lab217

Thank you for the fast response Malcolm Needs! Is there any literature or publication that I can refer to? Can't find this specifically in AABB.

Do any Blood Banks allow phenotyping of pregnant patients? Is there a timeframe defined during a pregnancy that accepts this practice? Some Laboratories phenotype and accept only negatives or strong positive reactions as conclusive. What does your blood bank do?

Do any laboratories include "disclaimers" when resulting evaluations of RHIG in the presence of maternal antibodies (ie. ABO incompatibilities). In the limitations section of the rapid screen (metal-maternal bleed screen) package insert, it identifies the potential of removal of fetal cells by the maternal antibody resulting in a false negative reaction in "any" detection method. How are other blood banks handling this?

Malcolm, you are a wealth of knowledge and are greatly appreciated! Thank you, thank you. Apologies in advance to your fellow employees, but I must say I would be glad to "put up" with your ego, any day!

The report of auto C and e is coming from our reference lab. The reference lab only added that their facility does not "follow" prenatal patients with autoantibodies. In 2011 her antibody screen was negative, no DAT was performed. Her phenotype is R1r(C+E+c+e). She is caucasion and has not been transfused. This is her second pregnancy. Could you give me a little more information regarding the two allos you mention. Lastly, is there anything documented that you know of that I can reference regarding not needing to "follow/titer" prenatals with auto antibodies. Malcolm, have I told you recently how awesome I think you are? Your expertise is greatly appreciated!

Would there be any benefit in performing/following with titers for a prenatal patient with a warm auto C and e?

Does anyone see any clinical value in testing the patient's plasma with commercial A2 cells?

Thanks everyone for your insight! Malcolm, do you see any clinical benefit to testing the patient's plasma with commercial A2 cells.

When testing for A subgroups, do hospitals routinely test the patient's plasma with A2 cells along with A1 lectin testing on the red cells even when the A1 lectin is positive?

I was wondering how other facilities manage using outdated panel cells. In our facility we not only do a DAT on the cells used but also antigen type for the antigen we are trying to rule out. This is very time consuming. In the hospital I worked previously we did a positive cell and a negative cell along with the cell being tested and if the performance was as expected, we deemed the expired panel "usable". Any advice is greatly appreciated!

Our blood bank is in the process of transitioning from Sunquest to Meditech in our hospital. We are mapping our processes and are having a difficult time with our pre-surgical process. We type and screen patients that have not been transfused or pregnant up to 14 days prior to surgery. Meditech doesn't allow to issue units on this account and is suggesting that we order a new "order" also on the day of surgery account. Is any other Blood Bankers on Meditech dealing with this issue and if so, how does your process work?

FDA requires plasma to be infused withing six hours and if it is extended to our standard 24 hours a variance must be requested from the FDA. Federal regulation 21 CFR 606.122 SUBSECTION 3. Any thoughts...

The issue with performing PEG or manual testing is that the comparison is not "apples to apples". Time and time again, the ECHO has proven to be a much more sensitive method versus other methods. The problem with the "three" panels available is that you are limited to IMMUCOR's selection. To match the automation's sensitivity, I chose selected wet cells and perform a crossmatch using the automation.

Our facility uses the ECHO by Immucor. Has anyone used the known liquid panels cells (panoscreen) as "donor cells" and patient plasma and performed a crossmatch to aid in antibody identification? If someone has done this, was there any validation or quality control defined by your facility?

Are any of your micro labs involved with quality control for your hospital pharmacy? More specifically do any of you run cultures to check their sterile techniques when making IVs?

I am sorry, i will clarify. Immucor offers a kit that is called the fetal bleed screen test (FBS). It detects RH positive rbcs. We do this test on all delivered RH antigen negative moms with a baby that is RH Positive. If the FBS is negative we only give on unit of RHIG. If the FBS is positive we then must do the Kleihauer Betke (KB) to determine how many units of RHIG is appropriate. The problem becomes weak D moms. They have very positive FBS results and negative KB results. In order to be sure that this is a weak D situation and not tech or some other error, we must do the weak D test. At this point we "know" the patient is a weak D and the AABB technical (seventeenth edition) manual states that these women are not RHIG candidates "clearly positive on the weak D test should be considered D positive and not receive RHIG, although rarely a positive weak D test can be caused by a partial D antigen". This statement from the AABB technical manual is confusing. We do not do weak D testing on adults, including prenatal moms. But we "catch them while doing the FBS. This ca

Our policy is not to do Du testing on adults. When we get to the fetal bleedscreen, post delivery, the rare weak D (Du positive) moms are identified at this stage (very positive fetal bleedscreen and negative for fetal cells). According to the AABB, these patients are not RHIG candidates. These patients are called RH neg up until this point and have been given RHIG. How do other facilities handle these situations? Any information would be greatly appreciated.

I truly appreciate that Malcolm! I would rather be proactive than reactive, if at all possible!

We have recently experienced some patients that encountered a suspected drug induced hemolytic episode. The offending antibiotic seems to be piperacillin. Does anyone have any policies or procedures in place, either through blood bank, pharmacy or another department, that helps in early detection (ie daily hemoglobins, DAT's). Any suggestions would be greatly appreciated!

With our automation "ECHO" solid phase technology, we do not have the luxury for "cell" selection. Immucor makes the panels and our facility purchases three different types of panels. We have to run the panel of all 14 cells so disregarding cells would make our job much more difficult. On a side note, their single dose vs double dose cell selection on much of their panels complicates ruling out with in-house policy. The comparison of tube method to the hyper-sensitivity of the ECHO is like comparing apples and oranges, they are definitely not the same beast.

LOL, loving the concensus! The philosophy, as explained, was that the results were not as "expected" and therefore should not be used to rule out other antigens. Gaging the responses, I will deduce that this is not a common practice or even an "old school philosophy". As always, thanks for the prompt responses!

A question has stirred some heated discussions in our blood bank. Any input would be greatly welcomed. The question is "if a known antibody is not detected/reacting on a cell, can this cell be used to rule out other antigens?"

I am interested in knowing how everyone tests and reports A subgroups. We only use an anit-A1 lectin and if the patient is negative, we report the patient as A2. It seems to be a common practice with our surrounding hospitals. Would is be more appropriate to report the patient as just an A subgroup vs specifically A2? I realize that A2 is the most common and the others are less so.

Thanks to each and everyone for your responses, you have been extremely helpful.

When testing patients for a bloodtype due to "no previous record" with a request for transfusion, does anyone only focus on non-O patients?