Joanne P. Scannell

This may seem like an odd question, but was the screen tested using a different method than the panel? I only ask this because there are some hospitals that run Antibody Screens using Gel then run the panels using Tube Testing. One cannot expect Gel vs Tube testing to give 'identical' results for several reasons. Incubation Timing can also make a difference. If only 1 cell in the Screen was positive and the entire panel was negative, I'd tend toward an Antibody to a Low Incidence Antigen. But, this case had 2 positive screening cells, correct? Other than sampling/dispensing error, I'm just trying to think of the reasons the Screen would not correlate with the panel.

By any chance did the Reference Lab perform any other antigen typing? Sure, you can't get Kell typings from a DTT Treated Cell, but what about the others? Having that information would helpful with the decision to transfuse 'antigen-negative' (yes, 'least incompatible' evokes a false sense of security). I vote to trust the Reference Lab/DTT Treated Cell testing and call her B Pos. You say she has a Warm AutoAntibody (of Undetermined Specificity, I assume) ... is the 'thermal amplitude' so wide that it is interfering with the Room Temperature backtype as well? I can't help thinking about some of those 'panagglutinin' situations. Am I running off the field with those thoughts?

The company told us. And really, it does make sense. We are testing the sensitivity of the reagents in the cards by sending a coated cell from the reaction chamber down through the reagent/gel. It shouldn't matter if the cell was coated a few minutes ago or a few days ago, the IGG Card is working.

We were told that because we prove the IgG Card is working properly with the positive and negative antibody screens, we do not have to make a specific sample for pos and neg 'DAT'.

We have had good success with just lowering our sensitivity. Example: 2+ Reactions in Gel can be negative in PEG ... Albumin ... or No Potentiator. Rarely do we have to resort to DTT. But an alternative sounds nice! Thanks for the tip!

Do you perform all the antigen typing on your cord samples so you know which ones to use?!

I always 'balk' at this idea because as we all know, the probability of two patients having the same blood type is high. We have had a few instances over the past few years where a wrong patient was drawn (we use BB Bands so it's very obvious) and they were the same blood type but one had antibodies and the other didn't. And yes, there are those who have had to come up with 'defensive measures' to 'assure' that there is no 'cheating', e.g. RN draws 2 samples and holds one in case the BB asks for a second, a witness (do you really think that happens as intended?), different colored tubes for the second draw (assuming they don't draw the wrong patient twice). I could go on and on about this ... but that wasn't your question, was it?

I agree with those who 'don't bother' with the actual math ... between 'natural selection' and blood suppliers 'holding' certain antigen types, exact math is just an academic exercise. To be practical (considering tech time and reagents are valuable commodities): If the patient's plasma contains demonstrable antibody, crossmatch a batch or two of units then do the antigen typing on the compatible units only. No luck = order antigen-neg from the supplier. If the patient's plasma is negative, then screen (highest frequency first) a batch or two of units. Again, No luck = order antigen-neg from the supplier.

Just to throw this in the ring: What is the consideration for storing Blood Substitutes on the Ambulances?

We do, 'just because' ... it's easy to find K-Neg RBCs and one never knows if they are going to try it again so we don't want to deal with switching around. We have one patient who seems to be chronically infused with this stuff!

Ditto!

DITTO!

KBs are performed in our Hematology Department. This test is not uncommon as it is run for more reasons than just to figure out RhIG dosage. I believe, because of this and their more acute training/experience in microscopy, this is the best place for this test to be done. Competency for KB belongs to the section who is performing the test no matter what anyone else uses those results for. The only 'competency' determination that I believe is necessary for the Blood Bank is to assure that the BB Tech who is processing RhIG orders knows how to acquire the KB result and how to calculate the dosage using that result.

We have been using an Erytra Eflexis (Grifols) for almost 2 years now and we are very happy with it and the service team. It is interfaced to Sunquest.

I agree ... but, unfortunately, along comes that occasional inspector who doesn't see it that way.