LAURAA80

Check under the quality forum on page 5, there is information and a validation protocol.

We use Immucor corQC. Item#0002400. It is a kit of red cells and antisera. We use the kit for positive control for ABORH and screen. Hope this helps. Laura

We also use 1 C for transfusion reactions.

Hi JOhn! Would you be able to send me your tube system procedures. I can't pull them up even when logged in. Thanks!!! lchumney@aultman.com

We only do ABORH and DAT on cord sample. All other testing is done on the mother's sample

testing reply

We use a saline control for this.

Hi Everyone!! I don't know much about blood warmers so I am hoping some of you out there can help me. In the past, our Blood Bank has not been involved with the blood warmers in our facility. This is all changing. Our Blood Administration policy states not to warm blood above 42 C, to avoid hemolysis. However, looking at the Operator Manual for the blood warmer, the warming device shuts off at 43.1 and will not alarm until 45 C. This seems wrong to me. Should the user be alerted with an audible alarm around 42.5 or 43 C, maybe sooner??? I'm also wondering what manufacturer of blood warmers other facilities are using. Also, are other facilities out there marking blood warmers as sticktly for blood and marked as such and separate warmers for fluid markers, also marked as such?? One last thing, according to CAP, the blood warmers need annual thermometer calibration. Would anyone be willing to share how this is done?? My idea is to have the blood warmer heat to 42 C and then aim the NIST laser temperature gun into the warmer. Does this sound acceptable? Any help would be appreciated. Thanks!!:cool:

Hi! I'm wondering whether anyone ever omits performing a panel. When a patient is originally admitted, we will run an antibody screen and identification, if required. For patient's with antibodies on a long term admission, if the patient is not transfused, do we need to run the panels every 3 days? If the patient receives blood, but it is antigen negative for the antibody identified, the panel does need repeated every 3 days, right? Since there is potential to develop new antibodies. The staff says they know of places where the panels don't need performed every 3 days. Is this even possible?? Any information would be appreciated.

Hi Everyone! I am in the process of updating our antibody identification procedure. I am interested in learning what everyone does for rhogam panels. Are there guidelines that you must have a date when the rhogam was administered and you can only do a rhogam panel 1 month since rhogam administration? I am also wondering about whether everyone routinely rules out V, Cw, Kpa, Jsa, Lua, Coa, Cob, Dia and Dib. Thanks in advance for the input!! Laura

This is perfect.....thank you so much!!!!:D

Hi Everyone!! I have completed a validation for tube testing using PeG and going to LISS. The validation looks good. However, the techs are saying that they're going to miss antibodies when we switch to LISS. The validation showed that testing with PeG was either equal reaction strength or a little stronger than with LISS (stronger by about 1+) on average. I am looking for information about specific antibodies that are known to be easier to pick up with PeG. For some reason, I'm thinking Anti-E and Jka....but I cannot find it written anywhere. Is this correct? Are there other antibodies? Does anyone know where to find this information?? Laura

I'm wondering if anyone knows if the Rh expression can vary. We have had 2 patients (pregnant) recently who had a history of being Rh negative that were then showing as weak D positive. Patient 1: Historically Rh negative 4x. Came in Jan and was weak D positive. Fetal screen also positive. KB stain was negative. This patient came in in April and delivered. Pre and post delivery samples were Rh weak D positive. Fetal screen was positive again and KB was still negative. Baby was Rh Positive. This patient had another pregnancy and the fetal screen was negative approx 2 years ago. Patient 2: Historically Rh negative. Sept 2010 to Feb 2011 patient was Rh negative. By April, patient was Rh weak D positive. Fetal screen again was positive and KB stain was negative. Baby was Rh positive. Can Rh change based on pregnancy? Wondering if these patients should have historical RH changed or remain Rh negative. If anyone has any insight about what is happening, I would really appreciate some information. Thanks so much!!!

Thanks for all the information and input!! Laura

We are in the process of getting an instrument for testing. Is there anywhere to look with information about what all needs tested? How many samples should be used for each assay being validated? For antibody identification, should the reference method match the new instrument exactly? If the reference method shows Anti-E and new instrument shows Anti-E with 2 cells unexplained reactivity (but all antibodies ruled out).....is this considered a true positive (since antibody ID is correct) or false positive (since some cells of unexplained reactivity)? Also, if nothing is found via reference method, but antibody is found with new method....is this a true positive (since more sensitive)...or false positive (since not matching reference method). Any help in this matter would be appreciated.

We perform cord blood ABO's on mothers that are Group O and all Rh- mothers. In our current procedure, we are to reflex DAT testing on all ABO incompatibilities. In practice, through the years, we began doing DAT on any ABO and Rh differences between mother and baby. If the DAT was positive, it was reported and an elution is always run. We report out as Maternal Anti-__. Our problem is enforcing the current procedure. If there is an A- mother with an A+ baby, we would relfex the DAT. Now we are looking into this and not thinking it's necessary, especially when the mother has anegative antibody screen. What if the mother has rhogam...is there a valid reason in performing the DAT? It is my understanding rhogam does not cross to baby. If there was an instance where a mother had a true antibody, we would do a DAT on baby for sure. I'm interested to hear what others are doing about Rh differences.

At 28 weeks, since the patient isn't in-house, we only do the testing that is ordered. Some doctors order type and screen, others prefer just a type. The rhogam is not discpensed from Blood Bank, but from pharmacy. Upon admission to deliver, we do another type and screen. Post delivery, we do a type and screen as well as a fetal screen.

Thank you both for the information. We are able to pick up these antibodies at the bench in PeG. The antibodies automation has missed are Anti-E, K and Jka....and there were at least two of each. In each example there was no reactivity seen at immediate spin, but was clear cut at AHG. Most of these were newly identified antibodies, which could be IgM, but I am still unsure how to differentiate given the situation. When validation a new piece of equipment, I would like to know for sure antibody is IgM so when solid phase or gel reactions are negative, I don't consider reactions as false negatives. Please let me know if you have any additional insight.

Thank you for the information. We currently do not have a procedure for a 'cold screen'...nothing in writing anyway. If we have reactivity on the screen at immediate spin, we automatically run a prewarm screen and if reactivity disappears, it is a cold antibody. What do you use as controls for your cold screen procedure? Would you be willing to share an outline of your procedure or where you found this information? This is something I think I need to get a process for and get into writing.

Are cold antibodies always seen at immediate spin? We have had some non-specific reactivity when using PeG and IgG, that always goes away with pre-warm. I don't think that these are PeG reactors, as they are not panagglutinins. But I am hesitant to call them cold antibodies for fear we are to miss something clinically significant.

We have solid phase technology and have been missing antibodies. We were re-validating our instrument due to missed antibodies. We test at the bench using PeG as our reference method. We have been picking up antibodies at the bench (with IgG only, not at immediate spin) and when testing with solid phase we do not pick up weak antibodies. Samples sent to the company for determining the discrepant results are always determined by the company to be IgM and solid phase does not pick up IgM. We don't see reactivity at immediate spin and use IgG. Is there a way to determine IgM antibodies that react only at coombs phase? Does IgG really pick up IgM antibodies frequently? Aren't IgM antibodies generally associated with complement? Any help with this would be appreciated.