exlimey

Careful, now. You're bordering on "spatial discrimination".

How about a "Del" ? Fits the description perfectly. One the other hand, "twice in the last few days" is worrying. While not impossible, it's highly unlikely that a facility would encounter more than one of these anomalies (zebras) in such a short period. I assume Malcolm's question regarding the Last Wash is an allusion to some laboratory artifact - bad technique, bad reagents, etc.

Understood. There are many things laboratories do because they've "always done it". Those in the decision-making roles probably saw a "bad case" somewhere along the way and it stuck in their brains. I will concede that there are a smattering of cases of Lewis antibody-mediated transfusion issues to reference, but most workers consider them an insignificant nuisance.

It's highly unusual, to put it mildly, to worry about antibodies to Lewis antigens. What's your institution's logic for this approach ?

Excellent point, Ensis01.

An interesting case/issue. I agree with your premise: doing anything to make the saline control nonreactive (warm-washing, CDP, acid-elution) will probably make the test with anti-IgG negative, too (assuming the positive saline control is due to IgM-coating of the patient cells, causing direct agglutination). Perhaps a DAT with an anti-IgM reagent could be arranged ? Did you try a DAT with polyspecific antiglobulin reagent or a monospecific anti-Complement reagent ? But even results from these could be "invalidated" by reactions in the so-called negative control.

Excellent use of your "abundant spare time" ! On a more serious note, analysis of this kind of data could lead to modifications in typical practice and result in efficiencies of time and money (and, ultimately, patient care/outcome). However, if the ultra-bean counters get hold of this issue, there's a very good chance that they will find, and put administrative restrictions on all kinds of "unnecessary testing". I appreciate that medicine evolves, but sometimes the appropriate approach has already been identified.

This is a very interesting question. I suspect that many, many, many tests requested by the ED (A & E) could be categorized as "unnecessary" during analysis in the quiet time after "The Storm", i.e., the results had no relevance to the patients' treatment. But, in the moment (especially, during trauma), the medics have very little idea of what clinical data is important at that time. A "shotgun" approach seems to be appropriate. I'm not sure there is a way to meter or control this process (other than having extremely savvy ED staff). It seems to be a necessary evil - the need for rapid turn around overweighs the concern of "over-ordering" tests. And, as Malcolm says, a little extra time for the BB to do its work is always appreciated.

That made me think. I must have done many hundreds of elutions and have never seen reactivity in the last wash. Perhaps I was just lucky. I assume someone on this Forum has encountered reactivity in the last wash. Anyone care to share their experience(s) ? What were the circumstances ? What was the patient's diagnosis ? How did you resolve the issue ?

Our machine is a combo color printer/photocopier/scanner. Just like most "multi-tools", it's OK, but doesn't really do all of its tasks exceptionally well. Grey shading often comes out bluish and when it scans colored materials, the colors are badly translated. Ho-hum, First World problems.

I agree. I like the blue ink option because it used to be an obvious indication that the document is the original. Now, with color photocopiers in widespread use, I have to double check. Sneaky !

Was the Antibody Screen also performed in "the tube" ?

Very interesting. May I ask what assay/test is being used to detect the antibody ? Tube (with or without additive), gel, solid phase ? And, may I presume that the anti-P1 is believed to be the the cause of "the hemoglobin has been dropping even with transfusion." ?

Interesting discussion. Yes, cardboard can carry dirt and/or insects, but to imply that the presence of such on supplies like saline cubes creates a risk to patients and staff is an extreme stretch. We don't live in a vacuum and most of us spend time outdoors with the dirt and bugs every day (potentially bringing them inside with us). A wipe with a damp paper towel should be sufficient to clean an obviously soiled outer container. If you talk to the manufacturer of the saline, I'm sure they would argue that the outer box is not merely a convenient shipping container, but also an integral part of the product itself, designed to support the flexible primary container and get the best performance from the product. After all, they've designed in a nice little tear-out section that creates a perfect hole for the spigot/tap.

But, but, but....you said "We QC the reagents". The equipment/instruments are qualified and deemed functional through calibration/certification/validation, and presumably, preventative maintenance.