Sandy L

In our LIS system we have anti-P1 classifed as not clinically significant. If the patient has anti-P1 in history and has a current negative antibody screen our system would qualify the patient as eligible for electronic crossmatch. Since moving to Gel for antibody screening in 1996, we almost never detect anti-P1.

Taking a guess, Fetal Maternal Screening??? Typically the fetal testing serology readily differtiates the sample for from maternal, e.g. the DAT is typically strongly positive when the Mom is allo-immunized. We would do a Kleihuer-Betke stain if the fetal cells don't test as expected.

We do get a fetal sample pre-transfusion when the 1st intrauterine transfusion is performed. We will perform ABO/Rh and DAT. The testing is ordered on the mother and is charted in a separate chart section "Fetal PUBS sample" in the Electronic Medical Record. The tests are named Fetal ABO/Rh and Fetal DAT to distinguish from mothers results. Pre and Post-Transfusion Fetal CBC results go in the same chart section. The bigger challenge is the actual transfusion as it currently is crossmatched to the mother and when transfused it charts as a regular transfusion to the mother. We are currently working on adding a result that states "Fetal Transfusion" that will chart immediately below the unit DIN for the Fetal transfusion unit. That was the best we could do to meet this requirement and we are hoping it will suffice.

What Scott said; plus there is the practical side of documenting in the Blood Bank Information System. I know our system wouldnever let us thaw a frozen plasma more than once.

Antibody screen plus antibody ID which consists of selected cells to rule out any additional new antibodies on every specimen.

Ours (Pediatric Transfer set with 150 u filter) come from Charter Med. They have options with and without a syringe attached.

There was another discussion on this topic maybe a year or so ago. If you can find that discussion there were some great suggestions. I recall Mabel Adams posting some good information and a checklist.

Our computer is set to NOT allow eXM if the current antibody screen is positive even if antibody is not significant (ABSC test of record is Gel). For historical antibodies and current Gel ABSC neg eXM is allowed if antibody is not clinically significant. We have anti-M set as not cignificant. We would do extended AHG XM anytime the ABSC is positive due to anit-M and we use Gel plus Immed spin as our XM method for these. If the anti-M is historical we would do eXM. We do not antigen type units for current or historical anti-M.

Ditto what Dr. Pepper said: we use temp not time. We also find RBC units to exceed 10C in 10-15 minutes. We measure the temp on return. If over 10C we notify the RN that the unit can be reissued for transfusion to that patient only if transfusion can be completed within 4 hours of the origianl dispense time. We document the required time for completion on the transfusion record with the following: Reissued Unit. Transfusion must stop at: Date_______________ Time_______ RN notified:_____________ by:

Same for us. We do require 2 ABO/Rh types in history if not typing a current sample.

Ours is 4 RBC:4 FFP and a Plt Pher for every 8 RBC for trauma with Cryo only as requested. Initially our OB protocol was to include Cryo pool per every 8 RBC's based on "California Maternal Quality Care Collaborative guidelines". We ended up wasting a lot of Cryo for our OB Massive Protocol patients, so our OB committee agreed to switch to Cryo only as requested.

Evilwaring is correct with the comments about EDTA vs Serum. Many years ago when we made the transition we did see an increase in detection of rouleuax. It seems that centirifuging the samples hard enough to achieve platelet poor plasma reduced the incidence in tube testing as well as avoiding problems in gel. Now that we do Electronic XM for qualified patients we encounter it less frequently.

We require one blood type on the current admission

I do recall a poster presentation at AABB meeting in San Diego in 2011 reporting an unusual ABO typing discrepancy. Instrument ABO typing differed from manual typing on a multiply transfused patient, where the patient had been transfused with multiple units of ABO compatible but non-identical donor RBC's. After doing additional testing manually, they noted that if the sample was centrifuged and they sampled from near the bottom of the tube they got donor cells and donor ABO results whereas if they sampled near the top of the red cell layer they got more patient cells and patient ABO type. You might want to look into where the instrument samples in the height of the tube.

Yes, what Malcolm said. We identify anti-f once or twice per year. The majority of these patients are D+C+c+E+e+ so presumably R1R2 and therefore f negative.

