goodchild

I'm going through the proposal now for my Erytra. Pysched!

Well, think about this... the indicator cells are rosetting any cell with IgM coating it  - test uses a monoclonal IgM anti-D.  But anything else that's IgM coating the cells may give you pos test. 
You cannot tell with certainty using this test the Rh of the baby.  Certainly it's not the test of record.  If you ever had to defend your result, you'd have difficulty. 
Picture this:  you've presumed the baby is Rh neg based on the FMH screen.  No RhIG for mom.  Baby is really Rh pos (variant?), and mom goes on to develop an anti-D.  Next baby is at risk.  Mom sues.  You have no defense, as this is not standard practice. 
In the case of a pos DAT with an inconclusive Du, we do a KB and presume the baby is Rh pos.  RhIG dose based on the KB.

Exactly what I needed, another distraction at work!

Exactly what I needed, another distraction at work!

AABB 5.11.4
CAP TRM.41800
You've never encountered a delayed transfusion reaction?

Without a doubt I would send it for KB, because the operative word in the limitations is "may" - they are not always destroyed.  In addition, even if the delivery was an uncomplicated PV, that does not rule out that there may have been a major, but silent FMH that requires a larger dose of anti-D immunoglobulin than your standard dose.

We would sort out the specificity of the maternal HLA antibodies, and then give antigen negative platelets, with no cross-matching, as the babies are not going to be producing any HLA antibodies, and, if the mother does, it is not going to affect this set of twins.

I agree, Mabel.  A handoff is a handoff.  We document inspection upon release in the BB.  We validated the system, all stations, then started using it.  We do not use secure send - it slows the whole system down and led to many complaints. 
We use Epic for med record, and it auto prints in the BB when they nurse is ready to transfuse.  We put a sticker on that print out to document who in the BB is sending, date/time.  RN documents receipt with initials/date/time and sends it back.  If we don't get it within 10 minutes, we call and track it.
I've attached our downtime request slip.  This is simple - patient name/MRN and the product requested.  Same documentation of send/receipt.  Works for either a person picking up or sending through the p-tube. 
I'm a big believer in the KISS principle - Keep It Simple, Stupid! 
Blood Request slip.pdf

There is a Replace BBK Crossmatch Test routine, which can swap the IS XM mnemonic to your IAT XM test mnemonic.

That's a very good thing to keep in mind, thank you for posting that.

Recent scenario we had, I thought was relevant:
Patient with newly positive antibody screen, ordered for transfusion of two RBCs. Had been admitted for about a month; now diagnosed with numerous medical problems that were previously unknown to the patient. Patient was transfused a total of six RBCs with the last transfusion five days prior.
The bench technologist wasn't able to determine a specificity with plasma testing but the autocontrol was positive. (Recent grad, a more seasoned technologist might have suspected the specificity based on pattern of positivity.) DAT was positive with polyspecific AHG and anti-C3. Our procedure indicates to proceed with elution in this case if the patient was transfused in the last 45 days. Eluate testing clearly identified anti-Jka.

Technical Manual, 18th edition, Chapter 17, DAT/Immune Hemolysis, page 428.
Test an eluate prepared from the DAT-positive red cells with reagent red cells to determine whether the coating protein has red cell antibody specificity. When the only coating protein is complement, the eluate is likely to be nonreactive. However, an eluate from the patient's red cells coated only with complement should be tested if there is clinical evidence of antibody-mediated hemolysis, for example, after transfusion. The eluate preparation can concentrate small amounts of IgG that may not be detectable in routine testing of the patient's plasma.

Technical Manual, 18th edition, Chapter 17, DAT/Immune Hemolysis, page 428.
Test an eluate prepared from the DAT-positive red cells with reagent red cells to determine whether the coating protein has red cell antibody specificity. When the only coating protein is complement, the eluate is likely to be nonreactive. However, an eluate from the patient's red cells coated only with complement should be tested if there is clinical evidence of antibody-mediated hemolysis, for example, after transfusion. The eluate preparation can concentrate small amounts of IgG that may not be detectable in routine testing of the patient's plasma.

