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.

I'm chuckling reading all of this because it's like the question, 'If the parents are both Group O, can they produce a Group A baby?' Ask a student, they'll say 'No way!'. Ask a BB fanatic, they'll say, 'Sure it could happen ... and here's how ...' And in this forum, there is never a simple answer!

I'm also wondering how one manages to validate that all units of blood remain within temperature range when the ambient temperature and handling is not consistent. We can't even validate our coolers for the same reason ... and one never knows if the cooler is left open or the units are removed then replaced. Are you using 1-10oC or 1-6oC? FDA instructed us to use 1-6oC for the coolers because they are really 'in storage'. If not in a cooler, we can go up to 10oC because they are 'in transit'. I haven't implemented that part yet, but I will be soon.

Yes: Positive Antibody Screen and Positive DAT.

When we first started using Gel, my techs would point out the shadows or 'jumpies' as they called them. I'd suggest 'Run the screen again using maxtime.' If they still saw the shadows, I'd just let them run a panel (maxtime) and go crazy with the results. After a while we all learned to ignore those reactions. Keep in mind, there are always a certain percent of any given cell population (especially stored reagent cells) that are just not going to make it smoothly to the very bottom solely because of steric hindrance (broken, aged, crenated, tagged for destruction, etc.).

We only use the microscope to check for rouleaux if/when rouleaux is possible/suspected ... and that wouldn't be the case in the AHG Phase.

Of course, all this may be a moot point because at this time, it is highly unlikely that anyone in the US will have an 'overstock' of vaccine. Due to failures and incompetency I don't need to mention, we will be lucky to get a fraction of what we need just to protect our 'front line'.

Congratulations, Malcolm! "For he's a jolly good fellow ... that nobody can deny!' ... so the song goes!

All Blood Products: We require a current BB sample, tested, etc. Plasma, Platelets, Cryo: No time limitation as long as the patient is still wearing the matching BB Band. Plasma: If there is no current sample tested, it is given 'Uncrossmatched'. If I'm interpreting the 'rules' correctly, that's what we have to do for plasma. Platelets: We stock Group A Platelets so that is what they get. We obtain Group compatible if we have to order platelets for a specific patient or a neonate. Shortest outdate is used first. Cryo: There is no consideration for ABO Group ... shortest outdate is used first.

We change all batteries annually while we are doing the QA on them so it's not likely that a battery will fail during the year. However, things do happen and I agree with exlimely, if you do have to change or replace (say it fell out for some reason) a battery, then a 'calibration' would be prudent. Also, we are not talking high precision here, i.e. wider acceptability range than a pipette would be, i.e. testing is done in ranges of time, not exact seconds. This 'calibration' is just a simple check up to make sure the timer isn't totally out of range. Most of the time, the error is the readout gets 'broken', not the accuracy of the timer.

There are actually 2 scenarios in this string: 1. Issuing plasma that you know is incompatible with a patient (i.e. ABO is verified) and 2. Issuing plasma when you haven't verified the patient's ABO with a current sample. For #1: If you are in the US, the CDC/FDA wants us to treat all incompatible plasma as if it were 'Emergency Release' so use your Emergency Release Protocol. For #2: If your patient's ABO Group has not been verified (e.g. sample tested using your protocol for verification), use your Emergency Release Protocol.