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.

Ortho's price increase went into effect 3-10-08. All traditional reagents increased 100% and the gel red cell reagents increased 10%. We currently do everything in tube, but are in the process of getting gel to implement later this year. So these price increaes are going to kill our budget... It looks like everyone is jumping on the "automation" band wagon! Good luck to us all.

We are a 115 bed hospital and use Soft Computer system. We also use the Hollister banding system. At time of unit issue, a RN must come to the Blood Bank with a completed Component Request Form. At bare minimum it must have the patient's name and Medical Record # on it (usually they use a registration sticker/label.) The form also has a place to check what product they need to transfuse as well as the date, physician, and diagnosis. If the RN doesn't have the request form - no blood is issued. A MT or MLT retrieves the unit and all of the information (Patient name, MR#, patient ABO/Rh, unit ABO/Rh, unit expiration date, and Hollister #) is compared to the Component Request Form, the Unit/Compatibility Tag, the Transfusion Slip, and the Computer system by BOTH the tech and the RN. The unit is issued in the computer system at this time and we enter the RNs initials & employee number as the person picking up the unit. The tech and the RN are required to inital the transfusion slip with date/time as to when the unit was issued. Only in cases of trauma, etc in the ER or OR do the techs take blood from the Blood Bank, and even in those situations. The check by the tech and the RN are performed at the bedside. Hope this helps! Nursing needs to understand the importance of these checks and they should also be confirming all of this information again at the bedside before the transfusion

Mabel, you do make a point about a large amount of RhoGam to cover Rh Positive RBC transfusions to an Rh Negative patient. However, instead of the 300ug doses we usually think of, we would recommend an intravenous verison. Our pharmacy has WinRho. Yes it would still take a large amount, I believe a 1500 IU of intravenous WinRho covers 15 mL of Rh positive cells, but doing this beats doing nothing. Thanks.

QUOTE] Stupid question time - I'm trying to get this implemented at my hospital as well. We are 295 beds and also do not perform electronic XMs. If a second sample is not available, I want to give only group O until a new specimen is drawn. When you say 'Group O' do you give only O neg or, if the patient in question is Rh Pos, would you give O pos? Do you give O Pos to males and O neg to females?

We are 115 bed hosptial and we do not perform computer crossmatches. We perform a second type on a DIFFERENT sample for any patient for crossmatch without a history. No charge to patient. If we have a properly labeled tube from a previous collection (within 24 hours) we will use it as the retype sample. If we do not have a tube, we order a retype ABO and have a sample collected. Our policy states that if we can't get a sample for retype before the transfusion is needed, we transfuse group O RBCs. We have been doing this for 1 year in April and we have had very little problems with samples being collected for retypes. So far we have found no discrepancies. As far as retyping the same tube (even when the original suspension is trashed and different techs), I find this somewhat useless for catching errors in sample collection - "wrong blood in tube". You could retype the same sample 100 times, if it is the wrong patient's sample - you haven't helped identify a potentially fatal problem. Hope this helps.

We have made a decision to switch to IgG and C3 separately, both on adults, IgG only on babies. I was reviewing the package insert for the Anti-C3 reagent (Immucor)and I was curious about the Quality Control. Of course we will use Complement Check Cells as directed in step 1 for negative tests. I was curious about the saline control mentioned in step 2. It reads as follows: "False-positive reactions in the direct antiglobulin test may be recognized by carrying out a control test...in which two drops of saline are added at step 3, instead of Anti-Human Globulin. The control will facilitate the recognition of aggregates caused by 'complete' (IgM) autoantibodies that have not dissociated during the washing phases or to other causes (such as spontaneous agglutination on centrifugation)." Are you reporting out this control step? If the control is positive, do you attempt to repeat the DAT with additional washes? Thanks!

I am interested in opinions about Gel and Solid Phase testing. Especially anyone that has used both, which do you perfer? Do you think one is easier to use over the other? Ect. Thanks.

What reagents do you use? Immucor, Ortho. etc Thanks.

I would like to see how others perform/result DATs. Currently we perform DATs with Polyspecific AHG (IgG and C3). If it is negative we are done. If it is positive we test with Anti-IgG only. Currently we report as either Negative or Positive. Do you follow this same testing pattern? Are you using complement specific reagents? Do you report as Negative or Positive or do you indicate what is bound (or not bound) to the red cells? Thanks for the info.

We perform a clerical check on sample, unit, and transfusion slips. We perform visual inspections for hemolysis, ABO/Rh and DAT on pre and post samples. We also test a post urine for hemoglobin. Negative results are forwarded on to our Medical Director for interpretation. If there are any positive results (excluding pos urine hemoglobin) that indicate a hemolytic reaction, we immediately notify our Medical Director and continue with additional testing. I have only been working at my present job for ~5 years, but I have been told we have never had a reaction progress to phase 2 testing.