JoyG

Actually, if you look back at the responses you will see that the best answer is all three in the proper sequence.  

A - to find out the specifics of the problem - personnel may not talk in front of supervisor, so this needs to be done 1st.
B - to get the other side of the story - if there is one.  Don't spring a meeting on the supervisor with other personnel present without discussing problem 1st. 
3 - to work things out - if possible.

We take the temperature of the unit when it is returned no matter how it was sent.
This has become an issue here in the US and the FDA considers these units 'in storage' if they are not moving so the restriction is 1-6oC.

Congratulations! Well deserved!

We issue O Positive for uncrossmatched male and female >50 right off the bat. 

We reached out to the trauma team and discussed with them.  We discussed that we use non group platelets all the time, we studied the affects to these patients once we made the change in 2014 to present with no adverse concerns with the patient.  When it was approved by trauma, it was made into our MTP protocol and emergency release protocol.

We reached out to the trauma team and discussed with them.  We discussed that we use non group platelets all the time, we studied the affects to these patients once we made the change in 2014 to present with no adverse concerns with the patient.  When it was approved by trauma, it was made into our MTP protocol and emergency release protocol.

To my knowledge there is not a shred of evidence that titers (or titres:)) have any clinical benefit in this situation. We are treating ourselves, not the patient. I understand the need to "do something."  In our case, our something is always giving ABO identical platelets, or, when this is not possible, we wash group O platelets.  Titer/titre then becomes a moot point. 
I also get that blood bankers hate to wash anything, especially platelets, but we have randomized trial data this improves survival in younger patients with leukemia.  Also avoids positive DATs, hemolysis and refractoriness to transfusion.  A culture change is needed in which we accept what we've know for decades. Transfusing a group O red cell (or platelet) to a non-O patient can very rarely result in fatal hemolysis. 
Why we keep doing this despite the ability to avoid this rare fatal complication is a mystery to me, except for inertia and inconvenience.  Of course a long standing practice that we assumed completely safe without a shred of data is hard to change.  But the evidence is quite clear that group O platelets and rbc are not universal donor unless you accept a small but real risk of death for the patient.  Not a practice to be defended in this day and age.  As hard as it will be, I hope we will all start doing that which is best for recipients.  Not what is best for inventory control or reducing wastage, which are important but lesser values.

There is no standard that requires a transfusion to be started within a certain time frame from release. 
the only timing that is critical is that the unit needs to be complete within 4 hours of release.

I took the BB (ASCP).  I had my MLT, went back to school for my bachelor's but had children and it took me 7 years.  Rather than try to study for the whole MLS, I took the BB and C (because those were the two areas that I worked in directly) then took my SBB.  For the BB (ASCP), if you work in the department and study the Technical Manual, you will be fine.  The SBB is much more difficult!  Hope that helps.

We consider Anti-DARA/CD-38 as a clinically INsignificant antibody.  Computer will allow ISXM/ELXM if current ABSC is negative and AB is insignificant and the workup is complete with no other underlying clinically significant antibodies.  We've had about 25 patients and transfused multiple times over the course of the year with no adverse events.

We consider Anti-DARA/CD-38 as a clinically INsignificant antibody.  Computer will allow ISXM/ELXM if current ABSC is negative and AB is insignificant and the workup is complete with no other underlying clinically significant antibodies.  We've had about 25 patients and transfused multiple times over the course of the year with no adverse events.

We consider Anti-DARA/CD-38 as a clinically INsignificant antibody.  Computer will allow ISXM/ELXM if current ABSC is negative and AB is insignificant and the workup is complete with no other underlying clinically significant antibodies.  We've had about 25 patients and transfused multiple times over the course of the year with no adverse events.

We consider Anti-DARA/CD-38 as a clinically INsignificant antibody.  Computer will allow ISXM/ELXM if current ABSC is negative and AB is insignificant and the workup is complete with no other underlying clinically significant antibodies.  We've had about 25 patients and transfused multiple times over the course of the year with no adverse events.

