Joanne P. Scannell

We haven't used "Post-Storage Leukoreduction" (aka Bedside Leukoreduction Filters) for many years. 
Search the literature and you will find that they are essentially useless.  Leukoreduction is accomplished by adhesion, not size so effective reduction is dependent upon the activity of the leukocytes.  Once they 'die' and breakdown during storage (a few days), they won't adhere to the filter no matter how old the unit is.  In addition, the by-products of their breakdown, which cause reactions, are now released into the plasma and there are now leukocyte fragments floating in the plasma which could result in reactions caused by pulmonary filtration of these particulates or sensitization to their HLA Antigens.
Bottom Line:  Leukocyte reduction is effective when performed shortly after donation while the leukocytes are still viable and will adhere to the filter. 

We haven't used "Post-Storage Leukoreduction" (aka Bedside Leukoreduction Filters) for many years. 
Search the literature and you will find that they are essentially useless.  Leukoreduction is accomplished by adhesion, not size so effective reduction is dependent upon the activity of the leukocytes.  Once they 'die' and breakdown during storage (a few days), they won't adhere to the filter no matter how old the unit is.  In addition, the by-products of their breakdown, which cause reactions, are now released into the plasma and there are now leukocyte fragments floating in the plasma which could result in reactions caused by pulmonary filtration of these particulates or sensitization to their HLA Antigens.
Bottom Line:  Leukocyte reduction is effective when performed shortly after donation while the leukocytes are still viable and will adhere to the filter. 

Worthless.

We haven't used "Post-Storage Leukoreduction" (aka Bedside Leukoreduction Filters) for many years. 
Search the literature and you will find that they are essentially useless.  Leukoreduction is accomplished by adhesion, not size so effective reduction is dependent upon the activity of the leukocytes.  Once they 'die' and breakdown during storage (a few days), they won't adhere to the filter no matter how old the unit is.  In addition, the by-products of their breakdown, which cause reactions, are now released into the plasma and there are now leukocyte fragments floating in the plasma which could result in reactions caused by pulmonary filtration of these particulates or sensitization to their HLA Antigens.
Bottom Line:  Leukocyte reduction is effective when performed shortly after donation while the leukocytes are still viable and will adhere to the filter. 

The point about warm auto-antibodies, even the ones that look exactly like an auto-anti-M, an auto-anti-Jka or a specific Rh antibody, such as auto-anti-e, is that they all tend to be mimicking specificities, and so, in reality, you might be fooling yourself by giving antigen negative units to the patient, but you will not be fooling the patient's immune system, and so the chances are that, in most cases, the antigen negative transfused red cells will last no longer than the patient's own red cells.
"Cold" auto-antibodies tend to have true specificities, but, even if you can find antigen negative units, the red cells will usually not last as long as the patient's own red cells, because the patient's own red cells are coated with C3dg, which gives them some protection from removal from the circulation, whereas the transfusion red cells have no such protection.
I agree with your Reference Laboratory - which, considering that is my own background, may not come as a surprise to a lot of people!

WOW!  CONGRATULATIONS!  It's a well deserved honor!

True, David.  FDA in action: We got cited during an inspection a few years ago and had to switch our Auxiliary Blood Box (aka Cooler) temperature limits from 1-10C to 1-6C.  Someday, they will straighten this out (why the two limits?), but until then, we are stuck with it ... here in the US, anyway.  What is the rest of the world doing?

The word 'significant' is interesting in this context.  In most of -Europe antibodies that are detected only in enzymes, including the enzyme-only anti-Es and -Cws would NOT be considered significant and most of the time would not be detected in the first place.  Nor would the numerous anti-Lea, -Leb and -P1 that you would pick up.  Always assuming that you are working with a sensitive IAT in the first place, of course.

We use one homozygous or if absolutely necessary two heterozygous to rule out. Then 3 positives and 3 negatives reacting as expected to rule in.
Of course you always have to look at the whole picture and use your brainpower to see if you can figure anything out when things are not clear cut. Which seems to be happening more and more often these days!

From the UK BCSH guidelines (these can be found in the reference section of BBT- Library/ UK/ compatibility guidelines):
7.7.2 The specificity of the antibody should only be assigned when it is reactive with at least two examples of reagent red cells carrying the antigen and nonreactive with at least two examples of reagent red cells lacking the antigen. Note that,wherever possible, the presence of anti-Jka, anti-Jkb, anti-S, anti-s, anti-Fya and anti-Fyb should be excluded using red cells having homozygous expressions of the relevant antigen.

A minimum of 2 cell samples expressing presumed homozygosity of the gene, if available.
In some cases, of course, this is not possible (for example, we had to group the partner of an Oh pregnant lady the other day. He was H+, but was he HH or Hh? Who knows?).
There are also rare occasions when we only have one example of a particularly rare "homozygous" type (such as a Cw+, Cx-, MAR-), but there is nothing else you can do under the circumstances.

Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) :
Select Product in this order ...
Indated product using shortest outdate first.  (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.)
ABO Group: ABO compatible are preferred but not essential.  (And then there's a chart because it is a procedure and that has to have everything in it.)
Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist. Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period.  Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated.  (And then instructions about how this is done and documented.)  
 
 
 

Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) :
Select Product in this order ...
Indated product using shortest outdate first.  (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.)
ABO Group: ABO compatible are preferred but not essential.  (And then there's a chart because it is a procedure and that has to have everything in it.)
Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist. Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period.  Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated.  (And then instructions about how this is done and documented.)  
 
