Marilyn Plett

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.

So, this PROVES that CAP do not know the A from their elbow.
ALL Blood Transfusion Reference Laboratory Staff, not to mention MOST Blood Transfusion Hospital Laboratory Staff KNOW that not all antibodies can, by any means, be detected by ALL serological techniques (saline, albumin, enzyme, LISS, IAT, inhibition tests, recombinant blood group proteins, etc), let alone by ALL technologies (glass, tube, plastic tube, liquid phase microtitre plates, solid phase microtitre plates, column technologies, etc), BUT THOSE WHO RUN CAP KNOW BETTER THAN EVERYONE.

They should be thoroughly ashamed of themselves, and go back to kindergarten.

With pictures???

Lol. Do you have a validation guide and procedure for that?

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.

In the UK, such a unit would be offered to the National Frozen Blood Bank, and would only be frozen AFTER a thorough aseptic wash, followed by addition of a chemical to prevent the formation of sharp ice crystals, and then  more washing upon thawing.  There would be no allo-anti-Kpb left!

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

We used the rate of transfused patients for each type of procedure. We carried out a survey of more than 5 years to identify the frequency of use of concentrated red blood cells for each procedure, including the immediate postoperative period (up to 48 hours). With this data, we define the reservation request guideline. When the doctor requests a reservation, he needs to select the type of procedure, and when doing so, the system fills the request according to the guidelines. For frequencies of use below 10%, zero red blood cell concentrate will appear and the blood therapy service will only perform T&S. We recommend that patients with requests a reservation whose frequency is greater than 10% have an ABO confirmation prior to the transfusion if they do not have at least two concordant ABO records in our system.

To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “

This reply also applies to the excellent post above by Debbiel.

Do these "experts" not understand, as do most, if not all people involved in blood group serology (and even blood transfusion) that it has been known for years and years that not every antibody reacts by all techniques, however experienced the person performing the test may be.

I once had an anti-S that reacted by tube IAT, but refused to react by gel, even though I sent it out to a large number of hospitals who I knew used both techniques.

I also think that all true experts have either read, or are aware of Leger RM, Garratty G.  Weakening or loss of antibody reactivity after prewarm technique.  Transfusion 2003; 43: 1611-1614.  Sadly, it would appear that (SOME) of the Quality "Experts" are not as expert as they like to think.

I get so annoyed when CAP "experts" give different answers to different people. It seems to me they also bring in their own personal opinion on things, like some inspectors we have to deal with. She stated she "suggests" doing ID on all methods
I would have to argue they we are testing the "method." If you get a positive AB screen using automation, do you also get a comparable positive AB screen using GEL and tube? Does the antigram for the same antibody across the 3 methods appear to be the same antibody. It shouldn't look like an anti-E on automation, a anti-K in Gel and an M in tube. They are not going to match in strength because the different methods vary in sensitivity. I would include the antigrams of each method to show it appears to be the same antibody across all methods. 
A set of screening cells is just a mini AB panel. If you feel like you must do an antibody panel using each method, I would just do an extra cell or two on each method and say it is not a set of screening cells but a mini selected panel. If we find a patient with a good, strong, clear antibody it is sometimes hard to come up with lots of extra plasma to do unnecessary testing. (My opinion only)
Gr-r-r-r-r!

We don't recheck antigen typings here in our hospital in Canada. The typings that have been performed at Canadian Blood Services, are embedded in the barcode on the bag, with all negatives printed on the End User Label. Every unit is antigen typed for K so if it isn't printed on the bag the unit is K Pos. Antigen typings we do are all linked to the unit through barcode. The reason of, "We were typing a lot of units and may have mixed them up", is not acceptable in a blood bank setting. Go work in a different department if you can't organize yourself. Anyway, there is also a full gel or whatever you use crossmatch at the end of that phenotyping, as long as the antibody is reacting, an anomaly could be discovered there. You have to have a little faith that people before you are doing their job properly, or you can cause yourself a lot of undue stress.

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

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

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

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

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