LIMPER55

Agree! Save the life first.
Our medical director would likely order at least one DAT the next day, possibly for additional days, to monitor. Anti-E is generally relative benign (though I have seen one patient who had an acute hemolytic reaction), We might also monitor plasma Hgb or haptoglobin, depending on the antibody involved.

You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.
Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

Basic guideline from our trauma center--
O Pos to all males and females over 50
Critical shortage--use O Pos.
The Medical Director can sign after the emergent event

Basic guideline from our trauma center--
O Pos to all males and females over 50
Critical shortage--use O Pos.
The Medical Director can sign after the emergent event

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

do the screening cells/control cells first--then if neccessary-panel
 

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

Our "LEAN" department makes us use everyone.  
In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

I need help understanding a strange phenomenon.  I have a D negative Mom by gel testing that has delivered  a D positive (3+) infant by gel testing.  A maternal post delivery sample was used for an FMH screen.  The FMH screen was macroscopically positive 1+w.   The Mom's post delivery sample was tested for weak D and was found to be 1+w.  The Mom's pre delivery specimen was tested for weak D and it was negative.  The sample was tested for FMH with a KB stain an no fetal cells were seen.  I was expecting the KB stain to reveal a large number of fetal cells. 

Thank you for mentioning this important concept which few know of. I presented accommodation at the meeting to decide whether to transplant or not. 
The literature is limited on iABO KT with A2B and AB but sufficient. We will transplant. They considered this case ABO mismatched but compatible as anti-A1 is absent.  May end up publishing they said. But I am just happy that he found a kidney. He is a young man and the live donor is his mum. Will keep you posted.
Thank you. 

Almost zero, because of the effect of immunosuppression, followed by the accommodation effect.

In my opinion, "unique" does not equal "independent".  We used to require handwritten blood bank tubes but switched to allow computer generated specimen labels.  The impetus for this change was the acquisition of hand-held phlebotomy scanners which printed the labels at the bedside after scanning the patient's wristband, however we had surgery personnel begging us to allow pre-printed labels for years because they cannot generally access the patient's wristband once the procedure has started and they often misspelled, copied, and omitted information.  Additionally, some people's handwriting is atrocious!  We have so many fewer headaches now that we made this change!

only perform the fetal screen on a post delivery specimen

We do not test again after delivery. We only do the Fetal screen testing unless the mother delivered without testing being completed.

The sensitisation stage of antibody/antigen reactions follows the Law of Mass Action.  The rate constants for the forward and reverse reactions will change both with the temperature of incubation, and also with the concentration of the antibody and antigen (amongst other things) and this will, in turn, alter the equilibrium constant of the reaction (which, in the cross-match, you want to drive to the right, but not so much that you will get "false positive" reactions).  You would be ill advised, therefore, to carry on the tests at 37oc and AHG after saline replacement, as there is every chance that the equilibrium constant would be altered to such an extent that some antibodies would not be detected in vitro, that may be clinically significant in vivo.

Our units have the peltier probes already
test activated and performed by touching the screen
validate annually with slurry of ice and thermometer 

I have submitted several complaints on this topic. The company and our rep deny, deny, deny

Safe-T-Vue on each unit issued to surgery cooler.  Safe-T-Vue for our trauma O Neg's kept in the trauma refrigerator.
Hemo Temps do not stay activated very long.

I don't believe you can perform a strict prewarmed in gel due to the 10 minutes centrifugation cycle.  I always do prewarmed in tubes.

We used some foam packing material and cut it into squares and they fit snugly in the channels of the rack.  #boom

Limper55,  I just looked at the package insert for anti-A1 Lectin and can't find anything in it that stipulates that you use two different A2 cells, but our procedure and a continuing education course from the Red Cross on resolving ABO discrepancies says to test the patient's plasma with at least 2 A2 and A1 cells.  The package insert does say there is no US standard of potency, so maybe that's it.

That was me Mabel but I put it in writing to the Standards Committee and asked about
platelets, our precious gold commodity.
Their answer about the unit turning into a pumpkin at midnight was: You cannot use it if it will not be completed before expiry.
Then they did explain that if it is needed and the Medical Director is called and approves you can CONTINUE the unit if started before expiry.
I was very interested they did say that the rules are there not for us to toss out units that we need, but to use logic. So individualize your case. As you said Godchild this has never happened before, so it is an exception. And no they don’t turn into pumpkins at midnight!