janet

For those using 2 homozygous when possible .... do you use that rule for the "clinically insignificant" M (Lewis and P for that matter too) 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)

Canadian here.....am I to understand that if "day 1" you crossmatch your patient, they get units that day then "day 2" (or 3) you need to redo the antibody screen before any more units can be issued? We have 3 day (or 96 hour) rule here - we would use that 'day 1' sample for all 3 days then on day 4 start over. Am I not understanding your rule?

Just a question to complicate things: do you not treat QA like a patient ..... would a patient be run on all 4 of your analyzers (does all the staff do a QA sample if you have manual methods??)

Ditto Banker girl!

Rhogain injection (should have been RhoGam) HBD diagnosis (Has Been Drinking)

Is your problem with the "fill residue"? If it is there's not much you can do in my experience - spinning sometimes helps ....Ortho reimbursed us some $ because of all the trouble we had. We resorted to loading extra cards with each run. Intermittant problem - some lot#'s worse than others!?!

To any European or Canadian users (I don't think they are approved in the U.S.!?): Have you noted an increased sensitivity in the IgG between the Diamed card and the regular IgG cards? Our provinical proficency testing agency is requesting a "root cause analysis" on why we reported a postive IgG --- we were one of 5 gel users reporting postive, 7 other gel users got negative along with 56 tube method users. I repeated the Daimed card and it still showed 1+, I also ran the IgG 'only' gel card and it was negative!?! Waiting to hear from our technical rep. to see if they can help me explain. Previous surveys have shown positive with gel when tube users got negative, but this is the first time 'us' gel users have been split (I'm thinking the others that got positive are Diamed users too!). I would hate to have to go back to a tube method Anti-C3d .... part of my explanation would be that a postive DAT should be assessed by the physician with other lab results and clinical correlation (sound good or will I get myself in more trouble?)

Mary; Did you search "cell savers" (here and "California Blood Bank Society" site).....there is some good information already written :0) Janet

We too use the @ marked cells and report as "Pasiive Anti-D. RhIg given__date___". Doesn't a full panel just confuse staff? The passive D's aren't very strong and rarely react with all D+ cells - someone not on 'the ball' could work all evening trying to figure things out!!!

We were amoung the 12% that got a false positive on the last CAP and have had 2 patients since. We switched to IMMUCOR when ORTHO was having problems with their positive control, found it easier to read so stuck with it. Anyone thinking of switching?

We went to platelet pools here in Canada a while back (4 platelet donations pooled into one of those donor's plasma). Before the switch I had read and was told we may have a greater chance of reaction when giving incompatible blood groups (as there is when giving an apheresis unit).....I was a little worried, read about some institutions that titre before giving or plasma reduce if incompatible - but we took a 'wait and see' attitude. Well the waiting brought about a hemolytic reaction for a 50 some year old man with myelodysplastic syndrome and coronary disease. The physician happened to be present when he reacted - she said it was so classic - the back pain, fever, burning, etc (along with chest pain...?the stress and pre-disposition to cardiac symptoms?). Thank goodness he recovered after a couple nights stay in hosptital voiding bright red urine!!! Now we titre any incompatible platelet before issue (we don't have the option of plasma reducing). There is no concensus about what the cut off titre should be ... I have read various articles. One European (I think) blood centre titres all the plasma they use to make pools and use 128 IgM as their cut off. We went with 64 IgM because that what was in a few of the articles I read and we wanted to be safe after having a close call. BTW the titre of the platelet the patient who reacted received was 128 IgM ... I tested 20 plasmas in validating my method and only 2 had high titre Anti-As (greater than 64) and no Anti-Bs. We try to keep group A platelets since they would be compatible with the majority of people, if the unit we want to give has a high titre and we don't have an alternate unit to give we get the physician's approval before giving it (hasn't happened yet).

Just curious Bill....are you quarantining because the SafTVue is red - what do you look for at the end of quarantine? We usually just discard because that unit's temp went over 10C and don't really know how long (we use them to 'spy' on the Operating Room staff). Thanks!

I am lucky enough to live in Ontario and I am using Transfusion Ontario's site for our competencies this year. A lot less work for me, questions are straight forward, and I think staff are learning new things (I would have only asked them the things we do - the site broadens that),

If the reaction looks like a cold or we are getting weak reverse reactions in gel but our tube method is 'no problem' we will not do any more work.....why work up what won't hurt the patient?

Our sickle cell patient had (what appeared to be) an auto-anti-e also (we too use gel - I don't think we questioned 'funny' looking reactions) .....started out as a weak unidentified, progressed to a perfect looking e which about 6 months latter went away. There is literature that states 35% (I think??) of sickle cell patients will develop auto-antibodies. We felt best giving him e negative (therefore compatible units) while the antibody was there ... now with a negative antibody screen we have gone back to giving him E-,C-K- (matching his phenotype). Just thought I'd add my experience - sorry, not an answer to your questions :0)

What do you mean by mf in absc if you load the incubation chamber in a sub-optimal manner .... what king of artifact do you get, how is the chamber loaded??? Thanks!

