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Mabel Adams

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Everything posted by Mabel Adams

  1. The Gamma/Immucor Fetal Bleed screening test package insert says samples should be drawn at least an hour but then as soon as possible after delivery. I remember that mom and baby being ABO incompatible was originally found to be protective for Rh sensitization. This implies that the baby's ABO incompatible red cells were destroyed intravascularly in the mom so were never presented to the immune system. Since ABO compatible cells probably would have normal survival in the mom, it has always seemed to me like not a very big deal, but I don't have the science to back it up. I wonder what the recommendations in the package insert are based on. Hmm.
  2. I thought I posted this last night but don't see it now. Pardon if it is somewhere else. How long is it taking to get ready for ISBT on Meditech? I had assumed we would just reset a few things and load the new product codes, but now that I have been live on MT for a few months I doubt that it will be that straightforward. Can someone tell me how much time I need to tell my boss to allot for me for the MT part of the ISBT conversion?
  3. We quit doing that about a year ago. It was a policy put in place by pediatricians concerned when moms started to go home with their babies after only a day or so in the hospital. When we proposed to the current peds that we only do it if they ordered it specifically they went along with no questions and have yet to order a cord workup. They have occasionally ordered a Type and DAT on a baby that was yellow.
  4. I guess it didn't really look like hemolysis after all. It was more like heavy haze in the gel columns. The patient ended up in ER by Monday so we had another sample on her that behaved the same way. It was neg with tube testing. Because we have had a lot of unexplained reactions with screen cell 2 this month I also tried this sample against the Gamma screen cells that I converted from 3% to 0.8% to run in gel and they were totally negative (no haze). Hmmm.
  5. I have seen an anti-E that looked like a cold antibody in gel and we get a fair number of anti-M's that show that bi-phasic look as well. It is a good thought about the incubator having a hot spot. It is possible the tech put his repeat screen in the exact same well. He ran other screens at the same time initially and they were fine so it would depend on the card locations he used. I will know more tomorrow, but the weekend tech said the cards don't look like hemolysis anymore, but there is now top-line. I suspect I got all excited over one of those cases where the red cells get hung up in the reaction chamber (static electricity, the book says) and then settle later onto the top of the column so they look like topline. I suspect there is something about this sample that made it prone to this since other samples at the same time were fine.
  6. I just got a call at home from a tech at work describing a prenatal sample that is showing what looks like hemolysis in all 3 screen cells. Red in the reaction chamber, some red down into the gel and a slightly smaller than normal red cell button. The problem is, we use EDTA so hemolysis shouldn't be a possible endpoint. I haven't seen it so I suppose it could be something besides hemolysis, but it still sounds weird. Other patients run at the same time do not show this reaction so it isn't that the cells are hemolysed already or hemolysing during testing non-specifically. He has run the test twice so it probably isn't a contamination fluke. He will go ahead with a panel if for no other reason than to run some different cells and of course to see if there is any pattern. She has historic results as an O neg with a negative screen. I will be interested in whether the reverse type shows hemolysis (this will be by tube) and will recommend we test by LISS tube method before turning it out. Has anyone seen anything like this? Any ideas what it might be? Could it be any drugs she is on? Some flukey reaction with the diluent? BTW, this lot of Ortho pre-diluted screening cells is showing us some non-specific reactions (mostly extremely weak) in cell 2. I think the lot is VSS104. Ortho said they had one other report of non-specific reactions so if you are seeing this too you might let them know.
  7. I am assuming you are still finding a pos DAT at the later visit so that is why you do a repeat eluate. I have read that many people that start making alloantibodies also temporarily make some autoantibody. It is almost like the immune system "ramps up" generally at this time.
  8. We had one patient that I suspect made antibody to a gel diluent constituent. It appeared to be significantly weaker with the new formulation. Ortho's notice said they used lower doses of antibiotics in it, so maybe that is why.
