jayinsat

We use Mobilab so it pretty much accomplishes that for us with MEDITECH. However, with so many agency nurses and the incredibly high nursing turnover since COVID, we still have to contact the floor to inform them of the need for the specimen. Nurses have so many areas of responsibility to learn and master and, in many cases, are not given sufficient time to learn them, nevermind master them. Our agency nurses only get 4 hours of training before being assigned patients. That's 4 hours to learn MEDITECH, Mobilab, IMobile, Point-of-Care usage and access, Pharmacy Pyxis, Radiology, and everything else they need to interact with for patient care.

I would use the Autoprint functionality with caution as having unsolicited labels print remotely easily leads to misidentification of patient samples. 

In my opinion while this sounds convenient there may be a potential issue with the labels getting lost or forgotten especially if the situation is emergent and nurses are therefore busy.

Agree with Malcolm. Our policy is antigen to any antibodies and the corresponding antithetical antigens plus C, c, E, e, K (and k if K pos). The full phenotype if we expect it to be useful.  

When I was working in the Reference Laboratory at the NHSBT and, come to that, when I was working for a short time in a Hospital Blood Bank, we would ALWAYS test for the C, c, E and e antigens, together with the K antigen, both for patients and donors, and we would also test for the antithetical antigen, as well as the cognate antigen (in other words, as in your example, the Jk(a) and the Jk(b) antigen.  We ALWAYS did this, except when the grouping reagent was exceedingly rare (e.g. anti-Dib) or the antibody AND the antigen were extremely rare (e.g. anti-Kpc).

The reason we did this, particularly in the NHSBT Reference Laboratory, was because we wanted to identify very rare phenotypes, such as Kp(a+b-), or even rarer (in most cases), null phenotypes, but there was also a paper that showed that people who were transfusion dependent, such as sicklers and thal patients tend, once they have made an initial atypical antibody (particularly anti-C, anti-c, anti-E, anti-e or anti-K) to make all sorts of specificities (I'll try to look up the paper and get back to you on here).  Other papers comparing their findings actually agreed with them.
I say ALWAYS, but then, of course, the Bean Counters, who know nothing about Blood Group Serology, or about Patient Requirements, and care even less, came along, and we were banned from doing this as, apparently, IT COST TOO MUCH MONEY, except in special circumstances, such as patients from the Black populations, where we were privileged to be able to test for both Fya AND Fyb, in case they were Fy(a-b-) - and, of course, most of those who were found to be Fy(a-b-) had the FYB gene, so would very rarely produce an anti-Fy3,  as they were homozygous for the GATA1 gene mutation.
Unfortunately, what these "suits" seem to forget, despite counting beans for a living, is that, if the patient goes on to produce other, clinically significant, atypical alloantibodies, they will occupy a hospital bed for longer while suitable blood is identified, including, sometimes, cryopreserved units, ALL OF WHICH IS FAR MORE EXPENSIVE THAN THE INITIAL TYPING WAS IN THE FIRST PLACE - but what do we professionals know!

RANT OVER!!!!!!!!!!!!!!!!

Thank you all for responding to this topic. Fortunately, the patient survived probably due to bleeding at that moment. Both poly- and mono-specific DATs were done and they (i.e. poly DAT, IgG, complement and saline control) were all weakly positive. An eluate was tested against A1, A2 and B cells and reacted with A1 and B cells, not A2 cells. The reaction strength with A1 cells was stronger than B cells. The possible explanation for eluate reacting with B cells is that the anti-A,B in this O patient's plasma coated on the A donor cells got eluted and reacted with group B reagent cells. 

I would wash the red cells in saline and test the DAT (I have occasionally found stronger reactions).
You can also try washing the red cells using cold Elu-Wash as that can help bind any weak antibodies to the red cells.
In this case I would do an eluate including A1, A2 and B cells irrespective of the DAT results.
Lastly I assume you can call the transfusion reaction irrespective of DAT results if hemolysis is evident in the post sample?
The only hemolytic transfusion reaction I worked-up was clear cut and involved uncrossmatched blood given to a patient with history of an anti-Jk(a), against the BB tech’s advice. As Malcom stated above not many red cells were left, including the patient’s as the hemoglobin went from a 6 to a 3! I could not tell where the plasma ended and red cells begun. 

I would be interested in knowing how many antenatal RHIG doses the mother received. While it is possible for RHIG to cross the placenta and cause HDFN, seems to be extremely rare. The probability increases with each antenatal dose. That said, I agree with you that the baby's own cells should have sequestered any residual RHIG in circulation though I probably would not change my policy. I would just document the deviations when necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877609/

I would be interested in knowing how many antenatal RHIG doses the mother received. While it is possible for RHIG to cross the placenta and cause HDFN, seems to be extremely rare. The probability increases with each antenatal dose. That said, I agree with you that the baby's own cells should have sequestered any residual RHIG in circulation though I probably would not change my policy. I would just document the deviations when necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877609/

I would be interested in knowing how many antenatal RHIG doses the mother received. While it is possible for RHIG to cross the placenta and cause HDFN, seems to be extremely rare. The probability increases with each antenatal dose. That said, I agree with you that the baby's own cells should have sequestered any residual RHIG in circulation though I probably would not change my policy. I would just document the deviations when necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877609/

If @Malcolm Needs doesn't know...nobody knows. Lol!

