janet

I agree Mabel .... how can one trust I.S. crossmatches to pick up incompatibilities in patient's with weak reverse groupings - those with computer systems that warn about discrepancies are safest. It seems silly to do an I.S. crossmatch with your gel if you have a computor system with that capability!!

So have titres fallen further by the way-side? Sounds like some labs are able to actually quantitate antibodies ..... how is this done anyway???

Reading this thread a little late too - but I am reminded of our MDS patient; group A who received group O platelets ..... he had severe hemolytic reaction - we started titering incompatible platelets, gave him a low titre group O again and he had another reaction (realize now how stupid that was!). The hematologist diagnosed him with PNH, stated PNH can develop in MDS patients (15%!??) and explained his severe reactions because his cells were already primed with complement. Not sure if any of our experience could translate here - antibody in the donor clearing some of his primed cells or as Shily stated something in the transfusion starting the complement process!?!

We do the same as aakupaku - started this 2 years ago after a hemolytic reaction: -- myelodysplastic patient group A received group O -- started issuing incompatible if titre <64, a year later we thought a low titre group O would be fine for him but turned out he has PNH so his cells were already complement coated + the Anti-A = crisis. There was a poster at AABB this past year - I'll try to post it here. A transfusion physician commented he doesn't really agree with titres, feels patients like ours are a 'one off', some will react to low titres too (seems to be the case this time!) I now think twice about the myelodysplastic patients receiving incompatible groups - we try to stock mainly A to be compatible with majority but still titre if incompatible

So .... medical records thinks there was a registration error, the original patients demographics were replaced with this new patient's when she was first seen a year ago!!!!!!!! A likely explanation - but SCARY!!! Thanks for the help!

A woman was seen at a hospital a few hours away from our hospital and grouped as O Rh:positive - we have a historical grouping of A Rh:positive (done in 2002 and 2004). They had the patient return, confirmed identification/transplant history(none), and retested (O Rh: positive again). Because we are linked through Meditech they are unable to file this result due to the historical discrepancy. Any thoughts of what is best to do? We could both change our blood groups to UNKNOWN since we don't match (but that's not really correct, we both know what group we got!!). Any thoughts or experiences would be appreciated!

Are any other users STILL having problems??

We've been having the same ?junky? looking results, negative panels and often will try the 3% screen made up in the MTS dilutent to 0.8% (often negative but occasionally still positive - we call the negs NO ANTIBODIES and the positives UNIDENTIFIED). Another thread discusses this problem (sorry don't know what it was called)! As far as volume problems go - is the volume problem at the end of the run?? We have ALWAYS had volume errors, usually we'll see bubbles at the top of the plasma well and we were told that those bubbles prevent the analyzer from reading the miniscus therefore it cannot read the volume = error. We don't repeat these (if the volume looks okay) - we trust our manual pipetting with a visual check!! We also get some cards with 'sephadex' (fill residue??) ... since the Provue rejects these before starting a run we use them manually. There were a couple occasions when we've had ALOT of cards rejected by the Provue from a certain lot # - Ortho replaced them for us :0)

We will wash cells for cases as Malcolm suggested (lloks like the patient is reacting with the anti-microbials/suspension medias in all the manufactured cells)....we always resuspend in the MTS Diluent because you need the LIS solution to use the small volumes and shortened incubation time! I beleive others have spoken of doing this in another thread where we've been discussing alot of weak/unidentified antibodies lately with the 'new' formulation.

Gel is much more sensitive than tube so I wouldn't compare the two .... we go down in sensitivity to gel when we need to get rid of a high titre cold or auto (gel seems to pick up more of these). Making the 3% to 0.8 % and running in gel has become a parit of our work up for weak reactions and negative panels.

This has been a 'dream' of mine for some time now. We're still on 5.5 and I don't know if the U.S. standards are the same as our Canadian ones (most likely - they seem to follow AABB for the most part) but can you answer some questions: 1. Is it up to the tech to ensure there is two blood groups on the patient or does Meditech warn you? 2. Is it up to the tech to ensure the antibody screen is negative/no previous antibodies or does Meditech warn you? 3. Do you still have units "on hold" actually tagged for a patient or do you just 'cross' as you issue for transfusion. If you 'cross' as you issue how did nurses and physicians accept blood was compatible for their patient even though Meditech didn't show it as such. THANKS!!!

Any Meditech users doing the electronic Xmatch now??

