[lab technician criminal check]

Am I reading this correctly? Doesn't it state that it is for non-licensed individuals? If you are licensed as an MT, MLT, CLS etc. it  appears to me that this does not pertain to those employees. I would say the state is trying to make sure everyone is accounted for in some shape fashion or form in the medical field and protect the safety of the patient as much as possible.

[Preparation of DTT for treating RBCs]

Don't reference labs/hospital labs use many things outside of IFU?  These things are used to aide in the identification of antibodies. They are not used solely for ID, as that would be ridiculous. Just like using expired panels, only, to ID antibodies.  Expired panels are only used to help rule in/out.  It seems that validation would be the fact that DTT works when the controls work.

 

[Preparation of DTT for treating RBCs]

If anyone is using PBS (made with pHix) you can adjust your pH with pHix to meet the 8.0 criteria or you could you the base buffering solution from an elution kit. We add this to already prepared PBS until the pH reaches 8.0.  It only takes a few drops in 32mLs.

[Sorvall CW2 plus Cellwasher problems?]

Recently changed from Sorval to Helmer. I am in love. Hoping that we don't have to replace heads as often either. Those things are quite expensive.

[DTT-Treatment of Screening Cells (Daratumumab/Darzalex)]

I am curious to know how this validation is coming along. We do several DARA patients a month, and I'm all for saving my techs time. We have also experienced issue when we try to hold on to treated RBCs longer than a couple of hours.

[Honoring f ag in WAIHA]

We don't worry about the f unless the patient has a true anti-f. Seems kinda overkill to me, but that's just my opinion.

[Cell Washer Regular Maintenance/Checks]

daily - volume fill, wipe down and check tubing

weekly - bleach clean

quarterly - RPR and timer check

yearly - regularly scheduled PM's (change tubing etc)

[Centrifuge RPM/Timer Checks]

Same as everyone else. Still quarterly here too.

[Multiple Myeloma Therapeutic agent Darzalex interfering with testing]

On Friday, February 26, 2016 at 8:25 AM, tbostock said:

Hey Liz.  I want to bring DTT in.  I'm having a hard time finding a source for it; is there any vendor that sells it already pre-mixed, or do you have to get the PBS and powdered DTT?

Terri, to my knowledge PSB and powdered DTT are the only options at this time. There is buzz in the reagent community about manufacturing this reconstituted for resale. Sigma Aldrich does sell the powder form. You can go on their website and find the info or contact one of their engineers. They are very helpful.

[Anti-Kpb]

You could also find out if the patient has siblings and test them for compatibility and then have them do directed donations for the patient.

[To R/O or not to R/O]

I'm with StevenB. Any positive reactions, no matter what screen/panel they are from, have to be investigated.

[Ortho 0.8% Surgiscreen Inconclusive Reactions (VSS517)]

Several months ago, we experienced this same issue but with Immucor's screening cells. Cell III was Wr(a)+. We identified several anti-Wr(a)'s with this set of screening cells. This was more of a "pest" than anything.

[A strange one - baffled!]

Cold would have been my guess. The sister sample could have been shipped in a cold environment and antibody adsorbed onto cells before testing? But other than that, I got nothing....

[Anti M with solid phase on TANGO]

I know as I write this post, I will be different than most. With that being said, the IRL I work at performs type and screens in tube and panels in gel. That way when we detect an anti-M in gel, we know where it's reacting. We do not consider anti-M clinically significant unless it is reacting at 37 or greater. The only time we don't push to ignore the M is when it is a heart patient.

[Unidentified antibody noted on RBC &/or FFP/PFP from Blood Center]

1. I work at a blood center that collects thousands of donations a month. We have our fair share of antibody positive donors who are regulars.  Whenever we identify a positive antibody unit, we work hard to identify the antibody. If the antibody can not be identified, we discard the whole unit. We discard all plasma products from antibody positive donors.

We service multiple hospitals, some small and some very large ones. With that being said, only ONE of those hospitals will take these positive units for transfusion and it is frustrating. Thanks AMcCord for shedding light on your usage of such units. It was so very refreshing.

[titrate allo antibody in presence of warm autoantibody]

_{I agree with Anna.} 

[History Warm auto w/neg ab screen]

No further testing but honor antigens patient is lacking.

[Platelet Screening and Crossmatching]

We use the same rule as standard drawn tubes for any crossmatching (72hrs).

[STAT- what if we can't find a Vel neg unit?]

_{If you are in the United States, several Mid Western states had units available when we went looking. Good luck.}

[How do facilities handle missed antibodies on automated testing platforms? What do you require before returning to using your automated method?]

Please understand that NO ONE method is guaranteed to detected 100% of the antibodies 100% of the time. We have 2 automated machines, 2 semi-automated machines and plain old fashion manual tube testing. We have seen, REPEATEDLY, where one method would detect an antibody while the other one would not. If your instrument failed to call a pos. a pos. then yes there is a problem. If it failed to detect the antibody, then as Anna said, you have to evaluate other possible issues and possibly chalk it up to methodology. Good luck. 

[New Ortho MTS Workstaion]

If it's like ours, we have a tube with saline and a calibrated thermometer in one of the incubator tube slots. Works for us.

[converting 0.8% to 3%]

I'm not sure I would agree with this. I have seen all positive reactions in gel testing but negative in say "solid phase". Could be a method dependent antibody but not necessarily an auto. (ie media used in diluent, gel cards, etc.)

Everything positive in gel, is often due to an autoantibody.

[ABORH testing on Platelet transfusions]

^{Right.  No need to worry about atypical antibodies for platelets (and you are not doing a AB screen anyway!)  But I do think you want to verify the patient's ABO/Rh for each separate visit.  It could just be one of those "lab must have a policy for..." regulations--which would leave it up to the pathologist.}

 

^Scott

 

 

 

^{I agree with Scott, only because phlebotomist  are human and mistakes can be made. I know that confirming ABO/Rh is more important in RBC transfusions, I just think confirming blood type should be a standard across the board.}

[Local newspaper publishes damning report against blood transfusion]

I think this might be the report for Dr. Marik's statements.  Also keep in mind, that most of these patients were already in sepsis status which compounds organ issues with or without transfusions.

 

http://jama.jamanetwork.com/article.aspx?articleid=195310

[Exclusion of anti-E in the presence of anti-c]

In our reference lab, when a patient demonstrates an anti-c, we phenotype for E. If the patient is E- we recommend giving c and E negative units even if we have ruled out an anti-E. Percentages are very high for the development of an anti-E to ignore the E. We don't do the reverse for anti-e because of the lower antigenicity of C (unless of course it's a patient that will be transfused multiple times)