Sandy L

Ours has sections for the following:
Accreditation
Staffing - minimum staff available, on-call, etc.
Testing Menu - including tests that can be sent to reference lab
Turn Around Time -- refers to a different policy
Critical Values
Blood Suppliers - outlines what is available, how far away they are, etc.
Blood Inventory - available and available upon special request
Delays in Provision of Blood Products or Services - what might cause a delay, what we do if there is a delay in testing
Transportation of Blood Products - outlines how we issue blood, includes info about coolers
Blood Administration - refers to a housewide policy
Consultation - how to contact blood bank for consultation with pathologist or our blood supplier's medical director.
 

In the UK, all the units are typed for C, c, E, e and K (as well as, of course, for ABO and D!).

Our criteria lately seems to be staffing.  Sometimes it would probably be more cost effective to screen units, but if it takes a tech a couple hours, then other work waits.  So we have to balance that.
Once a week, we screen about 10 type O units on our Tango for the Rh/K antigens.  So we always have some K and E neg units around to grab.

I'm 150 miles away from my blood supplier with delivery options that require orders be placed by 1330 or 2030 on week days - and obviously sooner if they need to screen units. If I need it stat, I can request a special delivery by volunteer, but I do not want to abuse that option. Weekends and holidays is a whole nother ball game - there is one routine delivery option on weekends, none for holidays. Whether or not I order antigen negative blood from my supplier depends on:
1) Is my patient an outpatient coming into the infusion clinic? Does the patient live in town or nearby? Does the patient drive or does someone have to bring him/her? Does the patient feel lousy, making leaving the house an ordeal? - I will order blood if the patient is local, brings themselves to OIC and it's not a major production for them to come in. OIC schedules patients with known antibodies that fit in that category for the next day automatically to allow us time to bring units in on the next delivery run. Otherwise we screen units. May not find them, but we'll look.
2) Is my patient an inpatient with a very low Hgb? Is the patient's condition unstable? Is the patient scheduled for dismissal after the transfusion? Is the patient scheduled for surgery? Is the patient actively bleeding? - If we answer Yes to any of those questions, we will screen for units.
3) Do we have the necessary antisera? - I stock the major players and in quantities related to how likely we are to use them. In other words, I keep 1 vial of anti-S but multiple vials of anti-c. This allows us to screen units for the majority of patients who need antigen negative blood and keeps outdating as minimal as possible while still stocking the antisera. If I use up the antisera screening or don't have a particular specificity or the price skyrockets (as has happened), then I'm going to have to order units.
4) If multiple antibodies - I do the math. How many units would I have to screen to find units? If it's a large number and I'm busy and the patient is not in dire need - I order them. If the patient is a type that we don't stock many units of - I'll probably end up ordering them.
Lots of things besides pure $$ for us. If you are very close to your blood supplier and/or have more delivery options,  the equations would change.
David's point about using the patient's plasma/serum (if the antibody titer is adequate) to prescreen units is a good one. It could potentially save a lot of antisera.
OK, I've rambled way past enough
 

That's what I was getting at.....but then, I got curious, and looked it up to see if it was actually true about water draining one way or the other. It turns out that in a perfect, static state of affairs, Coriolus forces can indeed cause the hemispheric effect, BUT in the real world those forces are vastly weaker than other influences at play and are overcome by variations in the shape and structure of drains and tubs, motion of the water in a basin caused by use or a slightly off center (which they all are) faucet filling it up, and so on. Hence it joins a long list of charming but untrue urban legends. There's an equatorial nation where, for a modest fee, you can see a toilet on the north side of the line flush in one direction and one on the south side flush the other. They're rigged.

They do fly but they spin around in the opposite direction.

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

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

Ah yes! The eyeball Hct. I called the OB unit urgently once and told them that a patient of theirs with orders for a chem test only had a really low Hct, probably in the 5 range, and maybe they should check into it. The doc wanted to know how I could possibly know (and he absolutely didn't believe me). I explained the whole eyeball Hct thing to him, he thought I was ridiculous, but apparently it worried him just a teeny bit because about an hour later we got an order for an H&H. Hgb was 5.0. He didn't believe the instrument either - made us redraw it. Hgb 5.0. Well calibrated eyeballs! 

