jojo808

Hi all, We had a 78 yr old female O negative pt last year come in as an emergency and got 5 units rbc total, 3 of which were O+ units. We had to switch types due to lack of Rh neg units. Anyway she came back and developed an Anti-D. All D+ cells on 2 panels were 1+. However there was 1 cell out of the panels that had a 4+ reaction. On the 'special/additional' testing column that cell was Mi(a+). Never heard of it, never noticed it on the Ortho panels before. I looked at 2 more panels we had and saw another Mi(a+) cell and tested it and that one tested as 4+ also! Should I put some kind of comment like "probable/possible Anti-Mi(a+) antibody"? Our ref lab does not have this antisera. Thanks in advance!!!

Yes the pedi bags are connected to the parent with a sterile connecting device. And no it is not just a clamp but an aluminum 'clip' in which you, I guess 'crush' or 'crimp' down onto the tubing which cannot be removed without a struggle. Thank you for the replies, very helpful.

Sorry for the late post (years later) but I was browsing and saw this question. Mable our late pathologist used to do as yours. It was always beautifully written. Full of great information that only a true blood banker could appreciate. Our 'new' pathologists are way too busy for that but will answer any questions that any physician has about an antibody identification but boy I miss those Path reviews .... just reminiscing about the good ol' days!

We are not a pediatric hospital but once in a while we have 'special' pediatric heart week cases where these specialists come and fix PDA's an other heart deformities. These are scheduled procedures so we usually have an O neg, cmv neg blood unit with attached 'Pedi Paks or transfer packs'. My question is if we aliquot a unit off the primary bag and use hand sealer clips (we do not have a heat sealer) to split the unit, does that make it an open-system split?? We cut the tubing with scissors cleansed with alcohol. That would make our expiration 24 hours if so. I've looked on the web and a closed system is always defined as "using a sterile connecting device". If we split a unit without the transfer packs attached to it then it is definitely an open split and the expiration is 24 hours however I'm not sure with the attached transfer packs where we are not spiking the primary bag to aliquot off of it but we also do not have it heat sealed, just crimped with a minimum of 3 clips

Not sure if you are still active on this site but if you are willing to share could you send me a template of the card? My email is joann.pacheco@hawaiilabs.com

Could someone explain why would anyone want to use anything other than Monoclonal antisera (which is so much more faster) than AHG antisera?? Would it have to do with sensitivity?? Our Rh's and Kidd antisera are monoclonal (Ortho) whereas our Duffy, S's (Biorad), and Kell are not. It would save a lot of time if we switched over to monoclonal (I'm hoping someone makes them). We do our antigen testing via tube method. Also read some interesting topics here about phenotype testing it with the Gel cards by taking 50 uL of 0.8% cell suspension of patient rbc's and adding 25 uL of the antisera. We would definitely prefer the Gel/card method if I had to choose between that or tube method IAT (we manually wash cells ) . Appreciate any advice

Found in clinic notes: Diagnosis- Lymphoma and mentioning now a probable autoimmune hemolytic anemia.

Yes eluate was done at our reference lab prior to transfusion and thus the warm auto with all other usually significant antibodies ruled out except the Anti E.

After 2nd unit of blood, pt had temp increase ~2C and chills. RN stops the transfusion and we do a complete workup. All pretransfusion testing is correct. Pt had a warm auto with our reference lab prior to transfusion. Ref lab unable to rule out Anti-E. Both units E neg ("least incompatible", sorry for those of you who hate that term). Post reaction specimen looks slightly icteric. Pre-transfusion normal light yellow. Both pre-and post reaction specimens had +/1 DAT's. Post reaction urine amber with 4+ bld (chemical) and 0-2 rbc's microscopic. Bilirubin jumps from normal to 5 something then the next day to 2 then 1.0. Never saw a bilirubin from a true jaundiced pt. decrease so fast. LDH was >500 on pretransfusion so that was no help. Pt is a Pacific Islander with about a total of 16 rbc units transfused within 2 years (i think). Just typing off the top of my head right now. It's not Jk3 according to our reference lab. Sure looks like a febrile, hemolytic transfusion reaction but from what??? Any advice is appreciated.

Although the 30 days would be great for anyone, we cannot guarantee or that our patient's have not been transfused or not pregnant to we are conservative and stick to the 3 days. The pros and cons were mentioned above and the consistency is what we bank on and again it was mentioned there is less room for error if you keep consistent. If you keep to 10 days or longer make sure the pre-transfusion consent/checklist has a signature verifying that the patient has not been recently transfused and is not pregnant! For our surgical patients: They have an ABO/RH, antibody screen drawn with their pre-op labs (anywhere from 1 week to 1 month prior to surgery) to detect any abnormal lab results that may postpone the surgery. Then they get "banded" and crossmatched on the day of surgery with no surprises.

