cmiller

We had a case of acquired B a few months ago, also in a cancer patient in a nursing home. We'd typed & crossmatched this patient many, many times as group A, Rh+. We detected the acquired B using manual Gel and had the following reactions: Anti-A: 4+ Anti-B: 1+ Anti-D: 4+ Ctrl: 0 A1 Cells: 0 BCells: 4+ When we repeated testing using tube reagents, the reaction with Anti-B was negative and all other reactions were as expected for group A, Rh+ individual. Very cool to actually see this. I just gave all our techs some case studies on A and AB subgroups with Anti-A1 and I also included this case on acquired B. I think the cases really made them think about things we don't see very often. They actually seemed to enjoy it - much to their surprise!

Thanks to all that replied. I was just surprised to see a 3+ reaction 47 years after childbirth. I may set up a titer just b/c of my own curiosity. Again thanks. Happy Monday to you all.

Just curious about possible explanations for the following scenerio: 71 year old white female Group A, Rh Negative Anti-D identified 2/5/10 with 3+ reactions using Gel. No other history available. The patient states that she has NEVER been transfused and her last child is 47 years old, no pregancies or miscarriages after. I would find it highly unusual for a potential Anti-D produced as a result of pregnancy to still be reactive at all, let alone 3+, 47 years later, at least not without some stimulation. Any thoughts on what might cause this, medications, medical conditions or diagnosis? Some one mentioned 5q- syndrome might casue this, but haven't been able to find any info. Input would be appreciated. Thanks so much. Candace

We are looking for feedback from anyone that has used or is using Data Innovations Middleware with Ortho Clinical Diagnostics instruments (Eci, 5.1, 5600). Any users? Please respond with contact information, our Chemistry Supervisor would like to hear from you or you can email any feedback to lkegley@apprhs.org. Thanks.

We are part of a system of 3 hospitals. We are a the largest and one of the other facilities is now a Critical Access Hospital, with only point of care testing in the lab. Previously they performed Blood Bank testing (very rare) and stocked 2 O Negative RBCs, but will no longer do this. Now, are thoughts are that if a patient at the CAH needed blood products, we would Emergency Release units to the hospital and then the sample for TS and compatibility testing would be returned to us for testing. The CAH would only be performing the transfusion. Our thoughts were to have "packets" pre-made that contained all the information, forms, ect that would be needed both at our facility (for sending units/insturctions for CAH) and at the CAH (for returning blood specimen), so that these could be "grab & go." Is anyone currently supplying blood products to a CAH, that would be willing to share policies & procedures? Any ideas or input would be greatly appreciated. Thanks in advance!

"Do you have SoftDonor as well? When we were looking at BB systems, Wyndgate said since we were a Transfusion only site we had to use McKesson Horizon Blood Bank which is the Wyndgate system branded with McKesson's name. The system is a good system but the cost and support was more than Soft. If you can deal with Wyndgate directly you may do better. Good luck." We do not have SoftDonor. I haven't seen any numbers on the support of any of the systems we are looking at, but I do know that we have had great support from Soft and I have been told it is expensive. Its not like we have a lot of choices for a BB system. The only ones I have been able to find are: SoftBank Sunquest Wyndgate Mekesson Horizon (which you say is Wyndgate) Psyche SBB I guess there aren't very many companies willing to go through all the FDA Regs to do a BB system... Thanks for the information.

Like I said, its not my decision to leave Soft. They won't let us keep SoftBank, b/c SoftLab has to "run in the background" and they won't pay for the support, etc. We really like SoftBank and I am very upset that we are being forced to switch systems b/c we don't have any choice in the matter.

It is not our choice to leave Soft. We really like it. The decision was made by Administration b/c we are part of a multi-hospital system (3 small hospitals) and they want to "standardize" across the system, bottom line is bottom dollar! We currently have Quadra Med as our HIS (Affinity - which we will also be switching) so they wanted to have an "integrated" system and decided to get Quarda Med's new HIS and also the QCPR lab module. (Our VP of the IT department is in fact the person that sold us Affinity less than 3 years ago...draw whatever conclusion you may.) So people that have no idea what is done in the lab/blood bank, let alone know what functionality we need with a system have made the decision that we will change computer systems - across the board at all 3 facilities...yeah, I'm a little upset over this decision. :mad: We will have been Live with Soft for 3 years in Septemer! We really like SoftLab. It is very customizeable over all. The few problems/issues we have had have been due to initial setup and not the best implementation team from Soft. They do have great support which cost $$, but is worth it. I guess we will get what we pay for!

