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Joanne P. Scannell

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Everything posted by Joanne P. Scannell

  1. My condolences to his family and friends. Yes, another 'great mind' has lost it's lights. He left a great mark on the world. Thank you, George Garrity.
  2. See an earlier post here about the monolayer method ... guess that doesn't pan out the way they thought it would. And I don't know of any 'routine' Blood Bank that runs their testing using this method. In my example, since gel picks up 'everything' while the lesser sensitive method does not, we use the lesser sensitive method to perform the crossmatch. And yes, we would transfuse antigen-negative, crossmatch compatible RBCs (crossmatch compatible with Albumin). BTW: In Sunquest, we add the testing we do. XMTS for the extended crossmatch with gel (1+, Incompatible) and XALB for the exten
  3. We, too, have dropped using the term 'least incompatible' way back when (along with 'in vivo crossmatch', I think) ... been so long, I forgot ... 1970's, 1980's? 1. Not all antibodies cause RBC destruction. 2. Not all antibodies that do, cause them in the same way. 3. Grade of reactivity is dependent upon the method and for some platforms, upon the tech performing the test. 4. Grade of reactivity is not proportional to the effectiveness of destruction. I think the only way to determine variations of compatibility is by using monolayer methods = specialized testing. Going back to 'the let
  4. I composed an answer to this yesterday and must have gotten 'sideswiped' before I posted it! Anyway, here's what I have to add to this conversation ... You cannot compare gel to tube testing. Aside from the 'sensitivity' issue (DAT could be positive in gel, negative in tube), gel has a totally different premise that needs to be taken into consideration. Gel: Slippery RBCs will make it all the way to the bottom of the gel column during a given period of time at a given centrifugal force.Tube: Cells must be agglutinated.1. Therefore, gel results are affected not only by coating of RBCs with a
  5. Are you using the same method for Antibody Screen and Antibody ID? If you are using MTS for the Antibody Screen and Tube Testing for your Antibody ID, the results you describe can happen simply because of the gel situation. (And 0.8% cells are not in the same preservative/diluent as 3% cells.) Just a thought ... some hospitals mix and match that way.
  6. "He's got a Kell" "A WHAT!?" ;| Anyway, way down on the screen on this, I forgot the subject! Oh ... using Hemo specimens for BB tests. Aside from the 'pendantics' (is that a word?) and interesting points about how reliable/contaminated these Hemo tubes may or may not be, I have a concern about the dilutional factor causing a false negative Antibody Screen/ID. Maybe I'm dating myself but I was told those little lavender top tubes used for Hemo contain liquid EDTA ... enough of which the hemo machine uses a calculation to 'correct' the values. The pink top tubes used in BB have a 'dry
  7. We, too, got 'the letter' from our blood provider ... and yes, it contained the information about the use of incompatible plasma (e.g. Group A). In a nutshell, we have elected to use Group A Plasma (or whatever is immediately available) instead of Group AB Plasma for the 'unknowns'. Also, we raised the question of the use of products like Kcentra instead of plasma. The MDs are hashing that out 'as we speak'. And like others, we are issuing non-type specific Apheresis Platelets routinely (mostly Group A). I think it's only fair to reserve the AB Plasma for the 4% of the population that
  8. To add another angle to this view ... Has the patient EVER been transfused? I'm thinking this because not only is that the first question I ask, but also because I have a tech in my BB who received 2 units RBC when she was a teenager. When she was a student in college during her BB rotation, she tested her own plasma and found Anti-K. Two children later ... no issues. Now, 20+ years later, her Anti-K 'comes and goes. It's possible it could show up now and then if her system becomes stimulated ... like maybe by an infection ... hmmm. We forget that antigens are merely chemical combos
  9. I think pre-warm testing got it's bad reputation because in the 'old days', when we were running antibody screens that included the IS/22C phases and used polyspecific AHG, if the test was positive at AHG and also at room temp, we would rerun the AHG phase using 'Prewarm Technique' to see if we were seeing a complement fixation due to cold agglutinins or a real IgG antibody. In those days, Prewarm Technique meant using NO enhancement; albumin wasn't allowed because it was said to enhance complement uptake, which is what we were trying to avoid. The change from Albumin to 'nothing' lowered
  10. I agree with the cautions ... here is what we do for your consideration: Our pretransfusion testing includes a test we call 'O CELLS'. (This is a pool of the 3 cells from the 3% Antibody Screen). It essentially replaces the old I.S. phase from tube testing so it tells us if there are 'cold agglutinins' or 'rouleaux' that would need to be considered during crossmatching. Test: 2 drops patient plasma + 1 drop 'O cells' ... mix, spin, read, grade and record. (Immediate Spin Phase). If results are questionable, incubate at 22C for 15 minutes and respin (22C Inc Phase). The result is helpful
  11. Our BB Band is 'per sample' (idea is that it identifies/links the sample to the patient actually wearing the corresponding band), therefore it remains on the patient until a new BB Sample is drawn. In other words, only the person drawing a new BB Sample removes the old BB Band because he/she is going to attach a new BB Band that corresponds to the new BB Sample. Everyone else is instructed to leave them alone.
