KatarinaN

And one more question.. Could it be AGE that is causing this? (advansed glycosylation end-products) Though one research says that AGE is in serum. How about in plasma? Any experiences?

I'm topping this, does anyone have any sources regarding this topic? Have there been any research about connection between renal patients and panagglutinin or is the information based on experiences only?

We also practise two draws policy but make exception with trauma patients. Traumas ABO/Rh is however checked next day from other sample drawn that morning. Two different phlebotomist, two different draws and phleb/nurse or whoever takes the sample must sign it for "proof" of proper identification.

Every patient 5 days regardless of situation and that five days is for minutes. If the sample is drawn 8th of June 2016 10:52 p.m. it expires 13th of June 10:52 p.m. We don't ask any questions and make no exceptions. (Well... never say never in immunohaematology )

Sorry for late answer! In Finland every donor is tested for ABO RhD and K. Other phenotypes are marked on the unit after tested two times (two donations). The most commonly tested other phenos are Rh CcEe, then comes Kidd, Duffy MNS (perhaps around 3000 donors/year) and Cw and for the last but not least Cx, Ula and Lwb (plus ~100 donors/year are tested for Lsa, Ana and WESa). That might sound a lot but we have centralized our production into one place in Finland. Donating sites are all over but blood products are only made, supplied and delivered from one center that is situated in our capitol. Small country

If a patient has any Rh-antibody, we give them Rh-typed blood. Such as patient has anti-E and pheno is E-, e+, C+, c-, K-, we give E-, c- and K- blood. But if the patient is only E- (others positive) we notify E only. So based on phenotyping.

Straight translation for our term is "unknown antibody" but the meaning is close to "antibody of undetermined specifity", so quite same as stated before.

Thanks for everybody sharing info and stories! Now, after info I got, I am even more suspicious the bothering antibody being Sda. Lets see where this goes..

Thank you! Later I discussed this with our head of department and he remembered that in "the old days" there used to be quite much anti-Sda but it has disappeared since gel technique. And I start to ask about that guinea pig urine (Malcom, what is so special in guinea pigs urine that for example cats urine can't do the trick?) since one of my collagues has one..

Hi! We have had mysterious samples that all are reacting weakly, medium or strongly, some with papainised cells and others not and also some in room temperature and others not. We had an answer that it is Sda that is bothering us. Can anyone tell me anything about Sda and/or anti-Sda? It is quite hard to find info about this antigen and antibody and this is totally new thing for me (haven't heard about it at all). Any good articles?

This is how we do this (in my lab I don't have to think about ruling out something that might be difficult, such as C under anti-D, we do the phenos): If the patient has a Rh-antibody we do the phenotyping for Rh (ECec + K) and then give blood according to phenotype. And because of electronic crossmatch, this kind of patient with (Rh)antibody will always be serologically crossmatched (not valid for type&screen) and blood units will be selected according to the phenotype, whether the screen is positive or not. Off course we try to rule out everything we can and luckily we have a lots of cells and panels to use. But sometimes there are situations that someone is hidden behind antibody and then we rely on the phenotype matched blood. Interesting conversation! (Now going to have a cup of coffee and going to solve one antibody and what to do with it. Last time the titers where so high that our machine was contaminated with the anti-D from the sample.. So manual pipetting it is!)

1. Mainly no, but our safety protocols say that in case of emergency (like train out of track, several patients coming, war, gas leak etc.) we need to call a supervisor, so I assume we will catch one if we need. We have their personal numbers in our protocols. 2. If we need to call, we just start calling in the order in the protocol and hope someone will answer. 3. They are basically not "in charge". We tend to handle most of the things by ourselves and there haven't been any issue I know that supervisor needed to be alerted. Although if they are they will be compensated. 4. Yes we do and we have all their numbers in case of emergency and also our lab supervisors supervisor numbers as well as the head of the department (doctor). 5. In the department I work there are maybe 300 BLS (phleb, microb, pathology, chem, hemat). Our company has also two other departments that are smaller.

How far are you transferring the blood products in case of MTP? If we are alerted with MTP it is from one of the surgeries or from first aid ward (acute). There are not that far away so we do not monitor the temperature. We do as goodchild wrote to us, check the time lapse and check the product. It is such a short distances (few hundred meters, 500 m max) and they (usually) don't go outside the building.

