2 hours ago, goodchild said:

It's interesting that you posted this because the supervisor and I reviewed our Meditech Antibody and Antigen dictionaries just recently. It hadn't been done in many years and whoever set it up previously configured antigen warnings and IAT XM for every antibody, so review/revision was a long time coming!

So which antibodies do you have as insignificant and qualifying for an EXM?  And I agree on the INC as well.

For specimen requirements, do you require two ABO specimens drawn at separate times (could use a Heme specimen or even coag??) a retype of a sample by two different technologists or retype by same tech if sample drawn using a "mechanical barrier system or digital bedside patient identification system" (per CAP checklist), for which we have Mobilab.

Applejw1, our EXM will be set up so it is not allowed with a positive AB screen.

Dansket,  what antibodies are NAD and INC?  

14 hours ago, Dansket said:

If so, the following antibodies are configured as clinically insignificant in our Meditech system when then allows electronic crossmatch: -Lea, -Leb, -M, -N, -P1, COLD, WARM, NAD, INC, -RhiG. 

So you are saying that if you haven't determined the significance of an antibody (maybe and HLA or HTLA) that you would just perform an electronic XM?  And if you have determined that it is a warm auto with no underlying all antibodies that you would also perform an EXM?  That would take care of least incompatible!  What if the warm auto is showing anti-E or anti-e type specificity?  I'm including a list of all the antibodies in our Meditech dictionary-a little bit of overkill I think.

Antibody list.pdf

Malcolm,

I agree!  I'm tempted to call all of them significant on my list except a cold or a passive D we named for residual Rhogam.  I do have the 3rd edition Blood Group Antigen Facts Book so I'll consult that as well.  I'll also use the info our reference lab puts on reports as a backup.

We are getting ready to start using electronic crossmatch with Meditech Magic 5.67.  My IT guy gave me an antibody dictionary page and you can select yes or no for significant, indicating that EXM would be appropriate or not.  As it stands in the dictionary now, there are more than a few that are listed as insignificant, such as M, N, Lea, Leb, P1, York and antibody of unknown significance/specificity.  And to be safe, since we don't antigen type for Lea, Leb, M or N, or identify an antibody which might be an HLA, we perform a gel XM.

Which antibodies do you routinely call insignificant that would be eligible for an electronic XM?

Also, does anyone have a procedure they would be willing to share?

TIA, Mari

That's what we did-took a basic hospital business card and changed it and put a place for the info on the back.  We have had a few faxed to us from the ED.  We have been doing this for almost 4 years.  Each month I print a report of antibody patients and send a letter and the card to them at home.  I make a copy and put it in their antibody file. 

antibody ID card.pdf

I wonder about using a patient known to have atypical antibodies qualifying as an adequate positive control.  Antigen-antibody reactions vary drastically, dependent on the type and quantity of both the antibodies and antigens in question.  The point being that a panel that produces a positive for a known anti-K (that particular vial has RBCs that are "viable" for the K antigen), is not necessarily going to detect  any other antibody.  It would be like saying that if your QC for a potassium  checks that everything else on a Basic Metabolic Panel must be OK.

Scott,

So probably what should be done is to run antisera (expired or not!) on a cell positive for the one you are trying to rule out and if it's positive and your patient is negative, you could rule that antibody out.  If you are trying to rule in an antibody and the cell you selected is positive then that would be adequate without a control.  Do you agree?

We have had Isensix probes installed for 6-1/2 years and are finally getting ready to activate it!!!  They kept giving the project to people who didn't follow through and finally I said-I'll do it!  That being said, I think we will probably keep our paper charts because Isensix was down for a couple of weeks.  Since we are not technically using it, I just stumbled on when I came back from vacation and checked it.  Biomed was unaware because they don't track it.  My problem with quarterly checks is that Isensix takes temps every 5 minutes, but as soon as my alarm goes off, I immediately pull the ice/warm H2O from the probe.  I don't want to listen to it for five minutes.  Our paper charts do register the alarm check.

