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Everything posted by mrmic
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Is it recommended anywhere to routinely use a microscope for BB? Me thinks not. If there is a significant reason to look for mixed field agglutination and one cannot see it macroscopically, then a microscope in the bb lab can be used. But a microscope at every workstation will lead to techs' overuse and reading at immediate spin......most "true" microscopic only reactions have limited clinical significance and use in a transfusion service should be limited. However, in a Reference Lab we did use it for specimens sent to us, trying to duplicate what the tech in the field was seeing..... An exception, as always, would be; What is written as your SOP...
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I agree with John. It may not be immune in nature but someting occuring during transfusion or dialysis. Aside from mechanical, what is being transfused with the blood, or could it be due to the temperature of the room and/or units, a cold autoimune process? Also, the other person that related it to meds the patient may be taking at or away from the hospital. Interesting case, hope you have some luck with figuring it out and the patient does ok.
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Again, Mr. Needs is right on. One must remember the gel tube is nothing but a minaturized LISS tube test and you will possibly get non-specific reactivity that is not clinically significant. I would say, with some reservations, that a clinically significant antibody would have a much more clear cut reactivity pattern. As far as the "naturally occuring" aniti-E, maybe it is really "E-like" and could be absorbed on E negative cells? We have seen other antibodies during pregnancy develop with the father and child negative for the corresponding antigen...good student project some day.
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I have not seen any current information published. As far as I know it is not harmful to the patients for reasons Mr. Needs has stated. We did accept them back at the blood center and we did have our reference lab investigate. Not for reasons associated with transfusing the unit but to contact the donor for their health considerations. Same may be on meds or herbs that cause the pos DAT or maybe it has some other clinical meaning they may want to contact our Medical Director or their personal physician.
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Du is relative. Can be defined by the manufacturers' reagent makeup (human source, plant source, specific clone(s) used. Can be defined by the manufacturers' test method, tube, card, microwell or solid phase. Can be defined by the red cell being used to validate the test. Whichever "weak D" expression you use to define you test, there will always be a weaker expression show up that you will miss. Now, does it matter you give a missed weak D patient Rh negative blood? Does it matter that you give a weak D positive donor unit to a Rh negative patient? Probably not, but that is another discussion. Grey area is what makes BB fun! Good Luck
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Room Temperature antibody positive cell
mrmic replied to eltonsey's topic in Immunohematology Reference Laboratories
Agreed, as a former Reference Lab manager we used them only when trying to reproduce what our clients were seing so could help them understand what was happening. Why it is still hanging around in the US hospital transfusion services is mystery to me. -
Room Temperature antibody positive cell
mrmic replied to eltonsey's topic in Immunohematology Reference Laboratories
Agree with Mr. Needs. The only reason to do RT is with the xm is to look for ABO incompatibility (If you are doing xm at all). RT incubation antibody screens are not for routine testing. Only for complex antibody workups and Reference labs. -
You might consider reviewing the transfusion policy of your outpatient clinic. Check to see if they are only transfusing with saline, not adding any meds or giving chemo simoultaneously. Actually gone there physically and check, what's written is not always practice. It could be a med problem, which is a pretty complicated workup, not done by many labs. Check what meds the patient is taking as prescribed and if they are taking anything else at home (not prescribed) herbal or some old quinine for leg cramps etc. If the research on the med suggest that one might be involved, see if the physician will discontinue or switch for awhile. Although, there are a lot of antibodies out there demonstrable by one technique or another and could be missed, you want to rule out other non-red cell antibody causes as well. good luck