MERRYPATH

We go by 100 days post last transfusion...alert...they may be transfused elsewhere, take the back type to AHG, the case is sent to the BBDoc for evaluation and they will also check % engraftment. PatO at 60!!!

I am guessing that the rate mom was producing an early anti c, in respose to a c pos stimulation from baby, was slow enough that it was hemolyzed before it was detectable. When the baby was out of the loop the Anti c was no longer taken up by the baby cells and the mom was increasing the speed of production. I would guess that the anti c that reached the baby was all hemolyzed and that is why the DAT was neg. Maybe the question would be, is the baby nursing, how long does the mom produce colostrum that might contain anti c. Is it hours or days etc. if this is not an issue the baby can no longer get anti c passively so it should be fine with c untested. Our protocol is to do a BTYSC (baby type and screen that includes baby screen, baby front type, baby DAT) the only way I can see needing to give c neg is if the crossmatching is done with mothers blood to avoid unnecessary draws on baby, we would do this if we have an unident aby on mom. Now I am confusing myself. PatO at 60!!!

Anyone else encountering Blood Bank problems with the drug Daratumumab? We get positive screens in gel, auto is negative, we repeat the screen in saline. if it is negative we proceed and work in parallel with gel and saline. If the saline screen is positive we send to ARC and they do DTT treatment to get negatives...as soon as we develop a procedure we will do our own DTT treatment. I am guessing 1/3 go to ARC. Our BB Docs are letting us know when they come in system...we do Kell typings before they go to ARC if they have no transfusion history, otherwise we give Kell neg. Big headache, hard to explain, causing delays in people who are used to no problems getting transfusions. So just letting people know that when you start seeing this drug causing problems get you docs to look into it. PatO Now 60!!!

In the last 15 years we have had several people retire from our BB and go to work at the ARC reference lab part time. We are our own hospital systems reference lab so we are accustomed to very complicated aby pictures WITH the added pressure of completing our reference work while operating the usual BB duties. I think also that the older techs have a greater tolerance for misery and don't tend to quit if the pressure is to high. Our local ARC reference lab seems happy to get us even if part time. Many of us tend to stay on in the lab as well...I am soon to turn 60 and have no plans to stop, I like blood banking. The usual reason people have retired is the pressure to do venipuncture and cross-train(or rather to work other areas with insufficient training). As challenging as our Blood Bank and reference work is the venipucture here is also only for those with the "right stuff'. It is just not fun to have to do several hours of venipucture on very difficult sticks after 30 years of not having that as part of your duties. I would bet reference jobs in blood banking would welcome your experience and discipline...blood bankers show up.

I was thinking more about the need for modern RBCs to be at risk if only out 30 minutes...or less. I wonder if the risk is so much less today that the 30 minute rule is only serving to waste a precious commodity. I agree that if the requirement is to keep the units under 10 degrees 30 minutes is the limit but if the actual danger zone is an entirely different temp range then the practice of the 30 minute rule is as obsolete as other practices we squirmed when we gave up...not looking micro is still hard for me. I think the 30 minute rule at least needs to be proven as necessary considering todays cleaner units. I think that using old practices as iron clad leads to stinkin' thinkin' as we know that there are contaminants that thrive at refrigerator temps as well as tropical temps.

I think that the 30 minute rule may be out of date for 2015...at least it seems to have been in 2013. I want to not toss units based on old practices. http://www.ncbi.nlm.nih.gov/pubmed/22845177

Isn't the very act of doing a panel also doing a kind of QC of the panel? Cells being positive or negative in a predictable pattern. When we get no reactivity or unknown reactivity on a panel we run a second panel to confirm the lack of a pattern or to find a pattern. With an allo we may confirm with an antigen typing. We are also confirming with xm of antigen negative units. The whole process of an antibody work up is check and double check.

First we do still use a microscope though now mostly for DATs which we still do in tubes and read micro. We are looking at changing to Poly gel card but I think our first handful of samples done both ways are an interesting mish mash of results. While we are a hospital Blood Bank we also function as the primary reference Blood Bank for the system so I would be squeemish about not having a microscope. We see lots of cold antibodies at times and lots of rouleaux...I just want to SEE sometimes what I am dealing with. As we are now not reading antibody reactions micro I am pretty sure that a 1+ gel is more comparable to a micro reaction than a macro tube reaction. Another issue I have come to find in our dalliance with a few years of Capture testing is that we lost a lot of skill at recognizing the affects of cold aby and rouleaux as they affected Capture testing. When you have SEEN a lot of colds and rouleaux you can SEE how they affect Capture and gels and tube testing. People with only Capture experience came to have unrealistic expectation of what you could expect from Capture testing...to me it was just another method at MY service...just a PART of the whole picture. I think the difference was having known blood banking through many years macro and micro is very helpful to me when resolving problems. IS micro a pain sometimes...TMI...yup but sometimes it gives me the knowledge I need to come to a conclusion.

