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Everything posted by gagpinks
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DTT-Treatment of Screening Cells (Daratumumab/Darzalex)
gagpinks replied to septima's topic in Transfusion Services
If patient on DARA how soon they can develop pan-reactive antibody? We had our first patient who is on DARA had negative antibody screen before treatment after 36 hours of treatment antibody screen is positive in all 3 cell line. Patient's antibody panel shows some pan-reactive reaction with 8 out of 11 cells .But auto is negative . Is it due to DARA or patient is developing some allo antibody? -
Baby is on phototherapy.
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Hi dothandar and Malcolm These are the card we use in our lab as part of DAT protocol. Malcolm , I guess this finding is not clinically significant then. Is there any particular reason for DAT to be positive in C3d or cause is unknown?
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Hi We have a antenatal patient who has developed AntiJkb with titre 64 at 37 weeks. She has been planned for induction at 37 week due to rising titre. We received cord sample where DAT is positive IgG 3+ and also C3d 3+ and control negative. I haven't seen any case in my career with positive DAT on both IgG and C3d on baby sample. Hb and bilirubin Normal. What is the reason for DAT to be positive in C3d? Does it suggest haemolysis?
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We have set up some criteria not to perform electronic issue if any group discrepancy, any manual group perform to resolve group discrepancy,any mixed field reaction or if antibody screen is positive. And also if patient's demographics not verified , if only one sample available, or sample is not valid. Our LIMS will not allow us to issue electronically in these situations.
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Sorry few more. Reaction specifity and strength correctly interprets as compare to previous result. Analyser recognise that QC has failed
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We have validate our IH1000 recently . I guess it's same protocol when you have to perform IQ. UR1 : analyser reading right barcode label and transiting right result to right patient. UR2 : Run 10 samples for each group and compare reaction with manual as well as existing analyser. UR3: Run known antibody positive sample and compare reaction. Also need to run NIBSC . UR4 validate all the reagents on board give expected reaction and no difference in reaction up to expiry UR5; validate all the test such as baby group, DAT and panel and same as above. UR5: check all the abnormal sample such as lipamic, Haemolysed, and insufficient picked up by analyser. UR6: Run same barcode sample on analyser to identify duplicates barcodes. UR7 : check LIMS on both direction.
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Uk guidelines suugest, "Any senisitizing event before 20 weeks not required KB test however lady required Rhogam . After 20 weeks, any senisitizing event required KB as well as anti-D depending on the bleed.
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If you any interesting case in your lab you can always discussed with us. I will be happy to discuss with you that way I learn as well.
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TWO UNITS WITH SAME DIN
gagpinks replied to jnadeau's topic in Computer Systems / Software / ISBT128
We use pack number if it is same product for e.g paediatric pack we have same DIN but also add pack more 1 to 6 in bracket. If product is differentthen we scan product code. -
Yes I understand if patient is transfusion dependent then of course you give Rh phenotypes matched blood. We use IH1000 and it pick lots of AntiM and nonspecific reaction. In this case it would unnecessary to provide Rh phenotypes matched blood. It is hard draw a line when you have to explain junior staff.
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Yes it's not hard to get Rh and Kell match blood in UK. But sometime it cause delay in providing blood. For instance if patient develop Anti Fya and so if we perform Rh and Kell phenotype as a precaution , in that case we might not find exact match blood and have to order blood from blood services. We also have some inexperienced staff who don't understand when there is an emergency situation it is not necessary to provide Rh match blood if patient hasn't develop any Rh antibody. It cause unnecessary delay by contacting clinician and Haem reg.
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Hi all Just want to know would you always perform Rh phenotype whenever patient has any antibody other clinical significant antibody and provide Rh and Kell phenotype match blood? e.g if patient develop anti M or Anti Jka in this case would you do Rh phenotype?. My understanding is you only give Rh and Kell phenotype match blood if patient is sickle, thal, haem patient , AIHA or whenever they develop Rh antibodies. What does other do?
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Hi Nic According to manufacture instruction you can keep reagent on board for 48 hours. Therefore we did our own validation (according to ISO if you want to deviate manufacture instruction you need to validate yourself) extent expiry on board. Because we run everyday 10 panel and it's difficult to remove and load reagent again. So we run daily control which are antiD c and Fya to cover all lines for negative and positive control. And leave reagent on board for 72 hours. By end of 72 hours all reagents will used up.
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I attended NEQAS meeting yesterday and they were mentioning that if patient is Weak D type 4, 11 ,15 ,21 ,57 they can make allo anti-D. I am bit confused 🤔. I know if patient are variant D such as DIII, IV V ........ can develop anti-D. But I wasn't aware of about subtype of Weak D and they actually can develop antiD
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Hi Nicola Agree with Malcolm. I am sure I am sure you mean running panel on IH1000. We run all our panel on IH 1000 and we interpret manually. To do this we run few known controls such as Weak antiD, Fya, S c ,K and AB serum. We also did few serial dilution for control and run on analyser to see any weak reaction. We also run some known patient to compare the result. We also performed intra comparison with these control to compare the result. We kept reagent on board for 48 hours run and control to see there is no difference in result after 72 hours because you can keep on board only for 48 hours. And there is no temperature control on analyser. Of course you take part in NEQAS to measure your performance. I hope this might be useful
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Thanks Malcolm !!
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Hi We had patient who is O Rh D positive and baby is A Rh D positive. Baby born very anamic therefore clinician wanted us to perform Kle to see any large FMH . A lady had positive Kleihuer and estimate 50 To 60 ml bleed. And baby had 2 unit top up transfusions. Just wondering wouldn't mother will have any transfusions reaction due to this much amount of incompatible blood.
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In UK we don't have to worry about retyping donor unit. Our national blood service give 100% assurance of their testing.
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Antigen typing on DAT positive
gagpinks replied to gagpinks's topic in Immunohematology Reference Laboratories
Sorry IgG antibodies. -
Antigen typing on DAT positive
gagpinks replied to gagpinks's topic in Immunohematology Reference Laboratories
Thanks Malcolm I was doing one of the IPEX excercise and there was case where baby had DAT positive due to maternal antibody. Therefore result on phenotypes( Fya Fyb) are not reliable. In this case you can use chloroquine phosphate to de nature Off antibodies. So I thought they might be using for all above cases. I knew about DTT and ZZAP. But never came across about CDP. -
Hi All Just wondering if FFP has been thawed at 37 c for 20 min and then stored at 2-6. Would We still able to see cryo deposition in thawed plasma. We had few case where FFP didn't get used and left in fridge for 12 hours and trying to use for another patient . While doing visual inspection on thawed product it look like it's clot in bag. So my question is does anyone think it could be cryo deposition?
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Hi How does or what method reference lab use to perform phenotypes ( Fya ,Fyb ,Jka Jkb S s etc). If patient's DAT is positives.? If patient with positive DAT e.g.. ( lymphoma or CLLor any drug induced ) and develop anti body how would you do antigen typing on theses patient?
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I just answered this question. My Score PASS
