L106

Have you never heard of that one before? It's a bit like 'Preaching to the choir' but on experience rather than belief. Where are you from? If you aren't from the UK - we have soooo many of these phrases it is ridiculous!
 
http://en.wikipedia.org/wiki/Teaching_grandmother_to_suck_eggs

Morning Donna, it was under protest that I returned to the hospital environment.  My wife told me that I still needed to contribute to the household income and as a dutiful husband (38 years today) I always do as she tells me. 
 
As far as hating gel, I have every right to hate gel if I so choose.    It's slow, it's cumbersome and it makes no sense.    My opinion and I am entitled to it.      As for as being behind, I don't consider gel as progress.    I first automated my transfusion service in 1999 and have been a proponent of electronic crossmatching for years.  The last transfusion service I supervised was well into validating the new computer system for e-crossmatching and I am sure they have been enjoying the rewards for the past 6 years.  (Most of the preceeding was typed with a small level of tongue in cheek)

TAR = Thrombocytopenia-absent radius syndrome
 
The child has lacking the radius bone in each forearm and they have a low platelet count.  TAR Syndrome is also often associated with other skeletal, hearth & kidney malformations.
 
Our patient took numerous platelet transfusions (and occasional red cell transfusions) during her 5 years of life before she passed away from an infection not directly related to her TARS.
 
Donna

TAR = Thrombocytopenia-absent radius syndrome
 
The child has lacking the radius bone in each forearm and they have a low platelet count.  TAR Syndrome is also often associated with other skeletal, hearth & kidney malformations.
 
Our patient took numerous platelet transfusions (and occasional red cell transfusions) during her 5 years of life before she passed away from an infection not directly related to her TARS.
 
Donna

Jesus did work for our lab for a while but then he got accepted into medical school.

Twenty-eight dittos to all of the above (if dittos are in policy and I have been trained in the use thereof and found to be competent). Needs to go through the exact same training/competency/signoff.
 
The only possible variable in our training is time: obviously, a seasoned vet will need less training time than a new graduate.

I would discuss this with the medical director, since ultimately it is the medical director whose name is on the line.

Must be formally trained to put out clinical data. Rank is not a privilege.

My response on how we would have handled the situation is the same as Mabel's response.
 
Donna

My response on how we would have handled the situation is the same as Mabel's response.
 
Donna

I started a new job yesterday.  I'll let you know in a few months.

We do the same but it is partly because we are remote from our blood center and surrounded by smaller hospitals that don't do Ab IDs.  We think it is worth preserving the ability to give Rh neg blood in an emergency to a patient with anti-E, whereas if they also have anti-c already reacting strong enough to detect, there are fewer and poorer options.  Others will argue that it is not appropriate to use the limited c neg units on patients lacking the antibody.

I understand some of your confusion.  When dealing with non-immunocompromised patients, the main thing to think about is:  "Is the donor of the blood product an unusually close HLA-match to the patient?"
 
When we are transfusing random Packed Red Cells or Platelets to the patients, it is very unlikely that they are a close HLA-match.  (Think about how difficult it is for most transplant candidates to find a close HLA-matched organ donor.)
 
If we are giving HLA-matched platelets to the patient there is an increased risk of Transfusion Associated Graft Versus Host (as JEMarti explained) because they are HLA similar.  If we are giving Packed Red Cells or Platelets from a close relative (ie: a "first degree relative"), it is also likely that they may be HLA similar to the patient (at least significantly similar to the patient than donor blood that comes from a random stranger.)
 
Now, if we are dealing with very young or immunocompromised patients, their weak immune systems increase the risk that transfused T-cells in the donor blood might engraft and result in TAGVHD, so those patient might need all donor Packed Red Cells and Platelets to be irradiated before transfusion.

I understand some of your confusion.  When dealing with non-immunocompromised patients, the main thing to think about is:  "Is the donor of the blood product an unusually close HLA-match to the patient?"
 
When we are transfusing random Packed Red Cells or Platelets to the patients, it is very unlikely that they are a close HLA-match.  (Think about how difficult it is for most transplant candidates to find a close HLA-matched organ donor.)
 
