Mabel Adams

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?

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.