R1R2

I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year.  It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK.  Sorry if this sounds egocentric, but I am very excited.

Which one will you report in the EMR?  A good response to your interviewer would be that you would consult the policy.  

I have seen dosage a couple of times and a >K reacting at room temp only.   I agree with Malcolm and his reasoning why K+k- cell is not required to rule out >K. 

The patients should be genuflecting to the FDA inspectors.  I know I would were I a patient who required a transfusion!

Same here!

lucky you if you know who the father of the baby is!!!!!  Minefield!!

Our SOP requires that newborns, who test negative with anti-D by immediate-spin test, must be tested for Weak D using anti-D antiserum formulated for Weak D testing.  If the Weak D Control is agglutinated, we report Rh type of the newborn as "Indeterminate" and "RhIG indicated" for the mother if the mother is Rh negative.

Sounds like a leaky segment.   Do you get the bag back so you could investigate?   I would document  this incident as a safety event.  
 

Sounds like a leaky segment.   Do you get the bag back so you could investigate?   I would document  this incident as a safety event.  
 

Sounds like a leaky segment.   Do you get the bag back so you could investigate?   I would document  this incident as a safety event.  
 

Anytime you add humans to the process you will have manual result entry errors and WBITs.   My suggestion is to document the errors and discuss with you one up and quality person.  You are doing a lot of TASs to warrant an interface IMO.  

I am OK with ruling out the presence of anti K with single dose cells. I think I have seen anti K showing dosage only 1x in all m years of BB. 

I was wondering the same about the platelets in WB.  There article addresses it briefly stating "In Pittsburgh, the decision was made to keep WB for up to 14 days in the refrigerator as it was clear from the literature that cold-stored PLT function was well maintained for at least that length of time. Continuous agitation of WB is not recommended as it does not enhance PLT quality and contributes to increased hemolysis during storage. On Day 15 the unused units of WB are returned to the CTS laboratory where the WB is concentrated into an RBC unit by removing the PLT-rich plasma, and the resulting RBC unit can be stored for an additional 6 days."
 
Not sure what is meant by "the literature", but there are a few cited articles that seem like they may shed some light on this, but I have yet to look at them..
Reddoch KM, Pidcoke HF, Montgomery RK, et al. Hemostatic
function of apheresis platelets stored at 48C and 228C. Shock
2014;41 Suppl 1:54-61.
Nair PM, Pidcoke HF, Cap AP, et al. Effect of cold storage on
shear-induced platelet aggregation and clot strength.
J Trauma Acute Care Surg 2014;77:S88-93.
Becker GA, Tuccelli M, Kunicki T, et al. Studies of platelet concentrates
stored at 22 C and 4 C. Transfusion 1973;13:61-8.
Yazer MH, Glackin EM, Triulzi DJ, et al. The effect of stationary
versus rocked storage of whole blood on red blood cell
damage and platelet function. Transfusion 2016;56:596-
604.

I would get back to God (Oh, sorry, I meant the OB) and get him to give the reference.
With all the work done by Clarke, Mollison, and the more recent work Urbaniak, all three of whom were professors for good reason, and all three of whose work showed this to be a waste of time, money etc, I have grave doubts that such a citation, by a reliable author/authors, exists (but I will try to contact Stan, because, if he doesn't know, I doubt if anyone else will, just in case).

I suspect that routine use of enzyme-treated cells (in IAT) by "Non-reference Laboratory Staff" would cause more confusion than it would solve. Even the largest, most proficient hospital laboratory doesn't have high caliber serologists available on all shifts. I would suggest that tests with enzyme-treated cells be restricted to more difficult serological pictures, e.g., post-transfusion hemolysis without obvious cause (read "anti-Jka or anti-Jkb"), or for investigation of antibodies to high-incidence antigens.
I also suspect that many of the "enzyme-only" specificities have a major IgM component - notoriously difficult to detect by CAT (gel).
Just my two cents/pennies.☺

sounds neat and tidy.   No handwriting anything!
 

Our traumas are assigned MR#s before they are arrived and given a doe name, it is usually a name of a car (Mercedes, Doe). The sex  is usually  known and the dob is the same for all patients (100 yrs old). The computer system we use (Cerner Millennium) allows us the dispense the units with a exception flag telling us the unit isn't crossmatched ,do we want to override and why (we pick emergency). A transfusion tag is generated but the area which usually states compatible says uncrossmatched and across the blank area of the tag which usually has special attributes(irradiated) there is a statement saying "emergency dispensed, uncrossmatched.  

