John C. Staley

My motto was "when in doubt, shake it out".  Seemed to work for me.

I'd also add that none of the cell washers are FDA approved for washing platelets. We've been washing platelets on the 2991 for about 40 years :).  I believe there may be a paper on using the ACP-215 to wash platelets but as yet we do not have any hands on experience.  We have developed a manual method of platelet washing using a Sorvall centrifuge.  If your volume isn't too high, you might consider a manual wash method.  It takes a bit longer, but actually has higher recoveries (>90% vs. about 80-85% with the 2991). 
 
Folks will tell you that washed platelets don't work clinically and the count increment is Washed Tx Leukemia.pdfWashed Tx Leukemia.pdflower.  The increment is indeed lower, but if you employ platelets that aren't ABO incompatible with the recipient and remove the supernatant, the clinical results are actually better than the clueless advice to give ABO major incompatible platelets routinely (e.g., group A to group O recipients).  The PLADO study had a bleeding rate using this abominable practice of about 70%.  Our bleeding rate avoiding infusion of ABO incompatible antigen or antibody is 5%, with or without washing.  A fourteen fold difference. So by all means give washed platelets to patients with severe or recurrent reactions, or avoid infusion of ABO incompatible plasma, and, if you believe our randomized trial data, to improve the survival of younger patients with acute myeloid leukemia. References attached if anyone is interestedWashing AML Greener_et_al-2017-American_Journal_of_Hematology.pdf.
Washing Review IJCTM-101401-the-clinical-benefit-of-washing-red-blood-cells-before-transfusion.pdf Washing AML Greener Am J Hemat AML Washing Supplementary Figures and Tables.pdf Jill's washing paper.pdf Plt Washing Vo.pdf

There is no regulatory nor clinical reason not to wash AS-3 units on the Haemonetics device.  Just validate it for red cell recovery and hemolysis, comparing AS-3 with five AS-1, CPD-A1 or other units you can obtain from another blood center, if this makes you feel more secure.  We wouldn't and won't bother to do so.  The results will likely be identical.  There is no material difference in red cell preservation issues with the various additive solutions and certainly no evidence of difference in clinical outcomes.

It sounds to me like you are doing everything that you should do, without either over-shaking the tube, or over-reading the contents.

I am extremely glad that you are not using a microscope, as, if you did, you would almost certainly see the odd couple of red cells "kissing each other", even if they have been incubated in isotonic saline.

The other thing is (and I speak with some 43 years of working in blood group serology) if the reactions in the tube are THAT weak, the chances of any atypical alloantibody that you might miss being clinically significant are absolutely minute.

If you are still worried, however, get a more experienced worker to read your tests as well, until you feel confident.  That is how I learned when I started.
I wish you the best of luck in your future career.

Bring back minor crossmatches?

Hi Mabel,

I contacted Jill and, although there was some talk about it, nothing has come of it yet.  The authors are aware, however, that the public would like a new version.

Oh, John, you are missing all the fun!  Everyone wants to give blood pre-hospital now--on air and even ground ambulances.  They prefer WB because it is easier to transfuse, has some platelet activity (yes, cold platelets work for trauma) for the first couple of weeks. and doesn't dilute the coag factors.  It started with the military and then got going in Texas.  With the O blood shortage, we can't give it to ground ambulances who would seldom use it, but we might be talked into providing liquid plasma (group A, never frozen, good for 26 days).  The link below may be educational for you.  Not everyone agrees with the research, but it is increasing everywhere.
STRAC Blood

In my interactions, Patricia was a grand lady. So very kind to new talent and so gracious with her peers. I have some of the letters that she and Dr. Polly Crawford exchanged over the years regarding interesting cases and personal life happenings. They had a unique friendship! And, I have a talk at AABB in Nashville where I used a quote from her 1962 publication (!!) regarding anti-D in D+ patients with a negative DAT as missing a part of the D antigen, what we now identify with molecular methods as partial RHD. How absolutely thrilling that must have been to see new techniques prove and go further with historic theories. An excellent scientist, she is missed. Sandy Nance

We do this occasionally, but we use plasma instead of saline.  We use the formula mentioned above.  We use RBCs diluted to a specific hematocrit when we have a patient who does not have the blood volume to safely prime an apheresis or dialysis circuit.  

I've always used the C1 x V1 = C2 x V2 formula for such calculations.  My question is why do you want a Hct of 35%??

