jtemple

What? All this time I have been using the wrong stuff! Ha! SPELL CHECK IS NOT YOUR FRIEND! 🤣🤣🤣🤣

What? All this time I have been using the wrong stuff! Ha! SPELL CHECK IS NOT YOUR FRIEND! 🤣🤣🤣🤣

What? All this time I have been using the wrong stuff! Ha! SPELL CHECK IS NOT YOUR FRIEND! 🤣🤣🤣🤣

What? All this time I have been using the wrong stuff! Ha! SPELL CHECK IS NOT YOUR FRIEND! 🤣🤣🤣🤣

I do not see how a genuine massive protocol can be supported with irradiated products. This is based on experience supporting patients during many massive transfusion protocol in a level 1 hospital, and also working in/with two facilities with three different types of irradiator. The irradiating process is just not that fast. I imagine the practical solution would be to give irradiated blood once the patient's bleeding is getting under control. I wonder if the patients stressed systems would prevent GVHD response? 

Hi Rich,

Yes you can, and, don't forget, under BSH Guidelines, you do not have to give blood that has been tested for the Cw antigen, if the unit is compatible by IAT with the patient's plasma/serum.  It is one of the few Rh antigens that can be given under these circumstances.

Be aware though, that I answer this in the knowledge that you are working in the Isle of Man (i.e. the UK).  This may not apply in other parts of the world (particularly Lithuania and Finland).

ALL Rh antibodies react with red cells treated with proteolytic enzymes, such as ficin, papain, trypsin and alpha-chymotrypsin (well, red cells that are expressing the cognate antigen, anyway), BUT, be careful because most monoclonal grouping reagents, including monoclonal anti-Cw, will often say to be used by either direct agglutination or by IAT, BUT NOT to be used with enzyme-treated red cells, because they can cause false positives.

Most of what I have written above can be found in Reid ME, Lomas-Francis C, Olsson ML.  The Blood Group Antigen FactsBook.  3rd edn, 2012. Academic Press.  ISBN: 978-0-12-415849-8.  The rest can be found in the manufacturer's insert, if the reagent is commercial.

Hope that helps, but feel free to get back if it doesn't.

Seems like a bit of insulation should take care of it. Not exactly sure what that would look like though. But something to slow down that temperature change. I usually sandwich mine in a couple of refrigerated cooler bags. 

The interpretation we use is if the patient is actively bleeding then yes we give them. If not we turn it over to the medical director to decide. We then just document and abide by thier decision. They decide after consult with the attending and lab values. 

Agree with Dr Blumberg. In an abstract from way back, 1996, Ann Church studied the value of an eluate, reference and abstract below (apologies for quality of print). 
A Church, S Nance, D Kavitsky.  Assessment of Elution Studies in Cases with 37OC Reactive Serum Autoantibodies (SA).  Transfusion 1996; 36:161S (Suppl)

I think you do what is practical in your setting. There is no evidence one way or the other for prophylactic use of cold vs. room temp platelets in terms of actual bleeding prevention.  Platelet count increments were the metric used, and we now know that platelet count is a relatively minor contributor to bleeding at counts much above 5-10,000/µl.  So we're all operating based upon "expert" (often wrong) opinion, not actual data.  In general, at platelet counts above 10,000/µl there is virtually no evidence of benefit for platelet transfusion and plenty of evidence of harm (particularly if not ABO identical). So the best clinical decision is often to postpone or eschew transfusion in my view.  The long standing view that transfusion is almost always better than no transfusion is tragically wrong.

That's an awfully big question and I am going to "try" to hit the highlights. PLEASE feel free to add or clarity anything to keep my foot out of my mouth! I will start with the standard Dat is positive. You perform an eluate and it is negative. That points to the possibility of a drug based reaction. It's the policy of some facilities to not repeat the elution if the strength of the dat has not increased in strength or a new allo antibody has been created. The elution can also help you determine if it is truly a auto or an allo antibody by seeing if the eluate reacts with DAT negative auto cells (retic harvested if needed of course). Next, what about the times when the DAT is negative? The auto could be be directed at something that is surpressed or even negative. The antibody might even be a different class of antibody such as Iga for example or perhaps a subclass of IgG that your antisera doesn't pick up. These are just a few things that I will note, quickly. Perhaps we can get Mr Needs to make a few comments. 
 
Jason Temple 

That's an awfully big question and I am going to "try" to hit the highlights. PLEASE feel free to add or clarity anything to keep my foot out of my mouth! I will start with the standard Dat is positive. You perform an eluate and it is negative. That points to the possibility of a drug based reaction. It's the policy of some facilities to not repeat the elution if the strength of the dat has not increased in strength or a new allo antibody has been created. The elution can also help you determine if it is truly a auto or an allo antibody by seeing if the eluate reacts with DAT negative auto cells (retic harvested if needed of course). Next, what about the times when the DAT is negative? The auto could be be directed at something that is surpressed or even negative. The antibody might even be a different class of antibody such as Iga for example or perhaps a subclass of IgG that your antisera doesn't pick up. These are just a few things that I will note, quickly. Perhaps we can get Mr Needs to make a few comments. 
 
