aafrin

I would agree that there is no correlation between the strength of the DAT and the severity of the HDFN (ABO HDFN quite often has a negative DAT), but I would thoroughly disagree with the comment that a weak DAT means that there was a smaller foetal bleed.  There is very little correlation between the amount of the foetal bleed and the strength of the maternal antibody.  There is much more correlation between the immunogenisity of the foetal antigen and the strength of the maternal antibody.

I would change to A Positive, as long as there is no transfused anti-A in the circulation.
 
ABO antigens are histoantigens, and so a) most, if not all of the transfused anti-A will probably be adsorbed onto the tissues, and as the A antigen will be expressed on the tissues, the baby's immune system should not recognise the A antigen as non-self.

Auntie-D, I certainly didn't set out to insult anyone.  I was simply commenting from my experiences and those I have heard from others.  The tone of your response was certainly accusatory.  One of the things I appreciate most about this site is the openess of the members and I hope it stays that way to encourage conversation.
 
Confirmation bias does not mean that someone was intentionally careless, it is often subconsious.  There is also plenty of use for 2nd checks (we use several), but it should not always be the answer without an investigation of the process.  Unnecessary checks can bog down a process, add cost and time, and sometimes not even add to the safety/accuracy of the process.  

Where I used to work previously we had 2nd tech checks and it eventually got to a 3rd tech check. This was an not the right thing to do. More tech became, comfortable that another tech would catch a mistake and more errors emerged. We went down to a 2nd tech to verify T&S and T&C. This we found to be a better approach; it also showed the benefits of having a second tech, because several mistakes are caught. The 2nd tech I like, It gives me better peace of mind. However, in a small facility, you don't have that luxury and must find other means. Where I am now, there is no second tech, but we do have an LIS that will cover most clerical errors. Catching mistakes is great, because it exposes our weakness and provides and opportunity for improvement, but not always will it be resolved by adding a step. Sometimes we must retrain the individual.

I love that Blood Bankers (the good ones) are all a little OCD.  We were joking at work one day that when we put an open bottle of ketchup in the refrig, we date it (some of us even initial it, which I found hysterical).

Yes Terri we are OCD, but we are the kind of people you want crossmatching your blood, labeling your tubes, etc.  If we were nurses, mislabeled specimens would be a thing of the past  .
 
No offense intended to any nurses that may be lurking in the background .  

Merry Christmas & Happy New Year to all our PAthlab friends.
May the year 2015 usher in peace, love and goodwill all over the world.
God Bless!

We also use tube testing for Blood Grouping and MAnual gel for crossmatching. We do a lot of blood groups daily and all the groups are read by two techs independently who sign in the register. The same tubes are then reviewed by me or MO for the blood bank and we also sign in the register.To avoid mix-ups when dealing with multiple patients, we number each patient sample tube with the serial number it is entered in the register, and all the 8 small tubes are also marked with the same number. Tubes without number are not read. Numbering each tube is a lot of work, but it gives peace of mind. Also if there is shortage of techs in aparticular shift or on holidays the rack can be stored and read later.
But as Dansket said earlier we are waitng for automation to take us to 21st century procedures....hope that day will dawn soon.

Merry Christmas & Happy New Year to all our PAthlab friends.
May the year 2015 usher in peace, love and goodwill all over the world.
God Bless!

We had to recently update and revamp our too - same reason.  Hope this helps.  Our procedure is specific for Meditech, but most of it is usable.
61-Newborn Exchange Transfusion - 2.doc
67-Transfusion of the Neonatal Recipient (under 4 months) (2).doc
Exchange Transfusions RBC Unit Worksheet.doc

Terri is abolutely correct. I find that a good worksheet (we do not have a computer) helps completion of less common processes like emergency release and antigen typing. If there is a blank to fill in, they are much more likely to document completely than if they are just supposed to remember. For antigen typing there are blanks for reagent lot#, OD, manufacturer, there are blanks for QC results, there are blanks for patient/donor test results and check cell results, blanks for the required patient identifiers - whatever it takes.
 
We do use the LAB LIS to generate reports for blood bank orders and for product pickup slips (beats a typewriter  ). For down time, I've got a form that covers all the necessary information. If we need to do an emergency release and the patient is not registered in the HIS or if there is not enough time to use the LIS report, we can use the down time slip for that, too, because it includes blanks for the info we need for that process.
 