  9. When you say the eluate "settles down" after several weeks, do you mean you are retesting the same eluate a couple of weeks later or making an eluate from a new sample collected several weeks later--or even making a new eluate from the original sample after the sample is several weeks old?
  10. I want to be sure I understand correctly. Are you saying that CAP has approved, as a mechanical barrier, using the pneumatic tube system's secure transport function (code required) with the unique BB wristband number as the code?
  11. OK, tell me what liability you speak of. Our pharmacy has handled RhIG for close to 15 years.
  12. Is the germ you look for at 4 degrees Yersinia, or something else?
  13. Thanks Shily. I happened to read the same item in Human Blood Groups--after I made the post. I stand corrected. Isn't the immune system an amazing thing? "Who'da thunk" that the body could forget "self" and start making antibodies to antigens it previously had. I wonder if the reported case was an aberration--although I guess Lewis antibodies often work like this.
  14. Is the patient young female? If not, and doc is just trying to get better response to plts, you might want to find in a book where it says that plts don't have Rh antigens. Oh, and a recent issue of Transfusion had an excellent, practical article on refractory plt pts. Not the one that just came but one or two before that issue.
  15. We do what the microbiologists tell us is necessary to make bugs grow--basically 37. Their system can pick up Yersinia fine. The logic of testing at the temperatures that blood products are stored draws blank stares from microbiologists. It would be like trying to grow all cultures from skin infections at 33 degrees because skin is cooler than body temp and that is where the infection is.
  16. The weakened reactions due to disease states should not represent a person becoming a partial D and thereby being at risk of making anti-D to the missing parts. That would be genetically determined. As long as the immune system sees D antigen as "self" it won't make anti-D, no matter how little antigen is on the red cells.
  17. Are you setting off a door alarm or a temp. alarm?
  18. We had an oncology patient once that had a weakening of D antigen and at the time I read up on it and found that this situation had been documented in the past. I don't remember any details. It seems what to give could be argued either way so I will stand back and let wiser heads prevail.
  19. I ran about 3 cold agglutinins (one is known to be anti-I) and found that one did not show up in either lot, one showed up in the old lot but not the new and one was opposite. All the "normal" antibodies that I ran had the same results in both. My eluate, last wash, warm auto and adsorbed serum all reacted the same in both.
  20. Correct me if I am wrong, but I think you are suggesting that we find a new method for doing titrations of anti-D that removes the variable of varying antigen strength on the different D positive cells used for titrating. I think you are proposing some sort of measurement of D antigen strength on the test cells defined in iu/ml. If this exists already I am not aware of it, but there are lots of things I am unaware of (just ask my teen-age daughter!). We always use R2R2 cells from our current panel or screen lot. Thus, we usually use different cells every month as we follow a titer. We don't see much lack of consistency, but maybe someone that does more than 1 or 2 titer series per year could provide better data. I know of recommendations that the same cells be preserved (frozen?) and used each time. What is probably needed is a whole new way to quantitate anti-D, maybe using flow cytometry or something.
  21. Is anyone finding any differences with the new formulation of Ortho's pre-diluted 0.8% screening and panel cells?
  22. Do the nurses copy the BB band number into the chart or go to the patient's wrist each time they need to request a unit. How do you handle surgery? We issue blood in coolers so don't use the tube.
  23. For those that are borrowing a hematology tube: do you just spin it down and ruin it for the add-on retic or WSR, or do you pour part of it off into another tube to spin down?
  24. We have only phlebs drawing which simplifies things. We recently instituted a Draw and Hold test in the computer. This test has to be ordered whenever extra samples are collected. That creates a track in the computer and a label for the specimen. BB has used a similar test called Band Only for many years.
  25. How does surgery handle these when the wristband with the blood loc code is often under the sterile drapes? Do they have a formal policy to record the wristband number when the patient comes into the room and for the duration of the case they refer to what they copied down?
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