Dr. Pepper

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.

We hired one last week for 3rd shift.

OK, the only magic to the "3+3" rule is that if you plug those numbers into the horribly unwieldy formula for Fisher's exact method of calculating probability, you will get a probability (p) of 1/20, or a 1 in 20 chance that the reactions could have occured by chance, or a 95% confidence level that your conclusion is correct. (This is a totally arbitrary number by the way.) Lower p values (1/15, 1/9 etc) allow for too much chance of random association. Higher values (1/28, 1/56) show that there's a much smaller chance that your conclusion is incorrect.
 
But there are other magic combinations that will give you an acceptable p: 5 and 2 (1/21), 4 and 3 (1/35), 6 and 2 (1/28) and so on. You do not necessarily need 3+3. See Goodchild's reference.
 
You run into problems when you only have one positive or negative cell: 7 and 1 (p of 1/8), 8 and 1 (1/9), etc. You would have to get to 19 and 1 to get the magic p of 1/20. If you think about it non-arithmatically, what if your one reactive panel cell is also positive for an unlisted low frequency antigen? What if your one negative didn't have serum added or isn't reacting for some other technical reason?
 
So you don't necessarily need 3 Cw+ cells; 5 or more neg and 2 pos would suffice. And you don't need 3 Js(b-) cells; 19 pos and 1 neg would be OK statistically. The problem I see with the high incidence antigens like this would be that with only one negative cell with which to rule out, you would still have a bunch of other antibody choices you would like to rule out, hence the need to test more negative cells.
 
So, pedantry aside, the bottom line is "don't base your ID just on the reaction with one cell". A second cell of similar makeup coupled with the pos or negs from the rest of the panel should bump your p past 1/20.

What you're both saying makes sense. I've tried it twice in test, though, issuing a unit after 72 hours but before 2359 on that 3rd day after phlebotomy, but I'm not getting an override warning, and nothing is showing up on the override report. It just let me sail through the issue string. The crossmatch was on my Old Crossmatch Report indicating the XM was expiring at 2359. The Specimen Expire hours are set for a minimum of 71, maximum of 72.
 
Our nurses are not using TAR (yet).
 
I went to the nice, big, comprehensive systems procedure manual provided by Meditech to check exactly how this works, but I must have misplaced it. Can't find it anywhere.

I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)

I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired!
 
 
 
 
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Hi Amy, welcome to the site by the way. I ditto what Mary and Malcolm said. He could also be an A3B. A2B or A3B, he should also show reactivity with anti-H. I would not consider this a typing discrepancy as your front and backtype match; the reagent anti-A is just a bit weaker than expected. In any event, there is absolutely no reason not to give him AB. Give him enough A1B, and you might even get that anti-A reaction up to 3 or 4+! 
 
Phil

Terri no doubt has an elegant solution involving packing foam, but have you called Helmer? Their tech support is very good. I'm not aware that the scribes can be adjusted but you never know...Short of that, you could replace the scribe, readjust it every morning (you're probably looking at it daily anyway), or learn to live with it. An hour is not much of a space on that little disc; I'm happy if my techs just get the right day of the week and AM or PM. The purpose, beyond satisfying AABB and CAP, is redundancy to your alarm system to see if your blood got cooked while no one was looking, and to see if an unfamiliar tracing might indicate a potential problem down the road. The batteries, by the way, are only for backup with a power loss and shouldn't have anything to do with normal operation.

Terri no doubt has an elegant solution involving packing foam, but have you called Helmer? Their tech support is very good. I'm not aware that the scribes can be adjusted but you never know...Short of that, you could replace the scribe, readjust it every morning (you're probably looking at it daily anyway), or learn to live with it. An hour is not much of a space on that little disc; I'm happy if my techs just get the right day of the week and AM or PM. The purpose, beyond satisfying AABB and CAP, is redundancy to your alarm system to see if your blood got cooked while no one was looking, and to see if an unfamiliar tracing might indicate a potential problem down the road. The batteries, by the way, are only for backup with a power loss and shouldn't have anything to do with normal operation.

Although the baby seems to be doing well, it would indeed be nice if the father's cells were available to test with the eluate (and Mom's serum). Or you could have a reference lab take a look for antiboduies to low-incidence antigens. Identifying the antibody might also be helpful in managing future pregnancies which probably would have a 50% chance of the same serologic scenario. I would think that no clinical signs of HDFN are no guarentee that the next child would fare as well. And if nothing else, the ex-blood banker in me would just want to know what the darn thing is!

Sigh - I guess I'll go bck to cleaning off my workbench in the cellar....

When we run into scenarios like this we will routinely test against the more common low incidence antigens (e.g. Jsa, Kpa, Cw). I think it makes all of the techs feel better.

I agree with every word you say Phil, EXCEPT that, as the baby is fine, trying to identify an antibody directed against a low-prevalence antigen is like hitting your head against a brick wall, over and over and over again!  One has to remember that it is not just the specificities within the 701 series (assuming that it is not a novel specificity all together), but most of the "larger" Blood Group Systems also contain low-prevalence antigens (just look at the Diego Blood Group System, as an example); you could spend many "happy" hours testing the plasma, and still get nowhere.
So, the serologist in me says "YES", the pragmatist in me shouts "NO"!!!!!!!
The thing is, the next pregnancy, if there is one, should, without doubt, be closely monitored (probably by MCA Doppler, or something similar), but, if either an IUT or an exchange transfusion (or a top-up transfusion, come to that) is required, finding compatible blood would be easy, even without knowing the actual antibody specificity.

Although the baby seems to be doing well, it would indeed be nice if the father's cells were available to test with the eluate (and Mom's serum). Or you could have a reference lab take a look for antiboduies to low-incidence antigens. Identifying the antibody might also be helpful in managing future pregnancies which probably would have a 50% chance of the same serologic scenario. I would think that no clinical signs of HDFN are no guarentee that the next child would fare as well. And if nothing else, the ex-blood banker in me would just want to know what the darn thing is!

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired!
 
 
 
 
Doc1.docx

I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired!
 
 
 
 
Doc1.docx

Copied, and sent to all my friends!  Thanks Phil.

I printed it out and gave it to the Micro Supervisor. She is going to hang by their C. Diff PCR instrument.

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired!
 
 
 
 
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The accompanying quote was "Cute little s..ts, aren't they?"

This does have a lab slant. And don't tell me I obviously have too much time on my hands now that I'm retired!
 
 
 
 
Doc1.docx

I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)

Enjoy yourself.