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applejw

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applejw last won the day on May 11

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About applejw

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    Showing our Paso Fino horses, dogs, chickens, etc...
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    Charleston, SC
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    Medical Technologist

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  1. applejw

    NAD but positive Cross-match

    I must be misunderstanding - the initial workup showed that there was 2+ reactivity with R1R1 cells and anti-c was identified. I thought R1R1 cells would be c negative and am not understanding the designation "non specific anti-E and anti-c". This isn't a term that I am familiar with.
  2. applejw

    Volume (Plasma) Reduced Platelet

    In my experience, if the platelet product is removed from the original container, the expiration period may be affected by the new storage container's ability to maintain optimal storage conditions. Apheresis platelets are collected in bags that are gas-permeable - if product is transferred to another type of bag (not validated for platelet storage), this should be considered when assigning the expiration date/time even if you volume-depleted using a sterile connecting device. I also consider this when removing the supernatant from CPDA or AS red blood cells (as in intrauterine or exchange transfusions) - you can do everything in a functionally closed system but when you remove the "food", the red cells do not exist in the same environment and cannot be expected to maintain the same functionality. The reason that the Technical Manual is not going to specify is that everything depends on the validation of functional survival of the stored platelet and there isn't data available to make a valid claim.
  3. applejw

    What are your rules for ruling out?

    Homozygous unless demonstrating anti-D (heterozygous C, E). With anti-c or anti-e, uncomfortable with ruling out E, c on heterozygous cells. Would prefer to type the patient (if possible) and give phenotypically similar.
  4. applejw

    neonatal transfusion

    If non-Group O red cells are transfused, verify that there isn't demonstrating anti-A, anti-B or anti-A,B in the baby. Test reverse cells through Coombs phase or crossmatch the red cell unit. To avoid the need to do this testing, transfuse Group O, Rh compatible red cells. In my experience, it's best to limit donor exposure to the infant, if possible, for small volume transfusions. Most facilities I have worked in dedicate a unit to the neonate from the first transfusion request until the unit expires or is used up. CPDA or AS-, AS3 anticoagulant preferred - the fresher the unit when assigning to the baby, the longer it will last. We also only assigned 2 babies per unit and aliquoted the desired volume from the original bag with each transfusion request as close as possible to the time of transfusion. We only irradiated the aliquot ,not the original bag to avoid an increase in extracellular potassium that occurs after irradiation with storage.
  5. applejw

    TM Data Logger Evaluation

    LogTag makes several different models - some which can have battery replaced and can be recalibrated so that they can be used for an extended life. They are simple to use and provide excellent temperature tracking records - can be a little tricky to work out how to start the "trip" since the button takes a little practice to get the feel of it.
  6. applejw

    Negative Control for DAT

    I thought the purpose of the Check cell was to verify that the AHG reagent was "working" and had not been inactivated at some point during the test, giving a false negative result. If this verification isn't performed, how do you know that it isn't negative because the reagent was inactivated?
  7. The initial A/B/D reverse card result is invalid as the Rh Control was 3+ as were anti-A and anti-B. This is why the testing was repeated using tube reagents. The reaction with anti-D was 1+ with the initial sample (this was repeated multiple times)
  8. Interesting - this antibody behaved as a warm autoantibody with 3+ reactions against all cells tested using MTS-IgG cards. Eluate was 4+ when tested with the same panel of reagent cells. There was no obvious difference in reactivity between D positive and D negative cells. Does anti-LW always demonstrate reactivity that is stronger with D positive when compared with D negative red cells? I try to remember that antibodies don't read books.... and do whatever they like!
  9. Does anyone have any experience with acute onset of hemolysis associated with decreased expression of D antigen? Recently worked on a sample from 8 yr old child presenting with a 2.6 g/dL hemoglobin. Patient initially presented with weakened D expression and 23 days after discharge was typing as strongly Rh positive (verified with second sample). Is it possible that the acute hemolysis was related to the weakened D typing? Initial testing results: Ortho MTS-Gel Tube Method Anti-A 3+ 0 Anti-B = 3+ 0 Anti-D= 3+ 1+ Control = 3+ NT A1 cells = 4+ 4+ B cells = 4+ 4+ Antibody screen LISS/IgG (tube) 37C IgG Ortho Gel (IgG) SC 1 W+ 1+ 3+ SC 2 W+ 1+ 3+ SC 3 W+ 1+ 3+ Differential PEG adsorption was performed and adsorbed plasma was non-reactive when tested against screening cells (same cells used in LISS/IgG screen). DAT was 1+ using polyspecific AHG and anti-IgG. (Negative with anti-C3b,C3d). Eluate was reactive with all cells tested using Ortho MTS-Gel IgG. Patient received multiple transfusions (approx. 1250 mL) of O NEG , incompatible, leukoreduced, packed red cells over a 5-day period. The patient returned for followup approximately 16 days after the last transfusion. Testing results 23 days after initial presentation: Ortho MTS-Gel Anti-A 0 Anti-B = 0 Anti-D= 4+ Control = 0 A1 cells = 4+ B cells = 4+ Antibody screen Ortho-MTS (IgG) SC 1 0 SC 2 0 SC 3 0 Any ideas about D antigen expression? Hemolysis?
  10. V1 x C1 = V2 x C2 where V1 is volume of initial unit in mL, C1 = hematocrit (%) of initial unit, C2 = desired hematocrit (%), and V2 = final volume in mL V1 - V2 = volume of plasma to remove in mL 1.06 g/mL is approximate specific gravity of whole blood. You will need to subtract the tare weight of empty collection bag and convert weight to volume using specific gravity.
  11. I just answered this question. My Score FAIL  
  12. applejw

    Cold Agglutinin Panels

    I have lived through a hemolytic transfusion reaction due to anti-Vel with no history. Reactivity was suggestive of a possible cold agglutinin but had a negative autocontrol (warning #1). Cold screen with pre-warmed testing was performed - both reactive. ReST adsorptions were performed (x2 since 1 pass did not remove reactivity - warning #2). Unit was issued was a recommendation to use a blood warmer. Patient received 90cc and alerted nursing staff of distress symptom of "I'm going to die". Initial post-transfusion sample demonstrated cherry-red plasma (warning #3). Patient refused any additional transfusions ....
  13. applejw

    Competency on Couriers

    42 CFR 493.1235 and 493.1451 refers to " personnel requirements that must be met by laboratories performing moderate complexity testing, PPM, high complexity testing or any combination of these tests" and the 6 required elements. Nothing about people who only carry products from the lab to the patient. I think, perhaps, this was a misunderstanding of competency requirements by the assessor and I would challenge the citation.
  14. Our facility uses Softbank and we have recently begun using the Ortho Vision. Vision is not licensed to perform IS crossmatches using a buffered gel card. I know that a few years back there was controversy over whether the validated computer system could be substituted for the immediate spin crossmatch and wording for CAP and AABB standards has changed to specify criteria to use the computer system to detect an ABO incompatibility when selecting blood for patients. My question is: Has anyone eliminated the IS XM for patients who have a history of (or currently demonstrating) antibodies, perform serological XM incubating at 37, perform reading at AHG phase and allow your validated computer system to detect possible ABO incompatibility? If yes, have you been inspected by CAP and/or AABB and was there an issue with it? I had a great deal of difficulty trying to word this question - since we have just implemented the Vision, it seemed like a good time to look at whether we needed to do the ISXM for our serologically crossmatched patients. My medical director agreed but I wanted to see if anyone has gone this route and gone through an inspection before I jump into the frying pan.
  15. applejw

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