AMcCord

Do you have collect cord blood samples?  Cord red cell samples from A or B babies of type O moms (with pos DAT not due to other alloantibodies) can be preserved in Alsevers for nice student project samples. I've faked samples for immediate use by combining A or B cells from donor segment samples with type O plasma. I wash some of the excess plasma away before I give the sample to the student to work with. I don't have a specific recipe - just add a splash of plasma to cells from a couple of segments, then check a drop for a pos DAT.

And there in lies the danger.  Well said John.

AS an ex-Reference Laboratory Manager, I think that ALL results should be confirmed, ABO or otherwise.

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

I believe the old saying is, "If the computer ain't happy, ain't nobody happy!!"

Giving O units (or A2) keeps our computer happier on patients with documented anti-A1.  Of course, that is the prime objective these days, right?  We bow to our computers!  

We use MediaLab also and scan the package inserts in a job aids.  You can revise them the same as you can your policies.

Wastage with plates for solid phase depends on what platform you are going to use. With manual testing and the Echo you use antibody screen strips that test 2 patient samples per strip. When I last looked at the Galileo (5 years ago), you could run 4 patient per test plate. That may have changed - I don't know. I also don't know what the Neo uses. Early on with the Echo, you had to use 2 test strips (which would run 4 patients) per run, sacrificing 3 antibody screens if you ran 1 patient. Now if you have a run that is for 1 or 2 patients, you use a balance strip so that large waste factor is gone. With 1 patient runs, you will still lose 1 antibody screen. If you never, ever run more than one patient at a time, you will lose 50% of your total antibody screens.
When cost per test is calculated, what you need to look at is how often you can 'batch' patient samples in runs of 2 (or 4 or whatever Neo uses) to determine waste. That percentage of waste is plugged into the reagent use formula and included in the cost per test figures. The Immucor sales people do that as part of your cost per test calculations (and very happily, too - naturally ;>). We calculated very conservatively and said we would have 40% waste and we still came out money ahead over gel for our contract with Immucor (3 years ago). Our actual useage pattern is better than 40% waste, as we are able to batch many of our runs with non-urgent tests like prenatal antibody screens, pre-surgical testing, next day transfusion patients and the like. So consider your work/patient order patterns when comparing automation methods. That should help make things clearer.
We have been satisfied with our Echo's performance and the technical support we get for it. I was concerned with how far away our service person is - about a 5 hour drive. BUT...we are in a rural area and that is not uncommon for service with any of the companies we do business with for hematology, chemistry, etc. The plus with the Echo is that it has been extremely reliable and we've only needed 1 service call in 3 1/2 years. All the other problems (and there have not been that many of them) were fixed by me with telephone assistance from technical support and a little box of parts that come with the instrument. **Disclaimer: I am definitely not a mechanically adept person, but I get alone with the Echo tinkering just fine.** It was designed for parts replacement by users, very simple replacement. Their capability to 'dial in' to the instrument, just like the technical folks do for the big chem analyzers allows for long distance diagnostics and adjustments to camera and centrifuge operation.
As of the first CAP automated survey of 2011, there were 407 Echos, 520 Provues, 130 Galileos, and 39 Tangos reporting. From the survey performance of each platform, I think you will see that they are all performing within acceptable limits. The switch from interpreting patient results in gel and interpreting patient results in solid phase is NOT difficult. None of my techs had a problem with that. (Note: we were manual gel users, not ProVue users.) We do have increased sensitivity, which is great for detecting alloantibodies in our patient population. We do see a few more warm autos that we did with gel, though that is a trade off I'm willing to make for the ability to catch a few more -Jk-a, Jk-b, Fy-a, Fy-b, and little c antibodies. We do not have an annoying number of non-specific reactions anymore (software upgrades, and a recent instrument adjustment, have helped that issue significantly).
Would I switch from the Echo to an automated gel system? If the ProVue has some new features that improve it's function over the function of the Echo and the money difference is significant...it's a possibility - gel worked fine for us when we were manual users. Am I satisfied with what I have right now with the Echo, functions and $$s...definitely Yes.

Agree. We don't issue type specific blood unless we have time to get a current type and perform an immediate spin crossmatch for ABO compatibility, and it's still issued as uncrossmatched until the antibody screen is done.

If the model is discontinued and no parts are available for repairs, I'd say it has reached its 'end of life' - however I'll bet it will still work a long time after that before a part needs replaced (especially older, quality scopes). I can see 'end of life' for more complex or expensive equipment, but a microscope for blood bank is more of a minor equipment purchase. My 'new' scopes are student scopes that cost less than $500 and they work just fine for our purposes. 

Below is our policy for switching Rh negative patients to Rh positive red cells for non-emergent cases. We would document that decision and any pathologist instructions in the patient's profile. 
For emergency release/MTP we follow policy and do not notify the provider unless it is a patient under 19 years or a female of child bearing potential. 

Below is our policy for switching Rh negative patients to Rh positive red cells for non-emergent cases. We would document that decision and any pathologist instructions in the patient's profile. 
For emergency release/MTP we follow policy and do not notify the provider unless it is a patient under 19 years or a female of child bearing potential. 

