BankerGirl

We have had two such patients this month so far (a very rare phenomenon for us!). The first was a surgical patient with a history of blood transfusion in Germany, and the second was a case of ITP-treated Rh Immune globulin. In the second case, the patient required a crossmatch four days after the RhIg and, surprise, the IAT and DAT were positive. The antibody ID came out as a clear anti-D, but what surprised me is that the elution showed a pan agglutinin, not anti-D. I guess this goes to prove that you can't always predict--which is why we do the testing, huh?

I just got done working up a new patient crossmatch where the patient forward typed an O neg and backtyped an A neg. I got a w+ reaction with anti-A,B, but could not get anything to come down with anti-A, even after refrigeration. I called the doctor's office to ask for a patient history and the nurse said his history was unremarkable. After further investigation she found a note that he had received some sort of transplant and prefered to have his care done at another facility. I called the other facility for their help. It turns out he had a BMT a year ago and his type went from A pos to O neg. Well, this explains everything! Apparently a bone marrow transplant is "unremarkable" now.

I agree whole-heartedly with the comments about Ortho's 0.8% suspensions. We had so many problems with weak reactions that did not ID an antibody, that I contacted our reference lab and they suggested that we use 3% cells and dilute them daily. We even went a step further and use our "other" manufacturer's screening cells and we very seldom have problems with fuzzy antibody screens. My question is for those who say they repeat these in tube (LISS or PeG) and wonder if getting a negative reaction in tube is enough, or do you perform the gel panel first and then do the tube screening. We have had 98% or our Rh negative Labor and Delivery patients show weak anti-D in gel that we do not see in tube. What are everyone's thoughts on using tube only for these patients? One of our Techs didn't think the AABB inspector would go for different methods for different patients.

Yes, we automatically crossmatch two units, unless it is an outpatient who will not be transfused on that admission. Our policy states that a type and screen will be covered by two units withing five minutes of the request, and we cannot do an immediate spin crossmatch for positive antibody screens.

We have a lung cancer patient who was typed twice in 2008 as O Negative by two different techs. When she came in two months later she typed very weakly O Positive by two different techs. We decided to transfuse her with O Negative again, since that was her history. Since that time, her anti-D reactions have gradually increased in strength to where she is reacting 4+ with the antisera. Nothing has changed during this time--reagents, manufacturers, procedures--nothing. The doctors office says she is not on any "strange" drugs that would cause this. I have heard of antigens weakening with age/treatment, but can anyone come up with an explanation for this? We finally changed her blood type and are now transfusing O Positive red cells with no negative consequences.

We use glass tubes and have noticed this with only anti-D when we perform our daily QC. All other reagents seem to be fine. If anyone gets the answer, let me know. We also spin for 20 sec.

We have a Dr. Payne, as well. He is a Urologist. I think these doctors should be required to change their names!

Thanks for the suggestions Brenda. I was trying not to get too bogged down in the details, but it turns out that the patient had multiple transfusions at several hospitals across our state. The Red Cross reference lab had worked her up for another institution and had her phenotype on file. They had actually identified all four antibodies previously, but the S and Jka had become non-detectable by the time she came to us. The antibodies we had identified were anti-E and anti-M, and we all know that M is supposed to be IgM and thus, not clinically significant, but in the end, she had developed an anti-M that appeared to be IgG specific. ARC had two units on their shelves that we transfused when we got them, but they had to call all around the country trying to find antigen negative units for her so we were not able to keep up with the Dr's demands. The final antibody was an anti-K that we think probably came from a unit we gave early in this catastrophe.

We refered this case to our Risk Manager and that is the last I heard about it. We haven't heard much from him lately, but I don't want to get my hopes up.

My favorite diagnosis: Tests ordered were KOH, Wet Prep, Culture and the diagnosis was "Dog Bite". After we stopped laughing I said to a coworker that I wanted to see that dog! Turns out it was ordered on the wrong patient and all the specimens were labelled incorrectly, but we didn't know anything about this part for two days. The ward clerk in the ED just crossed out the patient demographics on the results print outs and placed them on the "correct" patient's chart. Who cares that the computer has the results and charges under a different patient, right? My worst case Blood Bank scenario: Patient comes in with 2 known antibodies 13 days after several previous transfusions and goes to surgery with no type and screen specimen. Patient doesn't do well in surgery and Dr requests uncrossmatched blood STAT. We inform him that his patient has multiple antibodies and we don't know if the blood is compatible or not. He says patient is bleeding and needs blood and he will sign the consent for uncrossmatched blood. While she is getting the uncrossmatched blood, we work the patient up and find a total of 4 antibodies in the current specimen. The Dr insists that she is still bleeding the next day and needs uncrossmatched blood until we find compatible blood, and if we were competent in the lab it wouldn't be taking so long to get her blood (REALLY!) Long story shorter: patient ended up with a total of 5 antibodies, received 8 units of uncrossedmatched blood that wer each incompatible for atleast one antibody, developed a total bilirubin of 62 (yes, SIXTY-TWO) before she died 19 days later. Her doctor still thinks WE are incompetent. Even scarier, a similar scenario occurred with the same Dr. two months later with another patient. Obviously, he did nothing wrong!

Can this be done from Meditech without the Digi-Trax printer? Our LIS person says they can, but I am having trouble seeing how to print these for expiration date and time.

Hello, I manage a medium sized transfusion only hospital blood bank that aliquots and pools, but does not collect units. I have purchased unit numbers and other labels for ISBT implementation, but wonder what others are doing about outdates when they process units. It would be impossible to purchase expiration date AND time stickers for the limited processing we perform. Thanks

So far, we are in the minority on this one, but we have a keep ahead order that nursing puts in the computer. Then Blood Bank orders as needed, and so far, none of our inspecting agencies have had a problem with it.

We purchased a Sorvall CW2+ 2 years ago and had all the above mentioned problems PLUS the saline detector did not alarm consistently when the saline was out. We called sorvall and after hassling them for 10 months, they finally replaced it with a new one. We had all the same problems, and none of our techs would use it. It is now in the storeroom and we resurected an old Sorvall from 2002 to replace it. We have a Helmer cellwasher in the budget for this coming year.

We have been live with Meditech BBK module for 2.5 years now and have never heard of TAR. Our nurses use the PCS module to document their transfusions and it seems to capture the same data as what I am understanding TAR does. We have no problem with vitals flowing into BBK. Have you looked into PCS instead?

We do centrifuge and pipette the supernatant off prior to testing. I guess I will try centrifuging a few more times to see if that helps. I also am going back to using Immucor cells, as I have heard it may be due to that also. We are seeing many of the weak, non-specific reactions in our antibody screens and panels and we need to retest with Immucor cells anyway, so I am hoping that will help in that aspect as well.

YES! we get a few weak non-specific reactions a week. I love the Anti-fuju!!

I don't believe so, since it is not evident on the positive cells, and we do centrifuge the eluate quite well.

Does anyone have problems with gel giving mixed field reactions on their eluates? We have just begun using gel and are trying to correlate the eluate testing. We have run into a few samples that test fine in tube but show mixed field reactions in gel. The truly positive cells seem show clear positive reactions in the gel, it is the ones that should be negative that are a problem (i.e., solid line on top of the gel and a cell button on the bottom). Thanks!