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jojo808

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jojo808 last won the day on May 1

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  1. When you say that the antigens are soluble and will inhibit the patient's anti-Lea in vivo, does that mean there will eventually be no Lea antigen on the donor rbc's? And let's just say it is certain that this patient has anti-Lea. Would there (theoretically) be no further problems with the first unit? or subsequent units?
  2. Fast forward: We think the cause of the incompatibility was (maybe) an Anti-Lea. We came to this conclusion because the 2 units that were clean were LeA negative and the other 2 that were reactive with the patient's plasma were LeA positive. This would be the only antigen that did not match the patient's phenotype. Anyway we are hoping our blood supplier can continue to get these (few) donors in. I think I've read in the past where anti-LeA is not clinically significant, but if this is an anti-LeA, it is not being detected by our ref lab who uses solid phase and tube. We use Ortho Gel (we do not have automation yet), soon to get the Biorad IH 500. Can't wait with all our antibodies!
  3. So we did perform the tried and true tube method with Peg enhancement (actually our secondary method) and both units came out a clean negative. The MD wanted to transfuse only one unit and see how the patient does. I'm so ok with doing that. I will try and keep you all posted thank you all again.
  4. I apologize for the delivery of my plea. The patient only has anti-Jk3, anti-E, and anti-c period. The others listed is what he tests negative for regarding his antigen typing. Thank for for the quick responses, we will have a discussion with our pathologist and the patient's MD and decide from there. Malcolm I know you are retired but your expertise is welcome each and every time. I'm just wondering how to result our crossmatches. I guess we can result the units as "least incompatible" (because they are) and enter a comment on this sample such as " Phenotype matched (or identical) rbc's given for transfusion" ?? With phenotype identical blood that is incompatible, would the results of the bioassays, (MMA, ADCC ,CLT, IgG subtypes) possibly show that maybe he has an antibody to a low frequency antigen? Gee how 'unlucky' can this person be? I guess anything is possible.
  5. Patient has the following antibodies: (Pt is B+) Jk3, E,c, He phenotypes K, Fya, S, N negative. Our ref lab found us 2 units that are phenotyped matched, one B+ and one O+ rbc. They are both incompatible, the O+ is 1+ in Gel, the B+ +/-. Auto control Neg, DAT neg (reference lab results). What's our next step??? BTW hope you all are doing well during this time.
  6. Forgive my ignorance but what is the positive reaction you get when testing reagent Anti-A with A2 cells due to??
  7. There is an article from George Garretty called Problems Associated With Passively Transfused Blood Group Alloantibodies that kind of mentions this. Although I feel it is perfectly safe to give out of group platelets, (we have done so for years) my concern was at what point would it interfere, if ever, with ABO/Rh type testing with tube method? According to the article worst case would be positive DAT but again I wonder if it would be detected in the plasma
  8. Hope someone can clear things up for me: 1. Can a type B recipient have 'testable' anti-B, acquired passively via transfusion of a few type A and type O platelets?? Let's say one out of type per day for a week. 2. Does Type B and Type O persons have naturally occurring Anti-A2?? Inquiring minds want to know, thanks in advance.
  9. Previous Quote from Malcom Needs while searching older content on this subject: "In most cases, TRALI is caused by donor leucocyte antibodies reacting with alloantigens present on the patient's leucocytes, although patient alloantibodies have been involved in some rare cases. The antibodies concerned are usually HLA class I and II specific, but HNA antibodies have also caused this". The thread was actually discussing solvent detergent plasma. When investigating possible TRALI, exactly what tests are usually ordered on the implicated donor? (Antibodies against HLA class I and II? And what are HNA antibodies and what's the difference between HLA and HNA antibodies? Aren't they both testing for antibodies against white cells?? Also if donor is found to have HLA antibodies, does it matter to identify them and then test the recipient for the antigen??? I'm a little confused.
  10. Just wondering why most use a 2nd sample only within 24 hours of collection. Does anyone see anything wrong with testing an older sample, say 3-4 days old??
  11. Does anyone audit the units transfused in the OR? How does the individual units transfused in the OR go into the patients record? Does the units go on a flow-sheet and someone transcribes this into the chart? Does the whole flow-sheet get scanned somewhere in the chart? I'm just trying to get as much information prior to a meeting about this. It seems like most are using coolers in the OR which seems 'more safe' than one refrigerator to 'share'. I'm willing to trust the process once it leaves the blood bank as long as that is compliant with AABB and CAP.
  12. I do almost exactly like AmcCord except I do not discard thermometers every year (but it's sounding really nice right now). I also have a spreadsheet with the serial numbers listed and the location (refrigerator/ freezer/ room temp .....) there is a column on the spreadsheet to answer if the calibration was acceptable or not. If the answer is no (>1C from the NIST) then a comment of "discarded" is added to that row. Our old SOP had instructions for correction factors that meant if the thermometer is 0.5 C higher (warmer) than the certified, a label must be affixed to the thermometer that lists the correction factor (- 0.5 C correction factor) which means you minus 0.5 C from that thermometer reading. I wouldn't waste my time with correction factors, all techs will not remember to use it, just discard it and purchase new ones, less headache for you.
  13. Thank you everyone for your responses. As wrong as it sounds, it gives me some peace knowing that there are others going through or have gone through the same battles. And like John stated there are others 'stepping in' and just complicating the situation for blood bank with solutions that make matters worse, not better. I really appreciate the pep talk and I will pick my battles carefully and continue to do the best that we possibly can for the sake of our patients that we serve. I feel better now
  14. I have read several threads, some maybe 10 years ago regarding this matter but I didn't see anyone really addressing the following. My question is does anyone work at a hospital where anesthesia scans in the blood unit prior to transfusion?? According to AABB 5.28.4 "The transfusionist and one other individual (or an electronic identification system) shall, in the presence of the recipient, positively identify the recipient and match the blood component to the recipient through the use of 2 independent identifiers". There is also a similar statement from CAP TRM.41300. We had a near miss several years ago, same situation, different place. One refrigerator being shared in the OR, 2 big cases going on, you get the scenario. To me, it doesn't matter how great the cooler, refrigerator, blood tracking .... there is no fool proof system but can we get close to one? one of the threads addressed the Joint Commissions Sentinel Event Alert regarding blood for multiple OR patients in the same refrigerator among other things (1999). This was 20 years ago!!!! Have we not improved this in 20 years???? Is it that hard to scan in a blood unit? Does it not take more than 5 seconds to do this??? The people making these computer decisions at our facility just can't see how important this is. Geez and in this day and age of computers all I get is "Our computer system cannot currently check this and that and blah blah blah is all I hear. Calgon take me away! Sorry for the rant but I needed to get that off my chest.
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