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SMILLER

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Everything posted by SMILLER

  1. Oh, I agree Malcolm. And we do accept slightly or even moderately hemolyzed samples in our lab, depending on the test. My point was, in the case of a possible transfusion reaction, when one has to document pre- and post- appearance of the plasma, it is completely pointless if the pre- specimen is hemolyzed to begin with. Anyway, this thread seems to be more concerned with automated ananlyzer requirements regarding hemolysis. I have found a few papers online, but it seems like they are only verifying that analyzers only begin have problems with at least moderate amounts of hemolysis. Not being experienced at all with what Byfaith is working with, I would guess that if the manufacturer doesn't have a problem with lesser hemolysis, they may be nothing to worry about. Scott
  2. OK. But for a possible hemolytic transfusion reaction, do you not have to compare plasma pre- and post-transfusion? We do (maybe its not required?) If the pre-transfusion specimen starts out hemolyzed, it's not going to matter that your automated analyzer completes it's testing-- the comparison in the case of a workup would be useless. And I would agree with those who say it is generally bad lab practice to test hemolyzed specimens for any test. It indicates that there was a rough draw and the quality of the specimen is questionable for many analytes. Scott
  3. We are still doing it the old fashioned way -- manual gel -- but if the plasma is so dark that you cannot tell the difference between it and significant hemolysis (thinking possible transfusion reaction comparison), I would think you would want to have it redrawn. We let sight hemolysis pass with a comment added to the specimen when it's checked in. Not sure but I would think that would be around 50 mg/dl or less. For an automated platform, can you not consult specimen requirements from the manual? Scott
  4. SMILLER

    Auto-anti-D?

    LOL! I have the same problem with many of these articles! (More than you and others here I think!) Scott
  5. SMILLER

    Auto-anti-D?

    Interesting. One question Malcolm, up until reading this report from our reference lab (most of which could be written in Greek and I would not understand it less) I had never heard of the DAU partials. I saw in one paper that the DAU-0 is thought to be the "primordial" example of this particular clade (if you want to call it that), and that DAU-1 through 5 are further variants on that. This seems to go against the current distribution of the various DAUs (D - African Observed), where DAU-0 is found in Europeans, and all of the others are found in Africans. Would this mean that the DAUs started in Europe and then somehow spread to Africa where they further differentiated? It seem backwards somehow. Thanks, Scott
  6. Truth is important, but the appropriateness of such a statement should be measured by its usefulness. Scott
  7. SMILLER

    Auto-anti-D?

    Results of our reference lab testing on this patient makes him out to be a partial-D, specifically DAU-0. (Nothing about an anti-LW, which is where I was going.) They note that "patients with a partial RHD*DAU0 allele have not been reported to make anti-D, therefor, this patient's reported anti-D is most likely autoimmune." The Genotype is: RHD*DAU0-ce(48C) / RHD*03N.01-ceS. Also they found that the patient is homozygous for the "Duffy null promoter FY*02N.01-67c SNP". Whatever that is. The report seems very comprehensive with lots of information, including references. Scott
  8. There is a catch-22 there for the clinicians when they think an otherwise stable patient needs a transfusion If you think the patient needs blood, just one unit should be adequate; and if only one unit is ordered, why transfuse at all? In general, we require a recent Hgb before routine transfusions. Scott
  9. Any study that challenges the status quo should be met with caution (but NOT with derision I think!) This is an admittedly only a pilot study that, like others before it, suggests more robust studies need to be done. I think it is interesting though because it is from a different standpoint -- that of a vascular specialist or a perfusionist. Scott
  10. Similar to David, above. When a unit is ordered, it is ordered for transfusion. We have exceptions for OR, atypical antibody patients, and things like massive transfusion protocols. Scott
  11. My sense of the "advantages" of lower hemoglobin levels is not that patients thrive because of lower hgbs, but rather that, in many cases, they can thrive with fewer transfusions. Scott
  12. I believe the point of the post-transfusion H&H in this discussion is more to avoid giving another (perhaps) unnecessary unit. I think the consensus is that for a Hgb to stabilize fully, you want to look at it at 24 hrs. However, the H&H done an hour or even a half hour after a transfusion finishes is going to be close enough to make clinical decisions like whether to transfuse another unit. Scott
  13. An interesting look at low verses high triggers for certain surgical patients. http://www.bloodjournal.org/content/early/2019/03/11/blood-2018-10-877530?sso-checked=true Scott
  14. Pretty much our approach here in the US. Hgb is checked after every unit for the more routine transfusions of pRBCs. Scott
  15. SMILLER

