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Posts posted by Mosaics
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What are your procedures particularly for an intended transplant? Do you ask if it is a solid organ or bone marrow transplant?
Or do you give irradiated blood products to all patients with a history of cancer?
Thanks!
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So the other day, I had an interesting question from a neonatologist. Her question (and I am summarizing, not directly quoting) was in regards to a microscopically positive DAT and if there is less antibody present. Her concern was how aggressively she needed to treat the baby, because the baby was jaundiced at less than 12 hours.
Mom was O pos, baby A pos, and had microscopically positive DAT. So there was some ABO incompatibility
I wasn't completely sure how to explain this, but my co-worker said there was a smaller fetal bleed.
Today, I was reading a text that stated "the strength of the reaction does not correlate well with the severity of the HDN." The text was Modern Blood Banking & Transfusion Practices, 5th edition, by Denise Harmening, page 389.
So in your experience, does the strength of a reaction correlate with the severity of a fetomaternal hemorrhage? How should I explain this in the future? Thanks y'all.
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The population of the USA is much greater than the UK, so that is an educated guess as to why the population of HIV is greater than the US.
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As far as I know she hasn't recently been transfused. She needs to receive O negative blood if necessary.
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We do not have monoclonal anti-A,B where I work.
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To be a devil's advocate, don't your ABO grouping reagents specify in the package insert "tests should not be read microscopically"?
Nope. I perused them carefully and nowhere did it say that. Do yours say that?
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Any more detail that you can provide on the "weakly reacting with anti-A". Was it a microscopic reading? Was it mixed-field agglutination? Were the original results confirmed by a reference laboratory?
Assuming these results are from standard tube tests with polyclonal anti-A and anti-B? I would test with monoclonal anti-A,B. I would incubate the reverse grouping test for 5-15 minutes at room temperature, centrifuge and read.
We use monoclonal reagents in gel. Then it was tested in tube with monoclonal anti-A and was microscopically positive. Our supervisor suggested testing it with a type B patient (possesses anti-A). Do you use this method? This method didn't seem to change the results, as it was still microscopically positive even after incubating for 10-15 minutes at room temperature.
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ANTI-A ANTI-B ANTI-D RH CONTROL A1 CELLS B CELLS
0 0 0 0 0 4+Today, we had these results on a labor & delivery patient with history of type A negative, weakly reacting with anti-A. I am just curious as to your facility's procedures to resolve this discrepancy in comparison.
Thanks!
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For instance, would you consider a reading of 1+ (in tube, anti-IgG) least incompatible, provided no other units were found to be weakly positive or negative, or would you consider it incompatible and keep looking?
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New question: Do you see rouleaux frequently in patients that are type AB? My trainer said she sees this often.
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Your cell 3 and 6 were 3+ in Ficin panel, negative in Untreated panel. Anti-E was enhanced in Ficin.
Yep. I have had previous anti-E's that would react "as expected" in gel, but this is the first antibody where all cells were negative on the original panel.
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I am going under the assumption that you were using gel. I have seen that phenomenon many times,ie, cell 2 1-2+ with a negative panel. Ficin seems to make the E+ cells react, sometimes only the homozygous expression, the pt invariably types as E neg. I have also seen ficin destroy the cell 2 reactivity - I then go into the realm of HTLAs which are ficin sensitive.
You assume correctly. We use gel. Very interesting that you have seen similar results.
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The answer to the question is "way too often"! I agree with Brenda that, all things being equal, the panel should show parallel reactivity with the screening cells unless the antibody was teetering on the edge of detectability. Also, you mention that the E-positive ficin cells reacted. What I didn't see was the rest of them did not react. Please forgive me if a full ficin panel was performed - but be careful about just taking selected cells and testing them with a different methodology. The reactivity you see may not necessarily be due to the antibody you're suspecting - something else could be popping up that was not observable with the first method.
Phil
I was advised by my supervisor to run cells 1, 3 and 6. I will keep in mind to do a full ficin panel.
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You said you "suspected" Anti-E....was that based just on your Antibody Screen? If so, that is what I like to call, "biased blood banking." That may be why your supervisor was upset with you; because you based your panel on what you expected it to be (and I have seen people call negative reactions, positive, because they expected that cell to be positive; so biased blood banking can also be dangerous).
So what was your final conclusion? While antibodies "don't read the book," it still seems a little odd that it would be Anti-E if only SCII was positive but both panel cells negative (unless perhaps you used a different methodology for the panel)? I do see that you said it came up in Ficin. Also, not sure if the outdate of your Screening Cells is different than the outdate of your Panel (i.e. perhaps panel cells were old.....but in general, would still expect them to react unless Antibody Screen was really weak).
Just some of my thoughts.
Brenda Hutson
We used gel for antibody screen and panel. Then, used cells 1 (negative for E), 3 (homozygous for E) and 6 (heterozygous for E). All were in-dated.
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Did you try the Ficin panel?
Yep and cells 3 and 6 were 3+ positive.
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I had one antibody panel that I did that I suspected was an anti-E. It came up 2+ in gel during antibody screen, but negative on cells 3 and 6. What is your hospital's procedure for following up on testing? Reason I ask is that it didn't come up as expected, and I got criticized by the supervisor, and it is bothering me.
As my co-workers and boss say, "antibodies don't read the textbook."
Note: Cell 3 had homozygous expression for anti-E and cell 6 was heterozygous for anti-E.
Have you had negative reactions show up during a panel for something you suspected was anti-E?
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I have 9 months of recent experience in Blood Bank. I am more confident now than when I started, but think I have a way to go. At your facility, are questions well received from new employees?
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I had one antibody panel that I did that I suspected was an anti-E. It came up 2+ in gel during antibody screen, but negative on cells 3 and 6. What is your hospital's procedure for following up on testing? Reason I ask is that it didn't come up as expected, and I got criticized by the supervisor, and it is bothering me.
As my co-workers and boss say, "antibodies don't read the textbook."
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Just out of curiosity.
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What is your facility's procedure for crossmatching patients with a history of anti-Bg? For example, do you use gel crossmatch or another method?
Our location doesn't have antisera for antigen typing.
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Then, presumably, he has a positive DAT due to the anti-A in his own plasma? If so, you did not supply this information.
I asked the supervisor if a DAT needed to be done. She said no.
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Ding, ding, ding! He had a transplant with AB cord blood
- Malcolm Needs, AMcCord, EDibble and 1 other
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Is there a way to review the typings that were B+? Was the pt transfused as a B? I had this happen years ago before monoclonals. We had a donor who typed as B+; in evaluating monoclonal reagents this donor just happened to donate - typed as AB+ with anti-A1. We had transfused the unit to a group B individual - they got and maintained a good increment from the transfusion. The A ag was very weak on his rbcs. Yours is definitely more interesting.
Patient had history of multiple typings as a B positive.
We use monoclonal reagents.
Patient is Hematology-Oncology patient.
Missing Microbiology
in General Information
Posted · Edited by Mosaics
Hi, everybody.
I have generalist medical laboratory scientist training, but for over 2 years I have been specializing in Blood Bank. Although I like Blood Bank, I have often have an "itch" to switch over to Microbiology. Can you offer tips to "wow" a prospective interviewer so I can specialize in something new? My previous experience in Microbiology was as a student 4 years ago. Thanks!