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gagpinks

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  1. Like
    gagpinks reacted to Bb_in_the_rain in Mock-up case 1   
    Please let me know if you would like me to do more "mock-up cases" with RHCE variants. I can look for some good ones.  I think it is fun to interact with case studies here. (I mean it is quite fun to pick Malcolm's brain and learn from him... cough cough). 
  2. Like
    gagpinks reacted to Malcolm Needs in Anti Cob   
    Anti-Cob has rarely caused a clinically significant haemolytic transfusion reaction, and, even then, the antibody was, in both cases, extremely potent.
    An anti-Cob, only detected by papain-IAT is certainly not going to be clinically significant, although when the antibody can be detected by IAT, using red cells that have not been treated with a proteolytic enzyme, then Co(b-) units should be transfused.  In your case, it would be quite safe to transfuse units that are found to be compatible by IAT with untreated red cells.
    Geoff Daniels says in his book (Daniels G.  Human Blood Groups.  3rd edition, 2013, Wiley-Blackwell) that anti-Cob is quite a rare antibody and, while I am ALWAYS wary about gainsaying anything written by Geoff, I think that may be more to do with the Co(b) antigen not being expressed on most screening red cells and even on most panel cells because, when they were, anti-Cob was a comparatively common finding in the samples submitted to NHSBT-Tooting Centre's RCI Laboratory when I was Reference Service Manager there.
    As you are working in the UK, you might find it useful to read the specification (SPN214/4), issued by NHSBT, "The Clinical Significance of Blood Group Alloantibodies and the Supply of Blood for Transfusion.", written by my good friend Nicole Thornton, Head of Red Cell Reference at the IBGRL.  You can find it on line.
  3. Like
    gagpinks got a reaction from Jermin in ? Transfusion reaction   
    Thanks everyone 
    Clinician hasn't suspected transfusions reaction and hasn't asked for any investigations. This is something we noticed the results when they requested further blood unit.   just wanted to know causes of DAT to be positive in C3d therefore shared on discussions board.
     
  4. Like
    gagpinks got a reaction from Malcolm Needs in ? Transfusion reaction   
    Thanks everyone 
    Clinician hasn't suspected transfusions reaction and hasn't asked for any investigations. This is something we noticed the results when they requested further blood unit.   just wanted to know causes of DAT to be positive in C3d therefore shared on discussions board.
     
