tricore

Having met both Lawrie Petz and George Garratty, co-authors of their seminal work "Immune Hemolytic Anemias" (in this case, the 2nd edition, 2004, Churchill Livingstone), both of whom having signed my copy of their book, and having written a book review of this work for the British Blood Transfusion Society, I am prepared to put my head above the parapet, and dodge the shots!
The first thing I would say is "my own" (as it were), rather than from either of these two world renowned experts; it is this.  Does it matter one iota what is the specificity of the auto-antibody?  The antibody specificity will make no difference WHATSOEVER to the treatment of the patient, but makes even less sense concerning the patient if they actually require a transfusion.  If the antibody specificity turns out to be anti-H, are we going to transfuse Oh units of blood?  Not likely!  If the antibody specificity turns out to be anti-I, are we going to transfused adult i units of blood?  Not a hope!  If the antibody specificity turns out to be anti-HI, are we going to transfuse Oh, adult i blood?  Not in a million years, as nobody has yet been found who has the Oh, adult i phenotype, and so such donors do not exist.  There is a possibility that someone with atypical paroxysmal cold haemoglobinuria MAY require pp blood, but, boy oh boy, such a situation is disappearingly rare!
So, let's turn to the requirement to perform a titration.  Without a doubt, it is true that most individuals with clinically-significant cold auto-immune haemolytic anaemia (CHAD) have a high titre auto-antibody, but the word "most" does not mean "all".  Once again, I apologise for quoting one of my own publications, we published a case (Win N, Needs M, Rahman S, Gold P, Ward S.  An unusual case of an acute haemolytic transfusion reaction caused by auto-anti-I.  Immunohematology 2011; 27 (3): 101-103.) were the titre of the auto-antibody was quite low, but still caused undesirable clinical sequelae.
Let's turn then, to what is actually useful in the diagnosis and monitoring of CHAD, and, according to the two accepted experts on the subject, the ONLY worthwhile test is to see if the auto-antibody is reactive at STRICTLY 37oC (see the chapters on CHAD in the book by Petz and Garratty).  AHGGGGGGGGGG, that should have been STRICTLY 30oC and above!  Apologies to all.
I hope that helps!

If you're registered with FDA you ought to update your address with them, since your address is part of the registration record.

Yes you do! In accordance with 21 CFR 607.21, you must register and list the blood products you manufacture ( when you reconstitute, you are manufacturing a new product = whole blood ( new ISBT #) for commercial distribution every year between October 1 and December 31 and you must update your blood product listing every June and December. I hope that helps.
Simret
 

Same as Eagle Eye and we just had a patient with Anti-Vel last month. Would not have been able to retest the units sent by our blood supplier.

That is terrible - absolutely unacceptable.

We are about 4 weeks into EPIC and a new lab system - all at the same time - I NEED those lights to pop.

Love it. And, snow flakes too.
Especially needed. We are in the middle of a computer upgrade.

Love it. And, snow flakes too.
Especially needed. We are in the middle of a computer upgrade.

Over the years I came to realize that a lot of what we did was geared toward simply passing inspections and meeting requirement that, in reality, did little or nothing to aid the patients.  Smoke and mirrors to confound the masses. 
I've said this multiple time on this site and still believe it strongly; "Complicating a process never made it better!" yet every time something happened everyone's first response was to add more layers to the process in a effort to make it fool proof until some new fool came along. 
Human error will occur as long as humans are involved.  All we can hope for is minimizing the impact.  This statement used to make our corporate transfusion QA folks lose their minds.  
I've kinda taken a tangent for a moment.  Getting back on track, Cliff and Malcolm I agree with you completely.

This is correct...two different products.  The liquid plasma we use has a 26-day outdate, and was never frozen.

**REVISED** 08/21/2017 TRM.41350
Compatibility Label/Tag
Phase II
A compatibilityBefore issuance, a label or tag including the following information is securely attached to each blood or component unit before issuance, and it remains attached until completion of the transfusion.:
● NOTE: A label or tag must be securely attached to every unit before issuance and remain attached untilIdentification of the transfusion is completed. The label must include appropriaterecipient with two patient and donor identifiers
● Blood (or component) unit identifier
● Recipient and donor blood groups, andtypes
● Interpretation of crossmatch testing interpretations.tests, where applicable
● Donor unit expiration date and time (as applicable)
● Special transfusion requirements (if warranted)

Format: Abstract Send to
        J Allergy Clin Immunol. 1978 Jul;62(1):30-2. Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity.
Dolovich J, Bell B. Abstract
Patient D.H., on chronic hemodialysis, developed severe allergic reactions after exposure to articles such as plastic tubing and hemodialysis supplies which had undergone cold sterilization with ethylene oxide (EO) gas. It was shown that human serum albumin (HSA) exposed to EO (EO-HSA) in the usual sterilization procedure selectively elicited positive skin tests and in vitro histamine release. It is now demonstrated that D.H. serum reacts selectively in a radioallergosorbent test (RAST) which utilizes discs coated with HSA and exposed to EO gas. In addition, D.H. serum contained IgG antibodies reactive with EO-HSA. This antibody activity was not detected in the sera of 27 normal subjects and 25 chronic hemodialysis patients. EO-HSA and ragweed RAST inhibition tests with a number of proteins in native form and after exposure to EO demonstrated the EO hapten specificity of the IgE antibody

