janet

I didn't consider a maternal-fetal bleed because the gel was so straight forward negative (mixed fields are usually obvious). Our samples were pre-delivery....at the time I wrote she was post partum. I did type the baby anyway = O. Thanks!

We have a postpartum woman who we previously grouped as O Rh:positive (once by tube and once by gel). Both these historical results show negative with Anti-A and Anti-B, the reverse grouping is 2+ A cells and 4+ Bcells. Today one of our new grads noted weak 1+ reaction with the Anti-A, reverse again 2+ with Acells (weaker when warmed). We recollected the patient and got same results. Anti-A1 lectin is negative so we're thinking it is a A subgroup with an Anti-A1 ..... but gel doesn't pick up this subgroup at all!? We tried testing the patient plasma agianst two A units = one 1+ (weaker after warming) and the other negative. We tested the patient cells against group O plasma and got the result of 1+. My question: since the Anti-A1 is probably insignificant (decreases on warming) should we call her an A to prevent her getting group O plasma. This will be confusing when we group her on the Provue though....if we call her O and she received O plasma would it cause a reaction (was 1+ in tube).

I'd like to add that uless you're testing dosage of your crossmatched unit, that antibody that doesn't react with the heterozygous exclusion cell won't react with a heterozygous unit either. Crossmatching antigen negative units may give a false sense of security if you don't know it's heterozygous unit.

Do you use one or two homozygous to rule out (when possible?)

We have an ENT that does G&S on some cases and occasionally has us cross units....??he had a case go real bad?? - we sometimes to a VonWillebrand screen and when we were doing bleeding times his pre-op days were hell! I come from a 360 bed hospital in Canada - we don't have insurance companies policing orders (sometimes I wish we did!!). We can bring 'inappropriate' orders to our medical director but his answer is usually "they are the attending doctor, they are taking responsibility" so it is rare an order gets changed and to be honest I've given up beating my head against the wall unless I have a huge issue (sorry, I'm venting!!)

The autocontrol has also helped us with a few patients that have reacted with something in the reagent cells (preservative/antimicrobial??). As high-freq stated - it's that one negative that makes you think further.

Our process is similar to Kate's for the wards that request blood products. We have most of them trained now that if they haven't seen the unit within 15 minutes of sending the request form to call and inquire. It's been an uphill battle though! We do use secure code when the OR requests units (there is a fridge there, majority of units are portered back and forth but if more units are needed or a case is added we will pneumatic them up). We started using the security code when the units were not retrieved (I was floored how you could go from needing units NOW to forgetting about them for 2 hours!). We hoped the beeping will remind them (though I've since learned the pneumatic station isn't really in hearing range) what seems to have helped is that they request, we send then call them to remind them of the security code and to retreive the units.

We only elute if the patient has been transfused......In anyone's experience has an elution done more than make alot of work when it was an auto-antibody or drug/disease induced?

We have Meditech 5.5 and a Provue. We are uni-directional for group&screens only. We print out crossmatches and panels and enter them manually. Uni-directional for us means we select the G&S batch and send the results over to Meditech by clicking an icon. Blood group: the full group microtube results and blood group interpretation are sent over (unless results 'don't make sense'). Antibody screens: the microtube results are sent over but we have to manually interpret (which is a good thing .... for patients with previous antibodies we make a result comment about the previous Anti-___ beside the negative antibody screen result.) Hope that helps!?!

There are great resources at www.transfusionontario.org under resource centre - presentations there is "information for nurses". I also make sure med students know about the Bloody Easy link.

Are you looking at deglycerolized because they are IgA deficient and/or c negative?? I believe to truly remove IgA and prevent an anaphylactic reaction the unit needs to be washed 6 times (not that we wash .... that is what I was told - the units aren't deglycerolized only washed)

Our protocols state over one hour or specified by physician, not to excede 4 hours.

I was told exactly this too!!!

We get the Diamed cards here in Canada through Ortho. We QC by making a 0.8% mixture of coombs control and complement control cells.

I'm thinking it must be approved in Canada since I've been approached by Ortho to evaluate AlbQue.....it seems good - 4 samples of each blood group - one with Anti-D and one with Anti-c. Ortho 'suggests' only running certain ones depending on if you use a 2 cell or 3 cell screen ... seemed confusing - I think if we were to use them I would just have a G&S run on all four instead of setting the QC files up as they suggest.

Does anyone have any experience with Norlake freezers? Has anyone purchased a newer Jewett or Forma - reading threads from 2004 there was alot of fan freezing problems then....is this true with newer models? Is Helmer still the choice of the majority? Thanks!

We used to read our cord DAT's microscopically.....switched to gel 7 years ago. I generally find the gel is more sensitive than tube, for our adult DAT's before we do an eluate we evalute the tube DAT to see if it will be worth our while. Often a 1+ IgG DAT in the gel is weak microscopically in the tube. I can't see cords being much different. As far as missing anything significant - what would a weak DAT in a baby equal clinically ..... I doubt very much - there can be jaundice in a baby with a negative DAT too!

That is awful that they wouldn't look it at as a first time error in 20 years! Your work ethic for years should account for something! :0(

Any reason why you decided to use the "Lots" routine instead of an actual product?......we are working on using our Meditech system to track bones and tissues, but as a product (where we enter packed cells, FFP, cryo and Platelets). Any words of advise?

We do the same, also go to the KB if for some reason the RhIg was given before the sample was drawn.

We are interfaced.....'uni-directional' for group and screens only (still need to manually put in crossmatches and panels). We still tell the Provue what to run, then when the batch is done it is sent over to the Provue. Works great! We don't do cord's on ours.

Not that I've seen it done for Rh:pos cells given to an Rh:neg patient .... I have seen it more than a few times in treating ITP. Those patients we treated with massive doses of WinRho did not have anemia or signs of hemolysis develop. Cangene did send out warnings a couple years ago to watch the patient closely though!

We were using gel for titres .... until we were 2 over our proficiency testing result and cosistently higher (1 to 2 tubes) than the private lab physicians sent their patients to. In Ontario, Canada Q-MPLS gives us provincial standards to meet, they stated the tube method from AABB Technical manual is "gold standard" and should be followed.

Is this a formal discussion group. We haven't really looked at it to far yet (we don't prepare anything, our IS support says we shouldn't have a problem entering the new barcodes supplied by our Canadian Blood Services). If possible it would be nice to see your Meditech discussion threads for when we get closer.

We did serial dilutions (as galvania described) in gel for a couple years....until we were consistently 2 or more 'tubes' higher in our lab proficiency testing (the Province of Ontario sends out to each licensed lab). The proficiency agency stated that tube IAT testing is considered the "gold standard" so we changed back and follow the AABB Technical Manual method.