Recent scenario we had, I thought was relevant:
Patient with newly positive antibody screen, ordered for transfusion of two RBCs. Had been admitted for about a month; now diagnosed with numerous medical problems that were previously unknown to the patient. Patient was transfused a total of six RBCs with the last transfusion five days prior.
The bench technologist wasn't able to determine a specificity with plasma testing but the autocontrol was positive. (Recent grad, a more seasoned technologist might have suspected the specificity based on pattern of positivity.) DAT was positive with polyspecific AHG and anti-C3. Our procedure indicates to proceed with elution in this case if the patient was transfused in the last 45 days. Eluate testing clearly identified anti-Jka.

It's interesting that you posted this because the supervisor and I reviewed our Meditech Antibody and Antigen dictionaries just recently. It hadn't been done in many years and whoever set it up previously configured antigen warnings and IAT XM for every antibody, so review/revision was a long time coming!
One difference from the discussion here that we decided upon was to retain the requirement of IAT XM for antibody of undetermined specificity (INC).

We do something extremely similar to your daily executive safety huddle.
We previously had two individuals for laboratory quality/compliance, one for all lab and the other for blood bank specifically. Now we just have the one individual who covers the whole lab.

I need some guidance!  I did a quick search of the forums for any discussion about this, and the most current posting was in 2010.  I'm wondering if anyone has any new information, new experiences, or any advice about CAP TRM.40120.  The note states "...all analysts participate in QC on a regular basis."
How frequently is "regular"?  For example, when I was looking to complete our annual Competency assessment in September (don't ask...), I was looking for evidence that each individual who performs MTS testing had performed MTS QC.  There were some employees who had not performed MTS QC yet in 2016.  I'm inclined to say that someone who hasn't performed QC in at least 8+ months is not participating in QC on a regular basis.  Being new to my role, I'm just not sure how the assessors interpret this standard, and how others provide evidence of compliance. 

I can't agree more, with both of your posts.

I can't agree more, with both of your posts.

Enzyme-treated cells can be very useful in the hands of expert serologists who know the pros and cons of their use. Routine use by front-line techs is probably ill-advised.
In this case, some level of feasibility testing might be useful before switching to an enzyme-treated panel, but I would hesitate to call it "validation". Each facility should determine if such a panel is useful to them, or if it would cause more problems that it would solve.
As I mentioned in earlier in this thread - I believe these are FDA-license reagents and they do not require validation.

My personal opinion - no validation required.
You are switching from one FDA-licensed product to an equivalent. Unless you plan to use it in a fashion contrary to the manufacturer's instructions it's a business decision rather than one of quality or performance.
If you have an internal policy that directs you to "validate" in these situations, you should change that policy. Anything that an end user does to "validate" a commercial, FDA-licensed red cell panel is dwarfed by the process involved to get these products to the market. 
Perhaps more important is that the replacement product suit your facility's specific needs. The typical antigenic make-up of the panel you select should reflect your particular testing requirements. For example....if you have lots of patients with anti- D, a panel with lots of D+ cells my not be very useful.
 

Recent scenario we had, I thought was relevant:
Patient with newly positive antibody screen, ordered for transfusion of two RBCs. Had been admitted for about a month; now diagnosed with numerous medical problems that were previously unknown to the patient. Patient was transfused a total of six RBCs with the last transfusion five days prior.
The bench technologist wasn't able to determine a specificity with plasma testing but the autocontrol was positive. (Recent grad, a more seasoned technologist might have suspected the specificity based on pattern of positivity.) DAT was positive with polyspecific AHG and anti-C3. Our procedure indicates to proceed with elution in this case if the patient was transfused in the last 45 days. Eluate testing clearly identified anti-Jka.

Anytime I suspect weird interactions with reagent cells, I recommend grabbing a few units from the shelf and seeing what those results look like.

anti-D presumably due to RhIg, antibodies which fall into our bucket of "cold antibody", and Knops system/Ch/Rg/Cost antibodies. We may have another look at it before it's published to live and procedures updated.

When we were converting over to Meditech 15 yrs ago, we found an issue with emergency releases if it ordered the IS Xm and we found out later the patient had an antibody. We reported it to MT and we set up a XM profile that had the IS, gel, and tube Xm in it.  All are auto NP except the IS.  If we need to result something other than the IS, we NP it and change the NP on one of the other tests to the test result we performed.  We can't do electronic Xm with the version we have, but when we upgrade to 5.66, I would think we wouldn't have issues.