Bb_in_the_rain

During the serology workshop in recent AABB meeting, there was a presention from NYBC where HU5F9 clone was adsorbed out with red cells (3 cells /differential adsorption) was performed to mitigate this problem. There was also an abstract poster where HU5F9 clone was adsorbed out with platelet. Have you tried any of these adsorption methods on ALX 148? Let me try to find the hand out from the workshop and platelet adsorption abstract to see if I can scan it to here.

Here is to the awkward moment when you go on blood bank talk webpage from your work computer, made the sound of broken glass, your coworkers turn around, gave you concerned look and asked "are you ok? was anything broken?": Happy Holiday!

In addition to the scenario that Yan has describe above, I would like to add awarm autoantibody, where the antibody is saturated on the patient's own cells but has not "spill" into the plasma, therefore DAT and autocontrol may be positive but non-reactive with reagent red cells.

Hi I just want to revive this post to the top after reading up on anti-CD47,(Hu5F9-G4, c90002, ALX148, SURPa) clones . I found that not all the clones are IgG4 antibodies as Hu5F9-G4, therfore Immucor anti-IgG may not be a solution for all case scenarios. Have any of you encounter the clones other than Hu5F9?

Thank you for the detailed explanation and laying out all the possible case scenarios. Amazing as always!

It seems to most reasonable to either recruit donors or encourage autologous donation. Had the patient Hct is too low to donate autologous unit or there is no donor turned up by the surgery date (which hypothetically cannot be delayed), would you go ahead and thaw the cryopreserved unit from your frozen bank before a surgery (taking a chance that the unit may be wasted if not given within 24 hours) or would the patient go into surgery without thawed (or liquid) unit available on shelf.

Here is a hypothetical situation that most IRL may have faced. I am just wondering how any of you may handle this. Patient with an antibody to high incidence antigen (say, anti-Jk3) is going to surgery. Surgeon would like to have 2 units available in case this patient needs blood. MMA (monocyte monolayer assay) testing or ADCC (antibody dependent cellular cytotoxicity) assay indicate reactive (clinically significant). What would you do? 1) look for donor for this patient 2) Deglyz one frozen/rare unit right before the surgery 3) other (indicate)

I love made up cases!!! Do we get more information in this case after we answer your questions? Anyhow, here are my thoughts. "Female patient unknown transfusion history" I would perform antigen typing for D,C,E,c,e,K,S,s,Fya,Fyb, Jka and Jkb antigens and see if I detect mixed field reactions. "with mycoplasma pneumoniae" I would like to see the results of direct agglutination test (immediate spin or room temperature) based on this diagnostics using Group O adult cells and cord cells. This antigram only includes IAT where anti-I may not be demonstrable. "which what exclusions and further testing would you perform" I would also like to see the DAT and Eluate from the cells (especially if I see mixed field reactions in my antigen typing) "When would you perform a titre ?" If the reaction with Group O adult and cord were both positive (tested at room temperature direct agglutination phase), I would perform titer using Group O adult and Cord cells in parallel to confirm the specificity of reaction seen in room temperature. Reactions greater than 3+. "If emergency units required with titre greater than 64 what is your protocol ?" I would make sure that transfusion is absolutely necessary by involving medical staffs. Lastly, I would like to perform ABO/Rh typing, obtain hematology test results (H/H, retic count, any abnormal RBC morphology?), Chemistry results ( Direct/Indirect Bilirubin, Heptoglobin), transfusion history (getting a list of hospitals that the patient has been to and calling each hospital has helped me alot in the past to get this information) on this patient, as it is an essential information in all cases of immunohematology investigation. Also, Drug-induced AIHA maybe a far fetch without further information, but something to be included in the back of my mind.

I am just wondering if anybody (any Blood Centers) has been labeling units with historical antigen typings since 2017 FDA guidance came out. For those who are doing these, I am also curious to see what kind of processes you have in place and which antigens you are labeling using historical antigen typing. *FDA guidance document attached* UCM534978.pdf

Most people would sacrifice the entire unit to perform allo-adsorption. In this case, most hospital blood bank would not be able to use up the entire unit fast enough so will be wasting some the adsorbing cells, if not kept frozen (as most hospital do not have a nitrogen tank or ultra low freezer). The other option to use donor unit is to gluderaldehyde-treat and freeze the stroma for later use. The other more feasible option is to type the lab (or blood bank) employees (of course with their consent) to have them as donors for adsorbing cells. When you have to perform adsorption you can use your staff's red cells as adsorbing cells. In this case, it will be an adsorption using the phenotype similar cells with your patient rather than a differential adsorption using 3 cells.

I just answered this question. My Score FAIL

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I just answered this question. My Score FAIL

are you allow to average it?

What is the diagnostics? Is there any indication of hemolytic anemia or abnormality in manual differential (if performed)?

I dont think you need special state licenses for these states. CLIA (Clinical laboratory improvement amendment) defines most tests performed in hematology and immunohematology as moderate to high complexity testing, therefore needs specific education/experiences or accreditation. The easiest way to achieve it is to challenge accreditation exams conducted by ASCP (american society for clinical laboratory science). I have the link to their website below. You can go ahead and make an account free of charge and start looking through education/experience requirements and paperworks needed to challenges the exams. As you have 17 years of prior experience, recommend you to look into BB(work in blood bank), MLS (can work in every area of the lab except for cytology), H (can work in hematology)which are technoligist licenses. Also, specialized licenses SBB (specialist in blood bank, which majority of blood bank lab leadership personnel are certified for) or SH (specialist in hematology, which majority of hematology lab leaderships are certified for). https://www.ascp.org/content/board-of-certification/get-credentialed Please do not hesitate to ask us questions here. We are all here to help you with your transition.

This is an interesting thought. Chelating agents may or may not be the cause. The sources of plasma that I have worked with in this case are EDTA as well. It will be an interesting experiment to see if the serum and plasma from the same donors reacted the say way after being stored for a period of time.

I would love to have a national system where all transfusion/transplant patients are treated equally regardless of their genetic basis, here, in the US. Unfortunately here in the States, blood is often times is looked as a commodity and treated as such, as well as the services that goes with it. I do not even want to start talking about how deficient our healthcare system is.

we charge pre-warm tests as a screen or panel (depending on which one is performed)

It varies by the State that you are moving to. Majority of the US lab requires an ASCP certification at a minimum. May I ask which state you are moving to?

Here is a scenario regarding autologous donation for patients with antibodies to high incidence antigens for blood center. Upon freezing, procedure code CPT-86932 is billed for freezing and thawing preparation When the product is used, product code P9039(deglyc) or P9054(frozen+washed) is billed for freezing and deglycerolization. At this point, does 96932 needed to be refunded, since this autologous donor has already been billed for freezing procedure code?

Whats boring is American quality control departments? Cannot do anything without running into red tapes. :~

Here are my questions regarding this case. 1) Is it acceptable to assume an antibody predominantly IgM if reactive at room temperature, without using DTT or flow cytometry to confirm it? If there are enough IgG, it may agglutinate at room temperature as well. 2) We often time see problems in ABO plasma type due to anti-c and anti-e. We never questioned whether it is IgM or IgG since they are predominantly IgG in nature. Are we going to be "reinventing the wheel" if we DTT treat an antibody that is known to be predominantly IgG.