MAGNUM

We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.

We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.

I was joking about the specificity being between "anti-O" and "anti-Q", in that anti-P, the specificity almost always involved in a case of PCH is a "cold-reacting" IgG anti-P that "fixes" complement (and P is between "O" and "Q" in the Western alphabet).  A pretty poor attempt at a joke, I fully admit!

While I am not saying definitely that it is a case of PCH, the fact that the patient has a suspected AIHA, that the auto-antibody appears to be "cold-reacting", that it is IgG and that it also involves activated complement, strongly suggests that this may be the line to go down as an investigation.

We didn't perform a DL test routinely by any manner of means (despite being a London based Red Cell Immunohaematology Laboratory).  It was always discussed between our own Consultant (or, at night, weekends or Bank Holidays) by the on-call Consultant, but all of the staff knew how to perform the test, even if they were a lone worker.  We always used to dread being asked to perform such a test as a lone worker, as it took so long to do!

We do not retype any antigen typings that come from the reference laboratory.
 

Another bureaucratic authoritarian idiocy?  Sorry, couldn't restrain myself, but there is a cadre of "quality gurus" who are constantly thinking up irrelevant, pointless make work stuff for the rest of us.  This is how civilizations come to an end.  Why in the world would an SOP have to have the address, name, GPS co-ordinates, topographic elevation and postal code of the facility?  How does that address any patient care issue in the universe?  

We require a confirmation on anyone requiring transfusion of any product.  Our thinking is that if they are receiving plasma or platelets, they will probably require red cells also eventually. It is a no charge test so the patient only has to lose about 3 ml of blood and no money.

I whole heartedly agree with the pint!
 

I whole heartedly agree with the pint!
 

I whole heartedly agree with the pint!
 

We require a confirmation on anyone requiring transfusion of any product.  Our thinking is that if they are receiving plasma or platelets, they will probably require red cells also eventually. It is a no charge test so the patient only has to lose about 3 ml of blood and no money.

We require a confirmation on anyone requiring transfusion of any product.  Our thinking is that if they are receiving plasma or platelets, they will probably require red cells also eventually. It is a no charge test so the patient only has to lose about 3 ml of blood and no money.

DONE, SOMETIMES WHEN ARTHUR IS ACTIVE ITS ALL I CAN DO TO MANUALLY SQUEEZE THE SEGS.

DONE, SOMETIMES WHEN ARTHUR IS ACTIVE ITS ALL I CAN DO TO MANUALLY SQUEEZE THE SEGS.

DONE, SOMETIMES WHEN ARTHUR IS ACTIVE ITS ALL I CAN DO TO MANUALLY SQUEEZE THE SEGS.

I download all the patient histories to a desktop file on Monday, Wednesday, and Friday every week. I also have an encrypted flash drive that I download to and write over the previous data. There is a computer somewhere in the laboratory that is not down that can be used for checking histories.

I download all the patient histories to a desktop file on Monday, Wednesday, and Friday every week. I also have an encrypted flash drive that I download to and write over the previous data. There is a computer somewhere in the laboratory that is not down that can be used for checking histories.

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

I actually pulled the package insert for our panoscreen cells from Immucor, and on page 2 the insert actually says add plasma, then cells and mix. The the next line says add potentiator, the step to do the immediate spin is no longer present. I would never have noticed this if not for this blog. There is a note that if desired the immediate spin can be performed. I do believe that I will be having a discussion with my Director and Medical Director so that I can change the procedure because if it is not needed (which in my humble opinion it is not necessary) then we need to get rid of the steps.
scott
 
 

We give Rh positive to  males and females >45 for traumas and MTP's. The medical director still wants to be made aware of the switches though.

We give Rh positive to  males and females >45 for traumas and MTP's. The medical director still wants to be made aware of the switches though.

