BankerGirl

This made me laugh, because before I became a MT, I would watch shows like St. Elsewhere and the like and hear about how devastating "staff" infections could be in a hospital. Well no kidding...if the staff is infected, it would be a VERY bad thing indeed!

We used PeG for several years before switching to Gel and never had this happen. Occasionally there would be a check cell failure, but repeating it always worked, so it surely had to be the washing. I will be curious to see if anyone has an answer for you, as we do still use it for certain situations.

We have the same multidis policies and they are also on our intranet.

We use Meditech and most of our nursing units use TAR to document their transfusions, so the start/stop times, users, pre-transfusion checklists and vital signs flow to blood bank and the EMR. We still have ED and OR that use a different function to document their transfusions, and I enter the start and stop times so my review data statistics are correct. This works fairly well, but I would not do this for every transfusion...that would take all of my time!

I agree with what you are saying; however we just had a 53 year old male with a history of anti-c and anti-S (identified in October of 2009) who, as of two days ago, only has anti-S detectable in his specimen. I showed the case to our student and explained how unusual it is for the Rh antibodies to decrease in strength that way. She has been fortunate that we have had so many unusual patients in the short 2 weeks she has been here. We aren't really that big and most of our patients are "normal" or have "normal" antibodies.

That was actually my first thought, but the patient was A1 so that blew that theory. I was lucky that I still had the patient specimen and the segs from the transfused units to perform my typing on.

Yes, it was c positive. That is why I concluded that was the cause of the ABO discrepancy. It really surprised me that they would be c positive, but then I remembered that anti-c isn't supposed to react at IS.

I had a patient this weekend with a history of type A pos, negative antibody screen. We last transfused her on 05/13/10 with 2 units of A Pos RC with no adverse reactions. Ten days later, she is forward typing A but reverse typing O; all reactions are 4+ in strength. While everything is incubating/spinning I did an immediate spin XM and the unit was 1+ incompatible. Her antibody screen was 4+ positive with 2 of 3 screening cells. Panel turns out to be anti-c (4+) and anti-E (4+). The patient has been in the hospital continuously due to gangrenous transverse colon and subsequent surgery. Both units that were tx on 5/13 turned out to be c positive and one was E positive. I think the reverse typing reactions are due to the fact that the reverse cells are c positive, but I have never seen an antibody response this dramatic. Has anyone else seen anything like this? Can an antibody really form that quickly and strongly that it would agglutinate at immediate spin? I know that intestinal bacteria can modify antigens on cells, but could they be playing a part in this as well? Thanks in advance.

I opted to write our procedure to set the outdate at 5 days from the beginning. We cannot print expiration bar code labels, and I did not want to explain to nursing why the expiration date was crossed out, made shorter, then longer again if it became Thawed Plasma.

Well I did change the little boy's blood type to O positive and that is what we are transfusing him with now. Our supplier is much happier with O pos than they were with O neg, as they have been very short on O negs the last week. It just always causes us to shudder when we see a patient's blood type change, no matter what the reason. Thanks to all who responded...even you Malcolm! Happy zebra hunting!

I do not believe that they did. Had he been a newborn, the computer would have prompted them to perform a weak D, but there is no record of them performing it. Maybe I need to work on that for young babies as well as neonates. Thanks.

We have a 7 month old baby boy that was originally typed by two different techs as O Negative (he was 3 months old at the time). He came to us from another facility, and was multiply transfused with platelets and RC. We typed him using both gel and tube. He is now typing as O Positive by both methods. We have tested two different specimens and have not changed any of our reagents. He was born prematurely and is Hispanic. All specimens were drawn by lab personnel. His first Rh positive specimen was 2+ positive at 6 1/2 months and is 4+ positive today, 2 weeks later. Does anyone have any ideas? Could the multiple transfusions have masked the D enough to be undetectable on the first specimen? Thanks in advance.:(

We do not have enzyme-treated red cells, so that was not an option. Personally, I wonder if the Kidd was there the first time, but the ARC tech said she looked back at her first workup and it wasn't. We knew from the workup at the previous hospital that the patient was Jkb negative, which is what helped to cause our suspicions in the first place, but we deferred to the reference lab and gave what they sent us for compatible units (they actually did the crossmatch of record as well, since we sent them all our specimen).

We had a patient transfered to us from another facility who had extensive workup done at their regional Red Cross lab. They identified anti-Fya and anti-E, but we had several extra reactions that we could not explain. We sent her to our ARC and they reported a non-specific cold antibody as well, so one of our techs prewarmed her next specimen 8 days later. There were some other clinically significant antibodies that she could not rule out, so we sent her to ARC again. They said that we pre-warmed away an anti-Jkb (we ruled that one out based on the pre-warm). The tech that originally worked her up here was actually worried about Jkb, but couldn't ID it for sure. The patient had other complications, so we were not able to say if the Jkb-positive units were a problem for her or not, but it sure shook me up! As it turns out, the next two specimens we tested showed no reactivity with Jkb positive cells.

OK, thanks for the reply. I hadn't gotten that far, and had obviously not thought of that.

I am curious as to why. We are just beginning to try this as well, and have encountered a problem with the unit barcode not matching. Meditech seems to not have a clue why as of yet.

That is basically what we did. We have it attached to the issue screen so that the final check is performed at issue.

AMEN!!!! I still feel like since we are doing it on an ongoing basis, AND documenting that we are doing it, we shouldn't have to repeat this.

Well, I wrote the procedure the way she wants it, but I still think she is interpreting the regs wrong. I don't see anything that says the entire test menu needs to be performed on every sample. That is my main contention.

I had the same interpretation of the correlations, but I have inspectors here now that say we have to pick 20 samples twice a year and perform every gel test on each sample, then repeat it all in tube. We mainly use gel but also have tube for backup, trouble shooting, ABO/Rh retyping. I told here that we perform daily ABO/Rh testing by both methods and periodically repeat antibody screen/ID/crossmatching by tube and that is not good enough. We have to call it correlation and perform the entire test menu on the same samples.:cries:

Malcolm, This is a very old test for mycoplasma pneumonia. I don't know if it is of much clinical significance, but we still have docs that insist on ordering it. I found the following reference: "After M. pneumoniae infection, the anti-I levels may increase considerably, and occasionally, enormous increases may occur to titers of >1:30,000. " Kliegman: Nelson Textbook of Pediatrics, 18th ed.; Chapter 464 - Hemolytic Anemias Resulting from Extracellular Factors >> AUTOIMMUNE HEMOLYTIC ANEMIAS ASSOCIATED WITH “COLD†ANTIBODIES

Our serology department does the same thing, however they carry it out to 12 tubes. Our proficiency is the same, as well.

I am curioius about this case because we just had a patient who has, according to our reference lab, an anti-e like auto antibody in addition to an anti-C. The reference lab told me that they "might not always be able to send us e negative units." My question is, if the antibody reacts with e positive cells, why don't you have to give e negative units?

Well, Malcolm, I'm not sure my husband would say that I shake him gently either. I start that way, but it never seems to get the desired result, so I end up punching. That usually elicits a scowl from him. I think that I might receive more than a scowl if I punched a patient, though.