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Everything posted by janet
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Our oncologists do not want to give the injection. Recently we did have 2 oncology patients form an Anti-D from Rh:pos random platelets we gave them.....though I hadn't seen any in years before these two recently. We did have one young oncology patient who they just would not give Rh:pos platelets to .... fortunately we could always get Rh;negs in and they were willing to wait. For traumas or bleeds we would suggest giving RhIg to any female under 50!
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What it the "settle tecnique"?
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We use IgG gel cards for our cords/babies less than 4 months and a gel card made be Diamed distributed by Ortho (in Canada) with IgG/C3d/Ctl for adults.
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I guess I mislead saying you can't add samples to the Provue......we just choose not to I guess because it is so time consuming to wait for it to be 'ready' to accept the sample, then rescan everything and start on the new sample (causing your previous batch to be delayed). Much easier (and definitly faster) to set it up manually!
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You say you're not sure giving RhIg is neccessary.....do you think she probably won't make an Anti-D to any red cells in the platelet units? I've seen it happen (recently 2 within a couple months). Both were oncology patients - one post autologous stem cell if I recall. We don't give RhIg to our oncology patients unless they are female and childbearing age.....neither of these patients fit that criteria, were given Rh positive random or apheresis platelets - took a few transfusions but the Anti-D showed up :0(
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Our dialysis unit used to push 2 units through in 15 minutes before I educated them about the most severe life threatening (incompatible blood/anaphylactic) reactions happening with very little transfused and in the first 15 minutes of transfusion. Now they give each unit over an hour (30 minutes if they are under a time crunch). Didn't take much convincing!
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"Rh-positive" vs. "Rh-positive, weak D" protocol
janet replied to johna's topic in Immunohematology Reference Laboratories
We would perform weak D testing (anything <2+ must be 'investigated'). If weak D reaction >2+ consider the patient weak Rh positive - give Rh pos units and not give RhIg unless Dr. insisted. If weak D <2+ consider the patient Rh negative (I guess......better safe than sorry!!) -
They've said it all, you will be missed here!
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We do a type on each admission for plasma only.....platelets we generally give what-ever is expiring (we are 10 hours from our blood suplier).
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Our obs/gyn seem to order a g&s on every woman in labour.....midwives only if there is bleeding history or complications - those great midwives!
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We don't for either.
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What I.S. system do you use?
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Diamed makes a gel card that has an IgG, a C3d and a control well in each card (x2 TO make up the 6 wells). We get it through our Ortho supplier. It is wonderful, the rare time it is on back-order and we have to revert back to tube C3d testing the staff realize how lucky we are to have it!
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I've seen 'weak' or mixed field groupings with babies a few times now (the mixed field was an AB patient also). I've read in the literature that antigens may be weaker at birth?!?!?
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We will do panel and crossmatch prewarm in gel but often stronger colds 'come back' with the 10 minute spin at room temperature ... for those we use the good old tube IAT method prewarm, washing with warm saline.
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Don't you have to do a full crossmatch any time an antibody is present (whether it is clinically significant or not)?
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True, once a run is started on the Provue you can't load anything else until the incubation phase is complete. The Provue is very batch oriented in my opinion.
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We quit pooling platelets years ago - a bit of a fight at first but less waste if not used and less chance of contamination during pooling. But not to pool cryoprecipitate.....how did nursing get the cryoprecipitate out of the bag?
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Ortho Gel new prediluted cells formulation
janet replied to Mabel Adams's topic in Transfusion Services
Why do you think they are false positives as apposed to an antibody that seems to react only with that one cell? We've had a couple since starting the new formual.....but we would get an occasional "unidentified" before too. When we first started with the gel 6 years ago we were making up 0.8% from DBL 3% cells. We were having many reactions with S2 only......many were females and many of those females were childbearing age. Some were sent off to our reference lab along with a new aliquot of the cells.....they reproduced reaction with that cell only. We felt maybe it was in the Bg 'family'?!?!? -
A couple years ago I researched this......our Canadian standard (and AABB I believe) state "24 hours or as recommended by manufacturer". We use Baxter and when contacted they told me verbally 4 hours ...if you think about how long we allow a unit to be infused to prevent bacterial proliferation the 4 hour limit makes sense.
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We dropped weak D a few months ago when we went with the Provue (doesn't decect VI). Still use an anti-D that detects VI for our cords.
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How often does 'everyone' redo workups on patients who react with all cells tested? Our practice is to autoabsorb and do a full phenotype before transfusing. Attempt to transfuse phenotypically matched units to prevent allo-antibody production. We redo antibody screen, panel, DAT and crossmatch every 3 days - only to find the patient still reacts with everything (what we knew was going to happen).
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We used to do a G&S on all caths......they decided to drop it (by 'they' I mean the cath lab - said they looked at the statistics and thought it wasn't needed - didn't ask for our input). Over the 15 years we've been doing them I only recall 2 bleeds.
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Ortho Gel new prediluted cells formulation
janet replied to Mabel Adams's topic in Transfusion Services
I found one previous Anti-K that was no longer reacting came up weak with 2 of the 3 K+ cells in the new formula. A couple antibodies appeared a bit stronger (2+ to 3+) for me also. A weak unidentified was 2+ in the new formula but still had no pattern How many comparisons are you perfoming? -
I'm curious what others out there think of this: We have a hematologist/oncologist who has given "trial" platelet transfusions (two separate occasions to two seperate patients with ?ITP "to see if they will respond if platelets were needed during a planned surgery"). Both patients had platelet counts in the 80's but the surgeons did not want to perform the procedure before consulting a hematologist. I questioned him before the first "trial" happened and he was quite irrate to be questioned. Needless to say I just gave out the second "trial" set since my lab director didn't really back me in the first case. Platelet counts did not go up in the first case (actually dropped to 60 after 5 days). The second case did not show a response in the first day....see what happens to her counts the next few days! Any thoughts for or against this physicians' practice?