Kip Kuttner

I am in a blood center with an IRL and am concerned about our reports to hospitals. The only clinical lab we have is for immunohematology. Currently each report is customized and typed. We do not issue a computerized report. I can see using standardization for a numerical answer but we report things like the antigen frequency, ways to serologically approach the patient in the future, and transfusion recommendations that, while not impossible to turn into a "LOINK", would be difficult. We will figure it out.

Hello David. Thanks for responding. Yes I have started wading through the site. However since I am basically lazy, I thought I would see what others are doing too! )

Have any of you dealt (successfully) with "Logical Observation Identifiers Names and Codes" coding especially for reference lab results? http://loinc.org/ (LO- OINK?) It is designed to be a "universal" result coding system for laboratories in the US subscribing to the affordable care act ACA. It is supposed to unify the result coding for all health care computers making test results readable by any health care computer. From what I understand, Health care Laboratories must implement this reporting system by the end of 2013 or face government penalties. For free standing blood centers with an IRL is there a module for reporting reference lab results or does a facility need to implement the whole system (Hematology, Chemistry, Coag, Micro, etc) to get at the immunohematology reference lab report codes? Thanks:confused:

I believe there was also a problem with excessive bleeding. In addition Aprotinin was frequently used with SD plasma which caused with Aprotinin sensitivity should a second procedure need to be done. I have (tried) to attach a nice review of the SD plasma history. The current product Octaplas, will probably be distributed through your blood supplier. However the cost is rumored to be 3x what FFP costs.

I do not have experience with the BloodXrad. However we do have a Raycell. We we were in need of a replacement for our Cesium irradiator. The Raycell is a nice piece of equipment however: 1) the tube needs to be replaced approximately every 7 years. 2) The power supply has a 5 year guarantee but ours needed replacement after 1 year of blood center use. 3) Parts coming from Canada may take days to clear customs. 4) Service personnel cover the globe so a 2-4 day wait before a service person gets to your site is not uncommon. 5) if your ground water exceeds about 72 F during the summer a chiller is necessary in order to stabilize the temperature of the cooling water. Likewise if the water is too cold, ( I do not know the lower limit off hand but it is in the specifications) the water needs to be warmed. 6) The chiller/warmer is noisy. Other than these shortcomings, the Raycell is well liked by the techs.

GilTphoto I think what you are seeing is most consistent with reality. However the OBs should be following their patients using doppler ultrasound when they know the patient is a high risk pregnancy. I am working on the best advice to provide the OBs for follow-up based on the lab work we do when a potentially clinically significant Ab is detected during pregnancy. I can tell them to follow with serial titers, and that is easy for anti-D and even anti-K because there are published cut-offs but as you have illustrated above, titers are not always predictive even for well characterized antibodies. And... as was mentioned above one titer is not often comparable to another.

Silly me... I can do the net search. I appreciate your help.

Thanks for the replies. Yes, we would do titers on abs that have shown to be clinically significant. I would hope that the same lab would receive samples for further titer so the method for getting the titer would remain consistent. A rise in titer suggests increasing sensitization. How much of a rise is cause for concern may debatable. For Rh, the critical titer is 16 or 32 depending on the facility (and I hope the actual titer procedure. Would others agree that a difference of two dilutions regardless of the antibody involved, indicates on-going sensitization? Malcom, I do not know if you are the site expert. However I am having difficulty downloading the BCSH guidelines. I get an error message "0.4 of 179KB - Operation could not be completed. Connection reset by peer" could there be an FTP server that is feeling ill? Thanks to both David an Malcom

There are guidelines for docs to use in order to manage pregnancies when anti-D is identified in the mom and titers a known. I have read (somewhere) that the significance of doing titers for non-D antibodies is not known. Does anyone have a differing opinion? For example if anti-S or anti-Wra is identified in a mom to be, would following serial titers provide useful information? Another way of asking the question is "If the titer of a non-D antibody goes up one, two or three-fold, is it significant? Thanks in advance for the feed-back.

Here is how I look at HTRs. My first thought would be a high titer anti-A in one (or both) of the platelet products, true there should have been a positive DAT. Could there have been an antibody to a minor blood group antigen in the platelet? True, there should have been a positive DAT. I doubt the cold would be responsible especially if it did not react at 30 degrees. Cold agglutinin syndrome can occur with cold reacting antibodies because the blood in the capillaries of the skin and extremities is at a lower temperature so the thermal amplitude of the antibody would be good to know. In addition, Garratty's book on immune hemolytic anemias says that fever, chills and acute renal insufficiency do NOT occur with cold agglutinin syndrome. Also, Cold agglutinin syndrome is a chronic condition rather than being acute, so I would think the donor should have a history. The patient history does not fit that of Paroxysmal Cold Hemoglobinuria. Bacterial contamination can be missed even with the QC culturing we do and it would have been helpful if the patient and unit had been cultured. Additional possibilities include improper handling of the RBC units prior to transfusion (ie storage temp) administration with incompatible IV solutions, administration under pressure or through an IV needle with too small a bore, malfunctioning blood warmer, and the incorrect unit going to the patient, to name a few. Sometimes these reactions are difficult to sort out. My .02

I talk with donors having a hematocrit over 50. The issue with high hematocrit/hemoglobin levels include dehydration, living at a high altitude, hemochromatosis, erythroblastic leukemia (rare) and multiple causes of polycythemia. In the US a blood center can obtain an FDA variance to distribute blood drawn for therapeutic reasons, from donors with hemochromatosis but not polycythemia. In addition, the platelet collection equipment software (®Trima) begins to have difficulty establishing an interface if the hematocrit is higher than 51. However there is no upper limit established by regulatory agencies. Be sure to discuss this issue with your medical director.

I did a quick literature search and found several articles describing an "apparent" auto anti- Jka in the presence of chlorpropamide, aldomet, and methyl esters of hydroxybenzoic acid. There was one report of a DAT negative auto Jka associated with a case of Evans' syndrome.

I think that finding "best practices" is best done by looking at the specific application. For example, look at transfusion and coronary artery bypass grafting or transfusion and knee/hip replacement. This way you should come up with more pertinent information. Transfusion indications have become more segmented because there has been a movement away from treating a transfusion trigger and more emphasis put on treating the patient. May patients without complications can avoid transfusion when the Hb drops to 7 or so while others especially with cardiac complications may need to be transfused much earlier. One respondent mentioned the references in the most recent edition of the circular. While some are 10 years old or older, those references still have relevance to practice today and make an excellent starting point. Massive transfusion protocols and the ideal age of blood for transfusion are still under debate. With regard to massive transfusion, current search is for the ideal ratio of plasma to rbcs in massive transfusion. The jury is still out on this issue. Regarding the age of blood, there is a huge debate in the literature.

You could try to speak With Pat Arndt in the American Red Cross Reference lab located in Pomona and see if they can set up an experience for you. If that does not work Dr. David Oh at the San Diego Blood Bank may be of assistance. Finally you could try Life Stream in San Bernardino. Dr. Rick Axlerod is the CEO, but you might try their asking for someone in the Reference lab to see if something can be arranged.