We don't use moms first name at all, only last name. So in this case it would be BATES, GIRL or BATES BOY. In case of multiple births we go alphabetical. For example BATES, A-GIRL and BATES, B-GIRL etc. Eventhough this is not unique identification but it works for us. Names aren't too long for identifiers. Edit: Just came to my mind: naming is not that unique in our hospital but since babies will have a unique ending to their DOB, there is only o little opportunity to mix the identifiers/tags. Example: BATES, A-GIRL (070815A012) and BATES, B-GIRL (070815A014).

We give washed RBC's to IgA deficient patients. We also can give it, as Liz0316 wrote, in situations when there is a very sensitively reacting patient. But mostly in those IgA-situations.

I am hunting for tips where to study immunohematology or hematology in university in Europe. I was thinking Bristol or Malta, does anyone have any experience from these universitys? Any other schools? I am BLS in Finland and I don't have any opportunities here to continue my studies and do masters degree (clinical laboratory science were quit in Oulu University few years ago). Any tips will do!

This is interesting conversation for me! Our system seems to be a bit different that systems statet above. We do not have any extensions. Our T&S is valid five days and when the clock is pointing the time the sample was drawn T&S goes out of order and new sample must be drawn. If pt has surgery coming they usually go to phelb one or two days before surgery or the same morning. However we do have pre-op antibody screens and some wards send their patient to phleb for pre op testing that includes this screening. Then there will not be any big surprises. I would be happy to read some references also if there are any or is this based on experience mostly?

What was the reaction in anti-B again, 4?

Wards are informed to return RBC units with transfuse equipments. They also fill a form that orders transfusion reaction investigation so we don't fill any documents. We get phone calls from time to time and we inform them of course. But it is their responsibility to fill the forms and inform us and send units back to us. Mostly wards inform us when they have fill the form and are returning units. They do not call us (I haven't recieved these calls) if they suspect the situation may develop into possible transfusion reaction.

I can not share any form with you because we don't have one. I agree with Auntie-D. In situations where trauma patient has a history with antibodies we use phenotyped (neg for the antibody) RBC's if we have one and we don't have time to crossmatch. If we don't have any we inform the physician in charge and tell that there is a risk in transfusion. It is their decision and we can only give an opinion about the matter (I am BLS). If there is a trauma that needs urgent transfusion before any screenings will be ready (and patient don't have history with antibodies) we give O neg. We do take a samples from the bags to lab and crossmatch them afterwards if the screening is positive. We also inform the ward (by phone) if the screening is positive after the lab results are finished. All trauma blood bags are tagged with patient identifier and there is a note "urgent blood" (don't know how to translate it correctly from Finnish). If the trauma patient is newborn we always have a bag of O neg E-C-K- radiated RBCs that are donated less than 7 days before. In trauma situations we don't have any procedure matresses to follow. We just keep calm, inform the phycisian and the ward and release blood as much as thay want to transfuse. As BLS I can't decide whether it is safe for the patient or not. That is phycisians call.

In our hospital I have noticed that dialysis patients and patients with renal disorders seems to have positive DATs and autocontrols (not all!). I haven't found any research about connections between renal disorder, positive DAT and autoantibodies (panagglutinin). Can this be drug-related? If anyone have more information about this topic I'll be happy to learn.

That is exactly what we do! We do not take the risk and crossmatch all historic and new antibodie patients.

For the topic.. We have electronic crossmatch/issue (we call it Type & Screen and we also LOVE it) so we do the serological cross match for patients who have antibodies and are not valid for Type&Screen. We hold the bags for five days - as long as their X is valid and then put them back to our stock. We do not double tag units. Edit: We can have so called zero-orders. But in that case, if patient is antibody positive, we automatically also do two units for the patient.

Our massive protocol is following: First pack: 4 RBC units, 4 FFP and 4 units of platelets (equal to one bag). Second bag: same as the first ...And continuing as long as the physician in charge tells us that the situation is okay and they don't need any more. Usually one pack is enough to have the patient to stable situation.