margaretcox

We have used polystyrene for years. I was having issues with this cell washer not always decanting saline successfully during the wash. Tech support said the motor's designed to run with a full load of 12 tubes. We started doing that (using blank tubes as needed) and no problems since.

We're going to be moving to the bar-coded typenex band others have mentioned (uses a printed label), and I will be glad to leave the handwriting -error problems behind. All patients have a"regular" hospital wristband as well as the typenex.

What do others do about patients that come to light (for whatever reason) as "only" weak/partial D? Do you treat them as Rh negative or positive for transfusion or RhIg purposes? (We treat as negative). And, do you report them as negative, positive, or positive with a "weak" comment?

We don't stock enzymes/treated cells. One of the ref labs we sent to did include a ficin panel - still did not find anything. We did get some homoz Jka cells to react (so weakly) using PEG.

Hi RR: The initial patient "belonged" to bbbirder, and it sounds like they also did not detect a new allo-antibody. Being a new(er) BB'er (compared to some eminences grises reporting here), it astounded me to experience that case where the (presumed) antibody came, destroyed, and disappeared. I wondered if bbbirder's case might be similar.

Malcolm: we did the workup the day after she received. Because "everything" was negative, other thoughts (like PNH) were pursued. As I mentioned, a ref lab did find a few cells to react by solid phase. We continued to transfuse her and I kept thinking the anti-Jka might become detectable at a later point, but it did not. The episode is kept compartmentalized in a part of my brain labeled "is it time to adopt a more sensitive method than tube"

Our patient did indeed appear to have chewed up (2) units of donor cells. She did report "not feeling well". PNH testing was done but was negative. We never did find the presumptive anti-Jka by tube methods.

A reply to the original question: we had a delayed HTR (similar presentation to your patient, brown urine etc) that *turned out* to be (probably) an anti-Jka, even though we never found any smoking gun (DAT neg, AS and XM all neg by tube). Did a phenotype to get some possibilities, and a ref lab finally found a couple of homozygous Jka cells to react by solid phase. We continued to transfuse her with Jka-neg and she did fine after that. So my lesson from that was that it CAN be immune hemolysis even if you think it HAS to be some other reason.

We have an "RTS" order (redraw TS) for these people that had their TS done in advance. We repeat ABORh on the RTS specimen, but otherwise do nothing with it unless blood is needed - and then the RTS specimen is the one we use.

I don't have such a process, but also would be interested if someone does - seems AABB new std 5.1.8.2.1 is asking for this?

Wondering who performs therapeutics in your hospital: BB tech vs. phlebotomy staff? A few individuals vs. spread around among all staff? thanks -

We of course use more than 1 (say, 3) negative and 3 positive cells to rule IN an antibody. That's just statistics, to ensure a decent probability that the antibody is what you say it is. But to rule out: only 1 homozygous. You rule out plenty of antibodies with 1 homozygous cell every time you report a negative antibody screen.