Blood bankers, Just want to take a poll: What kind of patients at your hospital receives CMV seronegative blood products (rbcs/plts)? Note: Please exclude babies 1. Recipients of allogeneic or autologous stem cell, bone marrow or solid organ transplants? 2. Recipients of highly immunosuppressive chemotherapy (eg, leukaemia or lymphoma)? 3. Pregnant women who require transfusion regardless of CMV status? Also, my understanding is that if a person is positive for CMV antibodies, then CMV seronegative blood products are not needed. However, if the patient comes back 6 months to a year later, do we need to do repeat testing to check that the titer is still high enough to fight an exposure? Or is it once a person is positive then that is for life? Thanks in advance!

Just adding my personal opinion here: Although our procedures have us discard the unit in the scenario mentioned, I wish we could take back the (non-spiked) unit, quarantine it, make sure they come back to pick up the unit with at least an hour left (of the 4 hours from issue time). How will I know if they transfused it within 4 hours? I won't, all I can do is audit the unit as to the completion time to make sure the transfusion stop time was within the 4 hours. If you tell the nurses they HAVE to take it back or the unit will be discarded, they will take it back to avoid the guilt of wasting it and put it wherever they will. I imagine it would just SIT on a counter until they can get the IV re-started or whatever the reason is, I'd rather store it in our refrigerator. I understand both sides of the discussion here but we are importing blood now because of our dwindling donor pool and for us, every unit counts. I think the bottom line is the blood should be transfused within 4 hours of the issue time. The recipient should be fully prepared prior to the blood being picked up. Pre-meds, baseline vitals, consent signed .... all should be completed. The delay of transfusion for whatever reason should be very rare, if it happens too often then an investigation should be done.

Thank you

Would you use Polyspecific AHG or Anti-IgG (mono-specific) for this method?

Thank you so much, I am relieved to hear that!! I was initially taught with tube method, with and without enhancement (in the early 90's) and since then, thought that the newer potentiating reagents were somewhat 'superior' to the others. As I have read into more forums I see that they are just different. It's has been made more clear to me!

What do you think about using tube method with no enhancement for Warm autoantibodies?? It states in the technical manual that "antibody detection methods using PEG, Enzymes, Column agglutination, or solid phase red cell adherence generally enhance autoantibodies". "While methods using LISS or Saline tube methods may not detect autoantibodies, but most significant alloantibodies will be detected". I'm asking because we send our workups to a reference lab. However we had a patient with a history of a warm auto, nothing underlying, came in with 2+ reactions (Gel) on both screen cells. Autocontrol was positive 1+ and DAT was negative. We did a panel using tube method, 3 drops serum to 1 drop cells incubated for 1 hour with negative results. Would this procedure be okay? Would it be safe to say there is nothing underlying the Warm auto?? Why would you have to use adsorbed plasma for testing (especially if the DAT is negative).

Another hint about the patient's true H&H is visually looking at the spun down specimen for blood bank. If the MD's office is telling you the Hgb is 6 or below and VISUALLY the hematocrit looks normal, then I would question the sample. Either the current or previous sample. We receive "DRAW and HOLD" specimens from our ER and Oncology Departments. We will start an antibody screen right away when we visually see that the "Crit" is very low. After years of doing this, your eyes get "calibrated" to what a low hematocrit looks like. I know you know what I'm talking about.

We call it "Unidentified antibody" all significant alloantibodies ruled out. Kind of like a "UFO".

No it's not really a suspicion, just a part of our protocol. We culture all suspected transfusion reactions. Hmmm .. reading the responses and not sure if it's overkill. In over 25 years we've only had one positive culture. It was before using the fenwal coupler device. We used to "bleed" the tubing that was used for transfusion, to get our micro specimen for culture. In that incident, the patient had a UTI from Klebsiella. She eventually became septic with Klebsiella PRIOR to transfusion. The culture came back positive for Klebsiella. Fortunately after we cultured the contents inside the original bag (we sent the whole bag to micro at this point), nothing grew out. We found out that the nurse took the blood bag, laid it on the bedside table for a few minutes while phoning the MD for possible transfusion reaction. She then clamped it off after phoning the MD. It was concluded the Klebsiella was from the backflow of blood from the patient's arm into the tubing. Thank goodness the order of events were clearly tracked and documented.

The blood banker does it at our hospital. We use a sampling site coupler by Fenwal to spike the donor unit. From there you cleanse the rubber port on the coupler and obtain your blood sample for culture, all the time using aseptic technique. You can use a syringe with a needle or needleless cannula to access the rubber port.

My first thought was to check that they used the correct Saline solution.

We use "Inconclusive" Antibody Identification, when all significant alloantibodies are ruled out.

JPcroake, when you said that RhIg would give a mild hemolytic transfusion reaction would that be caused by the RhIg being attached to the Rh positive donor cells then subsequently being destroyed???

For future transfusions, if your screen is negative do you still give AHG compatible units? If yes, do you do this for all future transfusions?

Can anyone tell me where I can find references about extending the crossmatch? I think it could be a good thing for us to look in to but I honestly didn't think it was permissible.