TreeMoss

I remember being really confused in school as I was trying to copy the swirling that the grad student did when reading his tubes. When I went to the hospital for my clinical rotations, the blood bank supervisor taught me to hold the tubes with the button up and just tip the tubes over the finger on my other hand and watch the button as it came off the tube. This has worked so well for me all of these years in the blood bank.

I remember being really confused in school as I was trying to copy the swirling that the grad student did when reading his tubes. When I went to the hospital for my clinical rotations, the blood bank supervisor taught me to hold the tubes with the button up and just tip the tubes over the finger on my other hand and watch the button as it came off the tube. This has worked so well for me all of these years in the blood bank.

Yes, we use a tag attacher gun to label the units with the crossmatch slip. There is sufficient plastic at the top of the bag to pierce for the tag even if there is not a hole. I think we are more concerned with the MLS poking his/her finger!

Yes, we use a tag attacher gun to label the units with the crossmatch slip. There is sufficient plastic at the top of the bag to pierce for the tag even if there is not a hole. I think we are more concerned with the MLS poking his/her finger!

I could be wrong on this.....but I don't think the FDA would go to the other facility..........  We have several "sister facilities" that we send blood to for storage that are in our system and another facility that is not in our system.  When we get inspected, they don't go there.....  We are FDA registered because we irradiate and wash/deglycerolize units....ie - "create" products.  I think they just have to comply with CAP and or AABB standards for storage.

Our Red Cross just informed us that it will discontinue providing CPDA-1 rbc.  We primarily used it to provide volume reduced red cells to pediatric patients under 3 years of age.  We will volume reduce AS-1 or AS-3 by centrifugation or washing (Terumo 2991) instead.  Probably unnecessary for most patients, but this is a long standing practice here, and it doesn't seem worthwhile trying to adjust pediatric practice in this regard.  Most patients do not need the additional volume provided by the anticoagulant-preservative in AS-1, etc., and avoiding unnecessary volume is a reasonable goal in many patients. 
There is no inherent virtue to CPDA-1 vs. AS-1 and similar solutions, and rbc preservation is slightly better in AS-1/AS-3 by in vitro metrics.  There is absolutely no factual basis for using CPD-A1 in preference to AS-1, etc. in pediatrics.  Purely expert opinion and probably unduly conservative.
 
I've attached a nice presentation by Dr. Saifee at the University of Washington, who createdAdditive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx it to educate her colleagues about using AS-1 instead of CPDA-1.
Additive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx
Pediatric RBC White Paper - November 2021.pdf

We switched over to Adsol units -- we are a level 3 NICU with 28 beds.  Eastern Idaho Regional Medical Center.
 

I've had further thoughts upon this case (having told you not to worry about it - I live a sad life - NOT!).
It struck me that the patient has an Rh type of D+ C+ c+ E+ and e+, suggesting that the probability is that the patient has a genotype of DCe/DcE (R1R2), but this may not be the case.  She could have one of the rarer Rh genotypes, such as DCE/Dce (RzRo), DCE/dce (Rzr), Dce/dCE (Rory), etc, and this may be potentially important.
Some years ago, Joyce Poole explained to me that most grouping reagents labelled as anti-C are, in fact, a mixture of anti-c and anti-Ce, and this, she told me, included most monoclonal anti-C reagents (which surprised me, to be honest).  This is because the vast majority of the red cells transfused that stimulate an anti-C would have the haplotype of either DCe or dCe, or both, and will, therefore, also stimulate an anti-Ce.  As a result, these "hybrid" anti-C/anti-Ce reagents will react more strongly with red cells expressing the Ce compound Rh antigen (Rh7) and the C antigen (Rh2), than with red cells that only express the C (Rh2) antigen.
This would not, incidentally, explain the stronger than normal reaction with the e antigen.

However, if the patient does express one of the rarer Rh types mentioned above, say she is RzRo, she can actually produce an allo-anti-Ce, and most antibody panels only contain C+ red cells that are only Ce+ as well.  In other words, her antibody in the plasma MAY be identified as an anti-C, whereas it is actually a monospecific anti-Ce, which would neatly explain why she has an apparent anti-C.

Of course, she may also have an auto-anti-C, or a mimicking auto-anti-C (and, possibly, an allo-anti-Bg of some sort).  Sadly, for a nerd like me, I doubt if we will ever know!
I think it was John C Staley who once accused me of looking for zebras, when I hear horses hooves (I may be wrong, but I think it was John).  Anyway, this proves that he was absolutely correct about me!!!!!!!!!!!!!!!!!!!!!!!!

