TreeMoss

I looked up Method 5-3 "Using Antibody Titration Studies to Assist in Early Detection of Hemolytic Disease of the Fetus and Newborn" in the AABB Technical Manual, 18 edition -- One of the NOTES states: "Do not use enhancement techniques [albumin, polyethylene glycol, low-ionic-strength saline (LISS)] or enzyme-treated red cells because falsely elevated titers may be obtained. Gel testing is not recommended." The next note states: "LISS should not be used as a diluent in titration studies; nonspecific uptake of globulins may occur in serum-LISS dilutions."

BBK Product Dictionary -- page 3 -- UNIT SCREEN (about 1/3 of the way down the page on the left) -- look up the documentation (Shift+F8). "Order Screens are customer-defined queries created in the MIS Dictionaries." When we built our inspection statement, we made it so it would only accept "Y" as an answer -- thus the required inspection.

Our Massive Transfusion Protocol states that blood bank/lab staff will place orders for subsequent products needed. Other than that, we have a "Written verification of Verbal Order" sheet that we complete and send to the patient location for the physician to sign. This is used in those circumstances where the nurses are too busy to order so blood bank puts in the orders. For Emergency Issue products, we have the physician sign a release for the use of the emergency products.

We also get orders for cord workups on the babies of all O Positive and Rh negative moms -- and nothing on those moms who have been sensitized. It would be nice to only get orders on those infants who have symptoms of HDN.

The AABB Technical Manual states that antibody titers should not be performed using gel technology, so we revised our procedure to go back to tube method.

I suspect because anti-A, anti-B, and anti-A,B are usually cold-reacting. That would be similar to washing with cold saline if you were working with a cold autoantibody in preparation to performing a cold auto-absorption, I think.

The AABB Technical Manual says to wash cells once and make a 3-5% suspension. Then to wash one drop of cells (for each the DAT and DAT Control) a total of 3 more times prior to adding the AHG and spinning. Our AHG requires two drops. I have also read that the cord cells should be washed in cold saline to prevent eluting of the antibody while washing the cells. We did this years ago but somehow got away from that practice.

If the mother is a possible miscarriage of 12 weeks or less, we do a blood type or go by the patient's history. If she is Rh negative by history, or if she types as Rh negative on a current specimen, she is a candidate for 1 - 300 mcg dose of RhIG. No further workup is needed. A patient who is 13+ weeks pregnant and bleeding would have the ABO/Rh, antibody screen, and fetal bleed screen tested prior to administration of the RhIG.

One thing our reference lab mentioned was transfusing antigen-matched blood so you know no new antibodies will be formed. In that situation, I don't think we would need to continue sending specimens to the reference lab every time the patient came in for transfusion. Anne

Immucor's is 2-10 minute RT, spin and read.

This is also what we do and it works well for us.

We change the location to where the blood product is being issued if not to the patient floor. We have validated the blood coolers for 24 hours, so we indicate on the issue screen that the blood was issued in the cooler and then we just return to prior status when the blood cooler is returned to us.

We are a level II trauma center located 3 hours from one blood center and 4 hours from another. We normally stock 4 PLTPH units, and we can sometimes get some from the hospital one hour away.

We do not use cord blood specimens for any crossmatching purposes because the cord blood specimens are labeled with mom's armband label and are not always labeled at the time they are collected. When any Packed Cell is ordered, the computer automatically orders a type and screen with the crossmatch. We have the NICU draw us 1 ml of blood in EDTA, and we do the type and screen (in gel). If the screen is negative, we can result on that specimen until the baby is 4 months of age. We do not do any crossmatches on the baby unless the antibody screen is positive, and in that situation, a new specimen is needed every 7 days until the antibody screen is negative and a crossmatch is performed. If we need to test using the mom's plasma, we would enter results and add a result comment that the antibody screen was performed on mom's plasma.

Unfortunately, we get antibody ID and titer referral specimens from a reference laboratory, so we don't know for sure if these anti-D's are from RhIG or not. I think the docs may just be covering certain parts of their bodies! We have asked the reference lab to provide that information to us, but they don't contact the physicians' offices.