Jason Temple 

activated platelets are good for plugging holes in bleeding patients when they are naturally activated and inside the body with physiological limits but those activated outside the body by ice or violent shaking for example, cannot be used , you will never guarantee the good results 

A research team led by NHS Blood and Transplant scientists based in Bristol, at NHSBT’s International Blood Group Reference Laboratory (IBGRL), and supported by colleagues at the University of Bristol, has discovered a new blood group, MAL. 🙌 🩸

They identified the genetic background of the previously known but mysterious AnWj blood group antigen, thus allowing identification and treatment of rare patients lacking this blood group.

Louise Tilley, Senior Research Scientist, IBGRL Red Cell Reference at NHS Blood and Transplant, said: “The genetic background of AnWj has been a mystery for more than 50 years, and one which I personally have been trying to resolve for almost 20 years of my career. It represents a huge achievement, and the culmination of a long team effort, to finally establish this new blood group system and be able to offer the best care to rare, but important, patients."

hashtag#NHSBT hashtag#GiveBlood hashtag#SaveLive hashtag#NHSCareers Activate to view larger image,

At my institution. the Donor Network is now asking for 4-6 units of RBCs for organ perfusion for their machine after the organ has been harvested (similar to ECMO for the organ).  Those RBC units will not ever touch the organ donor patient.  Our policy is to always issue them the oldest O Pos units (uncrossmatched) we have on our shelf.  They will rinse all of this banked blood out of the organ before transplanting it into the recipient, and it is added to the perfusate solution to provide oxygenation to the organ during transport from the donor hospital to the recipient hospital.  AABB offered at least 1 very informative session at their annual meeting on this last year in Nashville, and I'm guessing that they will offer more in Houston this year (or perhaps an eCast session or articles in AABB News or Transfusion) since this practice is becoming more and more widespread. The unique nature of the process is proving to be a challenge for hospital transfusion services as far as who places the order, what testing is needed (if any), tracking for final disposition, what kind of records need to be kept because they are not being "transfused", billing of the products, etc..

Recently, I had a situation that bothered me and I wanted to reach out to this knowledgeable group for opinions. A patient was going into the organ donor process. They wanted 4 or 5 units of blood. Unfortunately, the patient was O Negative and I could only offer them 2 units. So, the group handling it contacted a blood supplier and got three additional units and brought them into my hospital. Then proceeded to use them during the course of the process. My first question, should these units come through my blood bank? How can they not have these units tested at all?  No ABO recheck, no crossmatch, nothing. Now according to them as the patient has passed, they can do that. I can find no exception in the standards. Is there something I don't know? 

Absolutely!!
And, no, in my 36 years of blood banking - I have never heard of anything like this........... But, I do think that since they went "around" you, it's not "ON" you or your hospital.  The organ donation group handling the 3 - NON-Blood Bank provided units is now responsible for it.  Although, I do wonder how they will document the fact that the patient received the blood and who will be notified if there's a recall or lookback.....

As a former compliance guy, this is one of my concerns.  It's almost untrackable now.

The standards probably don't apply to post-mortem transfusions.  I cannot imagine why an organ harvest surgery would require transfusion at all, but I'm not a surgeon.  I've had requests to transfuse platelets and plasma to organ donor patients, which we've uniformly denied.  I'd need some explanation of why transfusion, which is pro-inflammatory, immunomodulatory and pro-thrombotic, would benefit the potential organ recipient.  There is so much misinformation, partially promulgated by the transfusion medicine community, of the "benefits" of transfusion, that it is sometimes difficult to explain to clinicians why transfusion is a bad idea in many situations.
 

We have A LOT of outpatients.  Using our Outpatient Dialysis patients as an example - If we do not have a second type on them, we will give O units and do an ISXM on their first presentation.  Upon subsequent presentation for transfusion, another sample would be received at which time we will do a second ABO/Rh and barring any discrepancies - will then EXM units provided the screen is negative.

In my experience gel doesn't pick up Lewis antibodies nearly as well as tube testing. Also, Malcolm, we won't find Lewis antibodies to be lytic if we are using EDTA plasma samples, right?

PEG will be much closer to solid phase - sometimes stronger, sometimes weaker. Incubate PEG at least 15 mins, but you can also extend to 30 mins if reactions are weak. You will not be doing spins post incubation (the 37C spin and read) because PEG really sticks to the tube and it is not recommended by the manufacturers. If you still do the immediate spin read (if you are not dealing with a strong cold agglutinin) - do it before adding the PEG, not after. Also - PEG can be a little sticky even after the 4 washes (do NOT wash for less) - you might find yourselves having to get used to a slightly higher "background" reading in the tubes that is "negative" than you might be currently used to. (I am referring to a microscopic read, if you do that.) PEG will also enhance some colds, but not others.
With Solid Phase warm auto immune antibodies (you see some of these on Solid Phase), we do the DAT in tubes and repeat the Trio in PEG, if those are negative, we consider the patient negative and just do PEG coombs crossmatches and go on. We have been using PEG for quite a while, it is an excellent backup for solid phase. Hope you have a good experience with the reagent too - it is a useful and reliable enhancement media.

Sorry Yanxia, but are you absolutely certain that the bloody urine wasn't a result of the burns, rather than the anti-Lea?

Thanks a lot to you all for your answer and warm welcome.
:handshake