Bb_in_the_rain

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

We just got our first anti-CD47 out here in the sticks on a patient who went to Seattle for a clinical trial.  That drug is Hu5F9-G4.  No other name yet.  It interfered with her reverse as well as all gel testing.  We did a 30 minute saline screen and it was 4+ at 37C but negative at IAT using Immucor's anti-IgG which doesn't react with IgG4.  She was antigen typed before starting treatment so we got that information and gave her K and Fya negative units (lucky she is positive for most antigens).  We called them incompatible because we have not validated the Immucor anti-IgG as our test of record, the screen was 4+ at 37C and because the drug causes the patient's H&H to drop so I wasn't sure that the units would be certain to have normal survival.  I didn't expect to get one of these for a few more years since we aren't in a big teaching hospital region.  It would have been nice if the big center had sent her home with information that she was on this and instructions to tell the blood bank. We lucked out finding clues in Epic's Care Everywhere so we called the Seattle blood bank.

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

Ortho Confidence

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

I am sorry I apologize for  failing to realize that there may be more than one blood group recombinant proteins available for use in immunohematology. We may be talking about different recombinant proteins. The protein that I was thinking about is soluable CR1 recombinant protein (Mould JM, et al, Neutralization of Knops system antibodies using soluable complement receptor 1), which may be different from that of recombinant glycophorin protein by Schawalder A et al.  Therefore, when I made up the result that "rRBG-treated plasma was positive", I meant to exclude antibodies to Knops and Ch/Rg blood group proteins. 
I also failed to mention that the suspect would be anti-EnaFS (but not Anti EnaFR or anti-EnaTS, which I almost have forgotten about since I have not seen those before). In this case, I suppose we can throw in anti-Pr to the mix of possibilities (if the patient's cell is glycophroin-deficient, with autocontrol negative, long shot??). 
Thank you very much for an opportunity for further learning. Awesome as always!!! 

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

Are you saying it is anti-Ena, or anti-Ge2/anti-Ge4?
The reason I ask is because not all examples of anti-Ena are ficin sensitive, some are ficin resistant (see page 110 of Reid ME, Lomas-Francis C, Olsson ML. The Blood Group Antigen FactsBook.  3rd edition, 2012, Academic Press), but you also said that the antibody was not inhibited with rBGP, and yet there are Gerbich specificities available that would inhibit these antibodies (Schawalder A, Reid ME, Yazdanbakhsh K.  Recombinant glycophorins C and D as tools for studying Gerbich blood group antigens,  Transfusion 2004; 44: 567-574) and could even distinguish between the two specificities, as Ge:2 is on glycophorin D and Ge:4 on glycophorin C.

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

Most transfusion practices in neonatalogy, including this one, are not evidence based, but rather empirical expert opinion.  The use of reconstituted whole blood is more historical than anything else.  A unit or two of recently collected (perhaps 7-14 days) whole blood would probably be as rational.  One might check the potassium before using to make sure it isn't super high.  That is the rationale for washing a red cell.  It removes potassium from hemolysis during collection and storage, and makes the red cells more likely to absorb potassium once transfused.  It's definitely more useful if the baby is hyperkalemic to begin with.  Otherwise, whole blood would be fine.  The reason for using plasma is fear of hypocoagulability, which is probably mostly mumbo jumbo for small exchanges, but might be more of an issue for larger exchanges (2 or more blood volumes).  There is no real proof that any of these approaches is superior or inferior.
Calculating the hematocrit is a case of weighing the red cells and measuring their hematocrit and then diluting accordingly with plasma or albumin solution (5%).  You don't want a hematocrit higher than 40 in the exchange as normal neonates do not have high hematocrits and oxygen delivery is actually worse at hematocrits much above 30 in experimental models.  In this case, more is not better as far as anyone knows.  Once again, this is expert opinion not evidence based.

All the DTT treated cells were still positive so that should rule out Darazalex.  I wonder about the new one anti-CD47?  Has anyone run into it yet and do we have any way of coping with it yet?  Does it have a name yet?
I was thinking anti-Fy3 or anti-U because of the ficin testing results, but the phenotyping is wrong for that, isn't it?
 
 
 

No you charge for the product, then each process.  So the HCPCS for leukoreduced platelets, washed is P9035 just like non-washed but you have 2 procedures codes in your CDM to include a larger charge for the washing then you add the irradiation using CPT 86945.  For example a regular platelet unit is procedure code 63877 and is priced at $450 but when it's washed the procedure code is 68309 and you charge $611.  We have our computer system built so that if the product code is washed then it charges the procedure code for the $611 but if it's not washed it charges $450.  Unfortunately there's only a P code for washed RBCs.

It is with utter devastation and enormous regret that I have to pass on the sad news that Prof. George Garratty, one of the nicest and most intelligent people I ever had the honour of knowing, passed away on Monday. May he rest in peace.

For the simular case we had, all we did extra was a 30 min, 37 C settle test (unspun) to resolve the positive reverse A cells (A patient).  We did not see a point in doing anything else--the gel screen was negative.
Scott

What about genomic D typing this patient to see if he is Weak D type1,2 or 3? If he is, transfuse R1R1 units? 

Since it is widely publicized to consider Weak D Type 1,2 or 3 as D+, I think it will be a good idea to document anti-D production in Weak D type 1,2 or 3; at least as an abstract to professional organization if not as a full case report. Each case may count as "exception" and if there were too many exceptions, the hypothesis (or proven theory) may be challenged.  That is just "my feeling" anyways. I can be very wrong since I am not an expert . 

We have had some colds, non-reactive in solid phase but reactive in tube. In above case, I would approach it by performing antibody identification by tube method. (since I am conservative) 

That came up at an AABB session I attended last year. Policies seemed to range from 1-2 units up to 6-8 units of incompatible plasma. Some policies specified a time frame as well as number of units - X number of ABO incompatible units over X number of hours. I was hoping to hear some kind of concensus, but there didn't seem to be one from the comments I heard. Do your research, draw a line in the sand for what you think is reasonable, and write your policy accordingly. Since the standard does not spell out what reasonable is, you get to decide.

There is every chance that the UK may be to blame for this.
The MHRA, our equivalent of CAP (for want of a better way of putting it - maybe Mafia is the correct word, I don't know) have had high level meetings with people in the USA, and they have exchanged ideas as to how to make our job even more difficult and beaurocratic (sorry, "safer", and with a higher degree of "quality", I meant to write), and we have had this rule in the UK now for some years. I would not be surprised, therefore, if they have infected your Quality System.

I was thinking about a 5 screen panel by SIAT or GEL. If everything reactive I will set up some cord and group A and B cells .