We have one tech scheduled for blood blank weekdays (me), one for evenings weekdays and only one tech for the whole lab graveyard shift.  On weekends one tech usually does Chemistry and blood bank on days and evenings.  It usually works out okay, but obviously some days are quite hectic.

Thank you Malcolm!

Another question.  If a patient has a history of a warm autoantibody with no underlying alloantibodies, but the current screen is negative, do you still need to perform an IGG crossmatch?

We use TAR and even though nurses scan the (hospital) wristband and all barcodes on the units.   When we used paper forms, a CNA or other non-nurse could verify, but TAR requires two nurses to verify.  ER is still a hold out for us.  Can't force them to do anything the rest of the hospital is doing!

We use Safe-T-Vue for emergency release and anytime we issue anything in a box or cooler.  Usually Or just takes one unit at a time.  There have been a few techs with big thumbs, but I try to train most to just touch the edges and they work well for us.  We also TEMP-CHECK to check single units that are returned in less than an hour.  

 

Texas Lynn,

We call the patient's doctor or check hospital records to see if they have gotten a Rhogam shot.  If we can't document it, we call it anti-D.  

After reading the AABB technical manual, I agree we need to continue to do gel XM.  

I also thought it would be easier on my techs not to have an exception.

Thanks for the confirm! And welcome to the forum!

I am in the process of editing in Meditech to automatically order an IAT (gel or tube) XM for all patients with antibodies, but I wasn't sure if that was required for a patient with a REAL anti-D (mostly older women) or if we could do an IS XM with an Rh-negative unit.  

 

This is slightly off topic, but I wondered if anyone does a gel crossmatch for a patient with anti-D or just selects an Rh negative unit.  We also have a separate antibody for Rhogam (DRHIG) and do IS XM when the screen is negative.  I am not sure if I want to make an exception for my techs and have them not do a gel crossmatch.  Sometimes the less they have to think about exceptions the better!

98.6 F=37 C, so it's basically a normal temp to start.

Congratulations, Malcolm!!  Your sense of humor is wonderful, but the knowledge I've gained from your expertise...

PRICELESS!

This was just the information I was looking for!  We have a current patient who was transfused at our facility for the first time on 10/17.  Her antibody screen was negative and she received one unit.  She returned on 11/1 and had a positive screen, panel (some negative cells), autocontrol and 2+ IgG DAT.  I concluded that she had an Anti-Jka and found antigen negative gel crossmatch compatible units.  I even rechecked her previous sample, which had the negative screen and her IgG DAT was 1+.

We sent it up for elution and it came back with anti-Jka and a positive IgG DAT.  

Was I wrong to think we maybe shouldn't have sent it to the reference lab?  All significant antibodies were ruled out except Jka and the units were compatible.  I'm the only consistent blood banker (days) and everyone else is a little leary of blood bank.  In this case the tech didn't even rule out Jka, Fya or S.  She just stopped with the positive Autocontrol and DAT.

Last post!  When our IT guy checked the dictionary, it did say 5 days, but there was a 0 in the hours, so it defaulted to 5 days exactly.  He has tested it now and it defaults to 2359.  Yay!  Now I just need to update procedures that state to change expiration time in Hematrax.  Does it ever end??

I just tested Meditech and I can change the expiration time from "now" to 2359.  That is at least a work-around until I can check the dictionaries.

Our dictionary says 5 days and frozen expires at 2359, so I don't know why TAR can't scan it if Hematrax says it expires at 2359.  One of those computer mysteries.

Thanks, BankerGirl!  I will have to check in Meditech for the dictionary to see if it is set up for hours instead of days.

We inspected a hospital last year where everyone was wearing masks with upwards face shields.  I would have to quit if I worked there due to claustrophobia!

Scott,

I can print any expiration time on the Hematrax labels, and before TAR it did print out 2359, but since TAR when the nurses scan the labels, they get a conflict if the Hematrax label says 2359 because Meditech puts it at exactly 5 days.  We don't really waste much FFP so I don't worry about it.