John C. Staley

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

All great questions, but I would also ask, what is the baby's Hb/Hct requiring a transfusion, and why not test the baby's DNA for the gene encoding the antigen cognate to the maternal antibody?

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

Um, sorry Jason, but I think you mean Dithiothreitol (DTT), rather than Dichlorodiphenyltrichloroethane (DDT)!!!!!!!

AGREED - and killing the patient in some circumstances!!!!!!!!!!!!!!!!!!

Also, were any of the transfused units antigen positive? This is the quickest way to get a negative indirect antiglobulin test ;).

Sounds like a dilutional effect. How big is the patient and how much plasma/platelets did the patient receive during the time frame between blood draws?
I have seen this with massively transfused patients and with plasma pheresis patients and with patients who have received multiple products over a few days.

Several units of blood and plasma, in fact an MTP was called. Patient was actively bleeding.

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!!! 😉

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!!! 😉

I rarely post about me, or my family.
I was raised by a single mom from 2 until I was about 10. That was probably really hard for her in the 60s. Whenever I ask her, she just says it wasn't so hard.
We had a lot of roommates to help with the cost of apartments, one was Georganne (Giorgi Baino Sr.). She seemed to be around the longest. I really liked her, she was like an aunt to me.
Maybe 10 or more years ago, we got back in touch - Sadly, just on Facebook. I am going to try to have a video chat with her to catch up.
Anyhow, it seems my mom wrote a poem about me when I was a kid, and Georganne has always played guitar. The song was about me riding bikes, I never heard it until yesterday. For those that know me, you know I've been a cyclist (avid at times) for the last 15 years.
She put the poem to music and sent it to me yesterday. I cried.
Here it is if you're interested.
I cried.

My greatest apology for leaving you all hanging. We've been so incredibly busy and short-staffed that I could not even think about anything else but trying to finish up my daily duties. Anyway, seems that the patient also had an impella device that had to be "adjusted" and I believe that corrected the hemolysis. I'm only reading the responses today (2 weeks later)☹️so hats off to you all who thought mechanical causes. I would have not thought that the device would be that far-off to cause the gross hemolysis we saw. We do see slight hemolysis with impella devices but not like this one. I guess never say never. Thank you all for your responses.

The last time we saw this at our institution, the ECMO team found a crack in the cannula!!! I agree with Yanxia - the clinical and surgical team needs to check the ECMO circuit for causes of mechanical hemolysis and lines.  Our team had to redo the cannulas and circuit in this case and the hemolysis went away as soon as that was completed.

Patient should be monitored for a delayed hemolytic transfusion reaction for about 10-14 days, not necessarily in hospital. Most common signs are fever and progressive anemia. sometimes dark urine or jaundice. Patient education before discharge if earlier than this is essential.

You can also contact the FDA and ask, I have always found them to be very helpful.
Worst case, report it (again, I don't think it's reportable) and they will reject it and let you know why.  That is safer than not reporting it.
I understand a lot of facilities are reluctant to report, but I came from a large facility and we reported about 50 - 75 events a year and never got in "trouble" from the FDA.

I would say as long as the rule out was done per policy and appropriately then there is nothing to report.

No, not an error.

It's been a while for me, but my initial instinct would be to say no.  The safety, purity, and potency of the product were not compromised due to an error (intentional or not) on your part.
Is it your policy to always check to ensure that every patient has not been previously transfused at any hospital and does not have an antibody?  I'm not being facetious, but if it is, then yes, you did not follow your policy.
You can try to find a code for it here, but I don't think you will.  https://www.fda.gov/media/161919/download?attachment

Hi,
I realize you are not un the US; however, AABB has a lot of terrific resources available, for free.
https://www.aabb.org/news-resources/resources/donor-history-questionnaires/blood-donor-history-questionnaires
There is a questionnaire that you can administer, which will uncover the conditions you are looking at, and they also have guidelines on how to proceed should you receive an unexpected answer.
These should be reviewed with your medical director to ensure the suggestions are what they would like implemented.
In the last blood center where I worked, we pretty much followed them exactly.  Why reinvent the wheel 

I am retired now and will never forget the sound they make when they are dropped on the floor.
 

In our lab, we do 30 patients ABO typing daily in average. In those tests we will find out forward and reverse typing mismatch at least once daily. Maybe because we tested patients' sample, the incidence is higher than donors', but just as Malcolm said it is definitely necessary to do forward and reverse typing and make sure they are matching.

In the UK, we would test serum/plasma samples from pregnant patients to see if there was an anti-C + Anti-G, or an anti-G on its own, but if the tests showed an anti-D+C, we didn't go any further to see if there was an anti-G there as well.  I mean, what for?  What difference does it make?

I attach a PowerPoint lecture on the subject I wrote some years ago, but I think it is still pertinent.
The G Antigen and Anti G.pptx

Thanks Malcolm. Not pedantry at all. These exceptions are relevant and potentially important, particularly for ABO.

Sorry Neil, but I have to point out that this is not completely accurate.  Any red cell antigens that are adsorbed onto the red cell surface, rather than being an integral part of the red cell membrane remain the type of the patient, rather than the donor.  This is true of the Lewis phenotype (for instance, if the recipient was Le[a+b-], and the donor was Le[a-b+], after the transplant, the red cells will group as Le[a+b-], and not as Le[a-b+]}.  This is also true of antigens within the Chido/Rodgers Blood Group System, and certain others.

If the recipient is a Secretor, they will continue to secrete ABO substance of the original ABO type, which, of course, will also be adsorbed onto the red cell surface (as well as being in the plasma, leading to the phenomenon of "accommodation", and this is why most recipients stay with a reverse group of "AB" after an ABO mis-matched stem cell/bone marrow transplant.

SORRY TO BE A PEDANT, PARTICULARLY AS I AGREE WITH EVERYTHING ELSE YOU HAVE WRITTEN!

This may be a little outdated, it's from a prior facility.  We did a tremendous amount of transplant infusion, and this evolved over the decades I was there.
Management of Hematopoietic Progenitor Cell Transplant Recipients.docx