Byfaith

Glad to have found this thread today - we have a patient reacting just as described!

Resurrecting this topic - We have a provider who would like an elution on positive DAT babies when the cause is unclear ie O Neg mom who got RhIg and A Pos baby. The provider claims they would only use lights for ABO HDN, not if due to RhIg. Has anyone else run into this request and if so, do we need to do and elution or would a Cord antibody screen, including A1 and B cells AHG suffice? Thanks!

We will be going live with Safetrace in September, which can be set up to Autoverify. As I understand it only interpretations that match the Vision logic will be sent, and then the Safetrace truth tables come in to play. We would only be sending over negative screens, negative DATs and ABORhs that had a valid interpretation on the Vision. We don't have our interface yet but plan on doing extensive testing before pulling the trigger on autoverify. Hoping to implement it! applejw - any issues encountered with Autoverify?

Our BioMed department checks our RPMs and timers quarterly, as required by NYS. Should we be asking them to verify timers for every increment we use? (ie 20sec AHG, 25sec IS, 45sec Wash) Also, we found out they are just using their phones to check timer, not a validated stopwatch. Thoughts?

Is there a reason to do additional testing (ie absorptions) on an eluate showing panagglutination? We currently send a sample to our reference lab for further study, but wondering if there is any value in doing so. This of course assuming we have successfully completed antibody ID on patients plasma, then discovered the panagglutinin on elution - should we hold up transfusion for reference lab testing?

In our case it would be not totally trusting your own work and asking a second tech to double check with a new segment.

At my hospital the policy is to double check all antigen negative units, whether found by screening our inventory or ordered from our Reference lab. This was instituted many years ago after a mix up was discovered. At the time, there were no bar codes on the units to label tubes with and our computer system was limited. We would like to drop this policy, with an optional recheck depending on the techs comfort level - say they screened many units for several antigens and were multitasking as well. Wondering if anyone else does this double check as a routine? Also, do you recheck units ordered from the Reference lab - does it make a difference if they are antigen typed or historical?

We get an Irradiated/CMV Neg, O Neg weekly - only have infant transfusions once every year or two. They may not be the freshest units but they will do in an emergency, until infant is transferred to NICU hospital

We stock liquid plasma to save the thawing time in urgent situations. It has prevented waste of thawed plasma units that were not needed by the time we thawed them. We can assign the liquid plasma and place it back in inventory with its full shelf life (28 days)when not needed. Works well for us as a level 2 trauma hospital that often stabilizes and transfers patients. We do not use the liquid plasma for routine orders because it may have viable leukocytes.

Correct me if I'm wrong, isn't liquid plasma (from Whole blood, never frozen) only indicated for an emergency use? We had been using it for other cases when short dated but stopped this practice after review of Circular of Information. I believe the reason is that it contains viable leukocytes.

We save the dry ice we get with frozen blood products or tissues in a Styrofoam box with a lid in our deep freezer (-60C). Lasts a week or so depending on how often it is opened, how full it is etc.

New York State specifically requires this annually

We use EXM on Cerner Millenium. I'll try to answer your questions... For Blood groups, if you ever change the ABO-Rh interpretation it will disqualify EXM. If you are only correcting a reaction strength or something like that you can still use EXM. RBC units not entered electronically cannot be used in EXM. There is a workaround to remove the units from inventory if someone has manually entered, and subsequently enter them electronically. I hope this helps!

I tell my techs that the abbreviated panel performed when RhIG was recently given is like running an antibody screen using all RhNeg cells. It is not designed to identify an antibody, rather to detect the presence of clinically significant antibodies. In reality, every patient we get a negative antibody screen result on has not been subject to strict "rule outs", particularly if you are using a 2 cell screen.

In our BB system (Cerner) the blood status would first be considered Available, then Crossmatched, Dispensed (pick up by nursing), and presumed Transfused 30min after Dispense. We do somewhat use Dispense and Issue interchangeably in some of our SOPs. As far as when the blood is crossmatched and ready for pick-up, we would either say the blood is ready or crossmatched complete.

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".