YorkshireExile

I still don`t get why only O Neg is used for all babies. What if the baby is Rh Pos (with no maternal anti-D problems). We would use Rh pos for all our Rh Pos babies, and save the O negs for the people and babies who really need it - the ones who actually are Rh neg.

Do all your babies get O neg blood irrespective of the Rh group of the baby? If so, why?

Are you talking exchange transfusions or top-ups here? Do all your top-ups receive blood that is less than 7 days old? We assign a unit for a baby as much as possible to reduce donor exposure, so we may get four or five aliquots out of one unit for a baby. The fifth aliquot may well be up to 35 days old by the time it is used as a top-up - we still don`t bother washing.

We have a 50 bed NICU unit and we give only leucoreduced group O blood. No washing, no CMV- units (we wouldn`t be able to find any anyway) and even irradiation is optional for top-up transfusions according to British Guidelines.

That document is very good Malcolm. I may have to edit it slightly (only slightly) for our linguistically challenged doctors, but I will definitely use it the next time the "D grouping" question arises in my hospital.

We only do cord bloods on group O mothers and Rh Neg mothers. If the DAT is positive we send the cord blood for a bili. We simply report DAT positive due to maternal anti - whatever. No need for elutions as 99% of the time it will be obvious what is causing the pos DAT

We also do exactly what adiescast does.

Here in my hospital we currently use blood collected in CPDA1 for our neonatal top-ups. I would like to start to use units collected in additive solution (here we use SAGM) for these top-ups. I was wondering how other hospital go about this. When you aliquot a unit, do you remove any of the SAGM first to give a high HCT, or do you just give the aliquot as it is? Should all top-ups get irradiated blood, or would it depend on other factors such as prematurity, birth weight, etc.? After a unit/aliquot is irradiated, how long would you store that blood if it is going to be used for the same baby later? As far as I know, AABB says irradiated blood can be used up to 28 days after irradiation. British guidelines recommend only being used up to 14 days after irradiation, but most literature says it should be be transfused as soon as possible. We have babies of extreme prematurity at our hospital (<1kg) and I am wary of using stored irradiated blood because of the potassium leakage that can occur - although the AABB technical manual says its okay. Am interested to hear how other hospital go about their neontal top-ups, especially ones that use additive solution.

Malcolm, just a small point - why do you say almost certainly derived from the maternal circulation. Where else would the antibody come from?

Merry Christmas all Blood Bank people and especially the ones on this forum. I just want to thank everyone for all their help this year. I should have joined this forum a long time ago!

My previous hospital we discovered nurses were taking two samples at the same time. one would be sent to the Blood bank and when the request came later for another sample then the second one was sent down with a new time on! That way they didn`t stick the patient twice. A system is only as good as its weakest link, in this case that is the people taking the sample. My hospital now does not do a second group check. As we are a maternity hospital the vast majority of our patients have a prenatal group history. To try and get the right sample drawn from the right patient we insist all T&S and crossmatch specimens have hand-written details on the specimen tube (as recommended by BCSH guidelines) that must be written by the patients bedside immediately after taking the sample. Is a 2nd sample mandatory by any accrediting body?

No harm moving the deferral to one month, just to be on the safe side. We actually defer for two weeks after medication, if any, is finished.

this poll is two years old now. Shouldn`t it be closed?

We thought about this and couldn`t find any reference that limited the number of spins. We would only do one extra spin though after re-mixing the unit.

Borocliff. You mention the 2 minute RT incubation. Why? And where did this come from? Did you use washed cells? If you the test is quite reliable BUT you are actually not following the published procedure but a modified (and improved!) version. By the way. I was in Abu Dhabi 3 weeks ago. Just passing throught the airport but they confiscated my laser pointer!

Tim, Thanks for your comments about the, erm, saline phase ABO check. I agree its not really a crossmatch, but every piece of literature and guideline calls it that, so I suppose we are stuck with it. I suppose you could say the same thing about the electronic crossmatch. All that basically is is just issuing blood by the computer. What should we call that? I was interested in the Westmead hospital study. At my last place, before we implemented ISXM, we did an in-house test of 100 patients against various donor types using cells suspended in normal saline, not washed, and with a RT incubation of 2 minutes. Our failure rate was 0%. Every ABO incompatibility was detected. In over ten years of doing ISXM we have not, to the best of my knowledge, missed an ABO incompatibility. In the Westmead study what did they suspend the cells in - normal saline, EDTA saline, or LISS?

Thanks, very interesting

Thanks for the information

Quite right too!

we have our own institution deferral list with AABB guidleines and British guidelines mixed in.

We plan to have regular open days in our lab so maybe nurses will visit and will try to understand more of what goes on in the Blood Bank. One can only hope......

Yes Malcolm, thats the paper I was referring to. The AABB technical manual also refers to using the patients sample collected in EDTA as an alternative approach to prevent the steric hindrance complication. But it doesn`t give any of the science behind it. So... if I use EDTA samples can I use normal saline for my ISXM? Is using EDTA samples and making my suspension in LISS definitely not recommended? If I really have to use EDTA saline, do I have to make it myself or can I purchase it commercially? What do others do?

We use Cerner as well. Erm......... it`s not the greatest of systems.......by a long way!

How critical is it to use EDTA saline for the immediate spin XM? I know there is one paper from 1988 that warns about prozone and steric hindrance effects, but that is all I have ever managed to find concerning ISXM problems. Could you use normal saline? If you collect the patients sample in EDTA is this a help? Could you even use LISS? It just seems a nuisance to make a cell suspension in LISS for use with our Diamed Gel grouping cards and then another suspension in saline for the ISXM.

Hi Monica and welcome