BankerGirl

I haven't contacted them yet. I will update when I get their response. I was curious after reading a few other posts regarding Echo antibody ids whether this could be explained by the nature of the antibody. I will post their response when I get it.

We have a patient who had an anti-Cw identified 21/2 years ago during routine prenatal testing. She recently came in to deliver baby #2 and we are still detecting the anti-Cw 4+ in gel (manual method) and 2+ in tube. We are in the process of validating the Echo and ran her antibody ID on it and the panel was negative with all cells tested, even though there were 2 Cw positive cells on the Ready ID panel. The fact that we were able to detect the Cw in both tube and gel but not on the Echo makes me nervous. We did AHG crossmatches and had one donor who was 3+ positive in gel but was compatible on the Echo. Granted, since we don't have anti-Cw antisera we can only assume the incompatibility is due to the Cw, but this is also concerning me. Is it possible that the anti-Cw is IgM in nature? I couldn't find much in the Technical Manual on this antibody. We are also pretty much out of plasma and the patient has gone home. Any ideas? Thanks in advance.

I admit, I chuckled when I read this "new" notice.

We switched from CAP to API several years ago and I have to say, I am very disappointed in the Fetal Cell product. We have had two different surveys where we had to report that we were unable to assay the Quantitative (KB) portion on one sample. The sample looked degraded and by the time the tech got around to doing it and letting me know, it was too late to order a replacement specimen. I have asked the techs assigned to these samples to complete the testing ASAP and that hasn't seemed to make a difference. The samples arrive looking old--as in dark, almost chocolate brown. The last one was fine, but I am still sceptical.

The only other exception we make on issuing multiple units at one time is for dialysis. They can transfuse a unit in 15 minutes. Otherwise, we limit to the above mentioned units.

We evaluate every anti-M, each time, for 37 degree reactivity. Not taking any unnecessary risks. Although I still have a few techs who will screen units regardless of clinical significance on the basis of "I see it, so I can't ignore it."

I have actually done this with a MTP and was invited to do so by our Trauma Coordinator. She gets the implications and always has my back. The one I went to was a GI bleed in the ED, not in surgery, but it actually went very smoothly. Of course the folks who ran it were ones who had done it together a few times before and are always very good. Unfortunately they are both no longer employed here. I haven't had an opportunity to go on one since because I am usually the tech preparing the products. So, did I make a difference?? Probably not, because they were proficient to begin with. Oh well!

At our facility, nursing bills for this when they administer the transfusion.

I have basically the same statement in my blood return policy and during my last inspection, the inspector couldn't get past the "30 minutes" and told me it wasn't acceptable. Ours states if returned within 30 mins we will take temp and evaluate, but if outside of 30 minutes, automatic quarantine. I had to explain it to him three times. Then the lightbulb went on and he said OK.

When I was looking at the new and improved Tango Optimo, the rep told me that the current Tango "has a known problem with carryover..." and they have fixed it with the new one. Funny how they didn't mention that when they were trying to sell me the current analyzer.

I believe after looking at this several times that it may depend on what product you start with. The answer to the original question, "...what the product code is for TH pooled cryo NS" was answered correctly with "E5821 Thawed POOLED CRYOPRECIPITATE|NS/XX/rt". We have a few different pooled cryoprecipitate products and we use this one if we manually pool after thawing (extremely rare these days), but if the product is pooled and then frozen by our supplier, we use the thawed code that corresponds to the one the supplier uses for the frozen product.

That's what I had too, Terri. Glad you mentioned that.

We have seen immune, IgG anti-M formation as well, most recently 2 days ago, but the issue in this post is that the antibody is undetectable in tube. Were it positive in tube as well, it would have to be considered clinically significant, but since it is only detectable in solid phase (or gel, in my case) I don't believe it can be considered significant. Reaction strengths in my case are 4+ in gel, which if truly IgG in nature, should also be detectable in tube. I don't have any experience (YET!) in solid phase, so I can't speak specifically to that aspect.

I was on vacation when her second titer came through or we wouldn't have sent it out. I have put a comment in her history file so she doesn't get sent off again unless her tube screen becomes positive. Hopefully this will put an end to this nonsense.

We recently had a pregant patient who came in for an evaluation of a positive antibody screen in gel. It was not a definitive pattern and the technologist decided to send it to our reference lab. The results came back anti-M and the IRL deemed it clinically significant since it reacted in gel with IgG cards. I disagreed because it was not detectable in tube (by us OR them) and their titer came out 0 with a score of 0 since they titer in tube. I reminded them that anit-M is notorious for reacting in gel regardless of the nature of the antibody, but they still reported it as clinically significant. We just got back the second titer and the results are the same. I can't really argue with the Dr. since the IRL states that anti-M has been known to cause HDFN, but I really hope this patient has good insurance, since the initial workup was billed at more than $6000.00 and this last one was collected just after RhIG administration, so they had an anti-D to work with as well. How can titering something in tube make sense if it isn't detectable in tube to begin with?

I added that just for you, Malcolm, I really did.

We do pretty much the same as Terri. There are only three times we crossmatch units: 1. we have a give order, 2. the pt has an antibody or history, or 3. the OR requests blood in the cooler, usually for CVOR cases. Love, Love, Love that Electronic Crossmatch, even if the name is a misnomer.

We do the same as above for scenarios A & B, but for C we treat them like A. We don't make them register everytime, but if it is within the 3 days, they must keep their armband on.

From our blood administration policy: NOTE: No blood components will be issued from the blood bank to personnel carrying any food products into the lab. All lab staff have been instructed to stop any person entering the lab with food or drink on their person. Our secretary is very vigilant and strict on this policy. Haven't seen them bring the blood to the cafeteria, but we still have nurses come to pick up blood after picking up their lunch. They had no idea that was against policy. (It is at the top of the policy, in bold type and highlighted in yellow. Hmmm...)

We have a 6 RC, 6 Plasma and 1 Platelet Pheresis prescribed in our MTP policy.

When I became pregnant with my first child it was discovered that I had developed an anti-K from a previous blood transfusion. After I returned to work I discovered that the blood banker doing my type and screen forgot to crossmatch antigen negative units. Now granted, if I had needed blood, the odds were in my favor for receiving K neg units, but that didn't seem to work out too well with the first two units I received. With Baby #2 I reminded them to crossmatch the units this time.

My microbiology supervisor just told me this morning that if she ever needs blood on second or third shift, her husband has instructions to call me at home.

This all sounds VERY familiar!

We do not pool them, but rather have nursing do it when they start the transfusion. This avoids the issue all together.

We do the same as ANORRIS.