Couple of questions for clarification. What is the specificity of the known Alloantibody? "Baby is born and our testing shows negative antibody screen." Was this AB screen done on mom or baby? If on the baby, was a current ab screen performed on mom and if so what was the results? Was a DAT performed on the baby? If so, what was the result? If not, why not? Thanks

How many units of uncrossmatched blood did they receive? How active were they bleeding? How much later did the other hospital preform their own T&S? Inquiring minds want to know!!! 😉

5 hours ago, Malcolm Needs said:

Neil Blumberg, I'll leave this one to you!

That was my 1st thought as well!

17 hours ago, Tympanista said:

I was told by a past inspector that the annual assessment can be done any time in the following calendar year.  The 6-month assessment must be done no later than 7 months after the initial training, but there is no specific timeline for the annual assessment.

I hope you got that in writing or willing to argue the point some time in the future because there is a good chance the next inspector will have a different take on it.  Over the years I received contradictory info from more than one inspector and often they were representing the same organization!   

20 hours ago, Malcolm Needs said:

Did you mean that AuntiS.  I fully confess there were times when I did!!!!!!!!!!!!!!!!!!!!!!!!!!!

The birth parent  caught my eye more than the bloody type did!!!!  

I never regretted my individual AABB membership.  They can be an excellent resource, especially in your new position.  Having said that, I imagine things may have changed since my retirement.  I would suggest getting a membership, if you are not seeing the cost: benefit ratio in your favor you can always cancel or just not renew.

That's interesting because I was a long time user of Immucor products.  Thanks for looking that up.  Now I know something I didn't know yesterday. 

21 hours ago, Malcolm Needs said:

Just to be on the safe side though, and if you can, I would either treat the plasma from the sample with rabbit erythrocyte stroma (which will adsorb out most "cold" agglutinins), 

I'm curious, where does one find rabbit erythrocyte stroma???  Granted, none of my many years were spent working in a dedicated reference lab but I don't remember ever hearing or reading anything about this technique.  

 

I just had a thought that might help.  Some one on staff surly has a kid or grandkid with a 3D printer.  I imagine they could make you a couple exactly how you want them.  I have a 9 year old grandson who made me some boxes for 3 different sizes of shotgun shells.  They don't look all that different from what you are looking for.  Something to check into.

 

Over the years have I discovered that information like this is best provided to physicians by physicians.  There were a few that recognized my knowledge and expertise on the subject but the vast majority did not and some were even reluctant to get it from my blood bank medical directors.  I would recommend having your medical director provide the book recommended by Malcolm.  I wish I had a copy in my library when I was still working.  Good luck.  Let us know what you end up doing and how it goes.  I'm sure that this kind of problem will be with us for ever!

Malcolm, you are correct, the info is relatively simple.  It's getting them to step down, swallow their pride and listen that makes it difficult! 

 

 

6 hours ago, Ensis01 said:

I expect/hope that products getting close enough to expiry for different time zones to matter would not be shipped that far.  

Keep in mind that in some locations the time zone could change almost across the street or just across the state line and I live 4 miles from the state line and only 60 miles from the nearest blood supplier for the local hospital.  Just something to consider when making broad sweeping statements.  When I was supervising a transfusion / donor service we shipped blood any where in the country that needed it if we had a surplus.  Time zones were never a consideration.

If I were you I would cut my loses and go with a different company for my next analyzer.  I never did like anything about Ortho and avoided dealing with them any time I had the chance.  Just my opinion for what ever it's worth.

This is just one more example of how inertia is the most power force in the universe and how difficult it is to battle the "that's how we've always done it" mentality..

On 9/4/2024 at 6:50 AM, jtemple said:

 So, the group handling it contacted a blood supplier and got three additional units and brought them into my hospital.  

I'm curious, how is this group affiliated with the hospital?  It seems to me that this is something that risk management should be made aware of and should, at the very least, be reviewed by the transfusion committee if your hospital has one.  

5 hours ago, James Spears said:

Maybe I'm misunderstanding, but how is this any different rather the second type is being done the same day or 6 months later? Either way you're using that first type as a portion of the confirmation.

If the original type is for "potential" transfusion purpose then it is confirmed and the history of that type has been validated. It can be added to the paranoid reducing comfort level in assuming  the current sample is from the same patient.  If, on the other hand, the original sample was ABO/Rh type for some other reason and obviously not confirmed with a 2nd type then your level of paranoid reducing comfort will not be there when the patient returns for "potential" transfusions purpose. 

I have never been a proponent of the required 2nd confirmation ABO/Rh type.  I would like to say it was for the same reasons Neil Blumberg listed above but back when I was living in the blood banking world we did not have the data he is noting.  I just could not really see the cost/benefit ratio being in anyone's favor.

I guess the question then becomes, if, in the future can an unconfirmed blood type be used as confirmation for a current T&S / XM?  

I have heard that it is unseemly to walk through the halls of the hospital carrying a biohazard bag for all to see.   We actually transported all of our blood via pneumatic tube system so this wasn't an issue for us.

 

21 hours ago, applejw said:

I had a unit come from the OR with LR attached. The filter and tubing was full of clotted RBC.  This fit with my theory that adding calcium back into the unit didn't play nicely with the citrate anticoagulant.

As bad as it was, it's good on occasion to see first hand what can happen if things aren't done correctly.  That's when we become a true believer.

22 hours ago, Mabel Adams said:

Giving O units (or A2) keeps our computer happier on patients with documented anti-A1.  Of course, that is the prime objective these days, right?  We bow to our computers!  

I believe the old saying is, "If the computer ain't happy, ain't nobody happy!!"

Malcolm, I've up graded that from Zebras to Unicorns.  Thanks for remembering.

My question is, why are you looking at them under a microscope?  My transfusion service stop doing that back in the late 80s!  

21 hours ago, Malcolm Needs said:

Could NOT agree more Neil.

Same here.  At that point it has become an academic exercise with no clinical value.  

12 hours ago, Mabel Adams said:

Can not even Weak D type 1 patients be consistent in their ability to make anti-D?!??!  I still don't know why we got such different results than previously in gel. I verified that Ortho didn't change the anti-D clone in their gel cards between November and now. I guess this patient just wanted to mess with us.

That's what make the life of a blood banker so interesting!! Who wants to be an accountant where 2+2 always = 4!!!

I'm paraphrasing quite a bit but I was one time told by a blood banker I highly respected; "Get the ABO right first and foremost, then take care of the rest the best you can!" 

Another favorite of mine comes from an ER Physician, probably the best I ever worked with.  "Halitosis is better than no tosis!"  I'm sure that applies similarly to a severely bleeding patient. 

There is going along to go along and then there is accepting ample amounts of data from extremely reliable sources.  It's not about "sales" it's about trying to serve the population in general, based on the best knowledge we have currently and being willing to accept that.  If what you are doing works for you in your little corner of the world, that's great but making light of advancements because it doesn't fit your paradigm and accusing some of the best professionals out there of being uncaring is..........

I'll stop now.  I've been in this group for more years than I care to count and don't want Cliff to ban me.