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

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The response I got from ARC is that it is up to our medical director. There is no FDA exception needed, as the FDA doesn't have a regulation on shipping duration or transit time. They only care about temp, and since the temps are in range, there is nothing to seek a variance from. 
I heard from people who use other blood suppliers, and the general consensus is that if the packing is correct, ice is still present and the units are in temp range, they are acceptable, as long as there is documentation of this deviation from the hospital's normal policy. 
I ended up adding this tidbit to my SOP as an allowed deviation by our medical director, just need to fill out the deviation documentation form and have him sign, but this way, we can accept the units in immediately and not delay having them be available. Especially important for platelets!

ISBT has an excellent podcast I have been listening too. You can listen and subscribe here:https://www.isbtweb.org/resource/announcing-our-new-podcast-transfusion-practitioners-across-the-world.html 

Some references related to the Platelet Glycoprotein, GPIV
B. R. Curtis, J. G. McFarland. Human platelet antigens – 2013. Vox Sang 2013;106:93-102
Curtis BR, Ali S, Glazier AM, et al.: Isoimmunization against CD36 (glycoprotein IV): description of four cases of neonatal isoimmune thrombocytopenia and brief review of the literature. Transfusion 2002; 42: 1173–1179
Ikeda H, Mitani T, Ohnuma M, et al.: A new platelet-specific antigen, Naka, involved in the refractoriness of HLA-matched platelet transfusion. Vox Sang 1989; 57: 213–217
Curtis B, McFarland J: Detection and identification of platelet antibodies and antigens in the clinical laboratory. Immunohematol 2009; 25: 125–135

We issue uncrossmatched units in our BBIS, so it prints tags for the units that resemble those for crossmatched units. Fast, easy and accurate plus the RNs can scan the units in Epic to document transfusion.  We use SafeTraceTx.  We have a downtime uncrossmatched blood form we can complete on paper.  We keep a photocopy.  See attached.
Emergency Release of Blood Products (form) (20553_0).pdf

I didn't find much either, but from what I did find it looks like it could be another interesting blood banker's problem since CD36 is definitely found on RBCs. And it sure looks like it may be utilized with immunotherapy for multiple kinds of cancer treatment to make it more effective. Or for FNAIT.
https://pubmed.ncbi.nlm.nih.gov/1382721/
The link below is interesting - not sure how it would relate. 
https://pubmed.ncbi.nlm.nih.gov/8623134/
And then there are these tidbits:
https://pubmed.ncbi.nlm.nih.gov/34041523/
https://www.ahajournals.org/doi/full/10.1161/01.atv.16.7.883
If patients with African descent are more likely to develop anti-CD36 due to CD36 deficiency, are their red cell ABO types (or other antigen types) going to be affected by that antibody (which would be an autoantibody)??? 
I'm with Mabel - anyone out there know anything about using anti-CD36 for cancer treatment or FNAIT treatment?

I didn't find much either, but from what I did find it looks like it could be another interesting blood banker's problem since CD36 is definitely found on RBCs. And it sure looks like it may be utilized with immunotherapy for multiple kinds of cancer treatment to make it more effective. Or for FNAIT.
https://pubmed.ncbi.nlm.nih.gov/1382721/
The link below is interesting - not sure how it would relate. 
https://pubmed.ncbi.nlm.nih.gov/8623134/
And then there are these tidbits:
https://pubmed.ncbi.nlm.nih.gov/34041523/
https://www.ahajournals.org/doi/full/10.1161/01.atv.16.7.883
If patients with African descent are more likely to develop anti-CD36 due to CD36 deficiency, are their red cell ABO types (or other antigen types) going to be affected by that antibody (which would be an autoantibody)??? 
I'm with Mabel - anyone out there know anything about using anti-CD36 for cancer treatment or FNAIT treatment?

We have had HFAP until they were purchased by ACHC, and both of those have cited me for the lack of correlations:  one for not performing them at all, although I pointed out that we do that on every specimen without previous records, and just last year because I didn't include crossmatch tests with my Type and Screen correlations.  I contested the citation again, stating that it was the exact same methodology as the antibody screen, but was unsuccessful as their standards say "the same test using different methodologies ".  I gave up and added XM as well.  No concept of what we do and no common sense! 

I only wish I could know another language anywhere near as well as Yanxia knows English!  She has always impressed me with her blood bank knowledge as well.

Blood bank methods aren't expected to correlate perfectly.  We use their differences to avoid rouleaux, clinically insignificant, and weak warm auto reactivity so we can better detect any significant alloantibodies. No method will detect 100% of significant antibodies. I am going to tweak the above to say we can "better detect' antibodies so it works better with the next sentence and doesn't imply that we can detect "any" significant antibodies. 

I like it Mabel! We all need to start using that for our CAP inspections to see if we can shove them in the right direction.

I like it Mabel! We all need to start using that for our CAP inspections to see if we can shove them in the right direction.

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