If I understand what you are asking I think that is basically how I do our "High/Low" temp checks.....put the container of glycerin (with the probe in it) in ice cold water until the alarm sounds then warm it all up again until it goes off on the high end. This reproduces what would happen for a unit - right!?!

That works but you have to be REALLLY careful about how much you add, how long you incubate (especially with the monoclonal anitbodies).....you'll get such a strong DAT your blood group will be invalid and most of the antibody is on the cells so your antibody panel doesn't always fit! I keep the cells and plasma separate - that way you can add just a 'smidge' for the DAT and more to the plasma for the ABID. My students really like when we are doing transfusion reactions - I'll give them a couple scenarios.... 1. The 'wrong' patient collected for pre-transfusion testing (APos) then the post is mixed field OPos - really hits home if they do collections too! 2. Anamenestic antibody - negative screen initially then the post has a high incidence antibody. Some group O patient plasma you won't need anymore + pick group O unit (or old panel/screen cells if you have enough) phenotyped cells then you can just add some Coombs Control Cells to make up the positive DAT. Add your antibody and some positive 'unit' cells to the post "sample". Really good to ensure they know they can't phenotype that post transfusion sample when they figure out what antibody the patient produced (or if the DAT interferes with the phenotyping!!). Mom/Dad/Baby scenarios are good too.....have them phenotype all three - can that be the dad? Mom can have multiple antibodies but only one is on the baby's cells - do IAT testing to see what is free in the 'cord' plasma or an eluate. I often pick a real ABO incompatiblity because they are the most frequent and you don't have to worry about over-doing it with the antibody added. I ramble.......

Ozark Biomedical also .... Beebe, Arkansas 72012 Phone: 1-800-457-7576 Fax: 501-882-3986

The clue to these usually is a negative reaction with the auto and any units crossed (anything NOT in their preservative) .... I always try washed screening cells when I see those clues!

When I was revising our methods I searched and searched for a reference for our long time practice of mixing the platelets at least half an hour before issuing them for transfusion......couldn't find anything - I'll be interested to hear if you find any resources.

So you use gel now for your titres Linda? We did for a while but found we were sometimes 2 tubes higher than the other lab the obstetricians were getting reports from. We switched back when our provincial proficiency test sent out a sample - we got 3 tubes higher and they stated the tube IAT method in AABB technical manual was the "gold standard".

Ends up I was way off base......if only communication were better. There was an inutero bleed when vilas sampling was done to do a platelet count (worrying about NAIT). This was done at a bigger centre than ours. There was a bleed into the baby's abdomen (from hepatic vein I think they said) and the blood that pooled there caused the increased biliburbin as it was cleared. That propbably explains the normoblasts too - trying to compensate for the post bleed anemia. Still not sure why all the spherocytes though. Thanks for all your thoughts - I've learned to ask more questions before jumping to conclusions!

Thanks for the thoughts. We did elute Anti-A off the mother's cells. Baby's bilirubin is normal today and I somehow missed saying her hgb was up to 169 yesterday. This quick turnaround makes me think it can't be a hemaglobinopathy or enzyme deficiency (do you agree?).

We had a baby born with a hgb of 75, up to 113 after transfusion, now (2 days later). DAT negative but bilirubin was elevated, spherocytes and normoblasts present. Mom and baby are both A Rh: positive. Her Bilirubin peaked at 324umol/L about 12 hours after birth and is down to 204 today (almost normal). Mother was being given weekly Gammunex infusions - she had a still born July 2007 due to inter-cranial hemorrhage. We did platelet antibody studies on her in December 2007 which were negative but the physician felt it was safest to give IvIg to prevent this pregnancy ending as the other one did (she felt it fit NAIT even though antibodies were not present - father was drawn too and our HLA reference lab does do a compatibility between mother and father). Mother's hgb mildly low through pregnancy at 102, plt around 80 to 140 but was 368 before treatments of IVIgG. Our pathologist came in after he was asked to review the baby's smear - he asked if it was HDN, I told him about the IVIgG and how it can cause hemolysis in adults (mother does have a positive DAT (1+IgG), her reverse A cells react (1+), in October we had a weak antibody reacting with one of 14 cells, at delivery her antibody screen was negative, and all A units crossmatched were incompatible (O's fine)). Baby's DAT negative but we were thinking all those sensitized may have been cleared causing the anemia and hyper-bilirubinemia. I did testing on the cord plasma and it was negative with A cells and our antibody screen, only positive B cells. We are did an eluate today (just to see - I've read about eluates being positive even when DAT is negative) but it was negative!?!? Do you have any thoughts - have you heard of HDN caused by IVIgG being given to a mother?