adiescast

We are currently using the ABS2000. It is a good instrument, but it is a batch analyzer and operates much more slowly than a tech. It's biggest advantage is that you can set it up, walk away from it, and get other work done while it processes. We use it only for type and screens. We have ordered a Galileo, which is more of a STAT analyzer (as mentioned above). I have not done a recent cost analysis, but when I originally decided to go with the solid phase, it was considerably less expensive. Immucor did not raise their prices quite as much as Ortho did (although the price increase was astounding, as has been discussed in another thread!), so I suspect that the differential is still there.

We also use our reagents to QC our other reagents. We do antisera A and B against our reverse cells and A,B against our A2 cells. We do anti-D against positive and negative screening cells. We do our check cells against saline and AHG. We do our complement AHG against complement check cells. These are all done by lot number rather than by vial or rack. For the screening cells, we make up an antibody reagent that will react 1-3+ with all three cells in the set (anti-D and anti-c). We test the screening cells with the LISS and AHG reagent by rack to ensure activity in each vial of AHG. For solid phase, there is a positive and negative control for each run. Positive (heterozygous) and negative controls from panel cells are done with each (non-ABO) antisera each day of use. As far as using only positive controls for QC: I think the philosophy behind that is that you will get plenty of negatives in your run to show the negative reaction, but you might not get a positive, so you need to show that the reagent will react appropriately with the positive if there was one present. I would think that the only time that would be a problem is when you are testing something that shows positive for most runs (Like a cellano antigen). In that case, you might want to show that your positive is not false by running a negative control. Just my two cents...

I am interested. Thanks for the offer!

If the Rosys is anything like the ABS2000, you have to do QC with a new lot before you can use it anyway, so you will essentially be performing the parallel QC when you place the new lot on the instrument. If that is not the case, then you may want to have a policy to perform new QC when a new lot is placed on the instrument to cover your lot change.

We did not do a validation for the same reasons.

We also use SDP for infant platelet transfusions. Our blood center has the sterile docker and charges a nominal extra charge for putting the bags on. One concern we have wrestled with is that the aliquot bags are not the right plastic for platelets. How long can platelets stay in this bag before they must be discarded? We try not to aliquot until the very last minute to avoid concerns with the adequacy of the storage bags. Has anyone else considered this or heard anything about how long platelets can be stored in these bags?

Have you considered using washed or deglyced blood for your neonates? One institution I worked at deglyced an O neg unit once a day and gave to all the neonates from that unit for the day. (I don't know if they still do it that way - I've been away from there for years!) The problem with that process is more donor exposure for each infant, but it eliminates the plasma problem. Are you seeing infants develop a positive DAT after giving them blood from your type O units? If you are not, then you may not really have a problem. What actually ends up happening with the infants you transfuse regularly is that you replace their type A or B or AB blood with type O, so the antibodies don't have much effect on them. If you see positive DATs regularly after transfusion, then you are causing a problem and your policy needs to be revised. I'm sure you do not currently do DATs routinely on infants after transfusion, so you would have to experiment with it. This would also give you ammunition when you make your case with the people who think you have three heads (sometimes three heads are better than one! )

What does the infant's back type look like? If they do not have "free" antibody in their plasma you may be worrying about nothing with giving type specific. We still give all type O Adsol units, so the issue isn't big for us. I have a statement in my procedure about performing back types to detect free maternal antibody in any infant that is to receive type specific red cells. NEONATAL.doc

All handled by Pharmacy.

We try to ABO match when possible. We do not test the O units for anti-A or -B. If a patient develops a positive direct Coombs due to one of these antibodies, we give them platelets strictly within their type until the direct Coombs clears.

Does anyone provide information to their patients about the antibodies detected in their serum? If you do, what do you provide?

We do a weak D on 1) Cord bloods when the mother is Rh negative. 2) The patient has autologous blood that is labelled Rh positive (we don't draw donors - if we did, obviously that would be another condition). 3) The patient develops Anti-D (like an antigen type). 4) An obstetrician requests ABO/Rh testing on male partners of Rh negative women with obstetric diagnoses.