Joanne P. Scannell

We have found that washing the cells 3x with 37C saline will resolve this situation in just about every case where RT Saline wash doesn't help. If you are using Gel, there may be other reasons for the extraneous 'positive results' using your patient cells, e.g. sickled cells, acanthrocytes, protein coating. So, those must also be considered.

We validated using Anti-C3 in a Neutral Gel card.

Yes on every question except the 2u limit. If we have verified the ABO Group and we need to use 'incompatible' plasma (i.e. emergency), we use our Emergency Release Protocol, e.g. MD signs for it. If you want to view our policy, please message me.

I hear there is some chatter/literature about immunizing Rh-Neg Females under 50 is, today, probably 'much ado about nothing'. Well, not nothing, but the argument is, with today's techniques (in utero transfusions, more sensitive monitoring, etc.), the risk of HDN is less likely than it was 'all those years ago'. Does anyone have any articles or insight about this 'new turn' to share?

We switched to Rhophylac here in the hospital because 'everyone' likes having the option of giving the dose IM or IV. The MD's are still using RhoGam (no IV option) for their office injections (IM Only), e.g. Antenatal/Antepartum dose.

Without some sort of 'vending machine' device to control and document the in/out/in/out/transfused to whom information, just leaving O Neg RBCs in a refrigerator somewhere for nursing to take/return at will is not a good idea. I'm not even sure if regulatory agencies will support that. Not only that, giving O Neg to 'everyone' is not good management of resources. We (and most hospitals in our area at) restrict the use of O Neg to Females <50yrs old. (And even that is coming up for debate in some arenas.) There are 'vending machines' out there that will interface with some Blood Bank Software. Maybe someone who is using such a machine can comment on that.

As you see from the posts here, there are various opinions of what to do. Correct =The regulatory agencies do state to run some sort of controls, etc. You are in charge, therefore you do what you believe is best within the guidelines when there are gray areas like this. If you believe you should change the protocol to 'QC for the Antigen', then do that. Validation? You have criteria, I'm sure, for the cells passing inspection for use. I venture to say that most hospitals don't keep reagent RBCs more than a month or two past their outdate. It would be interesting to hear about that. If you are running QC for the tested antigen 'Day of Use', that's your validation that the cell is still working for your purpose. (I maintain that 'validation' is needed for situations where QC is not going to be run, e.g. You validate the time a box will hold a temperature so you don't have to take the temperature every time.) We do validate that a new panel is ok by running QC Antisera with them when they arrive. I've had inspectors tell me I must do this and I've had inspectors tell me to stop. Hmmm … I do what I am comfortable with, i.e. err on the side of caution. We don't use outdated panels … too many issues.

'Liquid Plasma' is never frozen so there's no need to thaw it therefore the outdate is not changed. 'Thawed Plasma' is the 5 Day product which results from Thawing Frozen Plasma (in all it's various forms, FFP, FP24, etc.). Note: When Frozen Plasma is thawed, it is assigned a 24hr outdate. You can extend that outdate to 5 Days IF you label it 'Thawed Plasma'. e.g. Frozen FFP is thawed to Fresh Frozen Plasma (24h outdate). You can leave it that way or change it to 'Thawed Plasma' (no FFP designation) and assign a 5 Day outdate to it. Most hospitals, if they go that route, just label it 'Thawed Plasma' with a 5 Day outdate immediately after it's thawed. (One Step vs Two Steps) Note: I'm using USA FDA rules, I don't know what they do in other countries.

I think that is the point = remove the requirement for the hospitals to perform the Retyping. Motivation? I agree that it is a waste of time and resources. The labeling facility has already tested the unit and rechecked it how many times? How many discrepancies have you found in your career? In over 40 years of mine, I have never seen a discrepancy. That's not of the units I have personally rechecked, it's of the 100s of thousands of units I have overseen. And, please correct me if I'm wrong, I don't think they do this recheck in the hospitals in the UK, maybe all of Europe? Help me out here with that. What is their kill rate because of mislabeled units?

Good point ... but most MDs give the RhIg when Weak/Partial D is reported because they don't understand the situation even if we try to explain it to them.

We use gel, and as other are doing, if Rh Neg with Gel, we test for Weak D. I must add this caution: Be mindful of what your Anti-D is capable of detecting. Some purposely do not detect DVI. You want to detect DVI on these newborns to determine the possibly of immunizing an Rh-Neg mother, i.e. Is she a candidate for Rh-Immune Globulin. n.b. Currently, we are using an Anti-D reagent that detects DVI (as well as other Weak D) at Immediate Spin, so the 'Weak D typing' is very quick and simple.

We keep them for a month or two. Once I do my 'turn around, vendor assessment audit', I toss them. Why? 1. These aren't handwritten papers anymore, we have other records bearing the exact same data generated by the exact same actions: All units scanned as shipped appear on the 'packing slip' and on our account, i.e. A unit is not going to be listed on a packing slip that does not appear on our account and vice versa. 2. The techs correlate the packing slip with the actual units at the time of receipt so we know the numbers are right. Discrepancies are remedied at that time. 3. The units are entered into the lab computer system where the record is kept 'indefinitely', not just 30 years (that rule reasoning goes back, again, to keeping those old handwritten log books) ... who decided 30 years was a good 'throw them out now' point, by the way? With computerization, we are keeping these records 'forever'. Maybe the rule will change to something past the max human lifetime, like 'keep electronically for at least 110 years'. 4. I can access the bills online which bear every unit of blood in every transaction and I can review every unit in our database if there is a question on a bill. Note that discrepancies are picked up when they are received, not weeks, months or years later. I don't know how it's been going in other BBs, but our discrepancies that I detect during my 'audit' are about the billing from the Reference Lab or other services such as 'STAT Fees' that should not have been applied, not about which units of blood did or did not arrive.