If @Malcolm Needs doesn't know...nobody knows. Lol!

If @Malcolm Needs doesn't know...nobody knows. Lol!

If @Malcolm Needs doesn't know...nobody knows. Lol!

@AuntiS - as far as running the last wash with A1 and B cells - my thought is that it serves as a negative control for your possible (although VERY unlikely) ABO specific antibodies that may be left.  
We run a panel and A1, B cells with ALL our eluates except cord blood eluates.  For them we run screening cells and x3 A1 or B cells depending on mom/baby ABO incompatibility (we prefer rapid acid over LuiFreeze for cord bloods)
For our last washes we run screening cells and A1,B cells
In the end it comes down to how the protocols are written for each facility.

As have I, but I STILL don't understand the need to try and determine the specificity of an antibody causing a WAIHA, when almost all of them, if not actually all of them, are only mimicking specificities only, and so, to give truly compatible blood would mean giving something like Rhnull units, or En(a-) units - and why would anyone waste such precious units on such a case?  Indeed, as so many were proved to be anti-Rh17 or anti-Rh18, or, indeed, anti-Wrb, why even wasted such rare red cells proving that the wheel has already been invented?  Sorry, but I just don't understand this obsession.

yep. I've seen that too.

I've seen it a couple of times. Both were patients with WAIHA who were very actively hemolyzing their own red cells. DATs were 4+++ - like almost didn't need to centrifuge - positive.  Sent both samples to reference lab and neither one could be resolved. I think they tried 12 washes on one sample without success (more than policy, but they were curious to see what would happen). Ugly cases, idiopathic as far as the experts could determine.

@Okie, we started doing the whole panel (on the eluate only, not the last wash) because we had an elution CAP survey that had a Di(a) in it. The screen cells, of course, did not pick it up. It was an ungraded challenge but we decided in the long run to perform a full panel on the eluates in case an antibody against a low frequency antigen is causing the positive DAT.
@AuntiS, I'm curious, why are you running Acells and B cells on the last wash? I understand the eluate but I do not see why you would need to ever run more than the screen cells on the last wash.

We do a screen and, if indicated, A and B cells.
sandra

Agree with @donellda. Running the antibody screen on the last wash is all that is necessary. It will show that there is no reactivity verifying adequate washing for the elution procedure, which is why you are testing the last wash.

In the blood banks that I have worked at, all used the screen cells to test the last wash except for the ARC IRL which had a very different method of testing the last wash.

We had an over zealous infection control team (made up of 100% nurses) come to our lab last year making the same demand. We told them, in essence, we will not comply because the risk of injury from handling those containers were greater than the risk they were trying to alleviate. Furthermore, the risk of accidently confusing saline with formalin, whose containers look exactly alike, was to high when removing from the cardboard containers. In addition to that, we told them the man hours required to keep up with that would require additional FTE's, which would not be approved. 
They conceded and we continued on, business as usual. TJC does not really inspect labs that are CAP, AABB, or CLIA certified. Those organizations understand the logistics of the cubes and do not have a problem with it. Most infection control officers are nurses and think from the nursing perspective only.

We had an over zealous infection control team (made up of 100% nurses) come to our lab last year making the same demand. We told them, in essence, we will not comply because the risk of injury from handling those containers were greater than the risk they were trying to alleviate. Furthermore, the risk of accidently confusing saline with formalin, whose containers look exactly alike, was to high when removing from the cardboard containers. In addition to that, we told them the man hours required to keep up with that would require additional FTE's, which would not be approved. 
They conceded and we continued on, business as usual. TJC does not really inspect labs that are CAP, AABB, or CLIA certified. Those organizations understand the logistics of the cubes and do not have a problem with it. Most infection control officers are nurses and think from the nursing perspective only.

We had an over zealous infection control team (made up of 100% nurses) come to our lab last year making the same demand. We told them, in essence, we will not comply because the risk of injury from handling those containers were greater than the risk they were trying to alleviate. Furthermore, the risk of accidently confusing saline with formalin, whose containers look exactly alike, was to high when removing from the cardboard containers. In addition to that, we told them the man hours required to keep up with that would require additional FTE's, which would not be approved. 
They conceded and we continued on, business as usual. TJC does not really inspect labs that are CAP, AABB, or CLIA certified. Those organizations understand the logistics of the cubes and do not have a problem with it. Most infection control officers are nurses and think from the nursing perspective only.