tkakin

I just answered this question.


My Score PASS  

We have been told not to use the Ortho Panels (or Reagents) with Grifols GEL Cards....you can get erroneous results.  We have also always used the Immucor Panel (and apparently that is ok for Grifols GEL), and Grifols has just come out with a 2nd panel. They asked my opinion of the cells on the panels and I honestly told them I was not excited about the panels (not enough homozygous cells; NO K homozygous cell; etc.).  I have also requested that they designate cells on one of their 2 panels that can be used as a modified panel for Passive D (as both Ortho and Immucor do).  They are working on all of these issues.  What is good about Grifols is that they are very open to suggestions and recommendations for improvement and seem to be quick to act upon them.  So speak up to your Grifols Rep!
Brenda Hutson, MT(ASCP)SBB

Just off the top of my head, I can't think of much more, except for the obstetricians to make sure that any preexisting anaemia is corrected by iron therapy, or vitamin B12 and folate or, in extremis, erythropoietin, so that, if there is any blood lose, the Hb and Hct are as high as possible prior to the haemorrhage (without, of course, making her polycythemic!).

Two other approaches that should be considered, likely employed are (1) minimizing blood draws and minimizing volume of any blood draws and (2) consideration to prophylactic use of EPO and/or intravenous iron.  Both have been shown to help maintain hemoglobin/hematocrit levels in bleeding patients.

cross trained, it is so hard for everyone.

I hope anyone who does genetic testing knows how to tell the difference between the tissue (including white cells, etc) that are derived from the graft, and those tissues (hair, etc) derived from the recipient.
I think all sides need to read, Hult AK, Dykes JH, Storry JR, Olsson ML.  A and B antigen levels acquired by group O donor-derived erythrocytes following ABO-non-identical transfusion or minor AB)-incompatible haematopoietic stem cell transplantation.  Transfusion Medicine 2017; 27: 181-191.  Doi: 10.1111/tme.12411, which explains the whole thing about missing serum reactivity.

If the titre is weak, it could be either, but if the titre is high, then it must be immune.
studies have shown that, even when repeated large doses of IM anti-D immunoglobulin are given, the titre still remains low.
That having been said, even if the titre is high, this will affect the next pregnancy, rather than the pregnancy just gone, unless the baby itself is showing signs of HDN.  If the baby is affected by HDN, then the titre result will not affect the way the baby is treated; the condition of the baby will govern this.

Why do I get the distinct feeling that someone is not giving you the full picture on this one....???

1.  We will perform an elution with a positive DAT within 3 months of a transfusion, BUT, will also perform elutions on other cases (even if the DAT is negative) if the clinical symptoms give us reasons to suspect that an elution may be of help.  Nothing in the world of blood transfusion is pure black or white.
2.  Normally, we use the acid elution technique, but will, occasionally use the Lui technique.
3.  Usually, but not exclusively, gel IAT.
4.  Full panel, as a minimum, but may include A1 and/or B cells, and others as required partner's red cells in the case of a suspected case of HDFN due to an antibody directed against a low prevalence antigen).
5.  I can't think of any - YET!!!!!!!!!!!!!!!!

The patient gets O until we get a second type.  If necessary, we can have a pathologist override and let us go to type specific on one specimen.  That would most likely be A or B neg female so we don't use up all of our O neg.  I think we maybe did that once in 3 years.  They are supposed to be drawing coags and/or iStats on our massives every half hour or so anyway so it is isn't like they aren't drawing more specimens.  It gets interesting when the redraw is after unxm O pos was given to a patient who is Rh neg because the second type will be Rh pos.  We have a policy for keeping the computer happy in these cases.

Hi Mabel,
We use the tube saline IAT method for crossmatch and it is allowed to skip the immediate-spin phase. So, as long as the anti-A1 does not react at 37C, we have no problem to result the compatibility of the crossmatch. Routinely, it is okay for us to give group O or B  blood for patient's with anti-A1 and that's what technologists prefer to do as it only requires immediate spin. However, for this particular patient, we just wanted to be more careful. 
Clarest

If you use Ortho gel for your IAT XMs they say that you must also do some other method to detect ABO incompatibility as their gel can't be relied upon to detect it.  So you can't skirt the incompatibility by doing just an IAT XM (unless you have an alternate approach to determining the ABO compatibility of the unit that is unaffected by the anti-A1). Our computer system would get all antsy about us giving A units unless they were specifically A2.  We just give O to keep the computer happy and make life easier.  Dr. Blumberg has been trying for years to get people to pay attention to the risks immune complexes.  Maybe I should read that paper.

I think I am missing something.  When we identify an anti-A1 it is typically at immediate spin in the back type.  So wouldn't that mean that my immediate spin crossmatch with A or AB would not be compatible ?