Interesting discussion. Yes, cardboard can carry dirt and/or insects, but to imply that the presence of such on supplies like saline cubes creates a risk to patients and staff is an extreme stretch. We don't live in a  vacuum and most of us spend time outdoors with the dirt and bugs every day (potentially bringing them inside with us). A wipe with a damp paper towel should be sufficient to clean an obviously soiled outer container.
If you talk to the manufacturer of the saline, I'm sure they would argue that the outer box is not merely a convenient shipping container, but also an integral part of the product itself, designed to support the flexible primary container and get the best performance from the product. After all, they've designed in a nice little tear-out section that creates a perfect hole for the spigot/tap.

When I first read this post yesterday I was tempted to answer but thought I would wait to see what Malcom had to say.  Glad I waited.  My thoughts were much the same but Malcolm presented it in a much more succinct and detailed manner.  As expected I have nothing to add other than my agreement .

No, there is a lot more to it than that.

Anti-A and anti-B are isoantibodies, rather than alloantibodies.  In other words, they are "naturally occurring" and do not have to be stimulated by either red cell transfusion or pregnancy.  They are usually stimulated by particles in the air (including human cells that have been shed into the air) that either express chemical compounds that mimic the A and/or B antigens or, in the case of shed human cells, actually do express these antigens (remember, the A, B and H antigens are histoantigens).
On the other hand, genuine alloantibodies (for example, let's say an anti-Jka) that are stimulated by transfusions and/or pregnancy, have, by definition, shown the individual to be a "responder".  It is by no means unusual for an individual who has produced a genuine alloantibody (such as the anti-Jka mentioned above) to produce an alloantibody of another specificity (or alloantibodies of other specificities).  Such other alloantibodies may not be easily detectable by routine serological techniques for various reasons.  Three of these are that the antibodies may not become serologically detectable at the same time (one may be detectable as early as the other, as not all antibodies "read the books"), that an antibody may be evanescent (or "disappears" from the circulation quite quickly - such as many Kidd antibodies - but these can remain clinically significant if re-stimulated), and thirdly, that the cognate antigen is not expressed on either the screening red cells or the red cells used in the antibody identification panel (for example, in the UK, to give two examples, the Jsa antigen and the Wra antigen, and both of these antibodies can be exceedingly clinically significant).

For this reason, it is very important that a serological cross-match is preformed (and found to be compatible), even if the blood provided is antigen negative for a known cognate antibody.

You may well ask, "Well, what about an anti-Wra (for example) that is present as a monospecific antibody?  Is that not clinically significant?", and the answer is "Yes"!  Indeed, there was a fatal case of an acute transfusion reaction caused by anti-Wra within the last decade in the UK, and the court decided that it was death by misadventure, because anti-Wra is known to be quite a common antibody, whereas the cognate antigen is sufficiently rare for the Law to recognise that it does not need to be expressed on screening cells (otherwise the Reference Laboratories would be overwhelmed with samples that have anti-Wra in their plasma/serum - and this is only one such specificity).  This may be one of the few times that our judiciary have used their brains (did I say that??????????!!!!!!!!!!!!!!!!!) and the decision may have been influenced by an editorial in Transfusion, written by the late, great Professor George Garratty (Garratty G.  How concerned should we be about missing antibodies to low incidence antigens?  Transfusion 2003; 43(7): 844-847.  DOI: 10.1046/j.1537-2995.2003.00492.x.).
SORRY THIS IS A BIT (VERY) LENGTHY!

One exception may be New York. They require you to take an exam regardless of whether you have already passed the registry exam,  if I am not mistaken. Needless bureaucracy and an absurd imposition on individual's rights to practice their profession.  In the face of a real shortage of medical technologists both statewide and nationally.

When using Immucor Solid Phase I have Rapid ID, Extend I (all Rh+ cells w 5-6 c neg and e neg cells), Extend II (all Rh neg cells w 1 Rh+)
3% panels:  Immucor Panocell (10 cells + 1 rare cell).
Used to use Ortho 0.8% panel A and Panel B
BioRad has 3% and 0.6% panels