ChrisH

For my mixed field, I will take about 7 to 8 drops of either A or B cells and add 2 drops of screening cells. This will show a nice weak mixed field.

We have used them for a few years.  A lot easier to clean up the sand then glycerol.  

We have used them for a few years.  A lot easier to clean up the sand then glycerol.  

Why don't you post to this message board your questions or thoughts as you read each chapter. I am sure we all you help you. It may also benefit those that are taking the exam at a later date.

I have been told that we have to do KB because of turn around time.  The OB/ER want to know now and do not want to wait a day or so for the flow results...

I have been told that we have to do KB because of turn around time.  The OB/ER want to know now and do not want to wait a day or so for the flow results...

Interestingly enough, I was at a conference recently where forum threads from Bloodbanktalk were used as source material and included as part of the lecture.

I searched a CLIA site and found this from the following site:
 
 
State Operations Manual
Appendix C - Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services
Table of Contents
(Rev. 140, 05-29-15)
 
(493.1271)
There generally are no daily quality control requirements for reagent red cell panels used in antibody identification. However, we encourage laboratories to follow the manufacturer’s recommendations for QC.
 
I printed this part so if an inspector tries to to say I HAVE to do QC I can show this. I think the red was what was revised in May 2015. I want to do what is good for the patient but I don't want to go overboard and use up all my panel cells trying to satisfy a nebulous requirement.
 
I use Immucor and the manufacturer's insert says "the reactivity may be checked periodically with a weakly reactive antibody." (??) MAY doesn't mean the same as HAVE TO. We get hung up on every word of standards, why not the package insert too?  After reading what Dr. Pepper wrote when he talked to CAP, I included a column on on our antigen typing form to add the panel lot # since we use panel cells for antigen controls. They should work as expected to show the panel is QC'd multiple times weekly. (Thank you Dr. Pepper, it was an easy fix)

There has been a lot of conern in my area about inspectors asking for daily panel QC. As is often the case, we need to educate them on the intent of the standard. I verified with AABB Accreditation who also holds deemed status as CLIA and CAP assessors, that the whole issue hangs on the word "detection"  There have been a couple of folks in my area cited for this and they challenged it with CAP (who was performing the assessment) and they won. So I wouldn't upset the assessor, just wait and call whoever the inspecting body is and sort it out.
 
By both FDA and AABB we must be able to detect clinically significant antibodies and provide crossmatch compatible units for transfusion. The identification piece is 1) an extention of your screen cells (more of the same manufacturing process); 2) often completed by a reference lab (within or outside of your system) and 3) is not specifically called out by any accrediting body becasue they follow FDA's lead.
 
Sometimes we are such a detail-driven group it is hard to take the step back and look at the bigger picture.

John makes a good point above, that if you are going to do QC, then you need to make sure each panel cell is testing with both a positive and a negative at least.  For example if you are using a diluted Anti-c as your QC material, you are only proving that the panel can detect Anti-c.  Any antigens that are only on the c negative cells on that panel are not being tested at all.
 
In the true sense of QC, you're not just making sure some of it works, you should have to prove that it can identify each antibody.  Which is just crazy talk. 

What they do not say is that the new Cent-Incub combo takes up more counter space then the old (since the old incubator sits on top of the centrifuge).

Yep -Macopharma bags

We use the macopharma phlebotomy bags (600ml) with the luer lock. That way we can attach any size needle onto the bag.

I like this, will have to check this one out.....did not think about using check cells....




 

I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!!
 
Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous.
 
An antigen can be described as either showing homozygous expression, or heterozygous expression.
 
That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we had one!).
 
That's got that off my chest.
 
Now then, there is NO doubt that there are some anti-K's around that only react with K+k- red cells (dosage), but they are fairly rare, however, how many people use antibody screening red cells that are K+k-?  I doubt if there are any.  Therefore, we are all ruling out anti-K using red cells with apparent K antigen heterozygous expression on every single sample that (apparently) has no atypical alloantibodies present.  Am I wrong about this?
 
It follows, therefore, that, over the years, there MUST have been occasions when a patient with a very weak anti-K (one that is only detected using red cells that are apparently showing homozygous expression) and who has been transfused with K+ blood (do the maths).  As far as I know, there are no papers within the literature that report a case of either a delayed or an acute transfusion reaction as a result of this.  Yes, this may cause the anti-K to become stronger (and, hence, be detectable using an apparent heterozygous red cell sample showing K+k+ expression), but then, if this happens, you give K- blood.
 
So, my considered answer is that you can exclude using K+k+ red cells.
 
I shall now go and lie down!!!!!!!!!!!!!

Are you thinking of the Matuhasi-Ogata phenomenon?
 
I saw this a couple months ago when a patient was having a transfusion reaction caused by anti-hrS/hrB antibody. We could elute their other antibodies from their cells even though they had been transfused antigen negative blood.

Our BB system, SafeTrace TX (HBB) does this.

We have units irradiated in our radiation oncology center on their linear accelerators.  It always flummoxes inspectors because they are used to the free-standing irradiators and don't understand the differences in dose-mapping etc.

I thought most people who love Blood Banking were strange. Who else would stay in this field for a long time?

I thought most people who love Blood Banking were strange. Who else would stay in this field for a long time?

For my mixed field, I will take about 7 to 8 drops of either A or B cells and add 2 drops of screening cells. This will show a nice weak mixed field.

Why don't you post to this message board your questions or thoughts as you read each chapter. I am sure we all you help you. It may also benefit those that are taking the exam at a later date.