I am a complete antibody nerd, but, in this case, I think that you would be knocking your head against a brick wall for no reward if you try to go any further with this one.
My first thought was that it may be a case of an anti-hrB, but when I saw that the patient was a Caucasian, that was virtually "blown out of the water".  Then I saw that she had a positive DAT with anti-IgG, but not anti-Complement, and I thought Rh specificity, and, like you, I immediately thought of a mimicking auto-anti-C.  The problem is that, if you performed an elution, to actually PROVE that was the case, you would have to have access to some exceptionally rare Rh types (red cells that even many Reference Laboratories lack, let alone Hospital Laboratories).
My mentor, Joyce Poole, who taught me so much, taught me (in no uncertain terms!) not to waste such rare red cells, when I was but a young whipper snapper at the International Blood Group Reference Laboratory when it was still in London - and I'm glad she did before her boss, Carolyn Giles, needed to teach me!!!!!!!!!!!!
In this case, particularly as the patient is even older than am I, AND has been discharged, even as an antibody nerd, I would be inclined to let sleeping dogs lie!

I may well be being very thick here, but what exactly is a reference range for an antibody screen?  Is it how many positive results you would expect on samples from individuals who are new to your own institution?  If it is, and I am not being completely stupid (I probably am), how can ANYONE possibly come up with such a range?
Surely, such a range depends upon al sorts of different factors, such as sex (women who have been pregnant are almost bound to have more atypical alloantibodies than either women who have not been pregnant, or males (who have never been pregnant), individuals who have been multiply transfused because of such things as Sickle Cell Disease, or thalassaemia, but even then, the atypical alloantibodies detected in such individuals depends upon factors like how many transfusions they have received, whether the donors are of the same/similar ethnicity as the individual, and, indeed, whether or not the individual is a respondent or not (or, as the great Dr/Prof Ed Snyder once lectured the British Blood Transfusion Society (BBTS) concerning patient's who have a "virtual transfusion" (they are shown a photograph of a red cell and, as a result, form an atypical alloantibody).

There are just so many variables, I cannot see how there could possibly be a "reference range", unless, as I suspect, I have got completely the wrong end of the stick/

Believe me when I say that you are lucky!  

In the UK, it is STANDARD practice in all laboratories that I know to use either the phrase "No Antibodies Detected", or, more frequently, "No Atypical Antibodies Detected", as the latter also includes such things as the iso-antibodies of the ABO and H Blood Group Systems.  Indeed, some go further still and use "No Atypical Allo-antibodies Detected", as this covers such findings as an auto-anti-H, auto-anti-I and auto-HI, as well as the ABO and H iso-antibodies.
These phrases do not mean that there are no atypical allo-antibodies detected.  It would be an incredibly rare set of screening cells and antibody identification panel cells that would both express, for example, the HJK antigen, or any other genuine low prevalence antigen.
In some cases, where an atypical allo-antibody IS detected, but it is known to be clinically-insignificant (such as anti-Kna), we may use the phrase "No Clinically-Significant Atypical Allo-antibodies were Detected" (or words to that effect).

One thing is for certain, and that is that a UK Reference Laboratory (and most hospital laboratories) worth their salt would report out as "Negative", or "No Antibodies", although, even using the phrases I've quoted above, occasionally the phrase, "All Clinically-significant Allo-antibodies have been Ruled Out using etc.", or words to that effect.

MIND YOU - you have to remember that I am RENOWNED for being a pedant - but I learned it from a few good sources; Peter Issitt, Carolyn Giles and Joyce Poole (to name but three).

This may or may not help.
Clinical Aspects of Transfusion Reactions.pptx

The storage temp does not need to be updated if you are not changing the product code for a plasma that is used in that 6-24 hour window.  If you are extending a unit of plasma to 'thawed plasma' that is good for five days, you'll need to change the product code and expiration date which will then include the new storage temp.

I am not sure I understand your question. 
If the mother had an admission type and screen and was rh negative, then all that would be required post-delivery is the fetal bleed screen. Why would you want to repeat and antibody screen post delivery?

We are using CH5214-18 from Cardinal - plastic, 2 mL, consistent drop size for Blood Bank. Had some trouble getting them for a while about a year or so ago, but not recently (knock on wood and rub my lucky rabbit foot!).

It's never safe to assume that everyone, or for that matter, anyone knows what you are talking about when providing one short sentence.  Especially us old, retired guys.  Both Malcolm and I thought you were looking for some philosophical discussion.  Hope you find the key you are looking for.

I believe OP is referring to this publication:
https://www.aabb.org/aabb-store/product/antibody-identification-art-or-science-a-case-study-approach---print-2285

I do not have any remote refrigerators but, is there a way to have an automated comment added to the unit history when a unit is removed from the remote refrigerator that states it was visually inspected? That would give you documentation. Of course, you would need to have clearly stated in your policy that visual inspection is performed when units are retrieved, and nursing training would have to have that documented as well. That's how I would resolve that issue.
That said, I think that the inspector may be improperly applying the checklist item to your situation. The checklist item states:
TRM.40900 Blood/Tissue Sign-Out Phase II The process for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient. NOTE: A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the product is dispensed.
There is no blood bank staff that is "issuing" the blood so, technically, there is no "person" signing out the unit. I would argue that the inspection would have to take place when the unit is placed in the remote remote refrigerator. I would challenge the deficiency on those grounds.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.