Need more info - what is your starting volume and hematocrit?  Use formula  C1 x V1 = C2 x V2.  DM if you need more  - jeanne.towery@prismahealth.org

We use some tie tag things.  Think zip ties but really fine and the line and connector are round not flat.  No gun required although I have used that process in the past and we never punctured a platelet in any way that affected quality, purity or potency.  We put our bag tag labels on manila cards and tie tag those to the units, (through the hanging hole on platelets).

Yes, we use a tag attacher gun to label the units with the crossmatch slip. There is sufficient plastic at the top of the bag to pierce for the tag even if there is not a hole. I think we are more concerned with the MLS poking his/her finger!

Hail and farewell.  

Well, the thing is John, when I first left school, I started to work as a VERY, VERY junior member of staff at the International Blood Group Reference Laboratory when it was in London.  At that time Dr Kenneth Goldsmith was the Director, but others working there were Dr Carolyn Giles, Dr Elizabeth (Jan) Ikin, and a VERY young Joyce Poole.  Across the carpark was the MRC Blood Group Unit, run by Drs Rob Race and Ruth Sanger, where Dr Patricia Tippett worked, along with Geoff Daniels, for a while Christine Lomas (before she went to the USA and became Christine Lomas-Francis) and, for a short time, Dr Marcela Contreras (before she became a Dame and a Professor).  Just up the corridor was another set of laboratories run by Profs Walter Morgan and Winifred Watkins (and the janitor was one Sid Smith - after whom the SID Blood Group System was named).

As you can imagine, with all those "NAMES" working in such a small area of London, it was like a magnet for all of the other world's greats to come and visit (I even met Dr Arthur Mourant and Dr Philip Levine on visits).

With all these people, ALL of whom were amazingly helpful to even me, as someone who had just left school, what else could I do but fall deeply in love with the profession, and count my blessings from day one until I retired 43 years later.  I have been one lucky man.

Malcolm, you appear to have know all the greats.  I had the honor of meeting a few  of them over the years and it's sad to witness the passing of an era of such amazing discoveries.

This is why all transfusion services need experienced/trained physicians.   It's a clinical decision weighing the risks of not transfusing urgently vs. the risks of alloimmunization.  And the risks of not having Rh negative red cells for patients where such products provide important safety (girls and women <40-50; patients with anti-D). 
Obviously the issues in alloimmunizing a male patient, particularly an older patient, are very different from a woman or girl with the potential for future pregnancy.  If not terrifically urgent, requires a discussion between the practitioner responsible for the patient and the transfusion service physician. I've certainly made decisions independently and only informed the patient's physician after the fact, when the maintenance of Rh negative red cell supply has been a priority.  Hard to write a procedure that covers all possibilities, so one would have to be broadly written, and probably kept it short on details, since these are so variable.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

We have it written in our policies.....based on what our Medical Director wants.  He'd much rather transfuse Rhpos and the patient live than NOT transfuse and have them die.
His philosophy is that we can deal with the anti-D later - (IF it develops - which it often does NOT).  There's nothing you can do with a dead patient.
We transfuse OPos LTWB to ALL our adult (or >50kg) MTP trauma patients.  If an Rh neg patient is bleeding - but not MTP, our policies allow us to switch to Rh pos after a designated # of Rh neg units have been transfused to conserve Rh neg inventory.

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

Good tip!  We use temp indicators on the units, so that when they are returned, we can see if the unit was out of temp at any point.  We also asked them to provide a packing slip attesting to the proper storage of the units, similar to a transfer form used by our blood suppliers.  

If you will be getting any of those units back then a FDA inspector may want to see their storage records.  Some will, some won't, depends on the inspector.  Better to be prepared for the one that wants to see them.  In this case a little paranoia may be a good thing.

If you will be getting any of those units back then a FDA inspector may want to see their storage records.  Some will, some won't, depends on the inspector.  Better to be prepared for the one that wants to see them.  In this case a little paranoia may be a good thing.

If you will be getting any of those units back then a FDA inspector may want to see their storage records.  Some will, some won't, depends on the inspector.  Better to be prepared for the one that wants to see them.  In this case a little paranoia may be a good thing.

The response I got from ARC is that it is up to our medical director. There is no FDA exception needed, as the FDA doesn't have a regulation on shipping duration or transit time. They only care about temp, and since the temps are in range, there is nothing to seek a variance from. 
I heard from people who use other blood suppliers, and the general consensus is that if the packing is correct, ice is still present and the units are in temp range, they are acceptable, as long as there is documentation of this deviation from the hospital's normal policy. 
I ended up adding this tidbit to my SOP as an allowed deviation by our medical director, just need to fill out the deviation documentation form and have him sign, but this way, we can accept the units in immediately and not delay having them be available. Especially important for platelets!