dcubed

I have 12 patients, all female, that gave a weak to 1+ reaction with cell 2 lot vs399. When retested with Ortho lot vs396 bot cells are negative. I am going to pass this info on to Ortho, and hopefully the red cell donor in question will be removed from service,

I always seem to come in to late! I actually had a pretty good idea what was going on here. Interesting case.

We have had several patients that are reacting weak to 1+ with cell 2 of lot VS399. Upon doing the untreated panel C the cell 11 has been positive. Reported this to Ortho. They sent us a different lot of screen cell, lot VS396. So, when we have been getting the w+ to 1+ on cell 2, lot VS399 we repeat in lot VS396. If IAT is neg with lot VS396 we are reporting as negative. Cell 2 of lot VS399 is probably Bg pos, when we are done using this set of cells we will report back to Ortho the number of patients with which we have had this problem. So far we have seen this in 12 patients, all females. In a related note, I can't understand why a manufacturer would include a Bg pos cell as one of the D neg cell from a panel that can be used as screening cells when the patient has gotten RhIg.

When we have an anti C to do titration studies on we use R1R1 cells per the procedure listed in "Judd's Methods in Immunohematology" third edition. Why?

anti LWa, treat panel cells with DTT and retest.

The only time we would use the cord blood is if it came with a baby transferred to us from another facility. And then only if the antibody screen on a sample from the baby is positive.

Thanks Malcolm!!

Just got a report back from the reference lab warning that a patient has a "high titer" anti Chido. We were warned that the patient may not fare well if given plasma containing products, with the possibility of an anaphylactic reaction. Any words of wisdom on this topic would be greatly appreciated.

shelleyk482, may I inquire as to why you are changing from 120 hrs to 5 days at midnight? Also, thanks for the reference to the Techical Manual.

Almost all of the plasma that we use is "plasma frozen within 24 hours". After it is thawed, it can be used for up to 5 days. My question: is the time of the outdate at midnight on the fifth day or is it 120 hours from thawing?

Hmmm, so in situation 1and 2 posted by L106 the anti c titer eventually drops to undetctable levels, but units selected for transfusion will be negative for c antigen, this is good. IF anti Q is also present in the March sample, maybe is has also dropped to undetectable levels by April (situation 1) or May (situation 2). I say honor it.

I know this is fairly obvious, but some of the Biotest anti sera only contain 2 ml per vial. Is this part of the problem?

I am sure that many of us have seen when FMH testing indicates that a D neg Mom needs to get several vials of Rhig after delivery of a D pos infant. For example, a couple of years ago we had to give 6 vials of Rhig. Six vials of Rhig will protect against 180 ml bleed of D pos blood. That much of a bleed would seem to represent more than half the blood volume of an "average" sized normal newborn. You would expect the infant to be quite anemic, yet in fact the infant in this case and others like it have not been anemic. What is the explantion?

Deny, previous posts about Rhophylac make the suggestion that a selling point of Rhophylac is that it can be given by IV, thereby avoiding the "trauma" of an IM injection. My post was a feeble attempt of ironic humor (humor is allowed on this site, I hope?). If an IV is in place I to would want to avoid an IM, but no I would not see the benefit of starting an IV just to avoid an IM injection.

Do you start an IV to give Rhig at 28 weeks and thereby avoid the "trauma" of an IM injection?

We have been doing electronic xm for a couple of years now and it is wonderful. If we have a current type and screen on a patient and they do not have any clinically significant antibodies, we can allocate units of PRBC's in about 2 minutes. When we were using the immediate spin crossmatch, turn around time was sometimes adversely affected when upon doing the immediate spin crossmatch a patient was found to have a cold agglutinin or rouleaux. Blood usage has not been affected, if a transfusion is required, the type of crossmatch employed is irrelevant.

Type O red cells,AS1 preservative solution, leukoreduced, HgbS neg, CMV neg, irradiated, 5 days old or less and antigen negative for maternal antibody capable of causing HDN. Cells are spun, and suppernant removed. AB plamsa added back to red cells to give a HCT of 50%. Sterile connecting device used for access to products.

For those institutions that employ the electronic crossmatch; do you regard passive anti D found in a patient's plasma/serum as clinically significant? That is, do you do an AHG crossmatch for these patients or have you devised a way to issue PRBC's with either an electronic or immediate spin crossmatch? Thanks in advance.

Negative result to a 2+ positive....hmmm. How do you explain the red cells traveling back towards the top of the well. That sounds like a pretty unlikely thing to happen.

Current sample on the patient was tested in Ortho gel card. Previous sample, nine years ago would have been tube testing. BTW: Ortho Provue samples cells from the bottom of the tube. The intrument is programed to have the probe go to 1mm from the bottom of the sample tube.

We have a male patient, 80 yrs old with a history of pancytopenia and has a surgery upcoming. His current pre-op specimen types as D neg weak D neg. Nine years ago this patient was here and typed as D pos on more than one sample and was given 4 units of PRBC's. In looking into his history it was found out that he has also been a patient at a neighboring hospital and they have seen this patient's D type go from D pos to weak D pos to negative. Are there any disease states that can cause suppress the production of the D antigen?

Got a couple: Fisrt, back when I worked as a generalist, was reading blood gas result to a ward clerk and she wanted to know how to spell pH. Second, a couple of year ago a resident was worried that it would take to long to get antigen negative blood for his patient (don't recall the antibodies but we did have to special order units from supplier). The resident suggested that we just get washed blood since that "washes the antigens of the red cells"!