kirkaw

@KBBB - that was my take on it also. The units are not labelled as biohazard, why would the cooler be?
:juggle::juggle::juggle::juggle:

Malcolm, I am not certain how to answer your question. I would not venture to contradict a person as experienced as yourself. We do not see a large population of patients with WAIHA who are repeat blood users. If/when we have a WAIHA patient who requires transfusion support over many days time, we would assess each sample. If the reactivity showed marked increase in strength, we would definitely send it out for work-up each time. We do not have the resources to do adsorptions at my facility. If however, the reactivity was similar in strength and IF we had the ability to give phenotypically matched red cells, we would do that as opposed to having the sample worked up again. I have heard of some institutions doing adsorptions every 7 days instead of every 10 days but we do not have a specific policy to this nature. I guess if this ever comes up, I would consult our medical director.
My original comment regarding not working up a specimen for a WAIHA patient who had received phenotypically matched red cells stemmed from a consult I received from a trusted blood banker who said her preference is to give phenotypically matched red cells and never doing another adsorption unlessthe patient has a difficult phenotype, a reliable phenotype could not be ascertained or the patient had a transfusion reaction.

If you do finish the testing it will be for purely academic reasons and you should not bill anyone for it. That's my 2 cents worth.

Our Translogic system has a process called "secure send" where we use a code to send the pneumatic tube and the nurse must use that code to retrieve the tube when it arrives.  If retrieval is not within 3 minutes, it is returned to the Laboratory.  In addition our tube system has a tracking program to show where & when a tube is sent and then received.

I think you should validate your tube testing first as it is classic (may even be the standard). It's not like you are doing a chemistry/hem analyzier. Once you prove your tube reagents work you can validate and compare your results to the automation. There is no need to send anything out. In your validation process you state what you are going to validate, how you are going to do it, the resullts you expect, the results you get, any corrective actions and repeat studies based on your corrrections and then the acceptance/rejection of the procedure. Make certain that if you are going to use differenct enhancement media (albumin, LISS, PeG, etc) that you validate all in the manner they will be used.
Validation just proves the reagents/instrument you are using works in the manner that you anticipate. You can determine how many samples you need to run - a lot of places run 20 . . . but that call is yours.
Enjoy and make certain to save the results for your first inspection/assesment.

Everwhere I have worked uses expired panels to rule out/in antibodies.  The cost of keeping enough in-date panels to work up all anitbodies would be enormous.  AABB, CAP and FDA have all inspected these sites numerous times with no problems and I do know at least once FDA was looking at antibody work-ups.

I did have a case recently where the Dr. wanted emergency release units on a patient we knew had two antibodies. I sent the paper to the ER and made sure I got the signature back before releasing the units.

We have an emergency release form that has a place for the Dr. to sign. We place unit stickers on the form, which we make up in advance for 2 ON units. If the Dr. needed more units, we would attach more stickers on the form, but he just has to sign the form for that number of units once. We also have a yellow manual card on each unit, but that is for transfusion recording. I can send you a copy of our emergency release form, but I think I attached it during another discussion. Try searching for emergency release forms.

A very good reason to use the computer crossmatch instead of immediate spin.
It seems to me that you already know that you have an antibody that doesn't react at 37 degrees, because it doesn't react at AHG which is incubated at 37. I generally oppose "getting rid of" reactivity without knowing what it is, but short of an anti-Vel that uncharacteristically doesn't react also at AHG, I can't see that you would be risking much. Certainly no more than those of use doing computer crossmatches and never finding that incompatibility to start with.

We are a CAP accredited lab and 2x year we compare all our testing methods. We compare gel, LISS, PEG, saline techniques. All methods have detected all clinically significant antibodies.
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