[How much experience do you have in the field and how long did it take you to feel comfortable?]

On and off, about 15 years.  It took me a couple of years to become more "comfortable" in all areas of the lab, in that I felt that my judgement improved to the point where I felt more confident that I probably wouldn't harm a patient from either overconfidence or "analysis paralysis". 

 

At times, Blood Banking may seem a little more dramatic thank some other areas of the lab, but one of the key points I try to make with students/trainees is this:  Blood Banking calls on the same skill sets that you use in the rest of the lab.  If you can multitask, keep cool under pressure, understand your limits, and recongize that little bell that rings in your head that says "Wasn't there something odd about (insert situation here) that I learned in school/read about in a journal/saw on a similar case once?", you'll do fine in Blood Bank, and welcome!

 

(Of course, it helps to love Blood Banking too!)     

[DAT and specimen age]

Hi bb4me,

 

I think that this may be a "hang over" from the days of using clotted samples for blood transfusion departments.  In those days, of course, the samples were taken into dry, glass tubes.  In such tubes, if the samples were stored for any length of time, the complement cascade could be started and then stalled at C3d, but in a non-specific way, so that you got a false positive result.

 

Now that we use EDTA samples, and EDTA chelates Ca⁺⁺, Mg⁺⁺ and Mn⁺⁺, all of which are required for the initiation of the classical complement cascade, this is no longer a problem

Thanks, Malcom.  Yes, the "glass factor" was always my favorite.  We also recognize that a positive C3b/C3d result from a refrigerated serum spec might be questionable, and recommend retesting using an EDTA sample, especially in the absence of historical results.  That being said, we rarely see serum samples in our Transfusion Service any more.

[DAT and specimen age]

I know that the manufacturer instructions (for our reagent) indicate that the specimen is acceptable for 72 hours as long as it's been refrigerated.

 

That's a good question.

Thanks, Goodchild.  We have multiple methods (gel and tube), so I will be sure to consult all applicable inserts.

 

[DAT and specimen age]

When evaluating a specimen for DAT testing, our practise has been to accept a specimen up to 24 hours old, refrigerated if not tested within a couple of hours of collection is preferred.  Some of us have been taught that older specs may yield a false positive or a false negative; others just a false positive.  We would like to clarify our procedure.

 

I would appreciate any guidance on specimen age and impact on DAT results. What is your practise?  Can you point me to any references?

 

Thanks!

 

[Quality Control of Anti-A and Anti-B reagent antisera]

We only test Anti A reagent with a positive control (A cells) and a negative control (B cells). Using O cells as well would be performing 2 negative controls, correct?

CAP has cited us for not doing daily negative controls on anti-A and anti-B, but (curiously) not with anti-A,B - same antisera manufacturer, same package insert. We have decided to institute daily testing of all 3 reagent antisera, since reconfiguring the computer QC worksheet is so labor-intensive, we don't want to do this again soon!

CAP has confirmed that using an in-house 3% preparation of group O cells would be acceptable. Does anyone else use patient cells to test their commercial reagent antisera, and if so, would you be willing to share your recipe? I would be grateful for guidance on additives and outdate/frequency of preparation.

[C3d Positive DAT in cord blood.]

I'll ask Geoff about that, because the anti-Jka MUST be IgG, otherwise it wouldn't have gone through the placenta.

We got around the Wharton's jelly possibility by washing the red cells Auntie-D.

I've sent Geoff the photograph and a quick explanation of what it is, but his out of the country until 26th November.[/quote

A most interesting thread, everyone. I might be a tad out of date, but It seems to me that "complement can't cross the placenta" was the mantra. So are we thinking that the baby is producing the complement? And then the allegory to the mantra was (or at least used to be) "there has never been a documented case of complement-induced HD(F)N" - is this out of date as well?

Also, in response to another query in this thread (sorry, I'm not sophisitcated enough to quote two posts - I'll frankly be impressed with myself if the first quote comes up! ):

Our lab tests infant DATs by gel card, either by polyspecific (just to use the inventory of polyspecific cards) or by IgG card. A positive by either of those cards is as far as we take it; we do not go on to characterize it as to IgG, C3, or polyspecific. We simply report out "weakly positive" )1 tp 2+) or "strongly positive" (3 to 4+).

[Thanks Button.]

LOL Thanks for that, Rashmi!

[Ortho ProVue and HCLL interface problem]

We have been using the ProVue for more than a year, and are now trying to validate the interface. We have run into a serious problem when trying to send results from the PV to HCLL when a patient has multiple Accession numbers pending. For example, Oncology will often order Type and Screens q3 days (in order to keep a patient crossmatch-eligible at all times), and there may be more than one set pending for a single patient on our Active Test screen at a given time. We have seen the PV send the results to the wrong Accession number. (When a future Accession number is wrongly resulted, that future order will be satisfied, and phlebotomy will not be signaled to draw the patient, which will leave the patient "bare".)

Our HCLL consultant has told us that since our Accession numbers differ from our Specimen numbers, there is no way for HCLL to address this. Has anyone else seen this problem? Any ideas?

[Sharing Patient Transfusion & Antibody Info]

We will call other facilities on occasion, when we have a difficult case and the patient tells us of prior transfusions. Likewise, we respond freely when other transfusion services call us with similar requests.

