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mrmic

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Everything posted by mrmic

  1. Sometimes I forget what I forgot? What happened to the S.C.A.R.F. group? I don't see anything on this site mentioned about it and it was a great exchange program for Immunohematology Reference labs. It was going through some changes when I changed jobs and left the membership.
  2. Ok, I'll start. The story of "Who turned off the Light". The year was 1999. Hospital "Notme Medical Center" supported an outpatient clinic for patients requiring transfusion, some due to sickle cell anemia. Often these were young adults that came into the clinic very early in the morning. After their blood was collected and they were waiting for the crossmatched packed red cell units to arrive, the patients preferred to sleep (pre i-phone years). Normally at least one light was left on, usually the bathroom light, while they were waiting. At 0530 the first of two tagged crossmatched
  3. SHOT report sounds a little "official". Although I'm not suggesting that serious hazards of transfusions not be reported as required, there are some events that sometimes remain "in-house". Having been in BB 40 years and worked for various transfusion services and few Immunohematology Reference labs for other hospitals there are some interesting stories to tell. Some may be helpful to facilities with newer TS or QA management. Some may be a little comical, some scary and some shedding some positive light on the lab saving the day. Just thought it would be an interesting topic to read th
  4. Would there be any interest having a topic area to share transfusion error stories? I thought it might be useful for Supervisors, QA and other transfusion services staff to hear accounts of problems that have occurred in other hospitals. It could help with training laboratory, nursing and medical staff. It could be lab error, patient ID error, transfusion error, donor center error, etc... No specific person, hospital, blood center identification, state or country ID. Or is there some taboo about putting this info out there? If there is, we could say it is research for a new TV serie
  5. Couldn't agree more Mr. Staley. Humans are what would keep me up at night. I was just suggesting that pneumatic tube systems have advantages but also new opportunities for errors, mechanical or software related and may introduce new types of machine/human interactions that may lead to a new set of human errors. This was a new realization for us and required more awareness training to hospital staff involved with the pneumatic tube system. I just would like to encourage TS supervisors to think outside the box as this type of machine/human interaction is likely to increase and may introduce
  6. Just a note of caution. The only issue that was observed with pneumatic blood transport was the following; A tech sent a crossmatched, tagged unit of red cells to the 5th floor nurses station for patient A. Twenty minutes later a tech sent a crossmatched, tagged unit of red cells to the 2nd floor nursing station for patient B. A few minutes later the 2nd floor nurse called the TS lab and indicated they had already received the red cell unit for their patient B and did not need the 2nd one. ?? That's right, the first unit that was to go to the 5th floor was misdirected by the tube system and
  7. I apologize for such a late comment for this topic and possibly bringing up minor point regarding this typing. I'm sure that the probability that the reactivity with the A1 red cells was confirmed by testing other sources of A1 red cells to rule out the possibility of a antigen of low frequency on the initial A1 red cells tested. I just did not see this mentioned in the comments. The blood center where I had worked took deferring donors very seriously as it affects the blood supply and the donor's altruism. Mr. Needs response and explanation of A subgroups is excellent and I always appre
  8. I haven't seen data or an SDS for Digitonin indicating it is a carcinogen. It is a detergent not drug. It's not related to digitoxin. We have used it for years for rbc stroma. Please link a reference to Digitonin as a carcinogen. We would need to update our SDS file if this data is reported by a specific manufacturer. Thanks
  9. I didn't say preparation of lectins was easy. It is challenging to find the right working dilution and QC. But to me, that is just one part of being a laboratory scientist. A part that makes me happy and one of the reasons I came to work. To those that haven't tried this or something like this, give it try, you may enjoy it, who knows. Mr. Needs, I guess we'll have to harvest the plants to obtain the seeds after they are buried with you! 😁 Until then "Live Long and Prosper".
  10. Wow! Thanks for the responses. Motivation is always patient care, always. I've worked at both Transfusion Services and Donor Centers. As a staff tech to management. There are multiple steps along the process of collecting blood from the donor to infusion of blood to the patient. Some steps involve human participation. As humans, we are not perfect. For the labs, automation and computer software has helped us with specific steps where we may make an error, but not all steps, not yet at least. And we still can't stop a doctor or nurse by-passing protocol and just giving it to the wron
