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I worked in the Metropolitan NY area and attended a lessons learned post-911 the following spring. The speaker, Dr. Kim, was discussing strategy. He stopped, looked at the audience and said... "You are Blood Bankers, you know what to do, you do what's best. I don't need to tell you." Standing ovation from a grateful audience. Janet

Well done on the refusal to issue. Do you have a chart of emergency compatable types which may be posted in the ER or in a protocol book?

The only acceptable sample is a completely labled sample (labeled at bedside) with unique identifiers. Full name, id number, date of draw and initials (signature) of person drawing sample. State and federal (or your country of residence) regulations may add to this such as in Malcolms' id requirements for DOB. The more info, the better able to trace the sample back to the patient/phlebotomist in event of questions. I prefer more information like DOB as well. Patients "hospital hop" here. There should be no difference between BB samples and other department samples. If the standards are the same for all staff, compliance is easier to maintain.

Found it researching...it's like meeting at a lunch break, so much Q&A from like minds! I enjoy the company. Janet

OK, OK, I take it back:) PLEASE. My comment about manufacturing was meant from my observational stand point! of seeing poorly labeled containers and no "directions" for use in some facilities. There are many roads to a city. The hope is that you follow good practices and guidlines to get there.

Wow, I did not expect backlash to a comment! The respondents obviously have tools in place at their facilities to do it well. There are facilities out there who have incomplete practices when it comes to storing screening materials and using them. Unfortunately there are multitudes of faciliteis who take gereralist staff with little experience and shove them into a Blood Bank.

Marilyn , Thanks for the plug (ARC) journal. I'd also like to vote for Marion and Christine's bigger book, The Antigen Facts Book, for those who wish to dive into deeper waters. Janet (Jersey Girl)

Here's my rule for saving a patient sample for screening: Assuming you have a patient sample saved from an identified antibody, this sample should have had all other common alloantibodies ruled out. In essence, you have an unlicensed antisera. And congatulations, you have just become a manufacturer. If if was an A positive sample and contained anti-Fya, you could use it to screen O and A units for Fya antigen. You should have a procedure in place to save the information on what is in the container, where it was obtained and when. You need to document the ABO and antibody contained on the container, the originating patient name, MR# and date obtained; this will be your traceable information. The expiration date is arbitrary. When it stops working to give a satisfactory result (2+ is ideal), discard it. Storing in small alloquats in a -30C freezer reduces the chance of bacterial contamination. You should run a heterozygous (single dose) positive control as it is necessary to prove it works. Consider the outcome if you did not check and it quit reacting. This works best when you have a patient with an antibody to a low prevelence antigen. Save money and you can screen your units yourself. I look at any procedure through the eyes of an inspector. What information would I want to review in your facility if you had a transfusion reaction and had to prove your work. Good luck

The last manual I have from Sorvall(Kendro, Dupont) calls for 10% bleach. Try the internet or call ...It's gone through so many company changes I'm not sure who may have the rights. The internet may get you a better shot. Some of the tubing could probably crawl away on it's own.

HTLA antibodies are usually indicated by a titer of 16 or higher and we run them in tube. When testing HTLA in gel we've seen all cells reactive anywhere from 1+ to 4+. If you can find any Knops negative cells, run one or two. Immucor has several donors who are Kn(a-), Yk(a-) and /or McCoy(c-). You may get lucky and one will prove out you Knops sytem antibody. Unless you have run a validation, I would not go with gel titers.

Where is your manual? Make sure you always have a copy of the latest version handy. The decontamination procedure is in the manual along with the routine cleaning procedure. You've got to wipe it off with ethanol (not isopropyl) aswell as run 10% bleach though the tubing. Be warned you can damage the lifting ring by allowing bleach to stay in contact with it. The ring will become soft and will fall apart; the bowl will not seat.

A weak dilution of anti-D should produce a 2+ reaction when tested with albumin, LISS reagent or PEG. MTS Gel usually yields the same result. Ideally for QC you would have a negative control with your panel to prove reactivity is not due to other issues. I mentiond the previous dilutions as I'm lazy in math and love serial dilutions. Make whatever gives you a 2+ reaction. I've noted some facilities use a 2-3 cell screen, others have done the whole panel. A representative amount of cells per panel lot should be sufficient to prove you have reactivity.

1:256!

Get more bang for your buck. Prepare a 1:128 or 1:256dilution of anti-D and test this against your screening cells. This way you won't waste precious and costly Kidd or Duffy antisera. Once you prove your sample reacts against reagent red cells you've met your requirement for the day. Save your panels!

Please don't say lack of reactivity with antibodies to low prevelence antigens. Reactivity should be the same as any antibody as well as the possibility of patient transfusion reaction to a unit positive for that antigen. Once antibodies to common antigens have been ruled out you may find that the 2-3+ reaction you have is your Wra or Jsa! What does occur is the lack of commercial antisera to test units for these antigens. Rule of thumb is if your patient has an antibody to a "low freq" and supplied units are negative for any antigens for other antibodies discovered, you can use your patient sample as your screening serum. Back to the rule out technique. Cross out on homozygous (double dose) antigens which are non-reactive in your testing is ther better way to go. To prove the probability (P-values) we commonly use 3 pos for the antigen and 3 neg, 2 pos and 5 neg.