I agree almost entirely with what you say StevenB - you may be surprised to know!!!!!!!!!!!!!!
The thing is that my laboratory (or what used to be my laboratory - I've changed jobs, and am now in a sort of national position, doing the theoretical training [as opposed to the practical training]) IS a Reference Laboratory, and so all of the people who work in it are trained to the nth degree, before they are "let loose" on live patient's sample, and all are trained in this technique and use it virtually everyday (therefore, keeping up competency).
I, myself, was trained by a combination of Dr. Kenneth Goldsmith, Dr. Carolyn Giles and Joyce Poole, when I was working at the International Blood Group Reference Laboratory, with help from Dr. Patricia Tippett, Dr. Robert Race, Dr. Ruth Sanger and Dr. Geoff Daniels - amongst others!  I had a good grounding!!!!!!!!!!!!!

Can I just remind everyone that whatever you do, you will NEVER provide anti-D to everyone who needs it and avoid giving to everyone who doesn't - at least not until someone comes up with a foolproof, cheap and quick way of genotyping.  Some partial Ds (who should receive anti-D) will be missed because they react exactly like normal D+, unless you are lucky enough to have a clone that misses the one epitope that they are lacking too.  Not all partials have decreased amounts of D antigen, and not all weak Ds can be sensitised to the D antigen.  This is 'grey areas' in spades.  The word 'simple' just does not exist when talking about Rh.

A four hour timeframe from start doesn't seem to make sense to me.  There has to be a line drawn at some time after the unit is removed from an appropriately monitored storage area where it is OK to transfuse before that time, but not after.  This seems to be set at 4 hours.  The start time is not the point.  Otherwise an unhung unit could sit at the patient's bedside for an indefinite period and still be transfused. ("No problem Mr. Peters, we'll just let it sit on the radiator for a few minutes so you won't get a chill...")
 
Or, I could be wrong. I would be interested in anything someone has actually heard from a regulator on this.
 
Scott

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.

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.

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.

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.

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.

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.

I'll sell one for $749 USD.

As for the 66 year old lady - well that opens a whole new can of worms doesn't it.  Masochistic lady (and sadistic towards the child!) and sadistic doctor, i reckon.  In my opinion, she needs psychotherapy, not IVF - and the doctor who did it should be struck off!

Totally agree.
We encountered same with ProVue....we tried running IS on buffered gel card and did not detect ABO incompatibility on one occasion!!
Try fighting with regulating bodies .....CLIA interpretation with Ortho letter......Most sites gets cited if you are not shaking tubes for IS when using gel methods......If your computer system is able to detect ABO incompatibility at the unit selection, is far better than doing IS by tube with Gel crossmatch.................but no one wants to listen and the reason being when people get cited they blindly do IS instead of justifying why computer is better than shaking tube for IS......

With all due respect to the AABB Technical Manual and the "Standards", a unit cannot "contain" the corresponding antigen!  A unit can "express" the corresponding antigen, but it cannot "contain" the corresponding antigen.  After all, red cell antigens are "expressed" on the surface of the red cell membrane (even those, such as Ch, Rg and Lewis, that are adsorbed on to the surface from the plasma are still "expressed" on the surface of the red cell membrane), and antibodies sensitise these surface antigens, rather than being absorbed into the cytosol of the red cell and sensitise red cell antigens "contained" in the red cells of the units.
 
One would have hoped that such a eminent organisation would have got that correct!!!!!!!!!!!!!!!!
 

We would do an extended Gel XM as long as the current screen is positive.  It's required by the LIS.  The computer system disqualifies them for electronic XM in this instance.  If the screen becomes negative in the future, they would qualify for electronic XM as the antibody is classified as not clinically significant

Another reason for the slow adoption of automation in the U.S. has to do with the slow process for FDA approval of automated instruments.  Alas, when Auntie D had her 3 instruments in 1989 there were really no approved instruments in the U.S suitable for Transfusion Services, just a few "Mega" sized instruments for batch typing mass quantities of samples in a donor center.  We purchased ProVues soon after they were 1st licensed, maybe around 2004, and at that time I believe perhaps the only other instrument was the ABS 1000.  Fortunately since then quite a few good instruments have been licensed in the U.S so things are looking up!