We give units tested for HgbS Neg only if they are for RBC Exchange Transfusions.

We, too, encounter Anti-M often using Gel. Apparently, Gel is just acidic enough to enhance this pest. Because the enhancement is more about pH than temperature, whenever we suspect Anti-M, we revert to other methods to help determine it's 'etiology'. Prewarming Gel does not change the pH issue so we don't do that. We can't trust that negative results in prewarmed Gel are truly due to a cold Anti-M or that the positive results aren't due solely to the acidity. (Besides, if testing is done using a Blood Analyzer (e.g. Vision, Eflexis), the cards are pre-warmed anyway.) So, we test the plasma using Prewarmed Tube Testing (e.g. PEG which has similar sensitivity for most antibodies sans the low pH). If positive with that, it's a Warm Anti-M. We also test at Room Temperature using Pooled Screening Cells. If positive, then it's a cold Anti-M. If negative with both Prewarmed Tube and RT Pooled O Cells, it's 'Anti-M (Detected using Gel Only)' ... just due to the pH drop, no clinical significance. Likewise, positive with both, it's an Anti-M with a broad thermal amplitude. Do what you like with the results. PS. Testing positive with Anti-M reagent does not mean the patient can't make Anti-M (Patient may be Mg Pos). Someone please correct/confirm that or am I working on old reagent data? (Like we don't see Anti-T or Aquired-B anymore because the reagents are 'purer'.)

Ok, I'll ask the other question that needs to be asked: Are you SURE that the cells put into the vial for Unit #1 are from Unit#1? Serologically, those discrepant results don't make sense (which is why you are inquiring) so I'm looking at the mechanical issues. Is it possible that during the heat of the moment (STAT, Uncrossmatched), the tech who retrieved the segments from the 2 units actually pulled both segments from Unit #2? When the crossmatches were repeated manually, was a new segment taken from the unit and that's why you saw the expected incompatibility?

Ditto (except for the AABB inspection). When we thaw, aliquot, and/or irradiate, the default message is 'Further processed by ...' followed by our Facility Name (exactly as our license states), address and FDA License #. Never been a problem this way.

Yes, I got one of those emails 'from you' and almost answered it until I saw the grammar and thought, 'No, he wouldn't write that badly!'. So, I decided to check with you in here to see if you did send it. Guess you didn't! Hoping you are well! I haven't done much in here because it's been ridiculously busy! And we are 'this far' away from being able to order/transfuse COVID Convalescent Plasma. A new product ... lots of fun.

If you know this patient is A Pos and you know the discrepant backtype is due to a cold agglutinin, why are you trying to re-establish what you already know?

We issue Group A Plasma (or whatever is shortest outdate as long as it is not Group O) until we have a BB Specimen and the ABO/Rh is verified. Then we switch to ABO compatible/specific. The expiration date of the specimen does not apply to non RBC containing blood products, so as long as the patient is wearing the corresponding BB Band, we will issue Plasma, Platelets and/or Cryo. I agree, the non-ABO match allogenic stem cell transplant recipients are a challenge, but as someone pointed out in an earlier post, these patients become obvious and we can deal with their 'new' blood type 'in the moment' according to our current protocol.

We purchased bins from VWR International. They are manufactured by AKRO MILS if you want to check their website: https://akro-mils.com/ They are inexpensive and come in various colors: Red, Blue, Clear, White and many sizes. We got Item# 75854-808 ... a case of 12 clear, 4" tall x 11.625" deep x 6.625" wide. 6 fill one of our drawers (3 in front, 3 behind them) very nicely. If you message me, I'll tell you the price (very reasonable). They sell dividers for them, too ... again, in the same colors. We also use them for our reagents. We stole the idea from Chemistry, by the way, so I can't take all the credit for this idea.

Ditto! More Questions: Didn't I read a few years back the the UK reference labs only do elutions within 2 weeks of a transfusion? What is the rationale for 3 months? I could never see the reasoning for that (Yes, I know an RBC 'lives' for 120 days but the math for that makes no sense to me.)

Ael? Or am I dating myself? I agree with Malcolm, for transfusion purposes, it doesn't matter what you call it. And ADsorption vs ABsorbtion ... I always looked at it this way: It depends on whether you are looking at the cell or the plasma. Antibodies are Absorbed from Plasma and Adsorbed onto RBCs.

Although I agree that treating a transfusion reaction is a lot easier than treating exsanguination, in this small hospital setting where they have only 6 units of blood to begin with, I don't think it would go so well to switch to incompatible after only 4u transfused. I'm with the group suggesting the hospital switch to stocking 4 O Pos + 2 O Neg RBCs. It is possible, don't let your provider tell you otherwise.

Ditto. We haven't 'split' a unit for a non-neonate for over 20 years! I agree with the above ... we'll just state what we do if we ever do get an MD who requests a split unit. I'd only add that the usual approach is for the MD to instruct the infusionist to 'Transfuse over 4 hrs.' vs the usual transfusion rate of 1.5 - 2 hrs. Eventually, hopefully, the CAP Checklist Team get the message that splitting the unit is not the only answer and shouldn't be unless it's done often enough to maintain competency, etc.

Devil's Advocate Asks: If we establish that the reason for the reactions in the backtype are due to cold agglutinin(s), why are we pre-warming ABO tests? Pre-warm = 37C reacting antibodies. If this is a valid alternative to RT/I.S. Crossmatch, then shouldn't we be performing an Extended Crossmatch (37C to AHG) to look for the IGG versions of the ABO Antibodies? Simple Answer: Immediate Spin Crossmatch: If due to cold agglutinin (other than ABO) = Compatible by Blood Type.