We currently have SoftBank & SoftLab/Mic. The decision has been made to change computer systems. The lab system is going to be Quarda Med's QCPR. A decision has not be made about Blood Bank. We are hoping to set up demos and site visists for Sunquest and Wyndgate. I am interested in any feedback on these 2 systems. Likes, dislikes about the system or functionality? Ease of use? For anyone that has recently set up either system - what were some questions you wished you had asked before going live? How are the statistical reports for the systems? Any other information about either system would be greatly appreciated. Thanks.

We currently have SoftLab/Mic and SoftBank with Quadra Med Affinity as the HIS. Our Administration has made the decision to go for an "integrated system" and we are changing to Quarda Med's QCPR for the Lab system. We won't be able to keep SoftBank b/c softlab has to "run in the background" and we won't pay for the support... For any QCPR users, which Blood Bank system are you using or have used with this system? Thank you. Candace

We have been using SoftLab & SoftBank since September of 2006. We love it! Previously we had McKesson Star and Hemocare. One of the best benefits about Soft is it is Windows based, so it is easier to navigate than some of the other systems. SoftBank is a little "keystroke" happy like someone else stated, but it flows very easy and each resulting menu works exactly the same way. One of the things that is extremely handy is the ability to "bridge" or link between SoftLab and SoftBank to view information without having to "sign-in" and "out" of multiple systems. As an example when you are working in SoftBank and need to view an H&H, with just a couple of clicks it links you to the result query function in Lab. Or if you need to add a test or order a test, with 2 clicks you are linked to the Order Entry function in Lab. We really enjoy SoftLab and I have found it to be much user friendly than some other systems.

Well thats what I was thinking when I went through the checklist in preparation for the inspection, but our inspector didn't agree. He used the line in the Note: "Tests found negative by tube methodology must be checked with the addition of appropriate check cells." His interpretation was that this included the complement component b/c it was stated after the statement about IgG coated cells for negative tests. He also refered to the manufacturer's package insert which states "The positive control of anti-beta[complement] activity is a test with red cells sensitized with complement." This indicates that the complement component should also be controlled in the same manner as anti-IgG. That was this inspectors take on it and we went with it - we wanted to change our procedure anyway... I didn't call CAP to check on this, but it might be worth while to others with pending inspections. Thanks for the reply Heather.

We were following the same line of testing for our DATs: Poly first, then if positive Anti-IgG. We assumed that if the poly was positive and the IgG negative it was complement. We had our CAP inspection in February and that seemed good enought for them, but if you do this you must also keep the Complement check cells inorder to verify the reactivity of the complement component of the polyspecific reagent. We got dinged on this. Because of this and the fact that ortho doesn't have complement check cells, I changed our DAT procedure. We no longer use Polyspecific reagent. For DATs we test with Anti-IgG and Anti-C3b,C3d separately, and use separate check cells for each. CAP seemed to be ok with this when I sent in our revised procedure/order request for complement reagents. Bottom line, I believe it is ok to use only the Poly and IgG reagents as long as you use complement check cells to check the reactivity of the complement part of the poly.

We perform retypes on a separate sample if there is no previous history. If a correctly labeled (name/MR#) from a previous sample is available (usually CBC) we will use it as the retype. If not, we recollect. If we can't get a retype before transfusion we transfuse group O rbcs. We require a "current" ABO/RH for other products (FFP, platelets or cryo), but not a second draw to confirm. (By current we mean duirng the current admission.) The whole arguement for retyping the same sample (even if by different tech or method) doesn't allow the opportunity to catch the mistake of a mislabeled sample/wrong person drawn. This to mean seems to be the point of greatest risk for their being a mistake. So by redrawing a second sample, or using a separate sample we not only catch mislabeling mistakes but also a mistyping mistake that could be made a tech.

We are looking to revise our transfusion indicators. We would like to lower the Hgb criteria for RBC transfusions. Would anyone be willing to share their criteria used for blood usage reviews? If so, please email me at cmmcoy@apprhs.org Thank you.