sniedz

How does everyone handle transfusing patients with warm autos, and do not perform adsorptions? We have a handful of patients with warm autos. We send them out to our reference lab the first time to see if they have any underlying allos, and to get their phenotype. From there,we give them antigen-negative blood for the corresponding allo, and we honor their Rh and Kell phenotype, so hopeully they won't produce any antibodies. We extend crossmatch and label it least incompatible. We require the physician to sign- which they always do. I just want to see what other sites do who also don't perform adsorptions. Shelly Niedzwiecki, MT (ASCP)

Can anyone tell me what they do when they suspect a patient is reacting to the ECHO method? Ex. a patient is reacting to all panel cells on the ECHO, DAT is negative, and patient is giving negative screens using PEG and LISS. I haven't wrote a procedure yet on how to handle this. I contacted Immucor and they said each lab has to decide on how to handle situations like this. I tell the techs if a patient is all positive on the ECHO, DAT negative, and the screen cells were negative using bothe PEG and LISS, we can assume they patient is reacting with the ECHO. We turn out "Clinically significant antibodies ruled out" and I tell them to still do an extend crossmatch. (Part of me still worries they could of had an antibody we didn't know about and thetiter is too low or they could be developing a new antibody.) Any help is greatly appreciated. Shelly

I recently started working at this small hospital and question some of their practices: whenever a patient has a cold antibody, the techs label the unit "BLOOD WARMER REQUIRED." I think this is overkill. The Technical Manual says blood warmers are rarely required and to use a blood warmer when you are massively transfusing or when a patient has Cold Agglutinin Syndrome. Can anyone shed some light on this for me? Thanks!

Our protocol for antigen typing patients is they can't have had a transfusion within the past 3 months and their DAT has to be negative. I went to a Blood Bank seminar a few weks ago and the case study presented had a positive DAT, but no recent transfusions. They antigen typed him. When I questioned this (because of his positive DAT), they said they use monoclonal direct antisera and you can type on patient's with a positive DAT. Does anyone use this practice?