Marilyn Plett

O negs are still used in excess of their numbers in the general population. I've worked on both the donor side and the transfusion side. The pressure on O neg donors is huge. They are asked to donate as often as possible. We owe it to these donors to be good stewards of their donation.

And hopefully, a slow day in the blood bank if you are working!

I was introduced to Dr. Tippett at an AABB annual meeting. I was a newbie SBB and manager. I had recently sent her my first example of an Rh positive mother who had anti-D. Dr. Tippett was very lovely and a giant in our field. I was thrilled to meet her.

If I'm not mistaken, both of those examples were whole blood units, not packed RBCs or RBCs resuspended in ADSOL. That would impact the amount of antibody transfused.

I'd also like the phlebotomist to identify me correctly and label my pre-transfusion sample correctly with MY name.

I've been retired for a long time, so I'm downsizing my library. If someone wants the following books, I'll be happy to donate them. U.S.A. only. Applied Blood Group Serology. Issit. 2nd edition. 1975. Clinical and Serological Aspects of Transfusion Reactions. Judd and Barnes. AABB. 1982. Selection of Procedures for Problem Solving. Wallace and Green. AABB. 1983. Problems Encountered in Pretransfusion Testing. AABB. 1972.

Early in my career, we used glass bottles. Since I was familiar with bottles, I got deputized to help my brother-in-law veterinarian collect a blood donation from the family dog.

Back in the 70's, two patients with identical names and identical hospital ID numbers except for one number were in rooms across the hall from each other. The O patient received the red cells intended for the B patient. I discovered the error when I accidentally entered the wrong room to collect a transfusion reaction specimen and did my due diligence on patient identification. Subsequent new admission rules forbade having two patients on the same wing with the same name.

Congratulations!

I don't believe that an optical aid necessarily refers to a microscope. In my pre-retirement years we used the agglutination viewer when an optical aid was required. Example: https://www.fishersci.com/shop/products/fisherbrand-tube-agglutination-viewer-5-watt-bulb-w-magnifying-mirror/22363560

When we converted to 100% leuko-reduction, my former blood center found that Hgb S units did not leuko-reduce even if they passed through the filter.

Once, as I was trying to help a student analyze a problem, she commented that she had had three years of college and I was the first person who had asked her to think! I suspect that's the norm.

Please discuss the importance of donation with this donor, and register the donor with the American Rare Donor Program. I remember having a pregnant patient with anti-Rh17. I believe there were only a couple of units available nationally. If I remember correctly, we had to resort to autologous donation, iron, and EPO.

I'm curious about the "diagnosis". Was the allergist thinking out loud about possibilities? Or has he done some diagnostic testing and issued a report? Could a hyper-reactive immune system respond to some of the effects of storage on RBCs or WBCs? (I'm really going out on a limb here since by knowledge is limited). I've collected donor blood in glass bottles 40+ years ago and more recently for my brother-in-law the veterinarian who needed to transfuse a dog. I don't know if they're still available.

Before I retired, we used leuko-reduced RBCs with antibody. When we began, we kept extensive records to study if the use of such RBCs caused subsequent problems; they did not. I certainly think O neg RBCs with antibody are suitable for trauma patients since much of the antibody will bleed out. Using these units increases the number of available O neg RBCs. Like David, I wouldn't use them for NICU patients. I might also avoid using them for patients with sickle cell anemia. Since these patients make so many antibodies, I wouldn't want to do anything that could potentially complicate subsequent antibody ID. We had a poster session at the 2010 AABB meeting discussing the impact.

I have very fond memories of living in Brussels in the "80s. Beautiful city; wonderful food. My son was born there. I passed through the Maelbeek station many times, so this feels very close to home. My heart goes out to all of its inhabitants.

You might be interested in the Last Chance Review webinar coming up Feb 13-14. http://www.giveblood.org/education/sbb-last-chance-review-via-webinar/

You might also want to look at the report of the AABB and CAP work group on Rh testing. AABB/CAP joint statement: http://www.aabb.org/advocacy/statements/Pages/statement150722.aspx Report in Transfusion (March 2015): http://www.aabb.org/advocacy/statements/Documents/statement150722.pdf

Here's a link to the FDA data on transfusion-associated fatalities. I know of at least one death to which an ABO mismatch contributed. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm346639.htm

Here's a link to an article about rare donors in The Atlantic magazine. Nice explanation for the average person. http://www.theatlantic.com/health/archive/2014/10/the-most-precious-blood-on-earth/381911/

Are there any family members who can be tested?

If you are in the USA, the mention of money can sometimes bring doctors off the ledge and back into reality. Rare units will be enormously expensive.

I've enjoyed this trip down memory lane. I remember using Ouchterlony plates to detect Australia antigen (Hepatitis . And we all had our coffee cups nearby!

It's been my experience that two nurses do the "bedside check" at the nursing station, i.e., they review the paperwork but not the patient ID. A family member was in the hospital recently. I had more confidence in the computer scans of the wristband and the medication than in any human "verification".

Gulf Coast Regional Blood Center sponsors the Last Chance Review to help prepare for the SBB exam. See http://giveblood.org/services/education/sbb-last-chance-review. You can attend in person, join by Webinar, or simply purchase handouts.