  11. I believe it refers to "Exchange Blood Transfusion". Someone can correct me if that is wrong.
  12. It's nice to be able to order commercially, but what's the fun in that? You should be able to contact a garden center, or maybe Google it these days, and get your seeds to make your own lectins! We did that in the 70s and 80s at our Immunohematology Reference Lab and was quite entertaining and challenging for the staff. I believe there is an AABB workshop book on Polyagglutination from 1980 that has some preparation and testing procedures. Very good reference book and I think even Dr. Bird had a chapter written on the development of lectins. We made a lot of the reagents that are com
  13. Wow, it's been awhile since I have thought about En(a) antibodies! From what I remember from the 80s there were about 3 or 4 groups based on the antigen site's susceptibility to trypsin or ficin? I believe John Moulds and Wolfgang Dahr were working with some of these variations. Peter Issitt also had some excellent review publications on the MNS system. Can't remember the clinical significance with regards to pregnancy and HDN. I agree with Mr. Needs recommendations and hope that we see follow up information on this case. What were the titrations and/or doppler readings' results? Was
  14. "Run Forest, Run" But seriously, Mr Staley's last paragraph was very preceptive and to the point. Remember you were a staff tech too! Work at the bench periodically, walk through the lab and talk with the staff. Most techs want to do good, be heard, offer ideas and get a little recognition. And I'll end how I started, your days are "like a box of chocolates, you never know what your going to get". Surprises happen every day in transfusion service, that's why we're blood bankers, keep a sense of humor! Enjoy the ride.
  15. As a "recommendation" I believe that leaves room for having another opinion. Even though I have seen only 1 case of TA-GVHD in 30 years of a pre-term neonate, that is one too many. And use of non-irradiated products would not be my recommendation.
  16. Wow, since retirement and having time to review past posts, I found a missed opportunity to respond to Galvania's comment on my LISS/gel column comparison. I agree they are different "methods" however, atigen- antibody reactivity does take place in an ionic environment. That being said, the LISS tube test requires manually added LISS, while the column technologies the gel or bead matrix is prepared by the manufacturer for you. I haven't seen the actual composition of the different column matrixes and their ionic strength, but they must have one. Although, in the late 80's we could actually
  17. Sorry, I cannot not have a question about this practice. Are you serious? A "neonate" is a general term. A neonate that is requiring transfusion is not a normal occurrence and "top-off" transfusions should not be considered normal practice. Transfusions should be considered carefully especially for neonates and the chance of TA-GVHD. Irradiated leukodepleted blood products should always be used. The risks of transfusion of irradiated red blood cells based on age of the unit prior to or afterwards of irradiation is another discussion and a medical decision based upon the patient issues and
  18. Sorry I missed this discussion, it was very interesting. Since an email sent out re-opened this discussion I would just make a brief comment. HDN is a terrible outcome for the child especially, and also the mother and family. Not using antenatal RhIg is medical negligence. Not giving a potential D negative female/mother RhIg is close behind. It has always been a challenge with our anti-D reagents to deal with interpretation of weak reactivity and females of "child-bearing" age. And our testing methods have improved over the years. However, with the advances in molecular biology is ser
  19. I somewhat remember that early on with the LUI freeze elution there were some attempts to elute non-ABO antibody specificities. At that time some suggested an additional source of protein and/or a minimal "LISS" environment might help with detecting these other antibody specificities. I'm not sure it worked out too well and other elution methods were much better. We just used for ABO elutes.
  20. What? No one questioned NISS? I am impressed. Long Live NISS!
  21. Inspectors are like a box of chocolates, you never know what you are going to get. I tend to agree with those who put forth do what you are comfortable doing for validation and/or QC. If you, your staff and pathologists are ok with your process then an Inspector (AABB or CAP) can have an opinion but they cannot tell you to stop or defend a deficiency. If your documentation has merit then you have a strong case of how you use your expired red cells or antisera for the care of your patients. We all do the best we can with what we have to work with.
  22. Wow this is a late post. I just can't find the time to keep up sometimes. I certainly was not implying that either Duffy antibody would not be able to cause HDN but rather theoretically speaking given the circumstances it didn't quite give the picture of HDN. Again, even that is not a absolute. Looking back at all the comments and possible causes, which all had merit, I failed to see any reference to the possibility of an autoimmune issue and that there may be a possibility that the specificities are part of an newly development of autoantibody complex forming, i.e. mimicking speci
  23. Since this is a accreditation agency group I would like to get an opinion on the requirement of the transfusion service's requirement to re-type the donor units. I do not know if this has been previously studied or written about in the past. Just thinking outside the box... If a donor center were to re-type the unit after the unit had been labeled and the unit tagged as such for the re-typed would the transfusion service be required to re-type the unit? You can't make an argument that you do not trust the donor center since you do not repeat HIV or etc. testing, and those tests are
  24. My initial answer would be no. Haven't seen this happen with a transfusion of 1 unit. Would have to recheck the whole process of the 1st sample (pre transfusion), starting from the collection (correct patient, correct collection site, correct person collecting, correct labeling, specimen handling, specimen testing, etc.etc)…. maybe there was an error along that path and not a immunohematological issue?
  25. Anti-Fya and Anti-Fyb are not well known to cause significant HDFN. I have not seen one, at least. Was there any follow-up testing of the infant? What were the laboratory findings, i.e. bilirubin etc. ? It has been a few months now, have you had a chance to re-type the infant's red cells? Is there a chance that it really was a weak binding of Anti-Fya with Fya+ red cell antigens? If only a gel-card method of interpretation of a "weak positive" as being negative was used, I wouldn't necessarily be convinced that the infant is Fya-. Gel card methods do funny things sometimes.
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