 
 

Never say never - bet you get an Rhnull next week!!!!!!!!!!!!!!!!!!!!!!!!

No, J Series does not count for Antigen Typing because CAP has cleverly classified those results as "Ungraded".  I'm not sure why they require it when it has no impact other than for us to use up valuable resources. 
As others have stated, they do have another series RBCAT which does 'count' and makes them more money.  We should petition CAP to remove the Antigen Typing section from the J Series.  I think I'll write to them ...
 

T&S on every delivery patient ... so, there's our Rh confirmation of the 'woman in the bed'.
Post-Delivery = Fetal Cell evaluation (currently K-B Stain, that may change).  Period.
n.b. Unless we can prove mom is producing Anti-D, MD wants the Rh-Ig anyway, no matter what.  In fact, we've had an MD want it given even when we CAN prove she's making her own Anti-D.  #MDsalwaysgetwhattheywantevenifitdefieslogic

Without getting into the details, we were told by a CAP 'inspector' that we must run QC on the panel, that using the QC results from our Antigen Typing QC doesn't count.  So, we started running the full panel with reagent QC Antisera upon receipt.  n.b. The 'Lab General' section of CAP, which BB is bound to as well, states that QC must be done on EVERY reagent upon receipt.
THEN, two years later for the next CAP, the 'inspector' tells us to 'stop this, it is non-sense!'.  *^&%)W%*
We didn't ... because of that 'Lab General' rule.
After reading all your replies and ideas, I think I'm going to revise our 'QC' to testing a few cells (rather than all of them) with diluted antisera, Fya+b- and Fya-b-, including the Ficin panel. 
Keep talking ... we need a 'standard' thought about this!

T&S on every delivery patient ... so, there's our Rh confirmation of the 'woman in the bed'.
Post-Delivery = Fetal Cell evaluation (currently K-B Stain, that may change).  Period.
n.b. Unless we can prove mom is producing Anti-D, MD wants the Rh-Ig anyway, no matter what.  In fact, we've had an MD want it given even when we CAN prove she's making her own Anti-D.  #MDsalwaysgetwhattheywantevenifitdefieslogic

T&S on every delivery patient ... so, there's our Rh confirmation of the 'woman in the bed'.
Post-Delivery = Fetal Cell evaluation (currently K-B Stain, that may change).  Period.
n.b. Unless we can prove mom is producing Anti-D, MD wants the Rh-Ig anyway, no matter what.  In fact, we've had an MD want it given even when we CAN prove she's making her own Anti-D.  #MDsalwaysgetwhattheywantevenifitdefieslogic

Without getting into the details, we were told by a CAP 'inspector' that we must run QC on the panel, that using the QC results from our Antigen Typing QC doesn't count.  So, we started running the full panel with reagent QC Antisera upon receipt.  n.b. The 'Lab General' section of CAP, which BB is bound to as well, states that QC must be done on EVERY reagent upon receipt.
THEN, two years later for the next CAP, the 'inspector' tells us to 'stop this, it is non-sense!'.  *^&%)W%*
We didn't ... because of that 'Lab General' rule.
After reading all your replies and ideas, I think I'm going to revise our 'QC' to testing a few cells (rather than all of them) with diluted antisera, Fya+b- and Fya-b-, including the Ficin panel. 
Keep talking ... we need a 'standard' thought about this!

I agree with this.  YOu may see rouleaux again at 37.  You can do saline replacement after this phase and then go directly to wash and ahg phases.

This is the way to go, because otherwise - as you correctly suspected - the 37C and AHG phases have no exposure to the plasma/serum with the alloantibody.  you would have replaced it with non-reactive (one hopes) saline.

Completely agree.  We have something called "the element of uncertainty" (it isn't "element", but it is something similar) that is required by one of our more officious regulators (not that any of them are less than officious), but we struggle with this because, apart from titrations/quantifications and measuring an FMH, I struggle to think of any tests that we perform that are quantitative, rather than qualitative, which means there is no "element of uncertainty" - as long as your controls have worked, but these numpties stil ask for evidence.  You will be surprised to learn that most of the inspectors for this particular regulator have never stepped foot over the threshold of a transfusion laboratory prior to inspection!!!!!!!!!!!!!!!

More Devil's Advocate: That only tests the K antigen - a very stable structure. What about other antigens that are more likely to and are known to deteriorate over time - Lea, Leb, Fyb, to name but a few ?
The only value to testing a K- cell against a diluted antisera is to check the DAT on the chosen panel cell, i.e., it's potential to cause a false-positive. You could simply do a DAT instead.
I'm certainly not suggesting that everyone completely phenotype their Screening Cells and Panel Cells each day (or periodically). I'm all in favor of a minimalist approach to this issue, and it appears that similar testing algorithms are acceptable to inspectors. 
I really just wanted to highlight the flaws in this whole concept, from both the regulatory side and that of the users. And.....don't forget.....the manufacturer's of the red cell reagents have a huge amount of stability data.

We do both of the above ...
1. Test the panel against QC antisera upon receipt, as we do for all reagents; It shows the reagent survived shipment.
2. Record the Lot#/Cell# and antigen types (zygocity) of the cells used for Antigen Typing QC (heterozygous except K)  ... that's periodic enough.