John C. Staley

Just for sake of argument, why is this a big deal??? You don't find a patient in a more controlled environment than an OR suite. If the original sample is drawn in the OR and is delivered directly to the blood bank where is the opportunity for mixing up the sample if it was labeled correctly in the OR? What, exactly are you trying to accomplish here? At some point is any process involving humans you will have to have a little faith that the others in the process are doing their part as it should be done. In emergency situations you need to make allowances. Which is the higher risk, running out of type O and not having it available for those who can have nothing else or the off chance of a patient getting the wrong type in this situation for any of the many reasons you can imagine? Just a little food for thought.

David answered your question exactly they way I would have. Validation does not require patient samples, only positive and negative samples in your testing procedures. Follow David's suggestions and you will be fine. The manufacturer has done all the heavy lifting to get it to market. You just need to show it works for you.

Yes, but the validation does not have to be exhaustive and unreasonable. All you need to do is prove that it works as advertised in your lab.

My best guess and it is nothing more than a guess, is that if these patient's require any support from the transfusion service it will be due to a preexisting condition and not the direct result of the corona virus. I don't recall in all my years, of any patients with pneumonia requiring a transfusion due to having pneumonia and I understand that pneumonia is the primary reason for hospitalization here. Now I may be way out there on this but only time and experience will tell.

Thanks for the info. That actually makes sense for a change.

I'm curious, why was blood requested for a patient with covid19/flu like symptoms??

I have to admit that when I first responded I was not looking at the big picture! I guess I've been away from the trenches long enough to have lost some of my perspective. I have to say that my priorities would still be staffing first and blood supply a very close second. Since my last facility did not have donor capabilities and depended on ARC for our blood supply I'm not sure how much I would have been able to do concerning the blood supply beyond encouraging folks that were well to donate.

Malcolm, I'm glad to see you are on the case. When I first read the question in the Transfusion section I knew I wasn't going to touch it!! Looking forward to see what you come up with.

I'm just curious but are you referring to the possible staffing issues due to staff getting sick and having the good sense to not go to work or are you concerned about any possible impact on the patient load? Or both? From what little I have read of the symptoms I can't imagine any patients hospitalized needing much blood bank support. I would think the biggest issues will be staffing.

If I remember correctly, back in ancient times, we did not include any control with the initial titer. (Probably because no one thought of it!) For any subsequent titers we would use a frozen sample from the previous titer.

If I read David's original post correctly the titre started at 2 then went to 4 and then to 8. That's why I asked how quickly it went from 2 to 8. If that's a relatively short time span then I would consider it significant and the RhIG dose would be a confounding factor on subsequent titrations.

Malcolm, her titre was already rising so I don't see the need to continue. There are better ways to monitor the fetal status during the third trimester when you know the titre is rising. At this point, it's just numbers and academic. David, you indicate there were 3 titres performed, how far apart were they? In other words, how quickly was it rising?

My first thought was, why on earth did they give the RHiG!!!! I'm with Malcolm on that. You great minds do think alike!! I really would like to hear the rational if there is any. To answer your question, I see absolutely no value in additional titers, at least not until the next pregnancy.

Things must have changed dramatically as they so often do over the past 42 years but I recall that immunoheamtology received no less emphasis or time than the other disciplines when I was studying in a MT program. Maybe the program I was in was the exception at the time but I hope not. Having already completed a BS in Microbiology when I entered the MT program I assumed that would be my area of expertise but after one year after graduation working as a Generalist, I found myself as a full time Blood Banker and never looked back. While the bulk of my knowledge in Blood Banking was attained "on the job" I always felt the foundational information I received in class certainly prepared me for my future. Wow, we sure hijacked this discussion!!

Just curious and an obvious tangent but why is the blood bank doing any testing for a broken wrist???