BrianD

the hemolysis at the top of the well makes me wonder if your pipet tips have been coated with a pre-wetting agent....these often have a detergent activity and can lyse red cells....but you'd be seing this in all testing, i'd suspect.

since the reagents and materials are already "in use" and that money is spent then i would finish the I.D. but it's not billable. we apply something of a "finish-what-you-started" rule....i have seen a couple of dead patients start breathing again.

this is very good advice. especially, try to get the physicians' C/T ratios included in their "scorecard" or however they are evaluated from the administration's point of view. we have been able to help several physician's improve and saved by the reduction is unnecessary testing and tech time.

we were able to move all BUT the RhIg-IM to pharmacy....we're still trying, tho'.

Tom, I agree your decision was practical and timely. Given the situation, there are 3 questions that come to my mind: Who is paying for the IRL testing? I hope not the patient because this testing seems to have been done in hopes of an EX-supervisor "scoring" points against a newcomer. Has it been established that the patient is Kell negative? Have you talked with your director to ascertain why he or she felt your decision couldn't be supported? Your director has established a potentially bad precedent for your transfusion service. best of luck.

Cymothoa exigua is the one i'm glad doesn't affect humans. i've dreamed about this one..... http://en.wikipedia.org/wiki/Cymothoa_exigua

no sheath and tiny for a microfilariae. maybe, Mansonella? i'm a hundred miles out on a limb 'cause i really cannot see very well.

i hadn't thought of that but it does meet the holiday theme. the folks asking didn't really have an idea of what they were getting into......

a basic, introductory example of how to calculate CPRT can be found at this link: http://www.ehow.com/how_6613033_calculate-cost-per-reportable-test.html a more exhaustive example can be found at this link: http://www.va.gov/nac/forms/Abbott_V797P_4742_08012008.pdf i hope this is helpful. b.

i'm feeling pretty fortunate, lately. no exceptionally unusual abs. i did get asked to help prepare anti-bat serum. yes, bat---the flying, echo-locating kind. step one: get a bat.....

her retic# isn't elevated so if she's leaking it's a slow leak and her chemistries suggest iron deficiency and protein malnutrition, could these lead to a depression of LW ag expression?

hope this helps. b. J Med Virol. 2008 Mar;80(3):484-93. [h=1]Evaluation of a new, fully automated immunoassay for detection of HTLV-I and HTLV-II antibodies.[/h]Qiu X, Hodges S, Lukaszewska T, Hino S, Arai H, Yamaguchi J, Swanson P, Schochetman G, Devare SG. [h=3]Source[/h]Abbott Diagnostics, AIDS Research and Retrovirus Discovery, Abbott Park, Illinois 60064-6015, USA. xiaoxing.qiu@abbott.com [h=3]Abstract[/h]Screening blood donations for human T-lymphotropic virus types I and II (HTLV-I/II) continues to be important in protecting the safety of blood products and controlling the global spread of these retroviruses. We have developed a fully automated, third generation chemiluminescent immunoassay, ARCHITECT rHTLV-I/II, for detection of antibodies to HTLV-I/II. The assay utilizes recombinant proteins and synthetic peptides and is configured in a double antigen sandwich assay format. Specificity of the assay was 99.98% (9,254/9,256, 95% CI = 99.92-100%) with the negative specimens from the general population including blood donors, hospital patients and pregnant women from the US, Japan and Nicaragua. The assay demonstrated 100% sensitivity by detecting 498 specimens from individuals infected with HTLV-I (n = 385) and HTLV-II (n = 113). ARCHITECT rHTLV-I/II results were in complete agreement with the Murex HTLV-I/II reference assay and 99.7% agreement with the Genelabs HTLV Blot 2.4 confirmatory assay. Analytical sensitivity of the assay was equivalent to Murex HTLV-I/II assay based on end point dilutions. Furthermore, using a panel of 397 specimens from Japan, the ARCHITECT rHTLV-I/II assay exhibited distinct discrimination between the antibody negative (Delta Value = -7.6) and positive (Delta Value = 7.6) populations. Based on the excellent specificity and sensitivity, the new ARCHITECT rHTLV-I/II assay should be an effective test for the diagnosis of HTLV-I/II infection and also for blood donor screening

of "appropriately selected" [i.e., O positive Kell negative] donors for the IAT-XM, roughly 40% of the donors are incompatible

i was thinking perhaps something along this line, Malcolm. isn't anti-LW(a) the same as anti-Bigelow....that's what i remember from a similar case at an IRL years ago. not convinced it's an auto ab since her DAT by both CAT and SPRCA methods are negative but it just might be some cold agglutinin stickiness but i'm not convinced of THAT because our IAT-XM reagents are anti-IgG. The patient has received 2 of the XM compatible units and has "pinked up" nicely. she'll most likely go home in the a.m.

