[Cold antibody reactive with A cells]

Were they able to obtain Lea and Leb typings? Was an eluate performed?

[Resulting A-subgroup blood type in LIS]

Do your users receive a warning prompt that the results entered does not match the blood type "A pos";however,

your users can override the message and enter the blood type along with the results comment?

Yes. If Anti-A1 is rescting at IS macro the ABO reverse type when entered will require a user override.

The overried is entered and the blood type A+ is entered along with internal blood bank comments.

[Rule out low incidence antibodies.]

We do the same. If an alloantibody such as Anti-Fya happens to react with a panel cell that has a low incident antigen we do

not try and find another Fya- cell with that low incident antigen to rule out the possibility of that low incident specificity to be

present. Units will be crossmatched through the AHG phase.

[Resulting A-subgroup blood type in LIS]

We result the type as A Pos and enter an internal blood bank comment that states patient is an A subgroup.

The A1 Negative type is resulted into the LIS. If Anti-A1 is present an internal comment is placed stating how

this antibody is reacting. If it reacts at 37C or AHG then grp O blood is x-matched.

[Transfusion Unit Tag Printers]

We use an old fashioned printer also which generated 4 stickers per blood component.

[Surgery Schedules]

We type out an internal surgery schedule on day shift for the next day surgeries. At this time, previous transfusions, available

autodonors, antigen negative units needed, and samples are ready and frozen(we freeze up to 30 days prior) are all verified.

The second shift gets the revised schedule and goes over the schedule made out on 1st shift to make any revised changes.

2nd shift faxes over to PSS the patients who still need a sample to be drawn.

I believe the last 3-4 months of surgery schedules are kept on file (not sure exactly).

freezing PAT samples up to 30 days prior does allow problems. Sometimes samples are frozen in wrong date, poured off from

the EDTA tube incorrectly, or do not get poured off at all. Some facilities allow refridgerator temp samples up to 21 days long.

So I was curious as to how many facilities separate the plasma from PAT samples and freeze them for the future OR date.

[Inconclusive Reporting]

Pos Antibody Screen gel method

ABID panel all neg

next step: report Antibody as Inconclusive and give gel(IGG) crossmatch compatible units

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility since majority of our patients are elderly. Inconclusive reporting is not routinely practice . Has anyone wrote a procedure suggesting "if all clinically significant antibodies are ruled out", report the Antibody as Inconclusive?. The previous facility I work has this practice but theres no written procedure thats directive to the process. I would like to eliminate unnecessary work but still provide a safe practice.

At our facility we run screens in solid phase. If screen is positive and the solid phase panel is negative we then

test in Gel If Gel screen or panel is negative then we report out a positive screen and enter the ABID result as

"CSRO" which stands for expands out to read "all clinically significant antibodies ruled out".

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

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Here's our procedure if it helps. We had to put an order rule in the LIS canceling the charge for the second typing if on the same day, 3rd party payers did not want to pay.

Very interesting.

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

At the facility I work at currently a second sample is not required.

Where I worked at in 2008, we did. This facilty's name is Holy Family Medical Center in

Des Plaines, IL.

[??Antibody to High Incidence Antigen]

[Most antibodies against high frequency antigens (if not all) are red cell stimulated.

Could this 13 yr old patient have an antibody that is reacting with one of the constituents

in Ortho's red cell reagent? Try testing the patient plasma with washed reagent cells

to see if the agglutination disappears?

[Hmmmm...its probably a COLD AUTO]

With a + reaction after 4C for 15 minutes this is most likely not a cold agglutinin. (Incubation time of 30

minutes at 4C is used in our lab.) Was the positive screen originally seen in gel?

[Solid Phase reactions in Newborn with no Maternal history]

Did you test the baby's plasma uing tube and/or gel. I have heard of a 20 day old infant making an Anti-K

IgM in nature due to an E.coli infection.

