Abdulhameed Al-Attas

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.
Our guidelines states unless electronic patient identification systems are in place, a second sample should
be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this
does NOT impede the delivery of urgent red cells or other components.
 
The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.
 
It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.
 
Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.
We must always remember that the most important test done in the Blood Bank is ABO grouping. 

Since you wash the cells several times anyway before use, it seems logical that any anticoagulant is washed away (or at least mammothly diluted). We have this issue more frequently finding enough cells for an eluate, or an eluate and autoadsorption. For both procedures I have successfully used citrated cells and cells from lithium heparin chem tubes if you can fight your way through the gel. (Speaking of lithium heparin, if a patient has a juicy antibody, I collect all the lithium heparin chem tubes and EDTA heme tubes I can to pool and freeze to torment future generations of students. If validated, does anyone know a reason why lithium heparin plasma cannot be used for, say, a panel if your serum or EDTA plasma is in short supply? Seems to work fine for the students.)

Your procedures are outdated and I agree with your pathologist.  Once an RBC unit exceeds 10C, it should be discarded per AABB, CAP, FDA.  We discard any returned units that have been spiked or if the outlet port covers have been opened, to that they may not be reissued...   
 
There have been extensive discussions on this website regarding this very issue.

OK, the only magic to the "3+3" rule is that if you plug those numbers into the horribly unwieldy formula for Fisher's exact method of calculating probability, you will get a probability (p) of 1/20, or a 1 in 20 chance that the reactions could have occured by chance, or a 95% confidence level that your conclusion is correct. (This is a totally arbitrary number by the way.) Lower p values (1/15, 1/9 etc) allow for too much chance of random association. Higher values (1/28, 1/56) show that there's a much smaller chance that your conclusion is incorrect.
 
But there are other magic combinations that will give you an acceptable p: 5 and 2 (1/21), 4 and 3 (1/35), 6 and 2 (1/28) and so on. You do not necessarily need 3+3. See Goodchild's reference.
 
You run into problems when you only have one positive or negative cell: 7 and 1 (p of 1/8), 8 and 1 (1/9), etc. You would have to get to 19 and 1 to get the magic p of 1/20. If you think about it non-arithmatically, what if your one reactive panel cell is also positive for an unlisted low frequency antigen? What if your one negative didn't have serum added or isn't reacting for some other technical reason?
 
So you don't necessarily need 3 Cw+ cells; 5 or more neg and 2 pos would suffice. And you don't need 3 Js(b-) cells; 19 pos and 1 neg would be OK statistically. The problem I see with the high incidence antigens like this would be that with only one negative cell with which to rule out, you would still have a bunch of other antibody choices you would like to rule out, hence the need to test more negative cells.
 
So, pedantry aside, the bottom line is "don't base your ID just on the reaction with one cell". A second cell of similar makeup coupled with the pos or negs from the rest of the panel should bump your p past 1/20.

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.
Our guidelines states unless electronic patient identification systems are in place, a second sample should
be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this
does NOT impede the delivery of urgent red cells or other components.
 
The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.
 
It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.
 
Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.
We must always remember that the most important test done in the Blood Bank is ABO grouping. 

dothandar, you are absolutely correct in saying that are known Jka variant antigens.
 
Under the circumstances, DO NOT give this unit to a patient with anti-Jka!  It is easy enough to find another Jk(a-) unit, without taking the risk.
 
I am going to attach (I hope!!!!!!!!!) a lecture I have recently written on the Kidd Blood Group System, which may explain why, BUT, be warned, I have yet to check this lecture for complete accuracy, so treat it cautiously.
 
In Depth Lecture on The Kidd Blood Group System.ppt

Well, it is never easy to make a hard and fast rule for all cases.  However, thinking back to first principles can help.  Anti-D is to avoid at all costs in women of child-bearing age who can still have children (For example, I mean in a 25 year old woman who is having her uterus removed for cancer is of child bearing age, but can't have children).  You have finite stocks of D neg blood, and your young women should be the priority.  Your second priority should be your patients who are transfusion dependent for life - like sicklers or thalasssaemics. For other chronic transfusions, well, it depends what 'chronic' means, and how much blood you have available and how often the patient needs blood.  I would argue that probably for a 90-year old who is not likely to live more than 6 months who needs 2 units of blood every month, you could probably switch to D+ if you needed to without much of a problem.  I wouldn't do it on a 40 year old who was receiving blood regularly now but with hopes of remission.   Then you have to think that in cases of massive bleeding, the blood doesn't usually stay in the patient long enough for the immune system to 'see' it, so in cases of heavy bleeding it's better to give your D+ first and then switch to D- once the patient is stable.  But that's only my opinion.....