We consider Anti-DARA/CD-38 as a clinically INsignificant antibody.  Computer will allow ISXM/ELXM if current ABSC is negative and AB is insignificant and the workup is complete with no other underlying clinically significant antibodies.  We've had about 25 patients and transfused multiple times over the course of the year with no adverse events.

You might find this article form John Judd to be of interest:
Judd, W.J., et al, The Evaluation of a Positive Direct Antiglobulin Test in Pretransfusion Testing, Transfusion 1980; 20:17-23
 
In this University of Michigan study, an analysis was performed of 879 samples with positive direct antiglobulin tests.  Eluates were performed and 83 were reactive.  Most were autoantibodies and a few contained penicillin/Keflin antibodies and a few contained passively acquired anti-A. 
In only 11 of the 879 cases allo-antibodies were detected in the eluate.  After 14 days allo-antibodies detected in the eluate were also detected in the plasma in all but one patient sample that eluted anti-K 17 days post transfusion. 
 
The article states, "One of the six patients whose red blood cells eluted a transfusion-induced alloantibody, but in whom the eluted antibody was not detected in the serum by routine pretransfusion screening tests, had been transfused 17 days before a detailed serological evaluation of the DAT was performed (case 4, Table 3). The red blood cells from this patient eluted anti-Kell. This isolated instance does not warrant an extension of our definition of “recently transfused” to a post transfusion interval beyond 14 days, for to do so would only increase the number of samples requiring evaluation with very little corresponding gain in terms of significant serological findings." 
 
The University of Michigan established a 14-day cut-off for "recently transfused" when determining if an eluate needs to be performed.  We have chosen 28 days as our "recent transfusion" cutoff to perform an eluate.  If the DAT becomes positive within 28 days we will perform eluate, if greater than 28 days since transfusion we will not perform eluate.  The article was written in 1980 and the automated testing methods for antibody detection widely in use today are likely to be more sensitive than those used in the study.

We do the same as EDibble.  Also, if we do not get positive reactivity in all cells with solid phase as in your scenario of 1+ in one screening cell and negative in the others, we perform antibody identification to the extent possible using solid phase and other test methods as necessary (we have PEG and Gel backup).  If all clinically significant antibodies can be ruled out, we call that unexplained and must perform XMAHG.  We have had some of these antibodies turn into real clinically significant antibodies with subsequent draws.  Also, while Immucor does appear to have "fixed" the problem they were experiencing earlier in the year, we just reported a problem with the newest lot that appears to be acting in the same fashion.  Keeping our fingers crossed that it is not happening again!

We do the same as EDibble.  Also, if we do not get positive reactivity in all cells with solid phase as in your scenario of 1+ in one screening cell and negative in the others, we perform antibody identification to the extent possible using solid phase and other test methods as necessary (we have PEG and Gel backup).  If all clinically significant antibodies can be ruled out, we call that unexplained and must perform XMAHG.  We have had some of these antibodies turn into real clinically significant antibodies with subsequent draws.  Also, while Immucor does appear to have "fixed" the problem they were experiencing earlier in the year, we just reported a problem with the newest lot that appears to be acting in the same fashion.  Keeping our fingers crossed that it is not happening again!

Yes, this is quite normal.
Kidd antibodies, as a whole, tend to be IgG, a mixture of IgG and IgM, or just IgM, but the IgG part of the mixture tends to be IgG1 and/or IgG3 (sub-types of IgG that are "good" at setting off the classical complement pathway), so, if the antibody has become labile in vivo and in vitro using anti-IgG, you have more chance of detecting it with a complement detecting AHG.
However, monospecific anti-IgG is more sensitive for IgG antibodies than is polyspecific AHG, and so, once again, yes!

