[Sorvall Cell Washer Plus]

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.

[Specimen Labeling]

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.

[Discrepant D typing results]

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?

[DAT Negative Hemolytic Anemia]

Sorry. Questions; always questions!

Did you try doing a tube IAT using enzyme-treated red cells. This method is particularly good at detecting anti-Jka, much more so, actually, than most CAT.

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.

[DAT Negative Hemolytic Anemia]

Greetings Margaret,

From the info given in the initial thread it seems that a total of three units of PC's were cleared. Also, what other testing is being done for this patient and are there any other diagnostic theories??:)

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.

[DAT Negative Hemolytic Anemia]

How long atfer the transfusion were you looking for the anti-Jka (or any other specificity come to that)?

:confused::confused:

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"

[DAT Negative Hemolytic Anemia]

Hey Margaret and Malcolm,

Are the posibilities you present here capable of causing the clearence of three units of PC's within a few days with no appearent outward symptoms (only a slight fever), and no appearent serologic evidence to support an immune response ( I did not see a result of an auto control mentioned). I think that this case is very interesting. The patient had "coca-cola" urine prior to the initial ER visit and upon subsequent admission. The pre-transfusion Hgb=7.9, and after three units of PC's the hgb was only 9.2 with no appearent bleeding. With a normal, yet depleted, system the hemoglobin should have reached approx 11.9 (1gram per unit). It seems that the patient is clearing the red cells at a very rapid pace; approx. one third the total circulating volume for this patient; and this is occuring with only a slight temp noted two days later and curiously the patients hemoglobin resides there after at 7.2; the approx starting hgb. Given these facts is it not posible that we are seeing an overall upset in the isotonisty of the whole blood such that only a volume of rbc's producing a hgb of approx 7 g/dl can be supported. I think that it is very interesting that the initial hgb=7.9, post tranfusion hgb= 9.2, and after clearence the hgb is back to 7.2. It appears that this concentration of rbc's is the equilibrium piont or product there of. I guess what I am trying to ask is if an immune response can destroy approx. one third the circulating rbc's with no appearent symtoms and go undetected by conventional serologic procedures or is it equally possible that we are seeing an isotonic upset of the circulating whole blood with currently an unknown origin????? It seems that the suspition of PNH is more probable than an immune response in this case.

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.

[DAT Negative Hemolytic Anemia]

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.

[planned surgery / type + screen]

Most of our preop T&S are performed prior to surgical date. We will save samples for 7 days. About 15% of our preop T&S come in on the day of surgery. Fortunately, we have had no serological problems with these same day admits. Also, unfortunatel, some preops come in up to 2 weeks prior to surgical date . . . these patients are redrawn on day of admission for another T&S.

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.

[cooler verification procedures]

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?

[therapeutic phlebotomy]

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

[What are your rules for ruling out?]

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.