SMILLER

There are a couple studies I know of;
 
ABLE - global but most are in Canada (&US?) started in 2008 and hope to have enough patients by end of this year -  synopsis: http://www.controlled-trials.com/ISRCTN44878718/
 
one out of McMaster University in Toronto - link to vidio presentation when just beginning  http://mediasite.otn.ca/Mediasite/Play/03201e7ac63d42e7a32c6d41704e9e441d?catalog=fd668812-d87c-47f9-b1ba-6d979fed9af4
 
One completed on babies - I believe did not show a benefit ARIPI - I can find info at work if you'd like

I attended a Red Cross seminar yesterday and this was one of the topics.  Many confilicting reports, no consensus in studies as to what constitutes "fresh" vs "old" rbcs.  2 major studies in progress which may provide further insight.  The Cleveland Clinic original article was by their anesthesia dept . . . the same department did another study (by the director) which concluded that the original study was flawed.  Very interesting seminar.

1. We are a 270 bed community hospital, level 2 trauma center, with a CA treatment center and neuro unit along with ortho nad other med-surg patients.  No OB or peds.  In general , for BB we staff 2-3 techs on days M-F, 1 on nights and weekends.
 
2. One hour for STAT T&Ss, but in general, these are finished a bit more quickly (uncomplicated ones anyway) as long as we get the specimen STAT.
 
3. Specimens are spun on receipt.  We monitor all phases from collection to final test result.  All BB specimens here are drawn by Lab phlebots, except for pre-op patients.
 
4. Manual gel, tube for ABO/Rh.
 
5. At this time we are not reporting TATs.
 
Scott

There are many conflicting studies out concerning the "old blood" issue, none that are definitive yet. So I think the jury is still out...
Which is fine with me, because I don't have enough new blood for everyone.

we run "qc" once every 30 days (more accurately, whenever we get a normal patient - seeing as how we only test 3-5 patients per month).  we also qc a new lot number.  we'll draw a co-worker that we know works if need be.

I'll do my best Scott.

Nice one Scott.  Anti-Csa is pretty uncommon - but you can see now why I say it should go to the Reference Laboratory before it gets urgent.
 
Just to illustrate what I mean, we have been dealing with a sickle cell disease patient (no name, no pack drill) for a while.  We couldn't work out what specificity was there (although we knew there was an anti-M and an anti-Fya.  We asked for further samples (several months ago) to send to the International Blood Group Reference Laboratory (IBGRL), but none arrived.
 
Late last week, we received a further couple of samples on the patient, who had an Hb of 69 g/L, and we still couldn't work out what was there.  They needed blood urgently (fortunately, the patient settled) because we then had to send the sample down to the IBGRL as urgent.  NOW, they are GOOD!  But, even they took a bit of time over this one.
 
The provisional report from the IBGRL is that this patient has a (papain) enzyme auto-antibody, an anti-M reacting at 37oC, an anti-s, an anti-Fya and an anti-HrB!!!!!!!!!!
 
Now, we have to get -D-/-D-, .D./.D. or Rhnull blood (rare enough in itself), that is also M-, s- and Fy(a-).  oh, and he is group O as well, so that cuts things down too!  We have none in the UK.
 
The patient has had no transfusions since the last time we saw him (so all of these antibodies were probably present the last time we saw him).  If our request for further samples had been acted upon, then we would not be in this position now, because we could have got it all worked out before his latest crisis.  Now, we are working as "crisis management".
 
Can you tell that I'm not happy?  Humph!!!!!!!!!!!!!!!!!!!
 
       

Scott, I can tell you my institution would have sent samples to reference with those kinds of reactions. We actually had a patient extremely similar to that last week (reactions in gel/tube from w+ to 3+ but with no discernable pattern that anyone here could identify, as well as a bunch of negative panel cells with no discernable pattern) but the nurse wouldn't draw any more pink tops for us and the patient was discharged without being transfused.

Thanks Malcolm, for your usual succinct and educational response. 
 
In fact, we have sent it out, but mostly to have an additional reference to be able to explain to a physician, should the time come, why we have to have them sign a "release least incompatible form". 
 
But I had not considered the situation that you outlined -- where we could be stuck next time without being able to do our rule-outs and having to dump a STAT specimen on our reference lab!
 
Scott

Hi Scott,
 
I can imagine you (and others) saying, "Well, he would say that, wouldn't he", but the answer is "Yes".
 
The reason I say yes is because this sounds quite an interesting scenario.  By that, I mean that the antibody appears to be strengthening, and it would be best to get the specificity sorted out now, than when the antibody finally decides to show its real muscles, just when the patient requires blood in an emergency.
 
From what you say, the reactions appear to give a sort of "mixed-field" reaction, which suggests either an anti-Sda or something within the Lutheran Blood Group System (neither of which are renowned for being clinically significant), BUT, and it's a big BUT, it may not be.  So you then have the problem that, 1. if it is, how do you know if there is, or is not, another, this time clinically significant antibody lurking under this clinically insignificant antibody or 2. if it isn't, and the patient needs blood urgently, what do you do, as this antibody specificity on its own may be clinically significant?
 
From the Reference Laboratory's point-of-view, I can tell you that there is nothing that makes us bite through 6 inch nails more than a hospital that knows "there is something there", but hasn't sent it to us to identify, and then requires us to identify the antibody specificity in an emergency situation, when we could have identified the specificity (or, at the vey least, had a go at identifying the specificity) as a "cold" case.
 
Just my slant on things!

We try to do 3 rule outs/rule ins for each significant antibody when following up a positive screen.  For antigens that show dosage, we try to have at least one of the rule outs on a homozygous cell. 
 
This may indeed be overkill for many cases. As has been pointed out -- most patients have a negative screen and in these instances we are routinely "ruling out" willy-nilly most antigens with only one or two cells.
 
Scott

I agree with the others.  Besides being an unnecessary expense, sending this one to a reference lab would result in a delay of having blood available.
 
Scott

We require that the blood bank armband number on the unit tag matches the armband on the patient. Therefor, the patient has to be a current admission (with a current ABO/Rh typing) in order to get plasma.
I am not sure that regulators would be real keen on giving plasma to a patient whose ABO/Rh has not been currently verified by testing. At our facility, over the years, we have had a few cases of patients using thier friends or relatives insurance ID card in order to get medical care. They were admitted as another person. Relying on historical data from a previous admission to give plasma in one of these cases would be asking for trouble!
Scott

I would agree that while smudge cells are almost always the result of fragile lymphs, you cannot count them as such since you really do not know. Sometimes PMNs smudge also, they do look different from smudged lymphs.
Smudged lymphs are not unusual in CLL patients and sometimes young children. Some think that once smudge cells dissapear in a CLL smear, it means a worsening prognosis for the patient, as the tumor cells have become more robust.

An older middle-aged woman came into our clinic to pick up her husband's Lab results for a routine physical. The clinic doc looked over his batch of Lab reports and then told her that there was a problem.
"We lost the identification information for two patients. We know that one of the reports is for your husband but we do not know which one, and I am afraid that there are bad results on each".
"What results are those" the wife asked nervously.
"One report shows early Alzheimer's Disease, the other is HIV positive. I'm sorry." said the doctor.
"But, can we repeat the tests to see which one is my husband?'
"I checked with Medicare already", replied the doc, "they will not allow us to repeat the same tests."
The woman, now even more upset, asked "But what should I do?"
The doc replied "I asked Medicare that, and they suggested that you drive your husband into the middle of town and leave him there to see what happens."
"Then what?"
"Well, if he finds his way home, don't go to bed with him!"