Antrita

That is good advise. Trying to come up with every "What if this happens?" could lead me to an extremely long NICU procedure manual that no one would read because it is "too long". They will just call me anyway. Antrita

This was just a "what if" question. Our NICU isn't open yet. I am just trying to come up with possible situations that might occur. One time we had a O positive baby come thru the ER. The mother was B positive with an Anti-c. We gave the baby O Positive little-c negative. So, I was just thinking about what we would have done if the baby was Rh negative. Thank you. Hopfully we won't have to worry about this one. Antrita

I have a question. If you have a mother that is Rh positve with an anti-c antibody. The baby is Rh negative with a positive direct coombs. The baby has Anti-c coated cells. Since Rh negative blood is almost 100% little c positive, you would have to transfuse Rh positive blood. How long does it take for an antibody to no longer be detected? Antrita

Thank you everyone, I talked to other hospital in my area and their procedures are really old. After reading her the technical manual she is changing her procedure to mine. I talked to my blood provider again and was told when we are up and running they will try to keep us a nonreturnable AB platelet. So, one less thing to worry about. Antrita

We are getting ready for a NICU in our hospital. I talked to my blood distributor about only giving type specific or type compatible platelets. They told me the other hospitals are giving any type to neonates but I can't find anything that backs this up. The technical manual transfusing ABO incompatible plasma should be avoided. Does anyone out there transfuse any blood type platelets to neonates? They also told me they don't wash or plasma reduce. Thanks Antrita:confused:

We have a blood bank analyzer in our budget for this year. Is this problem worse using the ProVue than in manual gel? Antrita

We also had problems with lot VS280 and I also called ORTHO. They also said low incidence antigen. I was never so happy to get a new lot. antrita

Thanks, everyone. When I was told about this they told me to just contact our donor center. They were sure that I could a pooled 2L bag of FFP from them. This is not so. At this point I am just going to give them our jumbo FFP which is about 400ml. We are adding a new patient tower with a NICU, I have enough to deal with. I have sent in a registration with the FDA to cover any exchange transfusions for the babies. So this should cover me if I have to pool the plasma. Antrita

I was told yesterday that in-patient dialysis bought equipment for therapeutic plasma exchange and that I needed to provide them with up to 2 liters of thawed plasma in one large bag. Does anyone have experience with this? Antrita

We are working towards a neonatal unit in the next year. From what I read the age and anticoagulant used in the unit is not important since such a small amount is given at one time. This would allow one unit to be saved for one baby reducing the amount of donor exposure. Also, should all units be irradiated? If all of our units are leukoreduced at donation, do we need the units to be CMV negative? Thanks Antrita

As a transfusion service we provide type compatible blood. I don't see a difference between giving O packed cells to an A patient compared to giving O packed cells with an anti-K to an O patient that is K positive. I am more concerned when I've typed units for K and give a known K positive unit to a patient that is probably K negative (our patient population is about 95% K negative). There is nothing in our contract with our blood supplier about antibody positive packed cells. It doesn't happen very often and we have never had a problem. AntRita

Does the red cross in California do genotyping?

Does anyone have the capability to genotype patients? I have gone to several talks from large out of state labs using BioArray Solutions and Progenika. I don't know anyone that does genotyping.

When we first started using the "C" panel I had a few techs that went to the treated cells first even though I had big signs "DON'T USE FIRST!!!". What I finally did was make up some competencies. The ortho ficin cells are really strong on the Rh antigens. I had a weak anti-E, it was really strong in the ficin and not positive on all cells in the untreated panel. I also had 2 patients that looked like they had either a Fya or a Jka. With the ficin the patient with the Fya no longer showed any reaction. The patient with the Jka had reactions at 4+. This seemed to really help us, and we've been using the "C" panel since it was available. Antrita

Is any one familiar with the company "Columbia Healthcare Analytics Inc." ? They are a web based utilization review. We've watched their on-line program but would like some input from anyone that uses their services. Antrita

I was really expecting a delayed transfusion reaction on this patient. She is a chemo patient so her immune system is depressed. Has anyone filed an event to the FDA like this one? I don't know what to expect. Also, since part of the root cause is the previous hospital this CLS worked at did not keep antibody histories on their patients, will the FDA want to inspect them? Antrita

A month ago a new employee, had a negative antibody screen on a patient with a historical Anti-E. He did not screen the units he set up for her. She got one E positive unit. Before the second unit was issued a second CLS caught the error and screened for E negative units. We checked the patient at 1 week post, 2 week post, and 1 month for visable hemolysis, direct and indirect coombs. She continued to remain negative. We still had to report this to the FDA #QC-93-11. The hospital he worked before us did not keep antibody histories. It can be scary out there. AntRita

I was annoyed enough with Ortho service that we switched pipets. We use MLA pipettes instead of Ortho's. Antrita

I am also interested in information on labelClinic ISBT label maker. I have information on the digi-trax and want to compare before we buy. Thanks Antrita

Theoretically cold antibodies are not picked up in Gel. Cold autos are suppose to be IgM and gel only detects IgG antibodies. Not all cold antibodies behave themselves and will show up in Gel. Most of the time it doesn't look like a true antibody. It will kind of cascade thru the gel. We have never found a way to "pre-warm" gel. When we pick up a cold in gel we have to go back to tube crossmatch on these patients. Has anyone found a way to do a "pre-warm" crossmatch in gel? Antrita

I'm at a CHW hospital and will probably have to go with the best deal offered to the hospital system. I use gel now and have been concerned with missing Rh antibodies with the Echo. Has anyone had problems with the Echo missing antibodies? Antrita

The MD and RN that are in charge of our NICU to be, want our aliquots to go to them in syringes. Any brand recommendations? Thanks

Ask your Ortho rep for "C" panel to try. It is 2 identical "A" panels but one of them has been treated with ficin. It is definitely worth the extra cost. If you do have a weak Rh antibody this panel really helps.

More clarification. My blood product provider will not provide type specific plateletpheresis because of their 5 day expiration date. The patient does not have a platelet antibody and we have now sent out a specimen on him for HLA matched platelets. Why I am asking about the red cells is because his hemoglobin doesn't rise much after transfusion. I am not sure if this is strictly because of his chemotherapy or if the fact we are giving him Anti-B plasma with every plateletpheresis. My thought was by O cells would have a longer survival time in the Anti-B plasma. I went to a conference one time and the speaker was talking how every Blood Bank should have a policy about how to give incompatible blood. He had a hypothetical case where there was no O red cells so the patient was to be transfused with B cells. He said in this case, you would want to also transfuse B plasma to dilute the patients anti-B antibodies. I can't imaging this ever happening. What I am thinking is the reverse should also be true. Also, I don't have any problem getting B red cells. Antrita

Do you the Ortho "C" panel? When I think I have weak Rh antibodies this panel really helps. Where the non-ficin panel will give me negaive -1+ reactions. The ficin panel will give me 4+. Antrita