Byfaith

That thought crossed my mind also - 86yr old woman - who knows?! Regarding the clones in Anti-D reagent, the results in 2009 were 3-4+, but I guess strength doesn't matter if a clone is either going to react or not react with this particular patient. Interesting case, whatever it is!

Hope some expert can shed some light on this. Patient history O Pos, done on 3 seperate samples in 2009. Patient received 1 unit rbcs in 2009. Today, patient is O Negative, done on 3 seperate samples, one of which was a witnessed draw by myself. Patient denies Bone marrow or stem cell transplant - diagnosis is CML. My best guess, based on Google, is a rare phenomenon seen in CML patients due to a mutation? Of course, she was given O Neg rbcs.

Has anyone else seen a case of WAIHA that was apparently caused by Nuedexta? Given in this case for PsuedoBulbar affect in a patient with ALS. Seems to be a particulary difficult case for us to work on - most patients we've seen with WAIHA can be effectively worked up using LISS. We don't do Autoabsorptions so sending to the reference lab for his frequent transfusions. Just wondering, as this is a new one for us.

So after an unforunate (and reportable) event where an ECC patient got transfused with RBCs instead of intended FFP, we made changes in Cerner. There is a crossmatch orderable and a seperate Transfuse orderable - the Transfuse order generates a page on the Blood Bank printer, which must be on hand prior to issue. Exceptions for emergency, MTP, and OR cooler issue. Babysitting at its best!

Thank you to all for an elightening discussion! Good food for thought regarding letting the analyser decide - we may consider that concept.

There is older literature referring to the concept of hemolysis as a positive reaction interpretation. I believe this is relavant only to tube testing. There is also the fact that using EDTA samples complement does not come into play and therefore no hemolysis of test cells? I believe our cutoff is random, going along with our chemistry laboratory cutoff.

We have always used a cutoff of 50mg/dl hemoglobin concentration (Visual color chart). We use EDTA tubes and Provue analyser. Are we overdoing it? Sounds like many places take everything but gross hemolysis, and even those on an urgent case.

We are looking to bring DTT treatment in house as well. Still working out the details and hoping to have the same question answered - does anyone test the treated cells in MTS-Gel? It seemed to work well for me when I experimented with it.

Thanks for your response! So another somewhat gray area - sounds like we will continue our practice of having our IRL work them up.

Another question on eluates - we often get apparent "panagglutinins" when testing eluates. Our policy has been to send these samples to our Reference Lab because we cannot perform rule outs. Is this appropriate or over the top? I kind of like the terminology "newbie" used "All cells reacting, no specificity".

I'm not sure how a serologic crossmatch will help? We do require a serologic crossmatch if we have given more than 4 type O rbcs to a non-O patient before switching back to their type.

I doubt our computer could do this either (Cerner). I am puzzled by the requirement even when the discrepancy is resolved - it would seem to me it no longer "exists" once a valid typing is performed, or it is confirmed that an Rh Pos patient got Rh Neg blood. Any other thoughts on this?

1. We perform an elution on patients transfused within the last month, who develop a positive IgG DAT or have an IgG DAT which has increased in strength. 2. Gamma Elu-kit 3. Gel 4. Last wash gets a screen, Eluate gets a panel That said, have any of you Elu-Kit/Gel users had issues with broad reactivity, usually fairly crappy looking reactions? We have had a few later proven to be false positives when sent to our reference lab for followup. Any suggestions? Should we drop the wash with the Wash Solution? Drop back to tube testing?

We do exactly the same with no problems to date. We also will issue Type specific plasma without the 2nd draw "Re-type" required for RBCs. The issue of the wrong patient being registered is a bit disturbing though!

We do the same as Banker Girl - Electronic XM if current screen is negative; IS if current screen is positive due to passive Anti-D (not clinically significant in our system)