Hi Amy,
We are the transfusion service for three hospitals in our area that don't have blood banks.  They follow our blood draw and patient identification requirements, send us the specimen and we perform the type and crossmatch and transfer the blood.  We have contracts spelling out exactly what is required of them, as well as us.   It is their responsibility to arrange for transport of both specimens and RC units.  Two hospitals send the specimen with couriers and someone from their facility will pick up the blood later, while another sends the sample with a hospital employee who then waits "in the Big City" for an hour (usually they shop!) while we get everything ready.  I have never been to any of their hospitals but they are required to send the transfusion paperwork back so I can review and make sure they are following policy for transfusion.  They also have protocol for how to what is needed for a transfusion reaction and we would work it up here.  We have been doing this for many years and no inspectors have questioned the process.  They just want to see the contracts and transfusion documentation.  We are a non-profit hospital.

We went with the second blood type but only on patients we are not giving group O blood to. Between that policy removing about half of the need, allowing use of another lab specimen from Hem or Coag and a lot of historical types on record, it hasn't been too bad.  We are AABB and TJC but not CAP inspected.  We made the change for patient safety at the time.  Now I think AABB is requiring something similar to CAP.

Minimum requirement is to present the patients name and MR# in writing. This ensures there is no confusion as to who the blood is for as there could be other emergent situations occurring. In this type of situation written can be on the RN's hand, glove, post-it note etc. If patients name and MR# not brought with them in a written form they call for the info, write it down and present to tech.

Google the report (page 9) "Fatalities Reported to FDA Following Blood Collection and Transfusion Annual Summary for FY2015". Where it states "The number of non-ABO hemolytic transfusion reactions represents a count unchanged with four cases in both FY2014 and FY2015 (Table 3). These cases are comparatively less preventable as seen in FY2015, where all cases were transfusions due to emergent need, and antibody history was not always known." The less preventable part refers to a death due to ABO HTR that resulted from a mislabeled specimen. Table 3 shows 6 deaths in 2011, 5 deaths in both 2012 and 2013 due to non-ABO HTRs.
I would hope presenting an FDA report to the "powers that be" provides an evidence based reason for them to enforce or at least encourage prompt sample collection and delivery to the BB. Please note that the report is more detailed and useful than my (simplistic) paraphrasing.
 

In our hospital, as soon as a Massive Transfusion Protocol is initiated, one of our phlebotomist goes to ER to draw a sample for Blood Bank. It is written in our hospital MTP policy that this will need to happen. In OR, The OR personnel is instructed to draw a sample for blood bank.
we are still in the process of refining our policy. We created a one page laminated placard that went to each department, describing what to expect during annMTP. Obtaining a sample for blood bank is mentioned on that placard. 

Our policy uses a statement that ends with "HIV or HCV viruses, or other infectious diseases, such as the HTLV-I/II virus, bacteria,  fungus, or other viruses". Our intent was to cover emerging diseases - like Zika. We haven't got a specific reference to Zika at this time.

Warm autos are a curious bunch.  Are antibodies present truly auto or are the allo?  Are they really allo or mimicking specificities of the autoantibody(ies) present.  Once you start transfusions you should be doing allo-absorptions since transfused red cells may be present.  Do multiple adsorptions have a dillutional effect with the absorbed serum which may cause a weak significant allo antibody be missed?   Maybe the crossmatch is of little use in these situations so whatever you do is ok?  In these situations the focus is on the cause and resolution of the warm autoantibody production by the patient and the determination of the benefits/risks of transfusion.  We had seen little differences with utilizing "absorbed" sera crossmatchs vs "least incompatible" crossmatches with regards to patient outcome.     However, it is a technically challenging/interesting when we get these cases sent to us and then to try to follow up of the patients as long as we can.

In NHSBT Red Cell Reference Laboratories in the UK, we used to cross-match with neat and adsorbed plasma too, but I could never see the sense of cross-matching with the neat plasma, when we knew before we started that the cross-match would be incompatible due to the warm auto-antibody.  It seemed to me to be a complete and utter waste of expensive reagents and even more expensive time.  We no longer perform a cross-match with the neat plasma (one of my few victories!).
We would adsorb an absolute maximum of eight cycles, and if these multiple cycles did not result in success, we would telephone our own Consultant Clinician and discuss the matter.  Almost every time, this would result in them advising us to give ABO, Rh and K matched blood, following an immediate spin cross-match (and, of course, negative for any antigen against which the patient had already produced a clinically significant antibody, such as an anti-Fya), and our own Consultant Clinician would contact the patient's physician at the hospital and tell them what we were doing and why.  Following such an instance, we would discuss with our own Consultant Clinician how we would approach subsequent samples (including how many cycles of adsorption we would try before "giving up"), so that we did not waste precious time and reagents in the future.  Unless there was evidence of the need for more frequent transfusions (suggesting the formation of a possible new antibody specificity), we would often go seven days between adsorptions, however, we would certainly NOT gauge this on the strength of the DAT, as variations in the strength of the DAT are no guide whatsoever as to whether a new antibody is present or not.

We use a tagging gun.  I don't think it takes any more time to use then sticking a label on the product.
 

2 cell for gel  for cost reasons

We use a tagging gun.  I don't think it takes any more time to use then sticking a label on the product.