Melanie

It is custom to use outdated cells for antibody identification and ruleout. Cells have shown to be useful more than two months past the manufacturers expiration date for most antigen systems. We use cells up to this time for all antigens except Lewis. Cells must be visually inspected prior to use and must not be hemolyzed or discolored.

With the use of monoclonal anti-D there has been many more patients that have been tested as Rh positive that are actually missing part of the D antigen. They are fully capable of making an antibody to the missing peice which would react with all normal Rh positive cells. These reagents are great for donor populations and not so great for patient populations. WE have instituted a policy so when we test a patient and it reacts less than 2+, we call then Rh neg. They receive RhIg if needed and Rh neg units. WE notate in their computer record that they are "Rh variable" for future reference.

We are setting up a QC protocol required for red cell recovery. The problem is that only about 50% of the units are passing the 85% recovery needed. It does not seem to matter who performs the freezing or deglycing, so we are not thinking it is the technique. Has anyone had similiar problems and if so, how did you resolve them? Any suggestions are more than welcome, thanks!

Another good idea is to pull your own patient workups and use them as teaching tools. I somtimes just give out a copy of some of the work and list a bunch of questions about the workup. Gives techs a chance to try and figure out how best to proceed when faced with a particular type of problem. An example would be a patient with a high freq antibody. I will ask things like "What methods could you use to rule out all common allos?" Techs get continuing ed credit for completing the questions and sitting for a quick review.

We only use the scope for DAT's and any questionable reactions in tube otherwise just a lighted concave magnifying mirror.

We give either type with a note in patient record that states "approved to receive Rh pos platelets, RhIg not required"

Rouleaux can really be a problem if you are using Peg enhancement with your tube testing technique. If so, I recommend you choose another enhancement reagent like LISS or make sure that you do extra washes prior to addition of IgG. Although it is said that no rouleauz is detected at the coombs phase, by adding PEG to a patient with abnormal proteins you can cause red cell agglutination without having an antibody present. Extra washes usually will do the trick.

WE have two eight unit plasma thaw devices as well as the old fashion Forma waterbath that can hold another eight. So, potentially we could thaw 24 at once and have actually done so for plasma exchanges (CPP or FFP). We now have thawed plasma on hand each day of different blood groups for OR cases and other emergencies. Types we have thawed at all times are 6 Goup O's, 6 group A's and 2 Group B's.

We match Rh and K for all routine transfusions to a sickle cell patient to prevent possible immunization. WE only give HbS neg units for a red cell exchange. We also try and get a compete phenotype on a pre-transfusion sample if possible, or use hypotonic wash and do it that way.

Grade reaction and notate "mf"

Kidds are like that. Once identified, they go away and drive you crazy..... Making you wonder if the original ID was correct.

Did you ever do an eluate? If so, what were the results? Sometimes the eluate is able to pull off an antibody that you can not detect using tube methods. It would be interesting to see how the eluate reacts in tube and using gel. Were you able to do a complete pretransfusion phenotype?

We do not repeat any antigen typing done by the reference lab. We are looking into alternative sources of reagents at this time because of rising costs. We keep all common antiseras in stock (C,E,c,e,K,k,Fya, Fyb, Jka, Jkb, S, s, M, N and Lea and Leb) WE use commercial antisera for donor screening and patient testing for all common allos when required by SOP, but, we also save plasma from donors and patients with allo-antibodies in frozen alliquots for those times when massive screening is needed. However, we require a confimration using commercial antisera with controls prior to labeling unit as antigen neg.

We have chosen the Tango to replace our sunsetted Rosys. A team from the lab investigated each and toured facilities to see them in operation and decided that for our workload and flow the Tango will meet our needs. We are getting three of them and they should be here in September.

It is really a matter of storage space. We save our samples for a total of five weeks. Samples are good for use for 28 days if not transfused or pregnant within the last three months. We save them for an additional week in case they get transfused on day 28. We completed a validation of sample viability with all methods we use and found that they are still reactive at end of storage period.

We are required to confirm type the original sample and this is done by a seperate technologist prior to transfusion.

We enter the ABS as "pos" with a comment that states: "Passive Anti-D due to Rhogam" This is used for patient's who receive Winrho or rhogam. There is no official antibody identification entered in the file.

At our hospital we have what we refer to as the "Trauma Coolers" Six units of leukoreduced O pos irradiated red cells and two units of leukoreduced "O Neg" irradiated red cells. What is put in the coolers is "prepared" ahead of time and in the fridge waiting for the call. The units are documented on an emergency release form, segments have been pulled and labeled and put into a plastic bag for future xmatch on patient and the units have all been verified to be available and ready for issue. We have coolers designated just for this purpose and are "prelabled" and just need to have the ice blocks and temp indicator placed inside along with all the units.

Rouleaux formation in gel usually looks "mixed field" with a faint ring around the top and some shadow along the sides with a button on the bottom. We repeat the screen using a different method (usually peg) and go from there.

We also get a tremendous amount of "passive Anti-D's due to Rhogam given". When the screen comes up pos, we do what we call a "mini-D ruleout panel" in PEG. If only the D+ cell reacts and we have the information concerning when the patient received Rhogam, we call it a "passive Anti-D due to Rh immune globulin received". We do not do titers.

licensed MLT's are allowed to do all routine blood bank testing, including basic antibody identification. The stipulation is that all work is reviewed by a Senior Technologist and tranfusion recommedations are made by a Senior Tech or Supervisor. MLT's are not allowed to work alone and must have a MT or higher to work with in the transfusion service. They are allowed to process components without direct supervision.

Equal pay for equal job. If an MLT is performing all the same tasks as a MT, then they must receive the same wages according to the law. However, if a MT must reveiw the work of an MLT and this is stated in their job descriptions, then the pay structure can be different. I may be off base with this, however, when I was a supervisor and writing job descriptions, it was imperitive that the tasks and responsibilities be spelled out for each position and education requirements to perform that job.

ok, Cliff, Why not make the Doctor's responsible for ordering the correct products for their patients? Why make the blood bank responsible? This is a huge expense with Radsure's costing $2.00 a label and the tech time it takes to Irradiate units?

Jane, I worked at the ARC reference lab and they are the transfusion service for many dialysis centers and other rehab hospitals. The nurses call in the order and collect the sample. The red cross then sends a driver to pick up the sample and deliver it to the reference lab. The sample and all the paperwork must meet all requirements or sample is discarded and facility must recollect. We then perfrom T/S, and crossmatch. Another tech must verify all paperwork before units are tagged. Once tagged, all work is checked again and the products are shipped out by distribution to the center on the day and close to the time required. they are boxed up like all other units with the proper amount of ice for the box, etc. Once the box is opened at the site they are responsible for the units. Units can not be returned to ARC unless the box has not been opened and it is within the time limit. ARC found that if the centers had refrigerators it was too hard to keep track of QC. Many of the centers did not comply with requlations, so it was mandatory that they only order units to be transfused. If patient was a no-show or was sent to other hospital, they were to notify reference lab and send products back in unopened box or units would be rejected and discarded. There is always more work than you think. Good luck!

We do a quick ABO/Rh on the sample that was already tested to verify result and computer entry prior to transfusion. A second sample is not required and we eat the cost of the testing.