Since group A plasma is compatible with group O and group A patients, group A plasma will be compatible with ~ 85% of your patients (US Caucasian, but even higher % for other ethnic groups).  For that reason, I know of some places that do not even inventory or use group O plasma.  Looking at the efficacy of the products, since group A plasma has higher levels of Factor VIII than group O plasma, you're actually getting more bang for your buck by using group A plasma products for group O patients.  Group O red cell products would continue to be compatible with group O patients receiving group A plasma and group A and group O red cell products would continue to be compatible with group A patients receiving group A plasma.
 
If anyone is still trying to justify the use of 5 day thawed plasma, group A plasma at 5 days has higher FVIII levels than group O plasma at 24 hours. By using group A plasma at 5 days, the O patient is getting an equivalent or greater dose of FVIII than they would if they received group O plasma within 24 hours of thawing.  Have you ever had a physician ask what blood type the patient was before they determined how many plasma products they needed to order?
 
There were some interesting discussions at the AABB meeting about the routine use of group A plasma for massive transfusion protocols when the patient type is unknown but that's a whole other discussion topic.

The independent double check has been something that came out in an article many years ago as a best practice for nursing (I can't remember if was an actual standard for nursing).  I know in one of my previous jobs, because nursing was required to do this independent check for medications, etc, the facitility wanted to be consistent, we required to make it a requirement at issue and administration.  See attached procedure for the independent check required of nursing during administration...
Independent Double Check for the Administration of Blood and Blood Components
 
 
An Independent Double Check as described below shall occur in the presence of the recipient prior to the initiation of all blood or blood components. The independent double check shall be concurrently documented as specified below.
 
 
Participants:
 
Transfusionist    (A physician, CRNA or RN who has satisfactorily completed training and competency evaluation for the PREPARATION FOR AND ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS MA05904 (IIIGen-6)  
Rechecker (A physician, RN , or CRNA who has satisfactorily completed training and competency evaluation for the PREPARATION FOR AND ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS MA05904 (IIIGen-6)  
Procedure:
 
Note: In the event of a checklist discrepancy or lack of agreement with patient consent, immediately return blood or blood component to the Transfusion Service pending resolution.
 
Transfusionist- Read aloud item #1 of the Transfusionist Checklist (□We have reviewed the patient’s signed consent and found this transfusion to be in agreement with any stated limitations.)  
Transfusionist- independently review the consent for completeness, that the consent is properly dated, witnessed and any stated limitations are in agreement with the order and blood component in hand.  
Rechecker- independently review the consent for completeness, that the consent is properly dated, witnessed and any stated limitations are in agreement with the order and blood component in hand.  
Transfusionist- Place a checkmark(Ö) at item #1 indicating that you and the rechecker have verified this transfusion to be in agreement with the patient’s consent  
Transfusionist- Read aloud item #2 of the Transfusionist Checklist (□Recipient’s name and identification numbers on the Transfusion Record and identification bracelet agree.)  
6.  Transfusionist- read aloud the patient’s name and medical record number as it appears on the Blood Component Transfusion Record letter by letter stating each letter, D” “O” “E”, “J” “O” “H” “N”, and  number by number “1” “one”, “2” “two”,“3” “three”, “4”  “four”, “5” “five”,“6” “six”.
 
