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exlimey

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Everything posted by exlimey

  1. Are you suggesting that one tests every panel cell every day of use ?
  2. Continuing my earlier thread: That approach doesn't check those cells that are Fy(a-).
  3. Apologies, I now remember you posted that earlier. The mind is a terrible.....wait, what was I saying.......... It's IgG4 nature and use of the Immucor/Gamma reagent won't help much if it's causing direct agglutination before the antiglobulin phase, especially in reverse typing.
  4. Perfect ! Thanks for the reference. So...a follow-on question: Who determined that 10% glycerol is a "liquid with heat transfer characteristics similar to blood" ? At least one user on this site is using 30% glycerol.
  5. Is that an official rule, standard, regulation, or something contrived that we've all convinced ourselves is true ?
  6. Just curious....why glycerol ? Does the refrigerator manufacturer require you to use it ?
  7. Fair enough. I was picturing the results living with each patient record, but if you're antigen screening donors and the results are kept together, that would be easy.
  8. Unfortunately, I'm not surprised. I would consider myself lucky to get an inspector who even knows blood groups.
  9. Well said. Smells like trying to fix a problem that doesn't exist. Or perhaps an attempt by regulators to align Blood Bank work to other pathology departments which do instrument-performed assays in a assembly-line fashion. Blood Bank doesn't fit.
  10. Very clever ! I like that idea, but suspect it would be a real pig to collect, collate and hand over said results to an inspector.
  11. More Devil's Advocate: That only tests the K antigen - a very stable structure. What about other antigens that are more likely to and are known to deteriorate over time - Lea, Leb, Fyb, to name but a few ? The only value to testing a K- cell against a diluted antisera is to check the DAT on the chosen panel cell, i.e., it's potential to cause a false-positive. You could simply do a DAT instead. I'm certainly not suggesting that everyone completely phenotype their Screening Cells and Panel Cells each day (or periodically). I'm all in favor of a minimalist approach to this issue, and it appears that similar testing algorithms are acceptable to inspectors. I really just wanted to highlight the flaws in this whole concept, from both the regulatory side and that of the users. And.....don't forget.....the manufacturer's of the red cell reagents have a huge amount of stability data.
  12. Just to clarify and to play Devil's Advocate: Your facility's interpretation of "periodic(ally)" is once upon arrival ? And, apparently, according to LaurieU, that met at least one JC inspector's requirements. Sounds too good to be true.
  13. I agree with the previous responses. I would cease and desist with routine microscopic reading - you don't read the gel tests microscopically. Perhaps keep the microscope around just in case there's an odd case where it MIGHT be useful, but I suspect that it will just collect dust.
  14. Forgive my ignorance.....I don't work in a hospital. In your facility, does the process of administering of other drugs require the concurrence of two "qualified individuals" at the bedside ?
  15. Everything JHH1999 writes is sound, and perfectly laid out. I like cake, too. I would, however, caution that one may get some regulatory push-back if one attempts to "validate" an extended expiration date on material that comes with a date assigned by the manufacturer.
  16. Malcolm - I was told (by Diana Brazier, of MRC/BGRL/BPL-D) that good serologists are often very good cooks. Are you suggesting you fall to either of the extreme sides of the Bell curve?
  17. Oh, my. I can't even begin to imagine what such a document would look like. There is so much grey/gray in transfusion medicine, especially in the testing realm, that any document would be as complicated and of as little use as the US Tax Code. For example: Positive DAT - abnormal; except when one or more of the following conditions exist: [add your list of 50+ reasons for a positive DAT] You would be listing so many ifs, ands, or buts, that any document would be practically useless. My vote echoes MOBB: Use the "get-of-jail" phrases like "as appropriate" and "where such exist".
  18. That's a new one for me too. Microscopically detectable auto-anti-P1??? I think someone had a little too much coffee.
  19. For clarification: These are NOT "antibodies to the preservative". If that were the case, they would be neutralized in the presence of the preservative and have absolutely no impact on the serology (except maybe coating RBCs with immune complexes). They are antibodies that react with RBCs only in the presence of a specific co-factor.
  20. There are lots of reports of antibodies that appear to need a "co-factor" to react. These are technically not "an antibody to a reagent", as Vikman suggests, but antibodies that only react in the presence of specific chemicals or ingredients in the test system. In this case, it appears that there are differences in formulation of the Quotient and Ortho reagent cells. Quotient has something in their diluent that Ortho does not (and probably the other way around). That "something" facilitates the detection of the ingredient-dependent antibody. As to proving it, I think your test results and that of the other lab already give enough evidence. I have heard of labs that "wash" their screening cells to remove that original diluent and then re-test. You may be able to do that, but bear in mind that if you are doing a gel-test of some sort, the magic ingredient may be in the gel. As to the crossmatch problem, may I presume that the cells from the candidate units are not suspended in Quotient diluent ? They might be compatible because the cell suspensions lack the magic ingredient (but see my caveat above).
  21. If one does as suggested (by AABB TM and Hemo) - 1 drop of PACKED CELLS to 4 drops of DTT, you should be able to make at least 15 - 20 drops of a 3% cell suspension after treatment and washing. To make 1 drop of packed cells from a commercial red cell suspension, you typically need to centrifuge down 20 - 25 drops.
  22. I vaguely remember that one. There are lots of anecdotes of funky results that were ultimately blamed on the saline in use at the time. More recently, there have been reports of excess ozone in "blood bank saline" causing inactivation of the S antigen. Apparently ozone is bubbled through saline to sterilize it. In colder months the warehouse is cold and the ozone does not dissipate as quickly. In the summer months it's not so much of a problem.
  23. Wow, David, you must live a charmed life if you haven't been tripped up by "bad" saline sometime in your career. Certainly in the vast majority of cases the actual pH of saline has little impact, but there are lots of examples where changing the pH of a test system has deleterious effects. Most manufacturers of blood bank reagents and test platforms now specify pH ranges for saline, essentially requiring the use of buffered saline.
  24. You were unlucky tripping over an antibody to a to a low incidence antigen. Sometimes the fancy commercial panels are too fancy. Some of the antibodies to low incidence antigens are quite common and only remain undetected because regular red cell panels do not have the corresponding antigens. In this situation, I would make every effort the get a blood sample from the putative father - a sometimes awkward and emotionally-charged situation. Test the father for Dia (and E while you're at it) and if negative, you don't have to continue to evaluate the potency of the antibody(ies). Getting a sample doesn't always work, of course and there's always a risk that the "father" is not THE father.
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