"We use leukoreduced as CMV safe for everyone, including neonates" Same for us

Regarding the question posed by Goodchild, "So you agree that the standard says we should be providing a disclaimer if our previous history check shows no history?" No, but that actually was our original interpretation of this CAP requirement when it was first published (2002). We had a rule written in our BB LIS. We have a History Check detail in our ABO/Rh that we answer and if we answered "No Previous HX", the rule would add a disclaimer that stated something to the effect that "No history of a previous result existed to verify the result". This was in 2002 and I don't remember the exact wording. After discussing with CAP, we determined that this was intended for "reference" type labs that really had no good way of checking previous history since they got samples from many, many other labs. Those labs that had no capability of performing history checks at all needed to put a disclaimer on their results. I am sorry that I don't have the 2002 documentation of this interpretation from CAP, but you could call them and see if that is still what they intended. Currently we just result a history check as "No ABO in history" or "Previous ABO in history". We reflex an ABO/Rh retype for a second sample collection when we answer "No ABO in HX", but we only actually draw the retype if it is a compatibility sample.

Our Transfusion Reaction investigation is similar to Liz D's. We do report the details of our investigation, .ie. Clerical Check, what type of product, ABO/Rh of the patient and unit (from the clerical check), unit ISBT DIN, DAT, visual hemolysis check, post sample repeat ABO/Rh type. Once that is resulted the reaction goes to the Medical Director for the Interpretation (what really matters to the physicians). The Medical Director can select form a variety of "canned" interpretations or write a custom interpretation.

We do not calibrate our digital timers on receipt. Ours come with a calibration certificate good for 2 years. When the calibration date is up we remove from service and replace. Many years ago we re-calibrated after the expiration date but they are quite inexpensive so stopped doing it.

AMcCord is correct. This is from the direction insert for Ortho, FetalScreenII Limitations of the Procedure If the infant’s red cells are shown to exhibit weak or partial RhD type, the test might not detect a feto-maternal bleed of more than 30 mL of whole blood. We required a Kleihauer Betke Stain in lieu of Fetal Screen whenever the infant is Weak D.

dcubed, Just another thought regarding "rr Kk cell=1+strong". Was this multiple examples of rr Kk cells or just one? Pregnant women are notorious for forming HLA antibodies. Frequently we see an occaional extra D .neg panel cell turning up positive. The extra pos reaction could be "Bg" reactivity and could be the patient's own antibody or in the RhIg

It seems like if your chamber is warming ABOVE room temperature, then you might be better off taking the platelet rocker out of the chamber, placing it on a counter at ambient temperature and monitoring the room temperature until you can get your replacement.

In Dispense and Assign there are multiple modes that you can select. These can be selected from the task menu and can also be selected from the row of buttons below "Task". As you hover over the buttons you will see that the 1st is "Assign", the 2nd is "Dispense", the third is "Emergency Dispense", and the last (with the lightening bolt) is "Computer Crossmatch Dispense". If you pick Dispense mode, you are correct; the system will think it is an uncrossmatched unit. If you select the Computer Crossmatch button, the system performs all of the checking to be sure that the patient is eligible, and won't let you proceed if the eligibility requirements are not met.

We used to use a form with a peel off label similar to sblanchard. The label had an FDA-approved adhesive for use on blood bags, but it didn't always stick well to cold plastic. We went to a system like Auntie-D describes. We print onto a label. One label sitcks on a tie tag and a 2nd label is attched to a pre-printed Transfusion Record form.

We do see antibodies, as Malcolm mentioned, that are directed against some component of the Gel test system. We suspect that they are directed at some antibiotic in the reagent cell suspending medium. They often give that characteristic “mixed field-ish” looking agglutination typical of IgM antibodies. Some are quite strong (even 4+). The Auto Control in Gel is typically negative because the patient cells are in MTS diluent and not exposed to the same antibiotics that are in the reagent cells. It seems like the 0.8% cells manufactured by Ortho for Gel testing have the offending ingredient and the 3% cells do not. When we see this pattern of all screening and panel cells positive, autocontrol negative we will prepared our own 0.8% dilutions of 3% screening cells to test in Gel and get negative Gel reactions. Of course all of this does not help with solid phase but the mechanism may be similar.