  12. Problem is, giving 'least incompatible' just makes the tech feel better. Patient-wise, grade of compatibility doesn't always correspond to clinical significance (that's a whole 'nother conversation). Knowing that, if we have a patient whose auto antibody cannot be either removed (e.g. autoabsorption or differential absorption) or circumvented by other methods (e.g. less sensitive method, prewarming, etc.) so we can see 'what is under there', then we transfuse antigen-negative for the antigens that the patient does not possess. In other words, we avoid potential antibodies/antibody formatio
  13. Ok, is my memory corrupted or was I really taught way back in the 20th century that we had to use Anti-A,B because it would pick up subgroups of A and/or B? And then when monoclonal antibodies became available (yes, it was that far back!), we didn't need to be concerned about that for routine ABO Grouping anymore? Assuming that ... we do not use Anti-A,B for our routine testing. But, we DO use it for ABO Discrepancy workups ... guess I'm still searching for that Ax or Bx patient ...
  14. So true ... the reagent antibiotic antibody issue has been around for years, too. This is covered by my 'interferring substance' interpretation. I guess I'm taking the attitude 'I'm looking for clinically significant antibodies.' All the rest is academically interesting but doesn't change how we choose the units from the refrigerator.
  15. Since they are all too pricey (this item used to cost about $16 years ago ... until they became required by the CAP!) so we make our own ... every 2 weeks. Sugar packet from the cafeteria, fresh donor cells from our therapeutic phlebotomy patients, saline and Alsever's Solution ... you do the math. We run these as Pos (Anti-C3bd) and Neg (no reagent) controls each time we run the test (gel) to show that the reagent works for that test at that time. (We don't run many Anti-Complement DATs.)
  16. Maybe I'm taking the simplistic approach but when we see mixed cell reactivity, we consider the 3 reasons given by the manufacturer for causing such results ... 1. Mixed population - this is not the case for screening/panel cells so that out. 2. Cold Agglutinin - you investigated that and got negative results so no cold agglutinin there. 3. Rouleaux - I'll assume you checked that out as well and found none otherwise you would have said differently. n.b. Logic tells us that rouleaux should be seen with all cells, but experience tells us that it doesn't always happen that way. In addition, the
  17. Ummm, yeah ... that looks right. Precisely why the MDs don't bother with the math. AABB ... who's going to calculate total plasma volume? Circular of Info (2013!?): So for an average sized person (70kg) with a 50mg/dL Fibrinogen (our transfusion audit trigger), the math says to give 7 bags to raise the level to 100-125mg/dL. Since the pools are 5 bags each, we have to give 2 pools to accomplish this ... even if the math said give 6 ... or 8 ... or 9 ... we'd still give 2 pools ... and that seems to be the trend 'policy' around here. We are just starting up with pools, too. I'm p
  18. We have a BB HOLD 'test' ... no testing is done but the information (e.g. BB Wristband #, Phlebotomist) is recorded as a 'test result' in our LIS. This provides documentation that there is a usable sample, when it was drawn, when it was recieved in the lab, and when the BB Tech addressed the sample. The main lab has similar. And we do have a policy that we (BB and the Lab) do not accept specimens with no orders ... so, either order a real test or order a 'HOLD'.
  19. We perform testing for two hospitals. FDA required we have a 'contract' on file with them ... that is all.
  20. We have in place the following: 1. If the patient exhibits signs/symptoms related to transfusion reactions (there's a list), there is no choice ... the transfusion is discontinued and a Transfusion Reaction Investigation is ordered. Period. This is because the transfusion is under the license of the BB Medical Director who is thereby responsible for it. Besides, if MDs have the powers to 'instantly know' whether the symptoms are due to the transfusion or not and that the blood was completely compatible or not causing any allergic, TRALI, Overload, etc. without any testing/rechecking/investig
  21. The purpose of a BB Band is to assign a unique number to the specimen that is definitively associated with the body wearing the matching number. The idea is that no matter what we call the patient (e.g. Mary vs Jane), the blood in the tube is that of the body wearing the band. It is really the only true link between patient and sample because the band was applied at the time of draw. Remove that band and you've removed the link = no transfusion. To have a consistent BB# does not serve this purpose, i.e. multiple specimens bear the same 'unique' number, which can be argued is no different
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