NedB

Have you run an IgA level on the Patient? The Patient may be showing IgA sensitivity, along with the stealth antibody.

As a matter of policy, if you know the Patient was transfused with RBCs within the previous 3 months, you should call. The big scare is to miss an Anti-Jka. You know how Kidds can show variations in titer.

What you want if for the blood to be cooled towards the target range. There are other considerations - most especially, time. If you are going to make FFP, you need to get the blood into Processing to make the six or eight hour window. The point being not to hold all the blood in one place and try to maintain a cooling but to break up the donations into manageable transportation and processing numbers of units.

We have had a lot of trouble with our Helmer, but I agree, when it works, there is nothing faster.

Want to hear from a retiree? What you bring up seems to me a Lab problem -not just a Blood Bank one. You can not forbid chit chat - after the Super Bowl, everyone will be talking about it. The same goes for breaking news. If your Techs keep their end of the chit chat to a minimum, the Techs from other sections will get the message - this is a mark of professionalism. At most of the places I have worked, the Blood Bank was almost always physically located centrally in the Lab, but was seemingly always segregated in terms of workplace interactions. Most Techs who have worked in the Blood Bank know the stress level and don't needlessly interrupt. At the last place I worked, we were once off the Main Lab - in what I refer to as a closet. Moving into the Main Lab at first seemed a bad idea, but turned out to be the best thing. The camaraderie between the Blood Bank and the Main Lab increased apparently to everyone's benefit. And it even helped donor recruitment. Just be careful of the rules you write. You have to live with those rules too.

TTP is usually caused by an autoantibody directed to the enzyme ADAMST13 which splits up the vWF multimer into small subunits that do not react with platelets. When the large multimers are not cleaved by the enzyme they react with and clear platelets from the circulation. FFP serves primarily to replenish the enzyme. The production of the autoantibody is self-limited. Many Patients experience a short-term relapse of autoantibody production a month or so after the initial resolution, but then never experience another episode. The exchanges are cumbersome to the Blood Bank and to the Dialysis Staff, but the procedure works. As for ITP, the last issue of Blood has two articles about H. pylori being one of the causes - specifically IgG antibodies to H. pylori seem to attract P-selectin from platelets.

Where are you getting brass weights re-certified? We have a set from Troemner and the only company I can find so far is Troemner themselves.

The temperature of the blood warmer is 40C, but the blood does not get that hot. It is only in contact long enough to bring the tmperature above 30C. Some work better than others. Any way, the exposure above 39C can't be long enough to degrade the labile coag factors. We recommend the Nurses not put platelets through because the kind we use has a mesh filling that I worry will trap too many platelets. I probably wouldn't worry about cryo, but in truth, that hasn't come up.

According to CAP and AABB we must keep segments seven days post-transfusion. Since we crossmatch for up to three days prior to transfusion, we only need to keep segments a total of ten days, usually. To take into account extending crossmatches (to a maximum of seven days from date of specimen, we devised a protocol of tagging the segment used for crossmatch with the unit number in a plastic 12x75 mm tube and storing this in a dated rack which we discard after two weeks. I don't see the need for repeating crossmatches when investigating delayed transfusion reactions - if an antibody reacted with red cell antigens, you would find the aantibody on elution. If the antibody reacted so stronly that no red cells survived to be coated, the symptoms would show immediately, not delayed. Services who do donor testing probably need to set up a longer retention, but the original pilot samples would be best for this.

It's not just Hepatitis to be concerned with. If you are unable to rule out blood transmission by tests done on the Patient, and as mentioned, Patient history, you should get all donors re-tested. This is not that hard to do and donors usually cooperate. In contacting the donors, you need to include such phrases as checking to make sure you do not have a 'hidden' illness and 'verifying that it didn't come from you'.

We use the gel system but don't get 3% Screen Cells. We get the A and B 0.8% Panels plus a 3% Panel. When we need to do a screen in tubes, some of the Techs will convert the 0.8% Screen Cells to 3%; I prefer to just make up a short panel from the 3% Panel - I can get more homozygous cells that way and can usually do so in 4 or 5 cells.

QED. No more need be said, except that I would note in the procedure that discrepant results would be vigorously investigated.

Well, you won't find that documentation, but here is some logic. The ProVue is the automated instrument for the gel system. When you prepare it for the day, you load a number of IgG cards onto the 37C rack. Guess what happens to the card or cards not used? They stay in place until you use them. That may be several cycles. At one time we acted conservatively and didn't load more than we could use, but as with many things, familiarity breeds not contempt, but relaxation. No harm has ever come to the cards. And think about it, the cards are sealed and the temperature does not rise above 37C, hardly a level to cause degradation.

We use a separate Arm Band for the Blood Bank. The band has a card with the Arm Band number embossed, from which copies of the number can be printed on demand. We allow the Patient to hand carry this back in and reattach on re-verifying the identification - with pictured ID, etc. This works for our serial Patients who come back in only for Platelets and Plasma Exchanges. We don't have to repeat blood work just to get an Arm Band number on the products. For crossmatches, naturally we start with a new Arm Band.

One more for not knowing the subject. An RN just refused to pick up a unit of blood after finding out it was irradiated. She is 3 months pregnant anf that is the most critical trimester for avoiding radiation sources. Had heard that one before, but not in a long time.