ANORRIS

Place a Blood Temp Indicator on the bag when it leaves the BB and inspect the indicator and take the temp when it is returned.

That is definitely what we do here.  We do not have what we would need for an autoabsorption, and our ARC Reference Lab folks serve us well.

what the heck does that mean?   
 

A number of years ago the President made a visit to our area.  His advance team visited our hospital and the blood bank.  They asked if we were AABB accredited which we regrettably answered no.  We are accredited by the Joint Commission   Consequently our blood bank was told we could not provide blood product in the event of a medical emergency!    

This is something that only works when there is expert physician to physician communication. Your medical director needs to undertake this project. There are substantial data from randomized trials and observational cohort studies that leukoreduction abrogates CMV seroconversion.  These are the studies we used twenty plus years ago to convince our practitioners that leukoreduction was not only good enough, but almost certainly superior in overall clinical outcomes to CMV seronegative non-leukoreduced transfusions.  Of course no patient should be receiving non-leukoreduced transfusions at this late date, but in the USA not all transfusion medicine physicians are convinced of this, in my opinion,  strongly justified clinical practice.

I take it that there was more than one example of R2R2 used, as you say "one R2R2 that was negative", which is a pity, otherwise I would have been thinking in terms of an anti-e (or, possibly, anti-hrB, depending upon the lady's ethnicity.  It still could be, but perhaps there is another specificity there too.
The real problem here is the transfusion three weeks ago.  This could lead to alloimmunisation, but, according to Petz and Garratty (and I certainly wouldn't argue with them!), it could easily be exacerbating a low-grade, almost undetectable auto-antibody, and anti-e is a very common specificity found as an auto-antibody, although often as a mimicking specificity.
This, together with the lady's underlying pathology, suggests to me that it is an auto-anti-e, BUT I HAVE TO STRESS THAT THIS IS A GUESS.  In a case like this,a sample really should be sent to a Reference Laboratory.

We don't give blood from sickle trait donors to sickle cell patients.  We are usually trying to bring the patient's % of HbS down, and using sickle trait blood will not do that as efficiently as sickle negative.  We do a lot of these transfusions, and have done for many years.
So, requirement?  Not of which I am aware.
Our workflow?  definitely.

I would classify my wife in the super responders category.
To attempt to answer the first question, it depends on a number of variables.  To start with, assuming she has the same father for all her children, what is his genotype?  R1R2 or R1r.  It makes a difference.  
On another note, FMH during the pregnancy will only be a factor if the baby is D positive and mom's titer needs a boost.  If mom starts with a high enough titer FMH during the pregnancy is not required for sever HDN.  My daughter was born with sever HDN and there was no known FMH during the pregnancy and all of the antibody studies suggested that she should not have been as affected as she was.  
Bottom line, there is no cut and dried answer to your question and honestly, there never is in the wonderful world of blood banking.  I suggest you get used to gray because black and white rarely if ever exists.  

Just for knowledge, my mother-in-law had 6 Rh positive kids and she was Rh- Negative. There was no RhoGam back then. She came in later to have surgery and still had no Anti-D. She was not weak D positive either.

Incubating patient plasma with patient red blood cells and then applying the antiglobulin test is no longer a Direct Antiglobulin Test but an Autocontrol test which is an Indirect Antiglobulin Test.  Some may think an Autocontrol test gives the same results as a Direct Antiglobulin Test, but that is not always true.
 

No guidelines, just clinical common sense.  There are absolutely no data to support the need for excluding heterozygous donors, nor the need for heterozygous recipients to receive only AA blood.  Heterozygous patients are physiologically normal except for some data to suggest that under extreme conditions of dehydration, altitude they are slightly more susceptible to complications that occur even among hemoglobin AA patients.

In the US, all accrediting agencies must satisfy CLIA, and Blood Bank regs are based on AABB standards.  So AABB standards are already in use by JCAHO, CAP, etc.
Scott

We have been AABB since the 70's.  My manager dropped it last year.  He dropped CAP also.  We are just Joint Commission.

We have been AABB since the 70's.  My manager dropped it last year.  He dropped CAP also.  We are just Joint Commission.

Most references do not use the single symptom of increased BP to indicate a TACO reaction. They usually list a variety of symptoms in which a combination of 3 or more of the following need to be present: 
Increased BP, Respiratory distress (dyspnea), Acute or worsening pulmonary edema via xray, tachycardia, jugular vein distension, increased BNP (brain natriuretic peptide), response to diuretics......
It's up to your facility to decide what kind of criteria you want in your policy. In any case I would think this is important to note in the patient's file since the patient receives dialysis and would probably need to be transfused sitting upright and very slowly if this is indeed a TACO or TACO-like reaction for future transfusions. 

incompatable ABO transfusion to sickle cell anemia patient complain of painful crisis  
women group O positive Rh has given 2 units AB negative packed R.B.Cs
the doctors dont sent any reaction and say that the patient take 2 units without any reactions !
now she in I.C.U section and her kiddney function test is normal or not worst 
her l.f.t is good
Is her immune weak and this reason to not obtain any reaction according doctors !
in this case do this wrong transfusion the reason 100% about her case I mean the respnsibility 
 

We work up a transfusion reaction for plasma or platelets just as we would a rbc

We get platelets from our blood supplier in their heavily insulated shipping boxes with 4 conditioned gel packs and we still get chilly platelets at least a couple of times each winter. I think the key is in how the shipping box/cooler is handled. Require your courier/shipper to keep your cooler inside a warm place, not in an unheated warehouse or the back of an unheated truck. And I wish you luck.

But if the donor was previously tested for any other patient and that patient was charged, you can't charge the current patient for antigen typing that particular unit.

PERHAPS weak D was included because a positive weak D would alert you to a possible false positive fetal screen.  

Has anyone heard of the Blood Bank supervisor being required to be proficient in another department?

ONLY if the FS is a strong positive.

ONLY if the FS is a strong positive.

We would do weak D on a post-partum patient only if the fetal screen is strongly positive.

What if you don't rely on the units chart drive or temp display?  We are not CAP.  We have many fridges, freezers, platelet incubators...  all are on a centralized temperature monitoring system.  We don't even put paper in our chart drives, haven't for 20+ years now.