Marilyn Plett

The +s stands for strongly expressed.

The expression of the P1 antigen varies considerably from person to person, but the reaction strength with anti-P1 is an inherited trait (i.e. the strength of the expression on the red cell surface).

"I apologize for this dumb question."  BBnoob69, NO QUESTION IS A DUMB QUESTION, IF YOU DO NOT KNOW THE ANSWER.  If you don't know the answer, the dumb thing is to not ask the question in the first place.  NEVER be afraid to ask a question on here,

As someone from the UK (born there, still live there and worked all my professional life there), I concur with jshepherd's post.  I, too, am an aabb individual member.

My facility is not AABB accredited, just Joint Commission and FDA, and I have an individual membership. I am the supervisor, and we are a large level 1 metropolitan trauma hospital. I have gained so much from my membership. Everything Cliff mentioned about resources is true, and I can't tell you how many times we've taken advantage of the discount on books for my pathologists (none of whom are transfusion medicine specialists). 
AABB membership also opened up all the subcommittees and sections, and I now sit on 9 subsections and lead one of them. I am also a mentor in the program Cliff mentioned above. 
I would say it's worth it for at least one year, so you can try it out and see what you get from it. Pro tip: if you love it, they do offer a 3 year membership option that knocks some of the cost down.  

I never regretted my individual AABB membership.  They can be an excellent resource, especially in your new position.  Having said that, I imagine things may have changed since my retirement.  I would suggest getting a membership, if you are not seeing the cost: benefit ratio in your favor you can always cancel or just not renew.

Good morning, Blood Bankers. I work at a Level 1 Trauma center and we just purchased 4 of these coolers. Has anyone had a successful validation plan? If so do you mind sharing. TIA. I am trying to find the most efficient way to validate and make sure we are covering every extreme possible.

Forgot to add, Plasmalyte is also FDA approved for use with blood components.  No data :).  In our OR, there is no normal saline at all, just Ringer's Lactate and Plasmalyte, the latter used for blood component administration.  Plasmalyte is slightly more expensive than normal saline, but also somewhat less toxic.

I'm paraphrasing quite a bit but I was one time told by a blood banker I highly respected; "Get the ABO right first and foremost, then take care of the rest the best you can!" 
Another favorite of mine comes from an ER Physician, probably the best I ever worked with.  "Halitosis is better than no tosis!"  I'm sure that applies similarly to a severely bleeding patient. 

Transfusion has much more serious adverse effects than making an anti-D.  Increases in infection, sepsis, thrombosis, inflammation and mortality for example. 
There are no data to my knowledge of long term effects of anti-D formation in patients not having future pregnancies.  Most such patients come to the attention of the transfusion service because they have anti-D or simply because they are Rh (D) negative. They are then transfused with D negative blood if need be, in something like 99.99% of cases.  The rare patient who gets Rh positive blood (trauma patients) do sometimes have increases in bilirubin, LDH, etc. and delayed or rarely acute transfusion reactions. These are bad for patients, so you are right, for these rare patients, the outcomes can be dire.  But there few alternatives to transfusing Rh (D) positive blood to most patients in emergencies.  And very few will have future transfusion reactions.

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.

There is going along to go along and then there is accepting ample amounts of data from extremely reliable sources.  It's not about "sales" it's about trying to serve the population in general, based on the best knowledge we have currently and being willing to accept that.  If what you are doing works for you in your little corner of the world, that's great but making light of advancements because it doesn't fit your paradigm and accusing some of the best professionals out there of being uncaring is..........
I'll stop now.  I've been in this group for more years than I care to count and don't want Cliff to ban me. 

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.

I've said it before, inertia is the strongest force in the universe.  From my 35+ years as a blood banker and supervisor of both donor services and transfusion services, I have come to the conclusion that, as a general rule, blood bankers are extremely slow to change when not resisting it completely.  This appears to be especially true if they are not actively involved in the change or keeping up on the literature.  I saw a great may changes during my tenure and not all of them were comfortable at first.  Giving O Pos blood to massive bleeds was just one of them.  The data supports it, no matter what our long held concerns and fears try to tell us.  Many of those long held fears and concerns were primarily theoretical, especially in how prevalent and disastrous the outcomes would be.  I have a number of stories to prove my point but I think I'll stop now and step off my soapbox.

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.

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.

Yes, when there isn't a true massive, it is more likely the patient may make an antibody. That said, we have the same procedure here as you Kym: we give O pos to males and women over childbearing age for ANY emergent release red cells. If they only get 1 or 2 units, then so be it. This is part of the battle of using inventory appropriately and calling a code/massive appropriately....and never the twain shall meet.....  

It varies from no reaction to lethal hemolysis.  Anti-D is not entirely predictable in causing severe hemolysis.  But mostly bad stuff happens :).  This is true to some extent for anti-A and anti-B, although these are more dangerous as they fix complement in vivo better than anti-D in general.  Joe Bove (my original mentor) reported a case of a patient receiving multiple units that were ABO major incompatible with no reaction.  Not typical, but illustrative of the variability.

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

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

Why are you even asking for a urine for an allergic rxn to platelets?

In the UK, NHSBT stopped performing a DAT routinely on donor units some time ago (when I was still working).  If a unit was found to be DAT positive through, for example, an incompatible cross-match, and the unit was returned to the supplier, the unit was tested, and then discarded, and the hospital reimbursed.  If considered necessary, the donor's GP was informed.

However, of course, it is almost certain that many DAT positive units were not discovered, and were transfused to a patient as a result of electronic issue.  I have NEVER heard of a patient having any serious clinical sequalae as a result of this practice.

I've been a BB'er for 35 years (at the same hospital)  my very first manager (who was a good,  seasoned BB'er) used to tell us........., "if you have to hunt for it - it's not there".
As you become more adept at reading tube reactions - your eyes will not fail you!  Trust your gut.
As for your technique - it all sounds good!  Practice with a few techniques to find the one that works best for you
I "tilt and giggle", button up, The tilt helps with seeing Mixed Field - which we tend to see a lot here - It also helps with seeing "how" cells are falling off the button - are they chipping off or are they "swirling" off.....or is there a little of both?  (For some reason I always think of the "tail" of an old RPR test .....which probably dates me, LOL!)

In my interactions, Patricia was a grand lady. So very kind to new talent and so gracious with her peers. I have some of the letters that she and Dr. Polly Crawford exchanged over the years regarding interesting cases and personal life happenings. They had a unique friendship! And, I have a talk at AABB in Nashville where I used a quote from her 1962 publication (!!) regarding anti-D in D+ patients with a negative DAT as missing a part of the D antigen, what we now identify with molecular methods as partial RHD. How absolutely thrilling that must have been to see new techniques prove and go further with historic theories. An excellent scientist, she is missed. Sandy Nance

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.

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.

If we have to hunt for a sample to use for this that will give consistently comparable results, we aren't testing the method, we are testing our ability to find a suitable sample.  I heard that CAP will sell you one that will consistently give the same results.  If we aren't going to change anything (can't recalibrate gel!) based on the answers we get (like chemistry would), then why are we doing this?  I talked TJC out of it last inspection (I probably got a little heated over the stupidity of it because I had to come in the day after a concussion to meet with them, but maybe they took pity on me and didn't cite me because of my unfiltered brain).  No one has been able to explain to me any meaningful takeaway from doing this comparison.  If I am ever forced to do it, we will just keep copies of sample results that we run by two methods to solve a problem and make a note that they are acceptable because we expect these differences between methods.  If anyone can give me a valid use for this, I would be very appreciative.