Sandy L

We've seen this same phenomenon in a couple of K negative patients over the years. Do you think this is like the autoantibodies that mimic an Rh alloantibody in a patient negative for the corresponding antigen?

We print all transfusion requirements on the transfusion tag regardless if they are associated with a unit attribute

When that CAP standard was 1st written it was worded differently and we interpreted it to mean that if there was no history for the patient, you had to have a disclaimer. At that time we implemented the disclaimer. We have a result field in our ABO/Rh test that we answer either "No ABO history found" or "Previous ABO in history". Based on that result the LIS woud automatically add the disclaimer to the "no history" patients, all patients, not just OB. After 1 or so years CAP revised TRM.40820 to indicate "add a disclaimer if history checks are not performed at all". We called CAP and were told that this was written for reference labs receiving samples from many different facilities and that did not do the history checks for any of their patients ABO/Rh results.

We rotate diluents every 12 hours on the Visions, plus we have one bottle of MTS2 open in the refrigerator for manual testing. Diluent 2 is used more slowly than 2plus. We did have an issue where a bottle was in open and in use well over a month and it grew mold. We now check all of the bottles weekly and discard anything that is a month old.

Perhaps there was confusion between training and competency. CAP requires training: TRM.40900, Blood/Tissue Sign-Out The procedure for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient. NOTE: A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the procedure is dispensed. Evidence of Compliance: Written procedures for the issue of blood components and tissue AND Written policy for the instruction of transporters on the proper handling of the product

I interpret "Transfusion Requirement" to mean the PATIENT's requirement, i.e. "this PATIENT requires Irradiated products". Irradiation is a unit ATTRIBUTE. So you would need to print that patient requirement on the compatibility Tag/Label along with the other required patient information. Our tag (Cerner) would include both unit attributes and patient requirements.

I just answered this question. My Score PASS

I just answered this question. My Score PASS

We get about 800 cord samples per month. We test all cords for Rh Neg mom's and perform ABO/Rh and DAT (IgG) on the cord. If mother is O pos, we do ABO only on the cord. If cord turns out to be other than group O a Cord DAT is reflexed. If Mom does have a clinically significant antibody, we always perform Cord DAT. For all other mom's, no testing. We run all of our cord testing on Ortho Vision.

I am looking at the Participant Summary for latest CAP proficiency, anti-D titer. For tube testing using the "uniform procedure tube method" that CAP suggests, they reported the following results: 333 participants, mode 64, consensus range 16 to 256. For Gel testing "uniform procedure gel method", 138 participants, mode 256, consensus range 64 to 1024. Per CAP, Consensus is determined by the Mode +/- two of the most frequent titers. It looks like in the previous 2 surveys for the gel anti-D titers, the mode for gel was 1 to 2 dilutions higher than tube, but so was the consensus range. It seems like there are a fair number of labs reporting gel and if you report that as your method you should be compared to other gel titer users. I would also think as more instruments are implemented that can do gel titers, the number reporting gel will go up. And of course what ever you do, perform method correlation and communicate with the obstetricians any changes they may see in titer results. We are contemplating this also. Also I am little confused by ""Do you want it to be faster and more hands-off or more exact?" It seems to me that automated titers in gel should be much more reproducible. We are just starting to look in to performing titers on Vision.

We get our cords collected in a sterile Screw top tube, no anticoagulant. We've been testing on our analyzer for years now, 1st ProVue and now Vision. For some reason, after these clot and retract there is very abundant serum with lots of free RBC's. We just pull a small aliquot of serum and RBC's off, ream for clots (which are rare using this method) and then centrifuge.

Thanks to Malcolm for your explanation auto-antibody with a specificity that closely mimicked an anti-K. Over the years I have seen a few patients that continued to elute anti-K for up to a year after the last transfusion.

We place our limit at 12 group A for a patient with unknown blood type. Mabel makes a good point, by then the patient has been issued 12 group O red cells. We start thawing AB plasma after the first 12, but it's pretty rare that we don't have a blood type by then.

We do the same as Kate, i.e. pull at receipt; would not like to try pulling segs from every unit during a Massive Transfusion episode. Each days segs go into a ziplock bag labeled with the date. We have a giant ziplock label for the month. At midnight the previous day's bag goes into the month bag and a new daily bag is created. The month bags are kept two months after the end of the month and then tossed so that the most recent segs are kept 2 months. It works well for us and we've never encountered a problem retrieving a seg for a delayed transfusion reaction investigation

Oh Web Master, Thank you, thank you!

Our supplier uses room temperature gel packs that are stored in a controlled 20-24C chamber. Platelets are packed in an insulated carton with the room temperature gel packs to assure that platelets do not get to cold or too warm during transport. It sounds like your supplier should address how they are shipping platelets.