I am glad to see this topic brought up. I have often wondered about this practise, and how in this day of patient confidentiality, we are so "casual" about exchanging information. We joke sometimes about a "bloodbanker's secret handshake" that would identify us over the phone to other bloodbankers. Any suggetions for passwords, challenge questions, or the like? :cool:

[O+ve to A+ve]

We had a case of coagulopathy due to liver disease and the patient was bleeding.. There ws shortage of A+ve PRBC so we had to swithch to O+ve PRBCs.

Male patient

5 units of O+ve compatible PRBCs transfused sucessfully.

After 2 days more demand for blood.

DAT on the patient 2+ in gel.. Do we go for O+ve or can we shift back to A+ve?

Did the patient receive any group A PRBCs prior to having been switched to Group O? If so, and if you elute anti-A, you might want to check to see if the patient is a subgroup of A before considering switching back to A cells.

[Just For Fun]

How about this.....

We are in the process of dumping our current LIS, and going with another. With the new system, we will be implementing the electronic XM. (Currently, our blood bank is on paper...). During one of the conference calls with nursing about blood administration in the new system, someone decided to try to explain the requirements for the EXM (need 2 separate samples, etc). Totally confused the nurses; they don't want the patients redrawn, and don't understand the reason for it. After the call, I remarked to my assistant lab manager that nursing didn't really need to know how we did the XM as long as we had the blood for them. At this point, she asked if I thought that maybe we should implement the EXM now, so they would get used to it by go-live (next year). I stopped, looked at her, and said "We can't do electronic crossmatches right now. We don't have a blood bank computer system!" Her response? "But we have history cards. Isn't that enough?"

I love this! In this economic climate, we are all being asked to do more with less and curb expenditures wherever possible, but your assistant lab manager is really thinking outside the box - and the workstations, and servers, and LIS support team cubicles....

[What do you think?]

At our institution, we must issue blood as "uncrossmatched" until a valid ABO/Rh has been recorded (i.e., all discrepancies resolved.) In a case such as this, I think that we would probably get the medical director's approval to issue group A, uncrossmatched (as opposed to group O), until the molecular results had come back. I'm curious - what would other labs do in the interim?

Thanks,

Julie

[How much is enough to change antibody screen from Positive to Negative]

Oh, we just call it normal saline. Thanks for the clarification. I must confess , I don't have any idea what "abnormal" saline might be. Why do we have the need to classify it as "normal"? Any thoughts on this?

Thinking back (WAY back) to school daze, i seem to recall that "normal" was the term used for saline that was isotonic with normal patient plasma (0.85% w/v, I think). Another term is physiologic saline. Anyone else remember this?

[Blood Bankers Help me...]

Our facility will issue multiple components at the same time to certain areas (OR, ICU, ED) as appropropriate, although sometimes a quick phone call to confirm a multiple issue is appropriate. We discourage multiple component issues to the floors.

One very important caution is that although we will issue components for multiple patients to a given location within a close period of time, we NEVER combine multiple patients in one issue (for example, sending a unit of packed cells for patient A and another unit for patient B in the same pnematic tube carrier.)

[Merry Christmas]

Merry Christmas to my fellow blood bankers. And to all of those who have the holiday shift this year,

special warm wishes - I'll lift in glass in your honor this year, if you'll remember me on New Year's Day!

All the best,

Julie H.

[Re-incubating a gel card??]

This is a very interesting question! Can I ask if you are going to be using an automated system? If so you will find the answer out during validation! I would think the analysers will recognise a card which has been incubated but not used yet & reject it for you if it falls out of spec. It should also be set up to use cards in order of loading (avoiding the situation in the first place). DiaMed analysers allow a 37oC incubation maximum of 30 minutes per test, then it throws them away for you. QUOTE]

We are using the Ortho ProVue. It does not reject an IgG gel card for having been previously incubated. It would reject that card if it saw other errors ("well incidences") such as bubbles or splashes. I am not certain if an unexpected volume level would flag the card for rejection before it is used, or if it would simply require a review after attempting to read the reaction.

[Just For Fun]

How about "I swear, I did NOT pour blood from the purple into the green!"

Really? Did your patient have a pulse? (calcium = 0, K = 20)

BUSTED! I would hope that the employee who would both collect a spec like that and then lie about it would have been re-educated &/or disciplined. It doesn't take a rocket scientist to see how you could easily harm or kill a patient by such actions! Again, "What if were your daughter (/mother/self)?":spank:

[Just For Fun]

One time I did the same thing and the caller didn't miss a beat. The caller was an aunt of mine who was a Head Nurse. When I answered the home phone with, "Laboratory, Ken speaking." she replied with, "Okay, I want to order a Stat CBC."

LOL - There's taking your work home with you... and then there's your work following you home!

This reminds me of years ago, when I was doing an internship, my husband asking me "What is a 'seg'?" I explained it was a type of white blood cell, and asked what prompted the question. He replied that I was talking in my sleep while scratching the bed, muttering "...seg...lymph...seg...seg..."

Nice to know that my career has made a "diff" in my home life!

[False Positive Anti-D in Gel?]

I was very glad to find this thread. We have recently gone live with the ProVue, and have run across a similar scenario. An OB patient typed Rh Pos by automated gel, but her retype by tube was negative (immediate spin). Because of the discrepancy, the tech carried it through to Coombs phase, and lo and behold! she came up as weak D positive. Although I had always viewed "weak D" as needing AHG to be demonstrated, the new method (gel technology) may have us rethinking this paradigm.

Our institution treats weak D patients as Rh negative when it come to receiving blood or products (including Rhogam), but they would be considered as Rh positive if donating blood. We explain it to our techs in terms of always trying to avoid stimulating the production of anti-D.

Julie H.