    Theranos

    The book by Carreyrou is pretty good. Holmes and Balwani go on trial next summer. Scott
  16. SMILLER

    Auto-anti-D?

    1) The original antibody ID matched an anti-D, as did the eluate. 2) Just one source for anti-D testing. Its a poly-monoclonal blend. and... We are pretty sure the gentleman has NOT had any Rh immune globulin. Genomic testing is, indeed in process, as we have sent the specimen to our reference lab. The forward reaction with anti-D was a strong and clear 4+. A partial or weak D is unlikely. The rest is being processed at our reference lab this week. I will post results here... Scott
  17. We currently have a 50 year old male in house that had an accident that damaged his foot 3 weeks ago. He arrived septic and has had to have an amputation. His ABO/Rh gives a B pos with a 4+ anti-D. His gel screen and panel give 1+ results that match up with an anti-D (all others rules out). His autocontrol was positive at 1+ by IgG, neg for compliment. The eluate results matched the original antibody ID. Presently this patient's specimen is on its way to our reference lab. Previous history at another facility lists him as B Pos, screen negative. As far as we know, he has never been transfused. What are the possibilities (for what appears to be an D auto antibody), and how should he be treated? Scott
  18. Just as a side note (see my post, above), our BB computer system is used by 3 hospitals with two different medical directors and CLIA numbers. Whatever you want to do, you should probably talk to someone at an agency that does your inspections. Scott
  19. Like many systems, we have an ancillary center where all of our outpatient transfusions are performed. Other than releasing products form the BB computer system, they do no testing at all. We ship units from our inventory to them after appropriate compatibility testing. We do all testing at the hospital. We also have two smaller hospitals within our regional system (Ascension), that share our BB computer system. On occasion, they send short-dated units to us. We do not re-type these units. Note that the initial unit typing, whether here or at a sister hospital, is recorded on the same BB computer system. We are FDA/JCAHO inspected. Scott
  20. Someone here will have better suggests than me. In the meantime, we will need more information. Did the patient have a prior history? What antibody was ID'd two months ago? (some antibody titres, like Kidd, can go up and down) If the most recent screen (from "1 week ago") was positive, what happened with the antibody ID testing? Also, what techniques are you using? If your current ID testing is inconclusive, and you have exhausted all of your methods, then you need to send a specimen to a reference lab. Even if the patient is not going to receive blood currently, you will want to know what is going on for future reference. Regardless of current antibody ID, at the least, you will need to screen units for that antigen because of the ID from 2 months ago. Scott
  21. We use the Ortho confidence system with manual gel. We have found that a dilution of 5 drops of Ortho diluent plus 5 drops of 22% albumin plus 50 ul of confidence sera works pretty well to produce 2+ to 3+ reactions. Scott
  22. From our experience, both negative and positive reactions should give a reasonable clearly delineated button after 15 seconds or so. (If you spin patients for 2 minutes, I would think that you would end up with a lot of "snotty" false positives!) Is your centrifuge running at the correct centrifugal force? Is it vibrating too much? You may want to try the process with another centrifuge just to see if there is something wrong with what you are working with in the Blood Bank. Scott
  23. We allow other areas to change BB armbands. We have a form for that that is returned to the BB so we can make the proper adjustments to the specimen ID, tags, computer, etc. Scott
  24. Signature each admission. After discussion, this is usually done by a hematologist. (It is really not that big of a deal "bureaucratically" for us. Perhaps large medical centers have more turf issues with this type of thing.) Scott
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