We use E6371 Thawed POOLED PLASMA|NS/XX/refg|Open Anticoagulant is Not Specified for this product as it is frequently a mix We also have in case we ever pool this again: E4992 POOLED PLASMA|CPD/XX/refg|Open|Cryo reduced

We use the same E code as the original unit (closed system) for the satellite bag. We only divide into the satellite bag the volume they are requesting plus 5 mL for the tubing. When we prepare the syringe with the corresponding open E code, we pull the entire contents of the satellite bag into the syringe, thus the product in the satellite bag is destroyed by the LIS system. If you leave product behind in the satellite bag and it is an open system, it would need an Open E code as well.

Based on John Judd's study, we changed our criteria to "transfused within 4 weeks" and based in his work we are still being overly conservative.

Mabel, We used to see this when plasma was thawed but just barely beyond the "slushy" point so that the unit was still very cold when it came out of the waterbath.. You will have cryoprecipitate forming in the refrigerator. It is sort of like the process where you make cryoprecipitate by thawing the FFP in the cold.

Another thing that I do for positive antibody samples when using outdated antiglobulin reacting antisera: add a few drops of anti-A,B to turn the plasma into “group O” and then pick a panel cell for the cell suspension. This would achieve the same thing as David’s mix of absc negative patient plasma’s. Patient’s with positive absc’s are also a good source for unknowns. Another source, once the reporting deadline for proficiency testing has passed, we re-assign proficiency samples (if quantity permits) as additional competency samples. We try to get a much mileage as possible so we use these types of unknowns for ABID, antigen typing, titers, antibody screens in gel (automated and manual platforms) and tube testing. For DAT’s, I will make a mix of outdated IgG sensitized Coombs Control cells and un-sensitized cells (outdated screening cell, etc.) to make a mixed field positive DAT. Also I save outdated Complement sensitized Coombs Control cells for DAT unknowns.

Ours are used to monitor temps in our portable refrigerators. These refrigerators have both a sensor for our remote temperature tracking and a data logger (belt and suspenders approach). The data loggers are set to log temp every 2 minutes and are just there as a backup in case our remote temp monitoring system goes down. We picked that interval so that the data loggers could go for up to 2 weeks before they had to be downloaded (when they fill up they stop recording so the shorter the interval the more frequently they need to be downloaded). We download weekly and export the data into excel-no paper.

What happens South of the equator. I wonder how that affects flying antisera?

We would not routinely perform eluates if the IgG DAT was negative but if we suspecting a delayed hemolytic transfusion reaction we would definitely consider doing this testing. I have been able to elute IgG antibodies from DAT negative samples on several occasions. Initially I thought this phenomenon was unique to the eluting of anti-A or –B from cord samples. I think we’ve all experienced this, with mom group O and negative antibody screen, infant group A or B and negative DAT. MD suspects ABO HDN and requests elution. Generally you will be able to elute the maternal IgG ABO antibody despite the negative DAT. As a med tech student we were always taught that this related to the way the infant’s ABO antigen developed, less branched structures. Over the years we have seen that this happens with other antibodies too. In several cases where mom had a known significant antibody, and infant DAT was negative but infant was positive for the antigen to which the antibody was directed. This has happened with anti-c, anti-Jka and most recently with anti-Ge3. Most of these eluates reacted 2+ to 3+ despite the negative DAT. Also think about Delayed Transfusion Reaction Investigations that you may have performed where the DAT may be weakly positive but the antibody in the eluate reacting quite strongly. Another observation: Just recently I was preparing competency unknown samples for eluate testing by coating cells with various patient antibodies. Some of the samples had DAT’s that were negative or only weakly positive yet the antibody was recovered in the eluates, again reacting 2+ to 4+. And this was not even increasing the concentration of red cells as Malcolm suggested. If you think about it, the process of preparing the eluate really does have a “concentrating” effect. The eluate is prepared from a large mass of red cells where the packed red cell volume to eluate volume is nearly equal. That eluate is then tested against a very diluted concentration of reagent red cells, e.g. 3-4%, compared to the very MUCH larger quantity of cells that it came from, thus you are greatly increasing the sensitivity of the test.

Another thing to consider... Although it looks like Anti-A1, it could be some other room temp reactive IgM antibody. Regarding the A2 cell reaction that was negative, was that also incubated at room temp like the A1 cells were? In this scenario we would set up A1 cells, A2 cells and group O screening cells as well as a patient auto control and incubate all at Room temp. Occasionally, an antibody other than anti-A1 (e.g. cold auto antibody, anti-P1 etc.) will be reacting with reverse grouping cells. Some of those cold reactive antibodies can give variable reactions,some cells reacting immediate spin others requiring room temp incubation.