  5. Like
    gagpinks reacted to yan xia in ? Transfusion reaction   
    Kidd system antibodies can bind complement.
    To investigate the reason, maybe you should do an elution, then test the eluate to see what specity /specities of the binding antibodies.
    Add fresh serum can strengthen the sensitivity of testing Kidd antibodies.
  6. Like
    gagpinks reacted to Malcolm Needs in Adsorption/Absorption   
    The Rh antibody specificities involved in WAIHA are usually something like anti-Rh17 or anti-Rh18, which are antibodies that are directed against antigens that are almost expressed universally on all human red cells, except those of very rare individuals with deletion or partial deletion of Rh antigens.  That having been said, these antibodies very often mimic other specificities, such as, for example, an auto-anti-e, but can be adsorbed to extinction by red cells apparently not expressing the antigen.  In other words, the apparent auto-anti-e can be completely adsorbed by using DcE/DcE (R2R2) red cells that are, of course, e Negative.  This is because the DcE/DcE (R2R2) red cells will express both the Rh17 and Rh18 antigens, which are the antigens that the auto-antibody specificity is actually directed.
    There are other specificities that can be involved in WAIHA outside of the Rh Blood Group System (such as auto-anti-Wrb), but these are much rarer.
    As far as your second point is concerned, I attach three PowerPoint slides.  The first is a diagram of how we go about looking at antibodies, the second is a photograph showing the store of some 400 rare red cells frozen down for use in RCI investigations, and the third is a (very untidy looking - but we know where everything is located) freezer full of very rare antisera, so that we can "attack" a problem from both sides, if necessary, by looking at the antibody in the patient's plasma, and/or the (usually) high prevalence antigen lacking from the patient's red cells.  Armed with information, such as the ethnicity of the patient (not politically correct these days, but HUGELY important), and how the antibody reacts with red cells treated with various enzymes and chemicals, we can narrow down the specificity without having to use, and possibly waste, a large number of different rare red cells and antibodies.
    Antibody algorithm..ppt
  7. Like
    gagpinks reacted to Ward_X in Sample validity for platelet transfusion   
    If they have a historical type on file, you do not need a current T/S to issue plasma and platelet products. For RBCs you do need a current T/S.
  8. Thanks
    gagpinks reacted to Malcolm Needs in Auto anti-G?   
    My own questions would be, firstly, what on Earth are you doing identifying the RCI Laboratory concerned (poor form) and, secondly, what on Earth are they doing wasting public money by proving the presence of an anti-G in a 92-year-old patient, when knowing the exact specificity of the Rh antibody/antibodies in the patient's plasma will make no difference to what blood she will be given, should she require a transfusion?
  9. Thanks
    gagpinks got a reaction from Malcolm Needs in Gold Medal.   
    You are well deserved for this. 
  10. Like
    gagpinks reacted to Neil Blumberg in Anti-Inb   
    Another expensive but possibly effective approach would be to use one of the complement activation inhibitors, such as eculizamab, that is used to treat paroxysmal nocturnal hemoglobinuria, a disease with inadequate inactivation of complement components.  
  11. Like
    gagpinks got a reaction from Bb_in_the_rain in ABO TYPING DISCREPANY WITH MTS GEL   
    This could be due to anti c IgM in nature. I have seen this many time especially in pregnant lady. 
  12. Like
    gagpinks got a reaction from Malcolm Needs in BloodBankTalk:Clinical Aspects of Transfusion Reactions   
    I just answered this question.


    My Score PASS  
  13. Like
    gagpinks reacted to Dansket in Immediate spin crossmatch   
    Could the Daily/Day of Use QC for the ABO Plasma Grouping Cells ( A1 and B ) be considered a positive and negative control for the saline crossmatch?  In both cases these tests use patient serum/plasma added to donor red cells, the only difference being that the ABO Plasma Grouping cells are stored in solution designed to maintain agglutinability  while the donor cells are stored in a solution designed to maintain oxygen transport.
  14. Like
    gagpinks reacted to cswickard in DTT for DARA - help!! :)   
    DTT SOP.pdf
     
    This procedure is based on the HemoBioscience SOP and the AABB SOP.  Works for us.
    Prior threads on this topic have indicated that the DTT treated cells will not last long, so we do this only at need.
  15. Like
    gagpinks reacted to BankerGirl in When is Rhesus D positive in test tubes?   
    I have a question about the "newborn card".  I am not familiar with this card, so forgive me if this is the case.  Does this card contain IgG, and is it incubated at 37 prior to centrifugation?  And when you perform the testing in tube, do you incubate and carry it through AHG phase?  This is how we detect weak D.
  16. Like
    gagpinks reacted to Neil Blumberg in Anti-Inb   
    Another strategy, which works for ABO incompatible kidney transplants in some cases, is a combination of immunosuppressive drug therapy, IVIgG and plasma exchange.   If it works for ABO, one would guess that it could work for Inb (or anything else, for that matter).  One also guesses that the antibody might be wholly or largely IgM if it only causes HTR and not HDN. If that were the case, plasma exchange could be particularly effective.
  17. Like
    gagpinks reacted to Malcolm Needs in Anti-Inb   
    She very possibly can (although two things; it would most certainly depend on the titre of the anti-Inb prior to EACH transfusion [and that would have to be 1) a doctor's decision and 2) a bit of a guess, as anti-Inb is so rare) and also, I would suggest IvIgG, rather than methylprednisolone (or, possibly, both).  However, having said all this, there is NO DOUBT that anti-Inb is clinically significant in terms of haemolytic transfusion reactions, although the same is not the same for HDFN.
  18. Like
    gagpinks got a reaction from Malcolm Needs in ABO TYPING DISCREPANY WITH MTS GEL   
    This could be due to anti c IgM in nature. I have seen this many time especially in pregnant lady. 
  19. Like
    gagpinks reacted to R1R2 in Reagents   
    Below is the exact text from the guidelines.    I agree that potentiators added to the reverse group may detect non ABO antibodies in addition to the ABO antibodies but who adds potentiators to reverse group routinely?   One reason that anti c is mentioned may be that reverse group cells are usually Rh neg.   I have seen strong IgG anti c react in reverse group with no potentiators. 
     
