exlimey

I just answered this question.

My Score PASS  

Thanks for letting us know, I worked with Imelda on a couple of projects when she was at Liverpool BTS.  I always enjoyed her humour and approach to life.
 
Noel

It is with huge regret that I heard today that Imelda Bromilow died towards the end of February.


 

I have no supporting references but for me, common sense dictates that in a space that small you could not get the probes far enough apart to get any significant temperature variations.  Having said that, regulations, requirements or other such problems seldom involve anything resembling common sense.  Much like common courtesy, common sense is seldom common.
 

Following - I am so glad you asked this question as I have asked the same thing to both Ortho and AABB with no direct response.
My question was, is there a requirement for an incubator and centrifuge to be an FDA cleared medical device?  We use them throughout the lab and blood bank for specimen centrifugation and for serologic tube testing, and those are not FDA cleared devices.  As long as your equipment is maintained and is meeting the requirements of the circular/instructions for use, aren't you compliant?
 

Thanks for your input.  I was hoping you might respond.
The Daniels book says that "No case of HDFN caused by anti-Lua or -Lub and requiring any treatment other than phototherapy is reported, although raised bilirubin or a positive DAT may be detected."  Does this description equal "clinical significant HDFN" by your definition or is there newer information on more severe HDFN from these since Daniels published the 3rd edition?  My thought is that, if there is no evidence of any case needing any early intervention, then there is no point in running titers to determine when to begin early intervention.
 

I wouldn't bother, to be honest.
Apart from the fact that the Lutheran antigens vary in strength of expression, making it difficult to ensure that the recorded titres would "match up" one to another, but the expression of the Lutheran antigens on foetal and cord erythrocytes is known to be weak.  On top of that, of course, there is the problem of finding a regular source of adult erythrocytes with heterozygous expression.
In addition, anti-Lua and anti-Lub can be either IgG or IgM but are more commonly IgM.  It might be worth your while treating the maternal plasma/serum with a reducing agent such as 0.01M dithiothreitol, 2-mercaptoethanol or ZZAP to see how much, if any, IgG is present.
Even if the antibodies are IgG, they are thought to be adsorbed on to foetal Lutheran glycoprotein on the placental tissue.
Lastly, as you so rightly say, clinically significant HDFN caused by anti-Lub is incredibly rare, and so, all in all, you could be giving yourself an awful lot of work for very little return.  If you do decide to test the maternal plasma/serum with reducing agent, and you find that there is an element of IgG present, it might be worthwhile just performing a titre once, in order to see that you have not got one of these incredibly rare examples that might cause clinically significant HDFN, and, as lone as the titre isn't massive. I would rest easy.

If you want, I can cite references to back up what I have written above, but I haven't done so straightaway, as actually finding some of these papers to read is equally hard work!!!!!!!!!!
I hope that helps.

I agree with all the previous comments. You cannot manage a transfusion reaction in a patient who has died from lack of blood.
One thing to add: In the time before time......emergency release units were always O negs. However, today's practice has evolved in a risk-based manner and it is now accepted that O pos units can fulfil this function. Perhaps ironically, if the old practice had been employed in this case (use O negs), it would have been very unlikely that this patient would get a E+ unit.

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

Not she, but it's possible the person that conveyed it to me got it from Dr. Worlledge.

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

My motto was "when in doubt, shake it out".  Seemed to work for me.

I've been a BB'er for 35 years (at the same hospital)  my very first manager (who was a good,  seasoned BB'er) used to tell us........., "if you have to hunt for it - it's not there".
As you become more adept at reading tube reactions - your eyes will not fail you!  Trust your gut.
As for your technique - it all sounds good!  Practice with a few techniques to find the one that works best for you
I "tilt and giggle", button up, The tilt helps with seeing Mixed Field - which we tend to see a lot here - It also helps with seeing "how" cells are falling off the button - are they chipping off or are they "swirling" off.....or is there a little of both?  (For some reason I always think of the "tail" of an old RPR test .....which probably dates me, LOL!)

It sounds to me like you are doing everything that you should do, without either over-shaking the tube, or over-reading the contents.

I am extremely glad that you are not using a microscope, as, if you did, you would almost certainly see the odd couple of red cells "kissing each other", even if they have been incubated in isotonic saline.

The other thing is (and I speak with some 43 years of working in blood group serology) if the reactions in the tube are THAT weak, the chances of any atypical alloantibody that you might miss being clinically significant are absolutely minute.

If you are still worried, however, get a more experienced worker to read your tests as well, until you feel confident.  That is how I learned when I started.
I wish you the best of luck in your future career.

Personally, if push comes to shove, (which it often does when dealing with closet dwelling bureaucrats) my reference range would be POSITIVE (POS, +) - NEGATIVE (NEG, -).  I don't think I would want to confuse them with indeterminant. 
   

Your comments are spot-on, Malcolm. A "reference range" is typically the expected result from normal individuals. This is fine for something like a platelet count or a creatinine quantitation (or any of the chemistries), but is absolute nonsense for an assay that has only two potential outcomes: Positive or Negative. I suppose "Indeterminant" might be a third option.
Here's your Reference Range for Antibody Screens: Positive / Negative / Indeterminant

Your comments are spot-on, Malcolm. A "reference range" is typically the expected result from normal individuals. This is fine for something like a platelet count or a creatinine quantitation (or any of the chemistries), but is absolute nonsense for an assay that has only two potential outcomes: Positive or Negative. I suppose "Indeterminant" might be a third option.
Here's your Reference Range for Antibody Screens: Positive / Negative / Indeterminant

Concur with the above. It would have be a very serious F-M bleed to impact phenotyping. While there is a theoretical risk of mixed field, and potentially spurious interpretation of the results, if a gravid patient develops an antibody that late in the gestation, the very small risk of mistyping/reporting is worth taking.

Thank you all very much for your responses. I'm glad to hear that this is not a common practice and I do agree that the risk of mistyping would be extremely rare. This was my first time as well seeing this kind of practice.  Definitely worth an SOP change. 
 

Concur with the above. It would have be a very serious F-M bleed to impact phenotyping. While there is a theoretical risk of mixed field, and potentially spurious interpretation of the results, if a gravid patient develops an antibody that late in the gestation, the very small risk of mistyping/reporting is worth taking.

Concur with the above. It would have be a very serious F-M bleed to impact phenotyping. While there is a theoretical risk of mixed field, and potentially spurious interpretation of the results, if a gravid patient develops an antibody that late in the gestation, the very small risk of mistyping/reporting is worth taking.

Not a sensible approach in my opinion.  No real chance of mistyping due to fetal bleed.  At very least, you'd see a mixed field if there were a fetal bleed with a different type.  So get rid of this requirement in my view.

I've been Blood Banking for 35 years......... (albeit in the same hospital) but I've never heard of that - nor do I know of any AABB or CAP regs that would imply that...... (and we've just been inspected by both!)