jssa1891

I am interested in how the following scenarios would be handled in your reference lab: [scenario 1] Test tube with PeG additive: negative panel at AHG. Gel panel: 1+ to +w with all cells. DAT and autocontrol are negative. What additional testing, if any, would you perform? [scenario 2] Same as Scenario 1, except: Autocontrol and DAT are positive. What additional testing, if any, would you perform? Thank you for your opinions.

As a Reference Lab tech, I can tell you that we do not hang antibodies onto patients lightly, especially antibodies to low incidence antigens. We are usually the party who has to find compatible units for the patient and antisera for lows is either very expensive, unlicensed or non-existent. A hasty antibody ID would only make more work for the Reference Lab in the long run. More important, like our hospital-based brethren, we take pride in the work we do. And we care about "our" patients, even though they are not directly under our care. So shortcuts and incompletely proven antibody IDs are totally unacceptable.

In addition to the antiglobulin prewarm you describe, we also perform a "37 degree spin" prewarm, in which the serum and cells are warmed separately, incubated for 30 minutes, then spun and read. This is done if a "cold" antibody seems to be reacting at the 37 degree incubation phase and we wish to eliminate the interference. There are some antibodies, particularly in the Rh system, that may be reactive at the 37 degree spin phase only. However we have never done an immediate spin prewarm. I believe the number of clinically significant antibodies that would be positive at IS but negative at 37 degrees and AHG is negligible. When reporting out compatibility tests, we specify the type of test that was performed, so I don't think we are misleading anyone by omitting a test at the IS phase.

We require the use of homozygous cells to exclude alloantibodies. The Technical Manual supports the use of homozygous cells by advising the use of "cells known to bear a strong expression of the antigen." It also notes that "many antibodies to antigens in the Rh, Duffy, MNS and Kidd systems" show dosage. I have seen a fair number alloantibodies that could have been ruled out using a heterozygous cells so I think it is a risky practice.

We serve several facilities apart from our main blood bank and I was wondering how often we might reasonably ask them to reconcile their electronic and physical inventories. It seems that a daily reconciliation is a fairly standard practice. Thanks to everyone who shared their inventory intervals!

How often do you reconcile your physical vs computer inventory of blood products? Daily? Weekly? Is anyone aware of CFR or AABB standards that might govern this process? Thanks.

We routinely prepare washed cell suspensions for crossmatching. It just saves some problems up front. The procedure should outline the minimum steps required; washing the red cell suspension could be an optional "extra" step that a tech could choose to do without being accused of not following the SOP.

Because there is a risk of aerosol, even with Hemoguard tubes, we must use either vinyl-backed gauze squares or a face shield when removing the stoppers from tubes.

Well, at the risk of being "old school" I have to say that I would want a microscope available in the blood bank. I agree that it should not be used on every crossmatch, but it is still useful in investigating transfusion reactions (mixed field DATs and antigen typings), possible anti -Sda, rouleaux and the occasional tube test that comes off "funny."

We have been doing immediate spin crossmatches with EDTA samples for several years. We have seen rouleaux only very rarely. However, if the EDTA tube is not well mixed immediately following collection, you could certainly have a problem with fibrin, which would make tests difficult to read and interpret.

Don't forget mom's type has to be figured in too. That's one reason why many places feel that using Group O is simpler.

How are you responding to Ortho's notification that their 0.8% rbcs may not detect anti -K or anti -E? The choices offered were: do nothing; incubate for 40 minutes or dilute 3% rbcs manually to 0.8% at the time of testing. In parallel testing using PeG and gel, we have seen weak to negative reactions in gel with an anti-E that was positive in PeG, and this is using red cells that were diluted with MTS Diluent 2 at the time of use. How long are you incubating gel panels - 15 minutes or 30 minutes? Forty minutes is starting to look appealing to me.

To transfuse platelets or plasma, we require an ABO/Rh on the current admission, regardless of prior history.

Does anyone keep a log of problems encountered with their bloodbank software? For example, the log could consist of a description of the problem, corrective action, resolution and supervisory review. If not a log, how do you track computer problems? Or do you try to track them at all?

What is a "member" vs a "junior member" in this forum? How are these levels determined? Thanks.