We have dropped the sex and use Baby1 and Baby2. Our protocol does keep the last name of the mother and the first name as you suggest for babies born in system...we have had a problem (or two) with different named babies and mothers matching antibody histories to what we find in a baby. We have our own NICU for our state wide system as well as receiving babies from outside our system so we are not just dealing with our in house naming protocol and it DOES matter when resolving antibody situations, if they give the baby a name before it comes to us...hate it when that happens as I am the oldie but goodie and I am supposed to pull this information from deep memory like my idol Jane Swanson can do...remember the mothers name by her antibody list...Jane is close if not 90 and she could still today pull those out of where she hides them. We have stopped sex assigning the babies as there is a lot more known about what affect this can have and more information is needed before some babies sex can be clearly understood.

I am getting confused in my D antigen thinking. I work at a BB that is fully capable of using a regions whole supply of RH negative RBCs. When we get into a shortage it is easy to look back and say this should never have happened and that should never have happened. While in the situation I think I need to push harder and stomp my foot more to switch to RH pos RBCs. On the other hand I am not the physician and I am concerned that my years of experience be used as a force for good and not evil. I am always thinking of changing to RH pos when we are getting to 8 units or more of RH negative RBCs...I am guessing most of you are thinking why so late...we have a good supply of all types generally. We are also seeing surgeries where they are 2 and 3 times or more into many patients, it can be a population of people who have multiple transfusions in their past...sometimes even RH neg patients who recd RH pos units their last OR. We actually see very little of the emergency uncrossmatched patient, but we see a lot of the issues of chronic transfusion, so I am wondering if switching RH neg patients to RH pos will be more problematic in our patient population. In the usual hospital situation a need for transfusion is transitory and those patiens my never be transfused again, in our situation they are likely to need to be transfused and soon. So we give RH pos to an RH neg person in a bad CABG, their 2nd or 3rd, or maybe an LVAD...the patient ends up on ECMO for weeks to a month and many more transfusions to come and then pehaps their heart transplant. If they DID make anti D it would finish them...right? I know that is the fear of the docs we go to for approval. How do you all look at this issue? Thanks

Infection Control is where the information is directed. Blood Bankers makes a smear and culture bottles (aerobic and anaerobic-which are sent to micro) from the remains of the unit and from a tube drawn post-reaction, retypes the patient and does the DAT...what happens from that point varies with results.

We do 1 to 30 days prior to surgery. We have the 3 questions whose answer must be no...has the patient been transfused? Has the patient been pregnant within the last 3 months? does the patient have a history of an antibody or transfusion related complications? Then the 2 questions...Has the patient been transfused withing the last month? Has the pastient been pregnant withing the last month? also must be asked withing 3 days of surgery and answered no. So the questioner signs the first past and the new questioner signs the recheck part which is returned to the blood bank. When I recieve the first part I put a comment in BAD...preadmit order recd (date) for procedure scheduled on (date) or perhaps with an unknown date. Tubes are saved in their racks for 37 days. If they have not answered a question correctly we respond saying they are not eligible for extended xm and must be redrawn withing 3 days of procedure and post it to chart.

I am confused...as per usual I will soldier on and say what we do. I am not sure how you detected the anti M(just saw the title...on TANGO)...if that was part of the history from another institution. We honor any information we can get our hands on. If we discovered a history elsewhere, in EPIC it is listed as CARE EVERWHERE, we honor it. We run our own workup if our Screen is positive. We don't depend on CARE EVERYWHERE...we still call and ask for additional transfusion history. So we would honor the Anti S...if the Anti M is not reacting we would not be typing for M. If you do your crossmatches on Tango then units would be S neg and crossmatched. If the M was reacting in the crossmatching method we would decide where the most annoyance would be...crossmatching for compatible or typing for M. Often if the patient is reacting with Heterozygous M cells I would type for M. If she is not reacting in my crossmatching method I would not type for M. Is it significant...the OB doctors like to make us titer Anti M...I am sure somewhere at some time there is a paper with such advice...and we have been titering Ms ever since.

AFP=APHERESIS FROZEN PLASMA

We scratch out the US license number when we attach a new label...our component label is a computer generated half label applied over the bottom half of the original product label. That half label has our Processed By: information with our FDA regustration number. We do not scratch out the original FDA Registration Number for the original supplier just the License number. In days gone by we had a separate sticket for each part as we relabelled components.