dragonlady97213

I just answered this question. My Score FAIL  

When I was in the hospital, we had an instance where a patient was in the ER and the admitting individual "picked" the wrong patient from a list of names only distinguished by different middle initials. Frozen plasma was ordered and when the tube from ER arrived in the BB, the type on the tube didn't match what we had on record. After investigation, it was discovered that the wrong patient record had been initially selected. New type on each encounter/admission is a good idea.

The AABB TM, 18th edition, states in Chapter 22, Perinatal Issues in Transfusion Practice, Serology and Mechanism, "Administration of RhIG during pregnancy may produce a positive antibody screening result in the mother, but the titer is rarely greater than 4 and thus poses no risk to the fetus." If we ID anti-D in prenatal sample, we perform a 1:4 dilution and if the results are non-reactive we have two statements in our report, "The antibody demonstrated a titer of less than 4 in saline at AGT indicating that it may be due to recent administration of RhIG." and "Due to the recent administration of RhIG, the antibody may have been passively acquired. To establish this as the sole cause of the antibody's presence, repeat testing six months post-delivery should demonstrate a negative antibody screen."

Back in the olden days when I worked in a hospital transfusion service, we allowed pre-printed labels, but the date and time of collection and ID of collector needed to be hand written. One of the unfortunate issues with computer generated labels is the amount of real estate allowed for patient names. With some names, especially hyphenated names, either the last name or the first name gets truncated and that can be an ID problem.

We use AntigenPlus, but ONLY for selecting panel cells. I understand you can enter results into the program and it will let you know what you can and cannot r/o, but that functionality hasn't been validated for use (and I'm glad it hasn't). IMHO, automation and algorithm's have dumb-downed our profession some, but that's another whole topic and can of worms. AntigenPlus is a godsend, though, for making selected cell panels since it keeps track of our 9-12 in-date commercial panels and I don't have to rifle through all those antigrams.

The only thing dangerous right now is what's sitting in the WH. ::cough, cough:: ...and now, back to our regularly scheduled program.

@Malcolm Needs Yes, you are correct. Enhancement is not added to the system and the tubes are incubated at 37C for 30 minutes, washed and AHG added. This is only done once we've established we're working with a warm autoantibody.

We incubate for 30 minutes. I have to add a caveat to this. Keep in mind that I work in a reference lab so shaking tubes is what we do 90-95% of the time and my techs are very skilled at it. We also require non-reactivity with at least one double dose red cell for rule out when using saline technique. Chapter 17, AABB TM, 18th edition states; This is why we don't provide guidance to crossmatch with absorbed serum/plasma.

When we come up against a warm autoantibody, we will run a saline panel (in addition to enzyme and PEG/LISS) and if the warm autoantibody isn't reactive in saline, we recommend using saline technique for crossmatches. If there is reactivity in the saline panel, we'll do an adsorption, auto or allo depending on transfusion status, to identify any underlying alloantibodies. If we find none, we communicate that back to the submitting lab. We don't provide guidance to crossmatch with adsorbed serum/plasma as that can give the clinician a false sense of security that the crossmatch is compatible; it won't be because of the warm autoantibody.

I agree, however, it opens the door to hospitals considering nurses as satisfactory substitutes for laboratory professionals. It's hard in some markets to hire a MT/MLS/CLS; I'm thinking rural communities in particular. I don't think any manager with laboratory experience would hire a nurse to perform lab work unless they were forced to by administration or desperation. On the flip side, if nurses are considered qualified to manage laboratories, who's to say they wouldn't consider a nurse for employment. Today's my Friday doom and gloom attitude. I have a bad feeling I'm going to wake up pissed for 3.9 more years.

Resurrecting this dead topic: https://www.ascp.org/content/functional-nav/boc-newsroom/epolicy-news-april-2017?utm_source=Facebook&utm_medium=Social&utm_campaign=ePolicy17&utm_content=APR3#3 It appears that CMS will not reverse it's stand on a nursing degree being equivalent to a laboratory science degree. It's an insult to the profession.

From what I've read, the antibody uses an IgG4 backbone. Using Immucor's GammaClone that doesn't pick up IgG4 alloantibodies should work, but I haven't seen anything verifying that.

Let me preface by saying we haven't seen this in my lab yet. From what I've been able to scrape up here and there, anti-CD47 binds to CD47 on cell membranes and blocks the "don't-eat-me" signal allowing macrophages to destroy the cells. Cancer cells apparently express high numbers of CD-47. They are in phase I clinical trials for treatment of AML. In testing all panel cells react 4+ at RT to 2+s at Anti-IgG. The RT reactivity is also seen in the reverse type. Further testing looked as if papain treated RBCs absorbed the reactivity. Hopefully, we'll see something in the literature soon or I'll see it in my lab and we can "play around" with it. Not sure if that is a good wish or a bad one...

Anyone familiar or have heard of HU5F9-G4: anti-CD47 (mostly looking at the European readers as you all get approval for drugs earlier than we do in the US)? It is in phase 1 clinical trials and I believe it is being used for treatment of AML and solid tumors.

As a reference lab, if we identify anti-D in a prenatal sample and don't have patient history of RhIg administration, we try to get it from the hospital/Doc's office. We also test a 1:4 dilution (no enhancement) at AGT. If it's negative (which most of them are), our report includes a statement, "Due to the recent administration of RhIG, the antibody may have been passively acquired. To establish this as the sole cause of the antibody's presence, repeat testing six months post-delivery should demonstrate a negative antibody screen."