Malcolm Needs

I hate it when my plasma tastes yucky. LOL. Really though, this is a very interesting thread.

We did this because Peter Issitt (and others) told us to. He regretted it in the next Applied Blood Group Serology. In hindsight, it was undoubtedly a conspiracy masterminded by the manufacturers of anti-Lea, anti-P1, anti-M etc.

I recommend NOT separating plasma from red cells. All that does is create an opportunity to mislabel the aliquot. I can tell you from having performed about 100 AABB and CAP inspections that the number of blood banks separating the plasma is definitely a minority.
 
I was concerned about stability of our samples for PAT testing, so I made it a project for one of the MT students. I had her take 100 samples, run them on the ECHO on the day of collection, then rerun them on day 21. The comparison was made on ABO/Rh reactions (since I was concerned about using them for immediate spin crossmatch. This was prior to electronic crossmatch.) In 100% of the samples the ABO/Rh matched after storage. By running these on an analyzer it removed bias in the readings.
 
There was a slight drop in strength of the back type, but not enough to cause an ABO front type/back type discrepancy.
 
The specimens evaluated were all EDTA.
 
Of course, the procedure for testing must use samples that meet the specifications in the package inserts for the reagents being used. They typically will give a 7 day limit for testing refrigerated specimens without separating plasma. Be sure to check all the inserts, since the reagent cells might have a different time limit than the antisera.

This is from the British Committee for Standards in Haematology:
 
"Maternal samples for confirmatory ABO and Rh D type and FMH testing should be collected after sufficient time has elapsed
for any FMH to be dispersed in the maternal circulation. A period of 30–45min is considered adequate (Mollison et al.,
1997) and the samples should ideally be taken within 2h of delivery primarily to ensure that the sample is taken prior to
woman’s discharge from the hospital (RCOG, 2011)."
 
Ref: TRANSFUSION  MEDICINE, 2014, 24, 8 - 20

Guess what Phil.  The Laboratory Technician couldn't read the Doctor's writing in the case of Lutheran/Lutteran.  Ring any bells???????????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Other things are that "Cellano" was actually "Nocella", "Lutheran" was actually "Lutteran", the first antibody/antigen discovered in the Kell Blood Group System was anti-Kpc/Kp©, so the system should be called Levay, and the first antibody/antigen discovered in the Diego Blood Group System was anti-Wra/Wr(a), so that system should be called Wright!!!!!!!!!!!!!!!!!!!!!!!!

Yeuk!!!!!!!!!!!!!!!!

Capillary IAT.doc.
 
Voila!

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

I guess our interpretation is a conglomeration of the AABB standards and the tech manual.
 
According to the technical manual the common clinically significant antibodies that should be excluded with antibody identification testing are anti-D, -C, -E, -c, -e, -K, -Fya, -Fyb, -Jka, -Jkb, -S, and -s.
According to the standards, "patients with previously identified clinically significant antibodies, methods of testing shall be those that identify additional clinically significant antibodies" and "when clinically significant red cell antibodies are detected or the recipient has a history of such antibodies, Red Blood Cell components shall be prepared for transfusion that do not contain the corresponding antigen" (5.14.3)
 
Relying on the antibody screen and AHG compatible units may detect but would not be useful in identifying additional clinically significant antibodies and if you weren't performing methods to detect antibodies to the other common clinically significant antibodies then how could you say you were appropriately providing antigen-negative RBCs?
 
As a follow up to Dansket's comment about a patient with a positive antibody screen and a history of anti-D:
Looking at our current antibody screen antigram we could be missing an underlying anti-C, -E, -K, -Fya, -Jkb, -Lea, or -s. This could be missed at crossmatch for reasons that Malcolm already mentioned.
 
Perhaps we're also just very cautious due to our geographical location (we're in the city and there are dozens of other hospitals in the immediate area) and our antibody caseload (we seem to pick up quite a number of significant antibodies and bring several delayed serological/hemolytic reactions to the medical director for review each month).

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

You mean you actually pour boiling chocolate on people every year to celebrate Anna?  And I always thought that Switzerland was a neutral country!!!!!!!!!!!!!!!!!