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.
Our guidelines states unless electronic patient identification systems are in place, a second sample should
be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this
does NOT impede the delivery of urgent red cells or other components.
 
The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.
 
It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.
 
Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.
We must always remember that the most important test done in the Blood Bank is ABO grouping. 

Well you would definitely want to check first whether the A and B cells are D+

I'm sorry Whitney Poplin, but I disagree with your post.  Just because the antibody screen is currently negative does not automatically rule out anti-C and anti-K, for the very reason that it does not rule out the known anti-e; that is also not detectable at present.  From the logic of your post, you could, therefore, also rule out the known anti-e, and give e+ units.
 
No, the anti-C and anti-K should have been ruled out properly in the first place in my opinion.
 
Now, because this was not done, you would have to honour the potential anti-C and anti-K, in case either of these "phantom" antibodies cause a transfusion reaction, due to an anamnestic responce - and, of course, the same applies for the "real" anti-e.

Oops misread - sorry about that!

Whoa Auntie-D.  Abdulhammed Al-Attas was talking about anti-IgA, not anti-A.
 
Although our blood is SAGM and leukodepleted, and so you are correct in saying that we do not have to worry about high titre anti-A in our red cell components, we do, nevertheless, still have to worry (big time) about IgA in the remaining plasma.  If the patient is IgA deficient, and has high titre anti-IgA, there is sufficient IgA in the remaining plasma to cause a very severe transfusion reaction, and so Abdulhammed Al-Attas is completely correct about that.

Yes, as Terri has mentioned the Medical Director is the one who interpretes the Transfusion Reaction,so untill he/she interpretes NO further Transfusions.
And we put a note for that to alert coleuges.
The reaction could be from Anti- IgA that requires either IgA deficiency blood or washed RBC's OR  FNHTR that may require Leukoreduced or HLA match in case of Platelets. 

Yes and in playing the game of semantics, anti-K1 and anti-K2 are both incorrect terminology.

You are going to HATE me David, but those are the genes - and should be in italics!!!!!!!!!!!

It depends the reason for transfusion if it's to restore coagulation factors my answer will NO because of compromised coagulation factor activity,namely factor V and VIII.

Anorris, I am afraid your report looks like a dilution rather than a titer.

Anorris, I am afraid your report looks like a dilution rather than a titer.

There is good reason for that Scott.
 
Firstly, the reaction well at the top of the cassette will be at room temperature when you add your cells and palsma, and so a "cold" reacting anti-M will sensitise the red cells prior to the cassette being put into the 37oC incubator, but the incubation time is insufficient for the anti-M to dissociate from the M antigen.
 
Secondly, even if you warm your cassettes, prior to adding the plasma and red cells, it will still not be at 37oC, as you have to take the cassette out of the incubator before you add the plasma and red cells.
 
Thirdly, the gel/glass beads in which the AHG is suspended is slightly acidic, and anti-M just LOVES acidic conditions, and so will react more strongly with M+ red cells in such conditions.

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.
Our guidelines states unless electronic patient identification systems are in place, a second sample should
be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this
does NOT impede the delivery of urgent red cells or other components.
 
The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.
 
It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.
 
Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.
We must always remember that the most important test done in the Blood Bank is ABO grouping. 

Do the E and S antigen typing , if it is mix field then do elution.

You can if they are Oh!!!!!!!!!!!!

Could it be that she had an Anti-E from years ago that had fallen to undetectable levels recently (as they do) and then any RBCs in the platelets have triggered an immune response and brough the titre back up to detectable levels. I have seen many Anti-Es that subsequently go undetectable with time.

Just had a FANTASTIC time at the BBTS ASM, where I learned so much.
 
The highlight for me was listening to Marion Reid giving her James Blundell Award lecture (amongst many other excellent lectures) and having her sign my copy of the FactsBook!  The attached photograph shows her talking to Martin Bruce OBE, the BBTS President.  The other photograph shows some old fool relaxing after the lectures!!
 
Worked hard - played hard - now exhausted!!!!!!!!!!!!!!!!!!!

The ABO/Rh confirmatory policy has been developed to prevent transfusion from a misidentified sample.
Our guidelines states unless electronic patient identification systems are in place, a second sample should
be requested for confirmation of the ABO/Rh group of the first time patient prior to transfusion, where this
does NOT impede the delivery of urgent red cells or other components.
 
The ABO/Rh confirmatory is a STAT test and should be handeled accordingly, it must be from a seperate collection phlebotomy and collected at a different time from the initial one.
 
It should NOT be a retained sample from the initial collection and delivered as a second one after Bank Bank calls for a ABO/Rh confirmatory sample.
 
Yes,post 4 months of age, we require a confirmatory sample, as MAGNUM stated.
We must always remember that the most important test done in the Blood Bank is ABO grouping.