide opening to the main lab. At the time, I did not want to be out in the middle of the lab where all the chit-chat could distract me, but it is nice to be close by. If we had been put out in the main lab, I would have positioned the bench for less distraction by facing away from everyone else. Maybe some half-walls or glass walls would help. Access for blood pickup is usually an issue.

To use flow cytometry you would need to have a system that could destroy the cells like they would be in vivo if you transfused them. If the antibody is a complement fixer, this might work in vitro, but if you need an intact immune system (preferably the intended recipients's) to destroy the cells if the antibody is significant, I can't think of any way to make that work in the lab except maybe the monocyte monolayer assay. Is there any way it could be adapted to flow cytometry? I am speculating heavily and probably don't know what I am talking about. There is a method called the "in vivo crossmatch" where you give the patient a small amount of the unit (like 20 cc) over 15 minutes then draw a sample from the patient and look for visible hemolysis (or measure free hemoglobin). If no overt signs of destruction are present, the unit is considered compatible, but this is a very insensitive method and could be risky to the patient. You could look for bilirubin, but bilirubin peaks about 6 hours post-transfusion so that wouldn't be very helpful. I would think LDH would parallel hemolysis, but you would need to know the patient's pre-transfusion level and I wouldn't trust it if the pre- were abnormal maybe due to underlying organ damage.

We almost never have more than one cooler out at once so we use a log sheet on a clipboard and leave the clipboard on the counter when a cooler is out. We enter on the log which patient, which cooler, times out and in, and the temp on return. They are seldom out more than a few hours and we have a thermometer in the cooler for monitoring on return. There is a plastic pocket on the cooler a for 4X6 card on which we write Name and Med Rec #. We put temp indicators on the units for the first year, but never had any problems so deemed it unnecessary. They really don't take the units out unless they plan to give them. We, likewise, don't let them send the coolers out of the OR with the patients.

Yes, anamnestic means a secondary response, particularly if the antibody titer had become too low to detect prior to the second stimulation. It probably varies greatly between patients, antigens and other concurrent factors. AABB used to require new specimens after 2 days, although I think that had more to do with the persistence of complement in the serum. The 3 day rule is a compromise between the use of resources to repeat testing on a patient every day and the risk of antibody formation over a short period of time. The level of compatibility problems found with the 3 day rule is considered an acceptable risk.

UNITEDADLABEL.COM appears to have a good list of ISBT product code labels. There are not pictures of them all yet, but there seems to be a correlation with their order code and the ISBT code (not perfect, but useful). I needed to be sure I could even buy pre-printed aliquot labels before I proceeded.

I called our Med Records dept. They scan the charts within 3-5 years so label adherence beyond that is no issue in charts. She told me they are only required to keep the chart information for 10 years, much less the paper charts. Inside the lab, it would depend on whether the record needs to be maintained on paper for a long period or not. I have 20 year old log books with unit number stickers in them showing no sign of falling off. Address labels are a different story. I had to tape them all on my old panel sheets. Now I require handwritten name and DOB at least. Some of the heat-based labels fade over time. Your blood supplier may be able to tell you how long they trust their unit label adherence.

I had trouble with the stop and start characters in the barcodes being in the wrong case. I just read something in MT info that sounded like the scanners would work opposite if you have cap locks on or off. If you are finding it works sometimes, but not others, check cap locks and check that the Bar code terms and Bar code fields dictionaries have everything in the proper case.

Does Mysis add the split (aliquot) codes at the end of the product codes as well?

Someone should be tracking this health care ID fraud. I would expect it to get worse as more people can't afford insurance. It seems to me to be a part of the national health care crisis. Do the hospitals where this has happened require photo ID or are they even faking that?