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exlimey last won the day on January 12

exlimey had the most liked content!

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About exlimey

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    Gaithersburg, MD, USA
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    IRL; Reagent Manufacturing

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  1. Negative Control for DAT

    Please excuse my ignorance, but how can a "DAT Control" not have an antiglobulin reagent?
  2. What to transfuse?

    CD = chloroquine diphosphate. A chemical treatment to remove immunoglobulins from red cells, in the hope of getting a negative DAT, thereby allowing the use of antiglobulin-reactive antisera without interference from a positive DAT.
  3. Allo anti-D

    Please supply the reference for this absolute nonsense. It sounds like I would enjoy reading such fiction.
  4. Autoadsorptions

    I agree with Malcolm - all the best people are DCeDCe.☺ I also agree with his analysis. The differences you are seeing are probably because you are not doing as complete an adsorption as the IRL. Indeed, this partial and sequential adsorption process was the heart of the early work by Dr. Issitt (and others) when they were trying to determine the specificities of autos. Most warm autoantibodies mimic Rh specificities (there are exceptions). The older literature is full of anti-e-like autos and antibodies to compound antigens (Ce, cE, etc.). There are also a smattering of anti-D-like autos. Not uncommon, by any means. Some labs used to make an effort to ID autos, but in recent years, time and money have have almost eliminated this potentially interesting technical challenge.
  5. A very good point, Anna. The same applies to anything done "off-label", regardless of how much validation has been done.

    Scandalous, Scott !!!!!

    I think you're joking, but just in case...... It's a simple C1 x V1 = C2 x V2 calculation. One of the few times when algebra gets applied outside of high school. To do this accurately, you must first know the hematocrit (concentration) of your "packed cells" - this will be used as C2. For this example, let's say the hct is 75%. C1 = desired hematocrit (concentration) - 3%; V1 = desired volume - for this example, let's say we want 100 mL of 3% cells. Using the formula and information above.... 3 x 100 = 75 x V2, which resolves to 3 x 100 ÷ 75 = 4 mL. Ergo: 4 mL of "packed cells" in 100 ml pf PBS will yield ~3% suspension. This process works for low cell concentrations where the added RBC volume is only a small portion of the whole (4 mL added to 100 mL). If you try to make higher concentrations, you have to take the RBC volume into consideration as part of the whole volume.☺

    ANORRIS, I think you might need a few more details in your question before anyone can lend advice.
  9. Cold Agglutinin Panels

    Good call !
  10. Crossmatch Billing

    Well said, John. We've all been in positions where "extra work" was logical because either the original request was wonky or we did it for our own sanity.
  11. Cold Agglutinin Panels

    First step: Is it reacting with autologous cells ? Fairly easy to make that call, IF the patient is untransfused. If the patient is transfused, it gets more difficult, if not impossible. Any reasonably competent IRL should be able to help. If necessary, they would be able to perform adsorptions and/or test rare cells. They may even be able to isolate autologous cells from a transfused patient.
  12. Crossmatch Billing

    I think Scott is saying that there is still a cost associated with each test, regardless of billing. Socialized medicine bean-counters have a very real interest in making things efficient and cost effective. Redundant or unnecessary testing is the target in such situations.
  13. Cold Agglutinin Panels

    The key question: Is it auto or allo ? This may be difficult to prove if the patient has been transfused. If it is an autoantibody, I agree with Malcolm's position - who cares? However, if the autocontrol is nonreactive, you may have to consider other things. Beware anti-Vel and anti-PP1pk (-Tja). These can behave like cold-reactive AUTO antibodies, i.e., demonstrate panagglutination, abolished reactivity by pre-warmed tests, etc. There is at least one case (published by Jill Storry) of an anti-Vel that was "dismissed" as a cold auto (it was rendered nonreactive by pre-warming). The patient was transfused with random cells and had a fatal hemolytic reaction.
  14. Blood Utilization Suyvey

    I would check the regulations VERY carefully. I suspect it would be very difficult to make this kind of thing mandatory, especially if there is some arbitrary cutoff (transfusions/yr). On the other hand, if your boss would LIKE you to participate, it might take some clever moves to convince them to decline. Good luck.
  15. Blood Utilization Suyvey

    A serious finger wagging ????? Twelve lashes with a wet noodle ????? A stern, disapproving look ?????