If we are giving HLA-matched platelets to the patient there is an increased risk of Transfusion Associated Graft Versus Host (as JEMarti explained) because they are HLA similar.  If we are giving Packed Red Cells or Platelets from a close relative (ie: a "first degree relative"), it is also likely that they may be HLA similar to the patient (at least significantly similar to the patient than donor blood that comes from a random stranger.)
 
Now, if we are dealing with very young or immunocompromised patients, their weak immune systems increase the risk that transfused T-cells in the donor blood might engraft and result in TAGVHD, so those patient might need all donor Packed Red Cells and Platelets to be irradiated before transfusion.

I have worked in Blood Bank for 20 years.  I felt comfortable fairly quickly but credit that to the techs that trained me during my clinical rotations and at my first job.  They were both BB "superwommen" and made sure I know everything inside out. 
 
That said I think how long it takes to be comfortable varies by the person... I know tech that have worked in BB nearly as long as I have and they still do not feel comfotable...
 
A very wise woman once told me that true blood bankers were not trained...they were born. 

Speaking with our small neighbors in mind (and a few not so small), many of the small facilities probably don't have a technical supervisor with proficiency in these kinds of methods, much less maintaining staff with competency. Many have such a tight staffing situation that just doing a basic antibody ID is stressful (it can be a stressor here if it's a busy day). In fact most of our small neighbors don't do any kind of antibody workups - if the antibody screen is positive or the crossmatch doesn't work, out it goes to the reference lab. I know of quite a few facilities that don't even do moderately complex antibody IDs. They don't keep the antisera or multiple ID panels on hand to do them as a cost cutting measure. Reagents for advanced methods aren't even on the radar screen. I don't keep DTT, though I do have WARM and chloroquine. I'm the only one that uses these methods - keeping other techs proficient would be very difficult/expensive with the volume of special testing we do. The money crunchers may take that away from me before too long. The only reason they haven't up to now is that we are a long way from our reference lab, though our transport options have improved.
 
It's not just the cost of reagents, either. You have to have surveys, if they are available. Those can be very pricey - I'm thinking that the elution survey alone is $800ish per year. If you don't do surveys you have to have some other way to prove you know what you're doing - like sending a split sample to a reference lab a few times a year. That could be even more expensive than a survey. 
 
If your patient is a Medicare or Medicaid patient, you aren't getting reimbursed now. Their diagnosis (DRG) is worth a pre-specified amount of $$$. If they have extra expensive tests done, too bad for your hospital...no more money. Most insurance companies are following the same game plan.
 
So, after rambling on, in answer to your question, if you don't have much volume for these kinds of tests, it is not cost effective for your lab to try to do them. If you do have the volume, it may still not be cost effective. If you don't have much volume, its probably better (safer) for the patients if your lab doesn't try to do them.

I understand some of your confusion.  When dealing with non-immunocompromised patients, the main thing to think about is:  "Is the donor of the blood product an unusually close HLA-match to the patient?"
 
When we are transfusing random Packed Red Cells or Platelets to the patients, it is very unlikely that they are a close HLA-match.  (Think about how difficult it is for most transplant candidates to find a close HLA-matched organ donor.)
 
If we are giving HLA-matched platelets to the patient there is an increased risk of Transfusion Associated Graft Versus Host (as JEMarti explained) because they are HLA similar.  If we are giving Packed Red Cells or Platelets from a close relative (ie: a "first degree relative"), it is also likely that they may be HLA similar to the patient (at least significantly similar to the patient than donor blood that comes from a random stranger.)
 
Now, if we are dealing with very young or immunocompromised patients, their weak immune systems increase the risk that transfused T-cells in the donor blood might engraft and result in TAGVHD, so those patient might need all donor Packed Red Cells and Platelets to be irradiated before transfusion.

I understand some of your confusion.  When dealing with non-immunocompromised patients, the main thing to think about is:  "Is the donor of the blood product an unusually close HLA-match to the patient?"
 
When we are transfusing random Packed Red Cells or Platelets to the patients, it is very unlikely that they are a close HLA-match.  (Think about how difficult it is for most transplant candidates to find a close HLA-matched organ donor.)
 
If we are giving HLA-matched platelets to the patient there is an increased risk of Transfusion Associated Graft Versus Host (as JEMarti explained) because they are HLA similar.  If we are giving Packed Red Cells or Platelets from a close relative (ie: a "first degree relative"), it is also likely that they may be HLA similar to the patient (at least significantly similar to the patient than donor blood that comes from a random stranger.)
 