Format: Abstract Send to
        J Allergy Clin Immunol. 1978 Jul;62(1):30-2. Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity.
Dolovich J, Bell B. Abstract
Patient D.H., on chronic hemodialysis, developed severe allergic reactions after exposure to articles such as plastic tubing and hemodialysis supplies which had undergone cold sterilization with ethylene oxide (EO) gas. It was shown that human serum albumin (HSA) exposed to EO (EO-HSA) in the usual sterilization procedure selectively elicited positive skin tests and in vitro histamine release. It is now demonstrated that D.H. serum reacts selectively in a radioallergosorbent test (RAST) which utilizes discs coated with HSA and exposed to EO gas. In addition, D.H. serum contained IgG antibodies reactive with EO-HSA. This antibody activity was not detected in the sera of 27 normal subjects and 25 chronic hemodialysis patients. EO-HSA and ragweed RAST inhibition tests with a number of proteins in native form and after exposure to EO demonstrated the EO hapten specificity of the IgE antibody

Format: Abstract Send to
        J Allergy Clin Immunol. 1978 Jul;62(1):30-2. Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity.
Dolovich J, Bell B. Abstract
Patient D.H., on chronic hemodialysis, developed severe allergic reactions after exposure to articles such as plastic tubing and hemodialysis supplies which had undergone cold sterilization with ethylene oxide (EO) gas. It was shown that human serum albumin (HSA) exposed to EO (EO-HSA) in the usual sterilization procedure selectively elicited positive skin tests and in vitro histamine release. It is now demonstrated that D.H. serum reacts selectively in a radioallergosorbent test (RAST) which utilizes discs coated with HSA and exposed to EO gas. In addition, D.H. serum contained IgG antibodies reactive with EO-HSA. This antibody activity was not detected in the sera of 27 normal subjects and 25 chronic hemodialysis patients. EO-HSA and ragweed RAST inhibition tests with a number of proteins in native form and after exposure to EO demonstrated the EO hapten specificity of the IgE antibody

This may be reportable to the FDA as well since AHG crossmatches were not performed. 

missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation.Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques."
I haven't worked on the bench for a long time. Have I missed something? I fail to see how a serologic crossmatch technique will provide any meaningful information about compatibility if there is "missing serum reactivity".

missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation.Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques."
I haven't worked on the bench for a long time. Have I missed something? I fail to see how a serologic crossmatch technique will provide any meaningful information about compatibility if there is "missing serum reactivity".

missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation.Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques."
I haven't worked on the bench for a long time. Have I missed something? I fail to see how a serologic crossmatch technique will provide any meaningful information about compatibility if there is "missing serum reactivity".

missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation.Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques."
I haven't worked on the bench for a long time. Have I missed something? I fail to see how a serologic crossmatch technique will provide any meaningful information about compatibility if there is "missing serum reactivity".

I do so agree with you mollyredone.  Sadly, in the UK, it is usual to have to perform a serological cross-match, using group O red cells if there is any hint of a mixed-field (even if the patient has, for example, been typed as group A for a decade, and a unit of group O blood was transfused the previous day).  This pathetic attitude to the professional ethos of the laboratory personnel is insulting in the extreme, and, because the "mixed-field reactions" will be "reinforced" with each transfusion of group O red cells, if the patient requires frequent transfusions, the "discrepancy" will never be resolved, and precious group O units (in particular, group O, D Negative units) will be wasted unnecessarily.
Worse still is when the patient has an alloantibody, such as an anti-Fya, when group O, Fy(a-) blood has to be selected for the group A patient (in my example), when group A, Fy(a-) blood may be readily available, leaving fewer group O, Fy(a-) units readily available for a genuine group O patient, with anti-Fya, who may require it in an emergency.
Worse of all is when the patient has a complex mixture of common antibodies, or an antibody directed against a high=prevalence antigen, when there are only a certain number of group O units available in the country (and less donors, as numerous cryopreserved units may come from the same donor) and these units are wasted on patients who are patently not group O.
RANT OVER - FOR NOW!!!!!!!

The way I read this, is "if discrepancies exist".  Not if discrepancies existed (in the past).  So if you have a discrepancy and resolve it, it does not exist anymore.  So if you can't resolve the discrepancy currently with other techniques, a serologic crossmatch would be required, but if you followed through with your procedure to resolve the discrepancy, it is no longer a discrepancy.

My thinking would be if the electronic monitoring system would go down for some reason, do I know that my alarms will still work at the correct temperature?

We transfuse febrile patients regularly. The nurses look for an elevation in temperature (1.5 C) above the starting temp to call a febrile reaction. I don't feel that we are doing a large number of workups simply because the patient transfusion started with an elevated temp.

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!!!!!!!!!!!!!!!!

You are quite correct.
I don't actually think that it is in most guidelines, but what one should remember is that a foeto-maternal haemorrhage is just another form of transfusion for the mother, and she is capable of being sensitised by the baby's blood right up until the baby is born.  Therefore, the mother's sample should be as fresh as is possible for use as a "baby's sample".