yiams

Several years ago (circa 2005) we had two sisters who would report to ER for anywhere between 8 and 12 units of FFP to treat their hereditary angioedema. Their symptoms were facial and airway swelling. We treated them as genuine emergency situations whenever they appeared. They had a brother who asphyxiated due to the disease. No recombinant product or other purified C1 esterase inhibitor product was available to us. The plasma worked but we were always worried about volume overload. No adverse effect was ever reported to us. We did discover that the sisters had been enrolled in a trial for some sort of inhibitor replacement product. They felt that it did not work so they came to us for plasma infusion. When our in-house transfusion guidelines were first developed we were instructed to use freshly thawed plasma, not 5-day thawed plasma, for these patients. Our pathologist had a reference but I'd have to do some digging to find it. There have been several angioedema-related articles published in _Transfusion_ over the years. They have mainly been related to hereditary forms or acquired forms (but not drug-related, to the best of my recollection). Have not heard about this in relation to ACE inhibitors, however.

I'm a little late to the party because my wife and I were on holiday. This post caught my attention because we had an O neg patient with allo-anti-c at our facility in 2015. I've attached a .pdf write up I summarized for our CLS students and any generalist in our laboratory who were interested. This is based on the patient history we could acquire and reports from our reference laboratory and the Blood Center of Wisconsin. Del Type.pdf

Hi, thanks for the response. you can contact me at williard@mercyhealth.com (work) or randy.vickie.williams@gmail.com (home). We're interested in how you documented the transfer of the unit. We've only been live with our Millennium blood bank package for a little over a year and we've gotten rid of quite a bit of paper. We'd like to avoid using paper documentation of the unit receipt at the other end of the tube.

Blood Bankers, I was asked by one of our pathologists to see if there is a US member who uses the Cerner Millennium system AND uses a pneumatic tube system to distribute products. Our pathologist would like to have a telephone conversation to discuss the processes used for distributing blood components. If so, please let me know privately and I'll provide contact information for our pathologist. Thank you.

Why or perhaps How did the protamine sulfate test fall out of favor? I looked through several coagulation sections of hematology textbooks and there is no to minimal references to this test (which should tell me something right there!). What is a good suggestion to replace or substitute for this test? Our laboratory is looking at revising our coagulation testing. This is one test on our revision list but we have a pathologist who is reluctant to give it up. What can I offer him in exchange for this?

I'm just getting to thread a little late. For those of you using buffer cards to perform anti-C3d,-C3b testing, how do you set this up? My assumption would be 50 uL of 0.8% RBCs and 50 uL of anti-C3b,-C3d. Do you place the cards in the centrifuge immediately or do you allow them to stand for 5 minutes before spinning? thanks,

Blood Bankers, I've started considering replacement of our three aging Immufuge II centrifuges. I've looked at a couple of supplier catalogs and I did not find much that excited me (obviously I don't get out much ;-) ) or would fit in our limited area. These would be used on a benchtop for tube ABORh and any other manual tests requiring tube tech. What would you recommend as a replacement for these three work horses? We need something about the same size and they need to be available in the US. Thanks for your input any hints are appreciated.

Blood Bankers, We're finally beginning work for a Cerner Millenium Blood Bank module. We wish to perform electronic crossmatching with this module. We've had a question come up regarding AABB Standard: 5.15.2.2: Two determinations of the recipient's ABO group (from Standard 5.13.1) "The ABO group shall be determined by testing the RBCs with anti-A and anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent RBCs." For other facilities performing e-crossmatching, do both samples for ABO determination need to have Back Types performed? The impression we get from others is that the primary sample has Front and Back Type but the second determination is Front Type only. Is that correct? The way this standard reads it sounds like Front AND Back Types need to be performed on BOTH patient specimens. I should also mention we do NOT have a bar code readers for our blood drawing personnel. Thanks,

Have a look at _Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma_ by de Biasi, et. al. Transfusion, Vol 51, No 9, Sep 2011, p. 1925. There's even CME available for the article.

Don't forget there is a sensitivity issue between gel and tube methodologies with gel technique being the more sensitive of the two. How long are you incubating your tube tests? How long are you incubating your gel cards? A 15 min gel incubation that shows agglutination should have an increased incubation time when moving to tube, probably at least 30 minutes with LISS-AHG tube. This is an issue we've been seeing especially with some of our younger techs who have trained with gel while tube reading skills are not as prevalent as they once were. We missed a weak anti-f by going to tube methodology from gel. As one of the Old Farts in our lab, I picked it up when I did the tube work on that patient.

We've had an MTP in operation for a little over a year. The majority of our cases have been patients where at least a type and screen was done or just finishing when the MTP is called. When an MTP is initiated we send a pack of 4 RBCs, 1 platelet dose (apheresis or pool), and 2 FFP (depends on patient's blood group). We keep 2 group A and 2 group O thawed plasma on hand at all times. We try to keep 4 uncommitted platelet doses available at all times. As soon as that pack leaves lab another similar pack is prepared. We then play leap frog. Pack 2 leaves and we prepare pack 3, etc. We will add cryo pools as they are thawed and become available. The ratios can change as products become available (more plasma thawed, more platelets received, etc.). Our Blood Bank pathologist spearheaded this protocol with the able assistance from anesthesia, EROPD and our trauma and cardiac surgeons. It was a joint effort. We do crossmatch -- eventually -- all RBCs given to the patient. I guess we always thought that was a requirement as long as we had sufficient patient sample available. No electronic crossmatches as this time so we program them on our ProVue. We have noticed that even though we are sending FFP and Cryo some has been returned. They use the RBCs and platelets but not the other two and it's not because the patient expired. So we're working on some education and MTP drills to make sure all involved parties know the products available.

I've been with our laboratory for 30 years. We stock and distribute RhIg. Pharmacy handles the albumin and clotting factors. My wife is a pharmacist at the same hospital. I believe some of the products can be returned, based on some of our prior conversations. Pharmacy is selective about the products they stock, some things but not every factor known and produced.

We had a call from one of our invasive cardiologists about Pradaxa reversal about a month ago. We happened to have a Siemens Technical Service Rep on site working with new coagulation instruments for us. His recommendation for monitoring was an Ecarin clotting time (http://en.wikipedia.org/wiki/Ecarin_clotting_time), a non-FDA approved, research-only test performed at a handful of laboratories around the US. Mabel, thank you for the information regarding Pradaxa. What was the source(s) of your guidelines?

They have to wait for AB plasma to thaw. It's almost faster, once we have a sample, to perform Front and Back types. We've even had times where we've started AB thawing, got the Front and Back done, tagged and handed out group-specific plasma before the AB was done thawing. If so, we convert the ABs to thawed plasma.

We keep 2 thawed group O plasma and 2 thawed group A plasma available. If we have a group B or AB MTP, they have to wait while we thaw the appropriate type. When we first suggested to our blood supplier trying to keep AB plasmas on hand, ooooooo! was there an uproar ;-)