[Outdated Red Cell panel - QC]

We keep the last 3 months of 3% expired reagent red blood cells and the last 1 month og 0.3% reagent red blood cells to use mostly for ruling out and rarely for ruling in. We QC the expired reagent cell with the antisera that

corresponds to the antigen we are using the cell for by testing the antisera with the reagent cell, a positive control and a negative control/

[Automation result vs Tube result]

We check for rouleaux in the tube whenever we see all wells of

solid phase reacting 3-4+. I have seen rouleaux to cause this

false solid phase pan agglutination. Gel is our back up and we get negative with gel we report out negative results to the floor but

like others enter in comments to alert the next tech who would

get a future sample.

If we see a nonspecific pattern of reactivity in both gel and solid phase and everything is ruled out in one of the methods we report out "CSRO" : all clinicically significant antibodies ruled out.

[Storage vs. Shipping/ Validation]

All of our coolers are validated once per year.

[Blood bank testing for OB admit patients]

We do a type and screen on only on patients having a C-section. An "extra" pink top

tube is drawn on every OB patient admitted.

[Not the same 5 day thaw plasma discussion]

We use both 24 hour plasma and 5 day plasma. We are a 500+ bed hospital

in the state of Ohio.

[Auto anti-D?]

Anti-LW does not react with 0.2M DTT treated red blood cells

so you could treat some Rh Positive cells and test then with

the patient's plasma. If no reactivity is seen then it is most

likely and autoanti-LW. If reactivity is seen maybe you could

absorb the the patient's plasma with Rh Negative cells, even

though her plasma does not react with Rh Negative cells,

to see if the autoantidody can be absorbed to exhaustion.

This would indicate a mimicking specificity.

Try and find out the patient's primary diagnosis. There are

diseases states where autoanti-LW forms transiently due

to antigen suppression on the surface of the patient's red

blood cells.

[Rh control]

For an AB patient you can use 2 drops of saline with one drop of the patient cell suspension as your

control.

We us a commercially prepared Rh Control reagent. This would be better to use than 6% albumin because the maufacturer puts the same material, minus the Anti-D, as what is in the vial of Anti-D.

The Rh Control reagent can be QC'd daily with the other reagents used for typing.

[Distinguishing between prophylactic and immune anti-D]

The highest titer I have ever heard of due to Rhogam was 32. I would let patient's physician know of

the 256 titer. He or she may want to monitor the baby since it is well above the critical titer for Anti-D.

An increase in a repeat titer(not necessary since the titer is critical) would indicate the presence of an

actively acquired Anti-D.

[QC on panel cells]

This may be dunb, but does anyone QC their panel cells? I saw the thread about using Expired reagent panel cells, and this question was brought up by one of our staff. We QC everything else, but honestly not panel cells. Do you QC all 11, or just 1? Never really thought about this. They just work...

We QC each new lot of panel cells (gel and tube) prior to use using a positive reagent control

and a negative(Monocontrol) on each vial. If we use an expired vial from a gel or

tube panel to rule out or in we QC this panel cell by testing it with the appropriate

anti sera.

[Anti-Colton B alone]

The only Anti-Cob we identified was also present with 3 or 4 other alloantibodies.

[Blood Conservation-Best Practice articles]

The website Pub Med may have some helpful abstracts. Search for an article using Transfusion Trigger.

[What Would You Do??]

Anti-K appears in patient plasma often times when an antibody against a high frequency

Kell system is present. Often times this Anti-K is a mimicking antibody. To see if it

is a true Anti-K or a mimicking antibody one can absorb the eluate with a K- absorbing cell.

If it is mimicking the antibody will be absorbed to exhaustion. If the Anti-K does not absorb out with the K- absorbing cell then it is a true Anti-K.

[Rh Enigma.]

It's real possibility that the baby's phenotype is a result from donated eggs. Recently, I typed a cord

blood as Group AB and the mom was Group O. The RN taking care of the mother said that she had IVF

with donor eggs.