Rechecker- concurrently with Step 6 verify the patient’s name and medical record number on the patient’s bracelet are in exact agreement with that stated by the Transfusionist  
Rechecker- read aloud the patient’s name and medical record number as it appears on the patient’s bracelet letter by letter stating each letter, D” “O” “E”, “J” “O” “H” “N”, and  number by number “1” “one”, “2” “two”, “3”  “three”,  “4”  “four”,  “5” “five”,  “6” “six”.  
Transfusionist- concurrently with Step 8 verify the patient’s name and medical record number on the Blood Component Transfusion Record are in exact agreement with that stated by the Rechecker.  
Transfusionist- Place a checkmark(Ö) at item #2 indicating that you and the rechecker have verified that the patient’s name and medical record number on the bracelet and Blood Component Transfusion Record are in exact agreement.  
Transfusionist- read aloud Item #3 of the transfusionist checklist (□The recipient’s ABO and Rh type on the Transfusion Record are in exact agreement and those on the unit OR Transfusion Service has initialed the statement: “ABO/Rh discrepancy noted – safe to transfuse to intended recipient”.)  
Transfusionist- read aloud the ABO and Rh type as written on the actual blood component.  
Rechecker- concurrently with Step 11 verify the recipient’s ABO and Rh type on the Blood Component Transfusion Record are in exact agreement with stated by the Transfusionist.  
Note: Agreement is not required if the checklist statement “ABO/Rh discrepancy noted – safe to transfuse to intended recipient” is initialed by Transfusion Service staff..  
 
Rechecker- read aloud the recipient’s ABO and Rh type as written on the Blood Component Transfusion Record.  
Transfusionist-concurrently with Step 14 verify the ABO and Rh type on the actual blood component are in exact agreement with stated by the Rechecker.  
Transfusionist- Place a checkmark(Ö) at item #3 indicating that you and the rechecker have verified the ABO/Rh on the actual component label is in exact agreement with the recipient’s as stated on the Blood Component Transfusion Record OR the checklist statement “ABO/Rh discrepancy noted – safe to transfuse to intended recipient” is initialed by Transfusion Service staff.  
Transfusionist- read aloud Item #4 of the Transfusionist Checklist (□The unit number, ABO, Rh type, and expiration date on the Transfusion Record and unit label agree).  
Transfusionist-  read aloud the component ABO/Rh type, unit number letter by letter and number by number and expiration date as they appears on the actual blood component  
Rechecker- concurrently with Step 18 verify the component ABO/Rh, unit number and expiration date on the Blood Component Transfusion Record are in exact agreement with those stated by the Transfusionist.  
Rechecker- read aloud the component ABO/Rh type, unit number letter by letter and number by number and expiration date as they appear on Blood Component Transfusion Record.  
Transfusionist- Concurrently with Step 20 verify the component ABO/Rh, unit number and expiration date on the actual component label are in exact agreement with those stated by the Rechecker.  
Transfusionist- Place a checkmark(Ö) at item #4 indicating that you and the rechecker have verified the component ABO/Rh, unit number and expiration date on the actual component label are in exact agreement with the Blood Component Transfusion Record.  
Transfusionist and Rechecker-legibly sign your names, title and date in the space provided on the Blood Component Transfusion Record, documenting that the above independent double check has been satisfactorily completed according to the steps above ( See Sample of Completed Blood  Component Transfusion Record on Attachment F).  
 
 

Google for articles on Tango methodology and sensitivity - they're out there. I second the idea of checking with other users. 
 
John's philosophical 'drivel' is right on - nothing is going to be perfect. You'll have to consider whether or not the misses on antibody detection are excessive for the patient population you serve based upon your experiences.

I won't be much help but keep in mind that no technology is 100% sensitive or 100% specific.  Your instrument will occasionally miss something.  I had a lot of problems from the corporate transfusion QA group when we first automated back in 1999.  They expected the instrument to be 100% and it simply was not.  Their expectations were far beyond the abilities of any technology.  I think it was the basic blood banker fear of change.  Luckily they got over it. 
 
It's always an excellent idea to check with other users for their experience and input.  I'm sure there will be a number of folks that can provide you with some real info and not just the philisophical drivel I provide. 
 
Good luck. 

If the conclusion is  weak reaction  because disease( such as antigen loss or antibodies loss ), low immunity or blood dilution or age youger than 6 month, the next time we will do the investigation again.
Because those factor can change , and if it still extist to influence the result, the ratio is not very high.

I only do it when deemed important. As I do most of my typings in gel it is fairly easy to detect mixed-field populations and so look at those typings in a different manner than a clean negative or positive result.