applejw

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

We refer our positive rosette screening test to Hematology for K-B stain. Results are reported as % fetal cells.

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.

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.

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.

It is usual for the C+, D- red cells (e.g. r'r) to react with an anti-G more strongly than a C-, D+ red cell (e.g. R2R2), BUT, this is by no means "diagnostic".

As Jsbneg says above, it would be far safer to perform the proper tests, to ensure you have ascertained the correct specificity/specificities.

The attached PowerPoint may or may not help (ignore if it is not helpful).
The G Antigen and Anti G.pptx

I have an idea of what I think it might be, but I would hesitate to say without a bit more information concerning the condition and underlying pathology of the patient.

How old is the patient?  Have they recently had something like an atypical pneumonia?

I think, without knowing the answer to the above questions, that the specificity of the antibody MAY be between "anti-O" and "anti-Q".

I would suggest performing an indirect DL-test.

I may well be wrong, OF COURSE, but the attached may help.
Paroxysmal Cold Haemoglobinuria (PCH).pptx

I suggest reaching out to your director of the O.R. and to your Biomed Director. Start a conversation with them showing them the CAP standard and ask them how they are measuring the safety and efficacy of recovered products. Ask them to provide you a copy of their data to include in your records. Also, since your medical director has to actively participate in the program, they may need to officially report to them as well. Perhaps this could be covered in your transfusion committee, if you have one.

Just last month, we had a unit from our supplier labeled as O+ but retype showed that it was AB+.  I personally don't mind re-typing units so that we can do an electronic crossmatch.

How do you get hold of the extremely rare antibody specificities I mentioned (such as anti-Vel) to regroup units sent from, possibly, frozen blood banks, that they have typed as Vel Negative before the unit is sent out?

We currently use the blood admin snapshot and BPAM.  I'm curious to if we can include it in the MAR medication admin module.  That's the screen nurses use most and blood admin would fit will within it.  It's a scrolling timeline that is visually very user friendly.  I just don't know if that information is something someone in Lab (me) can see for transfusion information. My problem with the snapshot is that with it being something rarely used for most nursing units, completion audits are awful.  I've even found a unit left in "currently transfusing" status for over 48 hrs.  

That is, in large part, why we HAVE different methods.

This reply also applies to the excellent post above by Debbiel.

Do these "experts" not understand, as do most, if not all people involved in blood group serology (and even blood transfusion) that it has been known for years and years that not every antibody reacts by all techniques, however experienced the person performing the test may be.

I once had an anti-S that reacted by tube IAT, but refused to react by gel, even though I sent it out to a large number of hospitals who I knew used both techniques.

I also think that all true experts have either read, or are aware of Leger RM, Garratty G.  Weakening or loss of antibody reactivity after prewarm technique.  Transfusion 2003; 43: 1611-1614.  Sadly, it would appear that (SOME) of the Quality "Experts" are not as expert as they like to think.

I get so annoyed when CAP "experts" give different answers to different people. It seems to me they also bring in their own personal opinion on things, like some inspectors we have to deal with. She stated she "suggests" doing ID on all methods
I would have to argue they we are testing the "method." If you get a positive AB screen using automation, do you also get a comparable positive AB screen using GEL and tube? Does the antigram for the same antibody across the 3 methods appear to be the same antibody. It shouldn't look like an anti-E on automation, a anti-K in Gel and an M in tube. They are not going to match in strength because the different methods vary in sensitivity. I would include the antigrams of each method to show it appears to be the same antibody across all methods. 
A set of screening cells is just a mini AB panel. If you feel like you must do an antibody panel using each method, I would just do an extra cell or two on each method and say it is not a set of screening cells but a mini selected panel. If we find a patient with a good, strong, clear antibody it is sometimes hard to come up with lots of extra plasma to do unnecessary testing. (My opinion only)
Gr-r-r-r-r!

Well, (drumroll please) is my answer from CAP:
COM.04250 is for comparing test results.  I do suggest comparing the antibody screen and ID for the different methods used in your laboratory. 

Thank you,

Amy Meier, MBA, MT(ASCP)
Technical Manager, Laboratory Accreditation Program

So I guess I will be figuring out how to have adequate sample for comparability studies across 3 methods with tube being the problem child
 

Just last month, we had a unit from our supplier labeled as O+ but retype showed that it was AB+.  I personally don't mind re-typing units so that we can do an electronic crossmatch.

Just last month, we had a unit from our supplier labeled as O+ but retype showed that it was AB+.  I personally don't mind re-typing units so that we can do an electronic crossmatch.

We do not retype any antigen typings that come from the reference laboratory.
 

I'd also like the phlebotomist to identify me correctly and label my pre-transfusion sample correctly with MY name.

I agree with the challenge. I got the same response from CAP as above within the last year or so. The person I talked to recommended that I include a statement in my SOP for method comparison that states that ABS and AB ID do not differ in methodology/utilize the same system or platform.  I also attached a copy of my communication from CAP to my checklist documentation in case an inspector questions what we do.

I suggest you challenge that citation. CAP inspectors are not infallible as proven by the response from CAP above.

Just underwent AABB and CAP inspection - we were cited for CAP in not including antibody identification, DAT, and compatibility testing for all method platforms. We have been performing comparability testing for ABO/Rh and antibody screen for the last 13 years and multiple inspections without citation.
Anyone else had this experience? 

Yes! That is the hardest part.  LIS cooperation.  It's hard to notify techs to treat a patient differently.

I could not agree more.  I believe that, if unchecked, some of the accrediting agencies will eventually regulate themselves into irrelevance. 

If the unit if leukoreduced, as all red cell transfusions should be, there is no need for CMV negative in my view.