hi Mabel. the usual suspects are ruled-out. the patient's ab (other than Kell) seems better demonstrated by tube-testing using PEG or by CAT. by the SPRCA/LISS, the reactions are not quite so definite. i'd prefer to complete the work up in-house but we are "managed" now and pre-approval for absorptions, elutions, enzyme panels, etc. is required. this reaction pattern reminds me of something i saw when i worked at an IRL years ago but i cannot recall the identification.....i've found as i've gotten older that i remember less and less. since the patient has been able to "take-down" 2 of 5 appropriately selected donors, i feel it would be a good idea to know what we're dealing with.....these were definitel 3+/4+ incompatible reactions. i admit that it's a bit irrational, but i feel like the job's not half-done. b.

i've spent the evening working on a patient demonstrating an anti-Kell antibody. she is O positive, with a negative autocontrol and negative DAT. she also has a cold auto-agglutinin but it isn't very strong. 2 of 5 Kell negative O positive units were IAT-XM incompatible. expanded Ab I.D. panels (D pos and D neg) were tested and we still haven't resolved what this other ab is. in the D negative panel, the reactions of the Kell negative "positives" are much weaker than those demonstrated by the D positive Kell negative cells. (+/- "equivocal" vs. 3+). the transfusion service manager has not approved further work up since we've 3 IAT-XM compatible Kell negative units available and the patient isn't likely to need transfusing. any thoughts of what this other ab could be would be greatly appreciated...i need the ammo in my campaign to gently encourage reconsideration of having this worked up, further. b.

we've switched to several of their Ag-typing sera and we've been quite pleased with them. their version of check cells, not so much. we had significant savings switching to their anti-sera.

our understanding is that it is suggested that transfusion begin asap upon removal from the bloodbank and we will not accept blood for re-issue if the 30' window has passed. the nurses tell me that they usually can start infusion withing 10-15' of receipt of the unit since their 'care maps' require completing a check-list (IV line established and patent, no infiltration, etc. ) before the unit is acquired from the blood bank. infusion must be completed within 4 hrs. of the unit being spiked because the product expires at that time.

this discussion is very interesting and helpful. we use SPRCA for everything (ABO/Rh, AbScr., AbID, Ag typing, DAT,Weak D, and IAT-XM). occassionally, we find 'false positive' AbScr's due to something reacting to the plate....nothing comes up in tube testing or at our IRL so we've just purchased a ProVue and have started our sensitivity comparisons between the SPRCA method and the CAT method....our intention is to use the CAT to "confirm or deny" these plate-dependant "maybe-abs" because in our experience, the solid phase is so much more sensitive than the tube testing (what is +/- in PEG/tube comes up 3+ in the solid phase system) that we feel very uncomfortable in using tube testing to identify a 'false pos' from the solid phase system. nb: a downside to these methods so much more sensitive than tube screening is a good portion of what we are identifying are very weak WAABs, HTLAs, or things that do not truly present a transfusion challenge.

with the DAT never showing a positive reaction and the pre- and post- ab screens being negative (especially the post) i'd lean more towards a nonimmunologic cause.......such as a mechanical problem. some bloodwarmers can produce quite a tremendous forward shear if the delivery line is using a needle with bore less than 19 guage. bacterial contamination could cause a problem like this but the patient would likely show signs of shock very quickly (low bp, high heart rate).

hello everyone. my hospital group(6 hospitals, 20-something clinics) is realizing that we need to implement some kind of document control system. ideally, this system would allow us to be more uniform, more efficient, and able to track-back and identify where bad ideas came from (heh!). anyone have any experience establishing a document-control plan? any suggestions? thanks, b.

i'm trying to get a hold of the paper, interested to see what credentials the authors are holding.

i do something similar to donna's procedure but include a well-washed O negative cord blood sample. b.

i cannot help but think of Issit's attempt to classify the e antigens of folks who were e+ and demonstrated anti-e in their sera: the 16 cases grouped into 12 categories. Issit PD. An invited review: The Rh antigen e, its variants, and some closely related serological observations. Immunohematology 1991;7: 29-36.

if you've started seeing flocs more frequently, try another lot.....we had a problem a few years ago with this and investigation showed the problem was lot specific and the flocculating vials had PEG at a higher concentration AND molecular weight than specified