Sometimes it makes me crazy that the generalist don't remember things that I think they should, but I try to be a realist (which is hard for an anal retentive blood banker). Instead of going postal, I work on a form and a process map and that helps keep them on track.

One more suggestion.  Get the staff involved in coming up with a solution.  Oddly enough they can come up with some amazing ideas and when it is their idea the "buy in" is almost automatic.  No one wants to make a mistake, especially in Blood Bank and they will get very inventive when coming up with ways to keep themselves from making mistakes.  BUT, keep in mind, complicating a process never, ever made it better.  
 
There, enough philosophical drivel for one evening.   

I think you are too!
 
If you get anti-A (or anti- in your eluate, it does not mean that there is no antibody there directed against a low prevalence antigen as well.  Proving that is going to be a nightmare, because, if the Mum is group O and the baby is either group A or group B, then you will not be able to test Dad's red cells against Mum's plasma, because there will be an ABO incompatibility, and your panel cells are unlikely to express the absolutely correct low prealence antigen against which Mum may have made an antibody!
 
My advice is to let sleeping dogs lie.  Even if baby needs a top-up, or an exchange (which is disappearingly rare under these circumstances), you would cross-match group O blood against her plasma in such a circumstance (I hope!), and so would detect an incompatible unit (1 in a million chance), and where would it get you?  Nowhere!
 
I'm all for doing necessary testing to the nth degree - but unnecessary tests are a waste of time, reagents and money.
 
RANT OVER!

Tedious indeed Peter - you mean PEDANTIC Sir!!!!!!!!!!!!
 
Anyway, we (NHSBT) now recommend giving M- blood - even though it is NOT required in more than 99% of cases!

I think our pneumatic tube might be a her. If it were a him, it would never ask for directions before it goes anywhere.

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/

Like they say above - if your ab screeen is negative and no history of antibodies the immed spin xm is pretty much the standard of care (at least in almost all the places I know or have inspected).  My only kudo to this is if you have a patient who does not have a reverse grouping - I think it is prudent to perform the ahgxm in this instance.  I have not seen a standard that addesses this but . . . if you don't have detectable abo isoagglutinins your i.s. xm cannot be valid (in my opinion).

i agree 100% with you Terri.

Malcolm, you are absolutely right. I recall that In the last year or so we have had one neonate who was of Bombay group. In the last week we also had one young adult OPD health check patient who was also Bombay Group. We have called him to check whether he can be suitable as a donor if required. Still awaiting him...

I am somewhat surprised that you "often" see patients with these subtypes as, working in a very large Reference Laboratory, we see no more than about 2 or 3 a year.
 
That having been said, with the advent of avid monoclonal grouping reagents, it is now almost impossible to assign a specific subgroup to an individual, without the use of molecular techniques.  The old way of assigning such subgroups is somewhat defunct, as the reactions we get with these modern monoclonal antibodies are so much stronger than those seen with human-derived polyclonal reagents (and even then, the "strength of the reaction" tended to vary from one laboratory to another, and from one person in a laboratory to another, as the reading was totally subjective).
 
Personally, I would not now attempt to assign a specific subgroup.  As long as the patient is, say, group A, it really doesn't matter if they are A1, A2, A3, Ax or Am.  They can still be transfused with group A1 blood, unless they have an anti-A1 in their plasma that reacts strictly at 37oC, and such an antibody is extremely rare.  If there is any doubt, they can be given group O blood.
 
From the donation point-of-view, again it doesn't matter if the donor has a subgroup of, for example, group A; they are still group A, and, as a consequence, their blood should be labelled as such, so that it does not go to a patient who is group O or group B.

You can if they are Oh!!!!!!!!!!!!

Cottonball, All the best in your new job.

i agree 100% with you Terri.

True Terri, but the MHRA in the UK has found that the more checks there are in a procedure, the more chance there is of something going wrong, because the next person checking thinks that the one before them would have found anything that is wrong, and the person before them doesn't check properly because they think that the person checking after them will find any mistakes.
 
I sort of agree with Karrie61, when she says that phlebotomists must take responsibility, but the same applies to everyone in the line, from the person ordering the blood, right through to the person who takes down the transfused unit.

Unlabelled tubes makes me very, very uneasy. If I were to drop dead in the middle of a bench crossmatch I would want someone else to be able to take over without having to start over and delay the provision of the blood.