Now, if we are dealing with very young or immunocompromised patients, their weak immune systems increase the risk that transfused T-cells in the donor blood might engraft and result in TAGVHD, so those patient might need all donor Packed Red Cells and Platelets to be irradiated before transfusion.

I started in the field in 1973, so I've had something like 41 years in the job.
 
I started as a very junior member of staff at the (then) Blood Group Reference Laboratory (working with, amongst others, Joyce Poole, when she was a humble Senior Biomedical Scientist) and stayed there for about 5 years.  I then moved to the (now defunct) Westminster Hospital (a large London Teaching Hospital), where I worked in Haematology for about 3 years, and then moved to Blood Transfusion.  Following this, I went to the Blood Transfusion Laboratory at Mayday Hospital in Croydon, Surrey (a District General Hospital).  After that, I went to the Blood Transfusion Laboratory at Ealing Hospital (another District General Hospital), firstly as a locum Chief Biomedical Scientist in Blood Transfusion, and then as a substantive Chief Biomedical Scientist in Blood Transfusion (the laboratories here were run by a private company, named The Doctors' Laboratory - all the other positions were with the National Health Service).  Then I went back to the, now, International Blood Group Reference Laboratory, working as a locum Chief Biomedical Scientist in Joyce Poole's (now Head of Red Cell Serology) laboratory.  After that, I started at the NHSBT-Tooting Centre as Reference Laboratory Manager in Red Cell Immunohaematology, and, a couple of years later, was promoted to Reference Service Manager in the same laboratory.
 
I have served on the national council of the British Blood Transfusion Society and am, at present, Chief Examiner in Transfusion Science for the Institute of Biomedical Science.
 
How long did it take me to feel comfortable?  In terms of feeling comfortable working in a blood transfusion laboratory, I suppose about a year, maybe a year and a half.  In terms of public speaking at conferences, on university courses, symposia, etc, I suppose about 5 years or more.  Now, however, I actually look forward to public speaking.
 
Maybe I should now go to a psychiatrist, after that last statement!!!!!!!!!!!!!!!!!!!

The answer to the question is "way too often"! I agree with Brenda that, all things being equal, the panel should show parallel reactivity with the screening cells unless the antibody was teetering on the edge of detectability. Also, you mention that the E-positive ficin cells reacted. What I didn't see was the rest of them did not react. Please forgive me if a full ficin panel was performed - but be careful about just taking selected cells and testing them with a different methodology. The reactivity you see may not necessarily be due to the antibody you're suspecting - something else could be popping up that was not observable with the first method.
 
Phil

I have always trained my staff with these words, "Record what you see, not what you think it should be." In other words, proceed based on observations, not expectations.

Sorry I didn't write my question very well
I had found the below article for Managing Recall and Market withdrawals and then had read in the technical manual a reference to FDA blood guidances on infectious disease. Within the article it had Table 3. Suggested Approaches for Follow-up of Blood Components Discovered After Transfusion to Have Been in Nonconformance (Biological Product Deviations).
Outside of Lookback for HIV, HCV, and Chagas, is anyone contacting the physician for recalls/market withdrawals received from your blood supplier of any of the items listed like the Malaria-risk travel and if so what guidelines do you use
Managing-Recalls-and-Withdrawals.pdf

I would like to know what's everyone's take on a patient with an Anti-Jsa. Do you have units screen or do you just XM Extend?  Please explain your answer.

Guess what Phil.  The Laboratory Technician couldn't read the Doctor's writing in the case of Lutheran/Lutteran.  Ring any bells???????????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I can give you the "Delores Mallory" explanation to retic separation. We all believed her
 
You have 2 points working in your favour. 1. The patient's retic rate has increased due to their blood loss/ anemia. 2. The dilution of the donor blood which should have a normal retic count at most, produce a very low ratio of transfused retics to patient retics.
 
While you may get an occaisional donor retic, it will not be enough to bias your phenotype results. If you do see a significant mixed field, you can assume it is due to the patient either not reticing or a 50% or more replacement of patient blood volume. And we know harvesting retics after recent, large transfusions, is a risk we often should not take. Particularly when we now have genotyping available.
 
Hope this helps