Does your laboratory staff have the necessary procedures to follow for this scenario?   I think flow charts work very well for things like this.  

One way of ruling IN anti-P1 is to incubate the panel at room temperature and below, in particular with papain-treated red cells.  This will lead to much stronger reactions if the antibody is an anti-P1.
Another is to inhibit the anti-P1 with either pigeon egg white (difficult to come by) or pigeon guano (difficult to avoid - particularly in Trafalgar Square!).

Am I the only one that thinks that performing lot to lot with  ABLA Q is not required?  

I think because Rh antisera is usually not IgG  and will agglutinate with cells in buffer cards so it is really not QCing the IgG activity in your IgG card.  

Yes.  Our OR nurses document every four hours.  If the cooler temp reaches 6 degrees C, they call and request a new cooler with fresh blocks.  We have quite a few cases that easily exceed four hours.  We also put temp indicator stickers on each unit to make sure they weren’t left out of the cooler.  We validated at RT, Trauma Bay (warm extreme), and CV surgery suite (cold extreme).  We did those for both maximum (6 units) and minimum (1 unit).  Message me if you need more specifics!

I remember seeing a blurb about QCing each methodoly in use but can't find it in CAP.  It might have been somewhere else.   But CAP does say that QC is required for only 1 vial reagent/lot in use  
 
TRM.31400 Antisera/Reagent Red Cell QC Phase II
There are records of acceptable reactivity and specificity of typing sera and reagent
cells on each day of use, including a check against known positive and negative cells or
antisera, or manufacturer's instructions for daily quality control are followed.
NOTE: Unless manufacturer's instructions state otherwise, the following apply:
■ Each cell used for antibody detection must be checked each day of use for reactivity of at
least one antigen using antisera of 1+ or greater avidity.
■ Typing reagents such as anti-D, anti-K, anti-Fy(a), etc. must be checked each day of
use.
■ Anti-IgG reactivity of antiglobulin reagents may be checked during antibody screening
and crossmatching.
■ Typing sera and reagent cells must be checked for reactivity and specificity on each day
of use, including a check against known positive and negative cells or antisera.
This checklist requirement can be satisfied by testing one vial of each reagent lot each day of
testing.

Reminds me of a donor we had once when I was a reference lab sup.  He had donated 12 times as O NEG.  The next time he donated, they picked up weak typing with Anti-A,B and with further testing, turns out he was a very weak subgroup of A!  Unbelievable.
I agree with A subgroup.  I see a lot of people want to automatically classify the subgroup....but without further testing, that is actually erroneous.  Best to just leave it at subgroup.
Brenda Hutson, MT(ASCP)SBB

The rationale for irradiation is that congenital cardiac anomalies are associated with immune deficiency syndromes.  Some of these are not easy to diagnose in the first months or even first few years of life.  Our own policy is for infants and younger children (<5 years of age) to transfuse only irradiated, ABO identical red cells and the first red cell is washed.  We only wash red cells <21 days of age because of data that washed red cells are associated with less inflammation and clinical complications if of shorter storage (<21 days), but greater inflammation and poorer clinical  outcomes if >28 days of storage.
Pediatr Crit Care Med. 2015 Mar;16(3):227-35
Despite the long standing policy of using "fresher" red cells for these patients, the safest red cells are probably about 10-21 days of storage according to our data and meta-analyses of the randomized trials.  Fresher red cells are associated with a higher incidence of post-operative infections, the major cause of morbidity and mortality in this population.  I would never transfused red cells <7-10 days old to any patient at this point in time.  We have some mechanistic data that is as yet unpublished that the mechanism is dysregulation of oxidation/reduction in freshly collected red cells.
Blood. 2016 Jan 28;127(4):400-10
Washed red cells reduce the risk of post-operative inflammation in the only published randomized trial and there is also a trend towards reduced mortality in the washed arm of the study.  This may be controversial but it's the only data we have to go on, certainly the only randomized trial.
Pediatr Crit Care Med. 2012 May;13(3):290-9.