Dansket

I believe the option statement in the poll "Can be used to confirm donor rbc units labeled group O" is synonymous with yours.

The purpose of this poll is to examine how an anti-A,B test result can be used to make decisions, either procedurally or policy. Use of the word 'can' is intended to mean 'is it valid' as opposed to 'may' which means 'is it permissable by regulatory agencies'.

What is the significance of red blood cells that are not agglutinated by a blended monoclonal anti-A,B reagent?

Cliff, I'll give it a try. Please close this one. Thanks, Dan

I've thrown out a lifeline to Cliff, just waiting for a response.

Without having tested with anti-A or anti-B, can a newborn be classified as group O if a newborn's rbcs are not agglutinated by a blended monoclonal anti-A,B reagent antiserum? Do you confirm group O donor red blood cell units by testing with a single reagent antiserum (blended monoclonal anti-A, prior to transfusion? Would your facility knowingly select and/or issue non-group O rbcs to a patient whose red blood cells are not agglutinated by your anti-A,B reagent antiserum? Do you accept the premise, “A patient can be serologically confirmed as group O if the patient’s rbcs are not agglutinated by a blended monoclonal anti-A,B reagent antiserum?” (I know this is not permissable by the AABB, but my question is posed as 'can', not 'may') Does your current policy allow use of a single test result with anti-A,B as meeting the requirement for a second ABO grouping for a computer crossmatch for a group O patient? (AABB accredited facility must answer 'No' to this question) Are you accredited by the AABB?

Have you tested with anti-A1 lectin? Has patient been successfully transfused with group A rbcs? Current diagnosis?

We are using VS612 without problems.

Which lot#?

That is correct, we have been doing this for years. It makes sense, otherwise, if you specify specimen outdate to the level of precision of hours, you have to monitor for expired specimens on an hourly basis. Typically (with exceptions), we release blood from crossmatch on the morning of the 3rd day after specimen collection.

I agree with you. However, this scenario was intended as an example to pose the question, "Whenever you have a reason to run Resolve Panel B and the K+k- panel cell is agglutinated, can you exclude anti-K if there are one or more K+k+ cells that are not agglutinated?"

We routinely test unwashed cord blood samples on ProVue without any problems.

Is there consensus that anti-K cannot be excluded if a single K+k- panel cell is agglutinated regardless of the number of K+k+ panel cells that are unagglutinated? Using ORTHO Resolve Panel A for a patient with weak anti-D (reacting 2+), anti-K is excluded on the basis of a single non-reactive K+k+ panel cell. If you add Resolve Panel B, anti-K is/is not excluded based on 1 panel cell that is D+, K+k- and 2 non-reactive panel cells that are D-, K+k+? With these findings, would your current policy require transfusion with K-negative red blood cells?

YES, we do

Elin, There was a white paper written by John Judd regarding a comparison of two cell screen and three cell screen using standard tube testing at the University of Michigan. Their conclusion was that differences were more attributable to variation in technique used by staff to resuspend red cell buttons. If you are using standard test tubes, you could make a case for using a 3Cell screen with a staff of generalists. Dan

Is your facility a trauma center? Was there a specific incident that triggered this request? How quickly can your staff issued uncrossmatched blood? Do you use a blood bank computer system? We will issue group ONEG rbcs from our Meditech system with only the patient name, usually John Doe using a customized NPR report. But we are not CAP accredited.

I like the magnetic door seal on Helmer products. Alarm testing is easily done!

There could be several reasons, one is a large fetal-maternal hemorrhage. I suspect that since Weak D testing was not done and given a 2+ reaction with anti-D that patient is Weak D positive.

I think it is optional if you put the calibrated thermometer in air or glycerol. If you do put it in glycerol, it should be a very small volume of 10% glycerol, e.g., less than 25 mL so that it will better reflect ambient air temperature. Our thermometer is in air.

You might review Chapter 1 Quality Systems: Theory and Practice of the current edition of the AABB Technical Manual.

http://www.statspin.com/products_us/Express3.php See this site. There is a link to a study.

A good project would be to challenge the long-standing practice of screening(ABO, Rh and DAT) for HDF/N on every newborn. Start from the endpoint, i.e., which newborns are identified for therapeutic intervention. Is therapy initiated based on the results of HDF/N screening tests. If not, why not. Are there infants treated for hyperbilirubinemia who are DAT negative and ABO compatible with mom? Does the DAT reliably predict which infants will require treatment? If not , then why do a DAT routinely on every newborn?. Just my rant....

Your SBB friend is correct. However, the FDA document referenced is for guidance, it is not regulatory.

This is the gold standard for correct classification of a patient ABO prior to blood transfusion. ABO typing of two independently collected blood samples will detect WBIT (Wrong Blood In Tube). Testing the same blood sample twice may detect testing/clerical errors but not blood sample collection errors. The reason we do this for plasma components is standardization of the process (establishing the patient ABO type) that minimizes the number of decisions to be made prior to issue of blood for transfusion. We follow the same process (specimen collection and pretransfusion testing) for Type and Screen or Type and Crossmatch. The decision to collect a second blood sample is made by the person doing pretransfusion testing, not the person doing specimen collection. Unsolicited blood samples are rejected and discarded.

To properly comment, it would be useful to know if compatible crossmatches are demonstrated without prewarming to thoroughly characterize the patient's antibody reactivity. Given a negative antibody screen and that the purpose of prewarming is to minimize false-positive agglutination, I don't see the point in prewarming crossmatches. The comment in the computer may have been appropriate at the time, but the transient nature of patient antibody requires that information be updated as situations change. I would discard a specimen that had been incubated at 37C for over 6 hours. Our SOP requires that specimens be stored at 2C-8C when not being tested. Based on your narrative, it seems that the processes in your laboratory foster problems rather than solve them, e.g., incubator not located in blood bank, no visual indicator posted in blood bank that a specimen is being prewarmed, computer comments out of date, prewarming an entire blood sample rather than an aliquot.