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Posts posted by applejw
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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?
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12 hours ago, yan xia said:
The patient received 1250ml o neg packed cells , after the last transfusion, the D antigen buzztest of this patient was 4+, where was the transfused cells? Have it been destroyed by the antibodies? sorry for my dizzy
buzz after the night shift.
I have noticed the initial Gel test result is D 4+ which is the same as the after 23 days test in Gel.
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)
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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!
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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?
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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.
- David Saikin and Kandahlawi
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I just answered this question.
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My ScoreFAIL
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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 ....
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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.
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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.
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One per year
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We have Softbank and use an approx. 2 x 4 label that prints directly out of Soft on a DigiTrax label printer. Includes patient info, order info, component info and compatibility results
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Standard protocols are in place but it's up to the physicians to tell us what category the patient fits into. Transfusion requirements are entered into our LIS by staff - if we know they have SCD, leukoreduced. If child with SCD and untransfused, we will do phenotype (complete) and match RBC for C, E and K.
All cellular inventory is leukoreduced but we will still enter the requirement for specific groups - heart or liver transplant or physician request
BMT and neonates < 4 months get irradiated and leukoreduced. Children less than 6 months get irradiated. BMT patients are entered into LIS by the cellular processing lab staff from information provided by BMT program.
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Does anyone have a procedure for using Hetastarch to reduce the volume of red cells in bone marrow collections intended for transplant?
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I visited the Vatican in 1998 (do get a guide to avoid the crowds) and the picture, while amazing, doesn't do it justice. The city is a piece of art - everything you look at, touch, stand on is amazing. I would love to go back and what an opportunity you have - at Christmas no less! Have a blessed trip and enjoy.
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I'm in agreement with the majority of replies. I would not feel comfortable calling this an autoantibody based on the two panels that were submitted. Without excluding anti-Fya and anti-C with certainty, I would suggest giving phenotypically matched blood until the suspect antibodies could be excluded- to be on the safe side. I also review antibody investigations and while I don't always agree with the interpretation, this study would require more work. An adsorption wouldn't be very high on my list of things to perform- mostly because of the negative cells using both LISS (gel) and PEG as enhancement. I would expect these agents to also enhance autoantibody reactivity which isn't proven to me given the presence of negative reactions.
We frequently see positive autocontrols using gel with a negative DAT.
Good luck being tactful - I sympathize since I suffer from a lack of filtering exactly what I'm thinking.
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We have a potential transplant scheduled this month using a marrow collected from a donor with Sickle Trait. Unfortunately, the donor and recipient are ABO Incompatible and the marrow will require red cell depletion. Does anyone have experience using ficoll to deplete sickle trait red cells from bone marrow? Please share as I have concerns about the nucleated cell recovery during this process and am trying to convince transplant team to pick a different donor.
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I should have been more clear - warm auto with little e specificity - she was e positive
Was it an autoanti-e or an allo? -
Just in case you needed more opinions - we recently had a mother with warm autoantibody with anti-e(hr") (IgG positive and negative with anti-C3d) We were unable to exclude anti-C on a homozygous cell but had several heterozygous cells negative in solid phase, gel and tube (she was C negative). Baby delivered via C-sectionwith a positive antibody screen showing a perfect anti-C and no other reactivity.
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We use automated testing on the Galileo as our primary with different test codes in our computer system to designate the 2 cell and 4 cell screen. When we switch to gel (our secondary testing method) we have a different test code to desginate a gel 3 cell screen. If we use tube, we have a 4th test code to designate the tube method (ABSC tube) with a 3 cell screen.
A similar method could be used for paper documentation but any time results are documented it is important to designate the enhancement plus Coombs reagent (polyspecific vs IgG).
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I'm not as concerned about whether or not I'm running a "full panel" as to whether or not I'm running enough cells to exclude antigens to the commonly encountered alloantibodies. Usually manufacturers will designate the 3-5 cells on their panel that may be used in the presence of anti-D - these cells are usually appropriately homozygous for Kidd, Duffy, MNSs, Lewis and include heterozygous C and E. I would be more concerned about the quality of the cells that are being run, rather than the idea of the "full panel". If the selected cells cover all bases, then that should be sufficient (I'm of the old school that likes to see 3 positive cells to call the antibody so still require a 3rd D+ cell to conclude that it is anti-D - passive or immune - matters not!)
We run antibody identifications on all antepartum OB patients - yes, most often it is a full panel because we do use the Galileo - but for those samples that come in and can't be run on the instrument - we will do the workup which doesn't require a "full panel" but we have to run sufficient cells to cover all the antigens with the required zygosity.
Hopefully this helps....
I've already run this one by Malcolm, by email, but wanted to see what everyone else thinks about it:We've had a go-around at work regarding the procedure for running panels on OB patients with a suspected anti-D. The way our procedure is, if we suspect a D, we are supposed to run only the 3 or 4 "@" designated cells on the panel, and if they're all negative, call it a D and you're done. This is regardless of whether or not it's a first time panel or a subsequent one on the patient.
My prior training was to perform a full panel on anyone, any antibody if it's a first time panel, then use selected cells to rule out on subsequent panels, making sure you account for homozygosity on those that can show dosage. All other area labs are doing it this way, and our procedure is being defended as correct because
A. All the other labs are automated and have no choice but to run a full panel (which I wonder about. . . ) and
B. If there's another antibody there, and it's too weak to react with heterozygous cells on those "@" cells, then it's too weak to titer, too weak to be of concern, and will be picked up later in the pregnancy if it gets stronger.
I'm not at all comfortable with this, because I feel it's setting us up to miss something, and cutting corners in the name of saving money on supplies. I've said my peace at work, and the topic and situation have been laid to rest/diffused, so I'm not going to push this one anymore. I'll do as I'm told and only sign my name to them when I have to (stats and other unavoidable sign-outs), but I wanted to toss this out there to see what everyone else's take on it is.
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My experience with reactions in patients that have received multiple products, making it difficult to determine which product or product(s) may have caused the reaction, would be to investigate all the potential products.
We've had trauma patients in the OR where they had a "suspected reaction" and all products were investigated. It's difficult but not impossible. Our investigation of plasma/platelet products is limited to clerical check and culture of the bag if patient had symptoms suggestive of bacterial contamination.
Has anyone wondered how to report a transfusion reaction if you have multiple products hanging? I've always wondered about that. -
We routinely tube all products except for cellular therapy products or tissue. We had some issues with syringes breaking or leaking under pressure, so now use a special tube that has a solid foam insert to prevent the syringe from banging around or accidentally putting pressure on the syringe plunger. We routinely tube platelet pheresis products with no problems (I have noticed that they are foamy after the process). All products are in a sealed plastic bag just in case of leakage. One tube system goes to our newer building which is 3 blocks away (tube runs under the street) All tubing was validated before use and so far inspectors have been satisfied.
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Are transplant facilities charging for storing stem cells (marrow or apheresis products - NOT cord blood) beyond the initial time period after collection? If so, what are you charging and are you sending a bill (annually, quarterly, monthly?) from the lab?
Our agreement states that the fee after 5 years is $100 but may increase without notice and the hospital financial staff says that "everyone charges a lot more than $100" so I'm trying to find out what labs are actually charging for storage and how it works for them.
If you like, also let me know how long you store products for...
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We're looking into getting another freezer as well - no money, no space - this sounds very familiar. It would be great if FACT would remove the requirement to offer alternative storage facilities since they don't seem to exist. Hopefully someone will read this thread and come up with a solution or relief to the requirement.
TM Data Logger Evaluation
in Transfusion Services
Posted
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.