     
    Other reverse grouping anomalies: Potentiators in the reverse grouping reagents may cause IgG antibodies such as anti-c to be detected in the reverse group.
  20. Like
    gagpinks reacted to Malcolm Needs in MHRA Forum.   
    Hope this is okay to post administrators, but I have been asked to publicise the MHRA Discussion Forum, especially for members of PathLabTalk who are either UK citizens, or who are working in a laboratory inspected by the MHRA.  The address is forums.mhra.gov.uk/forumdisplay.php?60-Blood-Forum.
    You can go on there anonymously and ask virtually any questions you like concerning their inspections, quality, haemovigilance and SABRE, and a whole lot of other subjects.
    This will also help the UK TLC group (of which I am currently a member) formulate their standards.
    Lastly, you have to remember that despite both the MHRA and UK TLC being rather regarded as "sticks" with which to "beat" Biomedical Scientists, both are actually there to help.
  21. Like
    gagpinks reacted to Bb_in_the_rain in UK qualification and experience in USA   
    I dont think you need special state licenses for these states. CLIA (Clinical laboratory improvement amendment) defines most tests performed in hematology and immunohematology as moderate to high complexity testing, therefore needs specific education/experiences or accreditation. The easiest way to achieve it is to challenge accreditation exams conducted by ASCP (american society for clinical laboratory science). I have the link to their website below. You can go ahead and make an account free of charge and start looking through education/experience requirements and paperworks needed to challenges the exams. As you have 17 years of prior experience, recommend you to look into BB(work in blood bank), MLS (can work in every area of the lab except for cytology), H (can work in hematology)which are technoligist licenses. Also, specialized licenses SBB (specialist in blood bank, which majority of blood bank lab leadership personnel are certified for) or SH (specialist in hematology, which majority of hematology lab leaderships are certified for). 
    https://www.ascp.org/content/board-of-certification/get-credentialed
    Please do not hesitate to ask us questions here. We are all here to help you with your transition. 
  22. Like
    gagpinks got a reaction from Bb_in_the_rain in C3d positive on cord sample   
    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?
  23. Like
    gagpinks reacted to Malcolm Needs in RESt and DARA   
    Well, the first thing I would say is that you would be wasting time and reagents to cross-match at the hospital, for the precise reason you quote; of course the units will be incompatible, so just perform an "immediate spin" cross-match (if you must) or perform an electronic issue, as you say that you trust RCI results.  As far as antibodies directed against low prevalence antigens are concerned (the antibodies are usually quite common, it is the antigen that is usually quite rare), I would advise you to read Garratty G.  How concerned should we be about missing antibodies to low incidence antigens?  Transfusion 2003; 43 (7): 844-847, which, basically says what I said above - i.e.  that NO TRANSFUSION IS 100% SAFE, but such antibodies are low down on the list of risks.
    Just before I retired, there was a move that all RCI Departments would go over to electronic issue, when there was a positive DAT and no detectable underlying atypical alloantibodies, but whether or not this ever went through, I don't know; you would have to contact your local RCI Department.
  24. Like
    gagpinks reacted to Malcolm Needs in RESt and DARA   
    There are two ways gagpinks.
    Either you can believe your local RCI Laboratory when they say that there are no atypical alloantibodies detected (and why send them there if you don't believe their results?), or do the work yourself with DTT-treated panel cells.  NO TRANSFUSION IS 100% SAFE.
  25. Like
    gagpinks reacted to cswickard in Benchmarking and Lean Expectation   
    Dear God, you have my deepest sympathy. 
    1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
    2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
    3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
    Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
     
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