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All, I am about to blow your mind....
Our plasma freezer is down and so is our backup. The freezer will not get colder than -18 C. I was preparing to move all the products into boxes with dry ice until I had a conversation with my 87 year old dad, a retired blood banker from University of Chicago. He said to me, do not take the plasma out of the freezer and put it in boxes, PUT THE DRY ICE IN THE FREEZER, IT IS THE BEST STORAGE BOX YOU HAVE!!!!
MIND=BLOWN!!!!
I did that. Our freezer is currently reading -25.1C and getting colder. Furthermore, the probes in the freezer continually monitor the temp in the freezer so you don't have to record temps every 4 hours, the chart is doing that for you!!!
Isn't that cool? That perfectly illustrates the difference between wisdom and knowledge there. I wish we could hire my dad.
I just had to share this here.
PS. Freezer is now at -26.4C.
 

You did everything necessary as others have said. At our facility, physicians seem to be unphased by the use of emergency released blood - we issue a lot of it.  It is not uncommon to discover that the patient has a historical antibody that may or may not be demonstrating. The physician and pathologist are notified when the history is discovered and the physician makes the medical decision to continue or stop the transfusion at that point. We perform antigen testing of the unit(s) and perform AHG compatibility testing of all units that are issued.  Further laboratory testing is ordered by the physicians caring for the patient. The most immediate concern is an acute hemolytic reaction and that is rare. Shortened survival of incompatible transfused red cells is expected.

You did everything necessary as others have said. At our facility, physicians seem to be unphased by the use of emergency released blood - we issue a lot of it.  It is not uncommon to discover that the patient has a historical antibody that may or may not be demonstrating. The physician and pathologist are notified when the history is discovered and the physician makes the medical decision to continue or stop the transfusion at that point. We perform antigen testing of the unit(s) and perform AHG compatibility testing of all units that are issued.  Further laboratory testing is ordered by the physicians caring for the patient. The most immediate concern is an acute hemolytic reaction and that is rare. Shortened survival of incompatible transfused red cells is expected.

Agree! Save the life first.
Our medical director would likely order at least one DAT the next day, possibly for additional days, to monitor. Anti-E is generally relative benign (though I have seen one patient who had an acute hemolytic reaction), We might also monitor plasma Hgb or haptoglobin, depending on the antibody involved.

I agree with Neil above. I would challenge that deficiency and not change my process. 

Aliquots will warm even quicker than that due to their smaller mass.

The answers are given at the end of each case study.

It's never safe to assume that everyone, or for that matter, anyone knows what you are talking about when providing one short sentence.  Especially us old, retired guys.  Both Malcolm and I thought you were looking for some philosophical discussion.  Hope you find the key you are looking for.

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

The first, and most important, thing to remember is that ABO antigens are "carbohydrate-based" and are not, therefore, direct gene products (not that any antigens are, as every one of them undergo post-translational changes).  The direct gene products are, of course, the A,  B and H transferase enzymes.  At birth, it is incredibly rare for the enzymes to be "working" at its optimum/maximum, so that it is rare for the ABO antigens to be expressed maximally (or anything like) at birth.  I am certain that you know all this already, so that I am probably "teaching my Grandmother to suck eggs", as the old (and in this case, almost certainly, insulting) adage goes.

As a result of the above, however, unless you can perform A, B and H typing by molecular techniques (NOT to be recommended - see Geoff Daniels book, Human Blood Groups), you either have to decide to ignore all serological cord ABO types, and call all of them O, or, you have to use serological methods that will enhance the antibody/antigen reactions.  Herein, there are inherent problems.

Firstly, whatever enhancement you use, you MUST use a suitable negative control.  It is fine (in my opinion) to vary the incubation temperature from RT to 4oC, but, to so do, it is very necessary to use another cord blood from a known group O cord sample (i.e. where both parents are KNOWN to be group O themselves, and so an A or B subtype in terms of the control is not a problem).

Similarly, the same can be said for enzyme-treating the baby's red cells, as long as the control cells are also treated in EXACTLY the same way with the proteolytic enzymes.

Finally (at least for now!!!!!!!), it should be remembered that we routinely use monoclonal ABO antibodies these days.  These are extremely avid, which is fantastic, but are also VERY specific, which can be a drawback.  By this I mean that the old polyclonal human-derived ABO antibodies we used to use (when I was middle-aged, and Karl Landsteiner was a young boy) had the single (and probably only) advantage that they were not quite so specific, and would, therefore, detect ALL (or most) ABO antigens, including those that the monoclonal antibodies would not necessarily detect.  For an explanation of this, there was a recent paper in Vox Sanguinis (Cripps K, Mullanfiroze K, Hill A, Moss R, Kricke S.  Prevalence of adsorbed A antigen onto donor-derived group O red cells in children following stem cell transplantation: A single-centre evaluation.  Vox Sang 2023; 118: 153-159.  DOI: 10.1111/vox.13386) talking about the A antigen being adsorbed onto the surface of group O red cells in vivo.  One of the references they use is the first peer reviewed paper that I ever wrote, concerning A and/or B substance being adsorbed onto the surface of donor-derived red cells in vivo.  What I failed to say in this paper was that this phenomenon was far easier to detect with polyclonal ABO reagents than monoclonal ABO reagents (36 years, and I still regret this omission!).

Anyway, IF I HAVEN'T SENT YOU TO SLEEP YET, my point is that, as long as you use suitable controls, particularly NEGATIVE controls, there is no reason why you should not use any modification to any technique (GIVEN THAT IT IS IN YOUR SOP, with all the qualifications given above), and, even then, if you feel it safer, GIVE GROUP O BLOOD.

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

Also, fetal bleed screen testing on a spun sample.  Those giant fetal cells will be on top.  Mix well before testing!

Because there are work arounds to the Rover collection process, we still require a second sample or historical lab-reported result before RBC products can be issued (or issue Group O).  Our hospital uses the Rover but some floors are designated nurse-collect and with this comes the non-Rover process where the electronic ID verification can be circumvented (circumvention is not nursing specific by any means).

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

There is an Epic report for scan overrides.  We had to tweak it so it covered patients who were already discharged but our phlebotomy  leaders used it to increase compliance and they made great progress to the point where we dropped our separate BB banding system last year.  It does require that your organization have a strong policy for using the electronic ID and doesn't tolerate extra ID bands lying on the desk etc. Our phlebotomists are now reporting instances of ID bands being misused and one recently got a hospital award for her efforts.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.

We have an active pre-hospital emergency service with both ground and air transport that carry blood products. If the patient doesn't come to a facility within our system, we don't have a specimen or even a system-generated ID, so the blood is issued in our LIS with a comment describing what happened in case of collection facility lookback.
An alternate scenario is where the patient expires prior to specimen collection - if you don't have the specimen, you can't test it and we document that the units were issued emergency release and cancel the system generated crossmatch with a comment that no specimen was received.

I wouldn't think they would use contrast during CABG - my guess is that it was given prior to Cath Lab but charting caught up later after patient went to the OR. I've never seen a specimen like that - very interesting.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.

Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.