Yes Linda, since we went to "ISBT" in Canada all our products have the volume on the label .... I just assumed all ISBT labels would?!?!?! (Now that I think about it though, it's just the barcodes that are 'universal' isn't it).

Linda - not that we use (or are thinking of using TAR) I just have a comment about the volume .... we enter the actual volume of the unit when we are entering the unit into the system. Staff don't seem to think the few extra seconds it takes is a big deal.

But .... could it be drug or disease instead of an acutal auto antibody??

Has anyone tried a different segment device? We really like them but I see cheaper things out there - do they work as well?

Knowing the answer to this has practical use .... some of my staff tend to spin Post Natal Fetal Screens ("we spin all our other samples") and when I tell them that the method states it should be well mixed whole blood they say "oh". I've told them I suspect the fetal cells may centrifuge in a different layer than the adult cells - now I have back up -THANKS!

We would warm that positive I.S. crossmatch - if negative after the warming then it must have been a cold, an insignificant cold if the 37C antibody screen didn't pick it up! If it was still positive after warming I would suspect rouleax and do a saline replacement. Compatible blood is usually found within 10 minutes using these two trouble shooting methods.

Thank-you Malcolm - I thought it was risky practice too ... but that's what they do. I believe it was a talk by Garratty that stated allo-titres were higher than auto's so I guess our reference lab isn't alone in the dilution step!?!

As some other gel users stated, we too 'drop down in sensitivity' to saline tube IAT with warm autos to see if we can get a negative screen .... or an allo antibody. We have a couple regular users who react with everything in gel, one has an Anti-e and the other an Anti-E .... my understanding is that the allo antibody is usually a much higher titre than the auto antibody (our reference lab even goes on to do dilutions when the 'neat' antibody screen is still reacting with everything by saline IAT.)

Years ago our reference lab stated they could do a "capillary test" to see if the antibody was IgM - if positive one could say it is a true Anti-D but if negative one still wouldn't know (as someone earlier stated about IgM changing to IgG after a while). We were told to check again in 6 months - if still there it is definitly a true antibody (as you know!).

Thanks for all the words of wisdom. So far so good for our patient .... his hgb was staying stable 90-100 g/L today (no more units given). A total bili last night at midnight was 101 umol/L and 68 this morning. DAT at midnight 1+ IgG (gel) and 2+ this morning. Our medical director requested they watch these the next few days. Post 'crisis' testing showed he had 17 compatible units and 7 incompatible (all in the last 2 hours before bleeding was controlled). I read up in ISSITT and feel a little better - these extravascular reactions don't cause DIC or renal failure very often. Spleen and liver work hard to remove all those sensitized cells. When I spoke with his nurse today things didn't look too positive for him (didn't sound like the transfusion issue was the only issue). Thanks again all - so nice to be able to reach out for help!

I'm a little worried.....we had an esophogeal varacies patient bleeding out this afternoon....he has an anti-c so of course it was tough to keep up. After the initial 10 units given before a sample was obtained (these units c negative) we thought all our hard work is just being bled out, we would wait until bleeding was controlled and give antigen negative for the units that would remain in him. Last request for 4 (still uncrossed - but we finally have a sample) we called once again to ask how the bleeding was - still profuse - so no phenotyped blood issued. I left after an hour overtime leaving staff with 8 compatible units, FFP, cryo and platelet pools just issued - instructions to communicate before any more blood issued and switch to those compatible units when bleeding controlled. I just called to see how things were going - tech told me things were good, he had stabilized and no more units were requested (hgb 129!). So, he is all incompatible units at this point - sure we've diluted his antibody with plasma, platelets and cryo - I am worried he will go into crisis due to transfusion reaction now. Any thoughts out there??

We titer 1:64 Immediate Spin if giving ABO incompatible. If reaction with this titer we try another units or warn physician this is all we have and possibilty of hemolytic reaction (we acutally had a reaction before implementing the titre policy). Those from the United Kingdom - is it true the National Blood Services dilute all donors on an Olympus analyzer 1/100 against A and B cells and if there is a reaction they mark units has high titer?? I found a document on the Internet when looking for methods before deciding to proceed with our method. I would like this verified!?!? THANKS!

I posted this in the "rule out" post too but for those who just give IAT compatible units (not phenotyped) do you bother rulling out these "clinically insignificant" antibodies? Our rule is 2 M, one for Lewis and one P but one of my technologists is asking me why .... we just give IAT compatible units for those antibodies so why bother ruling them out when in the end the crossmatch will tell all. I agree with here but am looking for other's thoughts for or against :0)