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

Happy Fourth of July for all of us here in the USA. Sorry Malcolm.
 
By the way, I signed out a unit earlier containing this sequence of numbers: 1776.
 
Beth

I get the idea of using selected cells (negative for known Abs) in order to rule-out any other (new) Abs, but I never saw the logic in assuming because a screening panels results look the same that one could assume on that alone, that no more Abs have developed.
 
Scott

ANY STAT BB order here MUST be called as well as ordered.  I don't know what type of computer systems you have but there are a number of things that can go wrong with ours, including our BB system being down, the printer with the orders in BB not working, or the interface between the ordering system and BB being down. 
 
In addition to what JALOMAHE points out above, there are just too many scenarios where an electronic order may not arrive in the BB in emergent situations to rely totally on it being the only way BB knows about an order.
 
Scott

The ER doc has a patient bleeding profusely so he clicks a button in the computer and voila, blood will magically appear at the patient bedside. This might be fine for non-emergent cases but what about the patient that needs blood right now?
How is the blood bank notified of this order? Does it pop up on a screen somewhere? audio alert? print on paper? Wherever/however the notification occurs is there someone present 24/7 to take immediate action?
 
We are a 400+ bed hospital with a level 3 trauma ED. When blood orders are entered in the computer a copy of the order prints in the blood bank HOWEVER there is not always someone in the blood bank to see that printout, especially on off-shifts where techs cover multiple departments.
 
For that reason ANY time there is an emergent need for blood/components whether ED or inpatient, the blood bank must be notified by phone because:
1-we have an open concept lab and there is always someone in earshot of the phone and
2-it gives the tech an opportunity to ask for clarification of needs i.e. your ordering 4 uncrossmatched O- pRBCs? Do you want FFP to go with that? 
You'd be surprised how many times the call for uncrossmatched pRBCs ends up being more components when blood bank asks the questions and how many times we have been able to anticipate additional need for product or staff (pt is being moved to OR for leaking AAA) because we asked the right questions. 
 
The ONLY exception to the call rule is when there is a Trauma patient brought in by squad, then the blood bank is alerted by a text pager (audible throughout the lab) with information about the type of trauma and patient conditions as observed by medics i.e. male, mvc, +loc, gcs 10, multi fx bilat legs. In these cases we immediately prepare a trauma cooler with 2 O- pRBCs for pickup by the ED runner. Any additional blood/components require again require a phone call.
 
So in the long run, what may seem like an easy fix to the ED director may not be the best fix for patient care. If the ED director/staff has no idea of your lab layout and your processes then it might be a good time to invite them down for a visit and for everyone to go over how the process works from the time the patient arrives to the time the blood they requested gets to the patient. This is what we did when we started Trauma services and it can be eye opening for everyone.

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

Thank you for saying what I meant in a better way than I could have accomplished.

4.  Or possibly another antibody that reacts with the expected screening cells, but is a different specificity, that is not detected in the IAT cross-match because, unlike the screening cells, which are in a preservative that is designed to "keep antigenicity", but not "oxygen carrying capacity", the unit's red cells are kept in a preservative that is designed to "keep oxygen carrying capacity", but not "antigenicity", and, in any case, may only have heterozygous expression of an antigen, whilst the screening cells have homozygous expression of an antigen.  Why take the risk with a patient's life, and your own future in the profession?

Oh, my gosh.......After a moment of thought, yes, I do remember those little steel beads.  I had completely forgotten that's how we used to start the blood collection flowing.
 
We had a day back then when we thought we were going to need to call a plumber, too.  There was this awful smell coming from the cabinet under the sink.  Didn't need a plumber after all........We used to pack our donor whole blood units into Packed Cells, then throw the bag of plasma into a box under the sink (and later sell the plasma to a fractionating company.)  Turns out that one of the plasma bags (several weeks old) had a leak and we had quite a disgusting population of maggots.  (None of us felt like eating lunch that day.)
 
Donna

In that case Kelly, there is even less to worry about.
 
If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.
 
Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.
 
Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

As a Reference Laboratory, we would do it every time....................but that's just us!!!!!!!!!!!!!!!!