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Statistical analysis of titration methods
Lucas Souza posted a topic in QualityHi, guys How are you? So, i'm doing a experiment where i'm testing two titration methods, the tube test and the column agglutination technique. Now i have to analyze to know if they have statistical difference and what is the correlacion of the two methods, but I found it difficult to decide which statistical test to use. Do you have any thoughts on which statistical test I should use? T teste? Pearson? Below is the table with the samples and their endpoints, for example: PLASMA TUBE A GEL A TUBE B GEL B 1 128 256 32 64 2 32 32 64 64 3 64 64 32 16 4 64 32 32 16 5 64 32 64 32 6 32 32 32 16 7 64 32 64 32 8 32 32 32 32 9 32 32 32 16 10 64 32 32 32 11 64 32 64 16 12 128 64 128 64 13 64 32 64 32 14 32 16 32 16 15 64 32 128 64 16 128 64 32 16 17 128 64 64 32 18 64 64 16 8 19 64 64 64 32 20 32 16 32 16 Thank you guys.
Research letter in NEJM describes our findings. https://www.nejm.org/doi/full/10.1056/NEJMc2034764?fbclid=IwAR1BQRvpaHBAMDaHxCPY07xBjPQHlIHoJCOmpjoT_pBNvQsV7pzzDVdLYaY Table 1. HLA-Matched Platelets as a Percentage of All Platelet Transfusions, According to the Initiation of Other Protocols.* Protocol and Timing of Initiation No. of Years HLA-Matched Platelets Difference from Previous Period (95% CI) median % (IQR) percentage points No leukoreduction and no ABO matching (1985–1990) 6 12.5 (4.2–13.7) NA Leukoreduction and ABO matching for patients with leukemia and MDS (1991–1999)† 5 2.9 (2.0–3.6) 9.6 (9.4–9.8) Universal leukoreduction (2001–2004) 4 1.4 (1.1–2.0) 1.5 (1.4–1.6) Universal ABO matching (2005–2015) 11 0.4 (0.2–0.8) 1.0 (1.0–1.1) Pathogen reduction of platelets (2016–2019)‡ 4 1.7 (0.8–1.8) ND The practical fact is that this can only be implemented by medical technologists, not physicians, and this is a daunting prospect. But the reality is that ABO mismatched platelet transfusions probably exacerbate rather than prevent bleeding, so waiting for ABO identical is likely better than just transfusing whatever is available. This is going to require a major change of approach because the (incorrect) dogma, based upon no data, is that ABO doesn't matter for platelets. I understand why many people's instant reaction is this is not feasible. But it is once technical experts in your transfusion service figure out how to implement it gradually. In our randomized trial back in 1993 (see ref below), the ABO identical group only required <50% the number of platelet transfusions (every other day instead of every day on average) compared with the usual first in, first out regardless of ABO type group. ABO mismatched transfusions create a hostile environment with gigantic immune complexes that compromise subsequent transfusion that may be ABO identical. Avoiding this is key. Our suggestion is to start gradually. Pick new previously untransfused patients with aplastic anemia and good prognosis AML (young, favorable or normal cytogenetics), groups O or A, and start with them. Eminently doable since your platelet supply is 45% O and 40% A, just like your patients, on average. Get the hang of doing this and prioritizing ABO for at least some patients. Once you get this in place, extending it to other patients and eventually all patients can happen. We use washed O or A platelets and red cells for group B and AB recipients when we don't have group B or AB platelets. No increase in bleeding and fewer transfusion reactions, lung injury and congestive heart failure (what we call TRALI and TACO). In the end, you have more surviving patients and fewer headaches and transfuse many fewer platelets per patient and essentially no HLA if you can get your referring hospitals to stop our current standard harmful practices. Godspeed. Heal JM, Rowe JM, McMican A, Masel D, Finke C, Blumberg N. The role of ABO matching in platelet transfusion. Eur J Haematol. 1993 Feb;50(2):110-7. doi: 10.1111/j.1600-0609.1993.tb00150.x. PMID: 8440356. Happy to have discussions or visitors so our technical experts can show you how it is feasible.
Switching blood types in trauma situations
maybe posted a topic in Transfusion ServicesMy facility's current SOP is to transfuse O red cells and A FFP in trauma situations until we have all the testing completed (including the second ABO typing) and enough compatible products are available to switch. We've not had any problems with following this process in the past (our trauma surgeons are amazing!) and we've always had enough O red cells and A FFP. However, last month we had a horrific trauma case come through that just decimated our inventory (hundreds of units in <24 hours) and the patient was AB Neg. Between this one patient and an emergency bleeding TTP patient we used almost all the A and AB plasma in the surrounding areas. What do you do in these situations when you can't provide type specific products? Giving a patient incompatible red cells is a huge red flag, even though I have heard of other hospitals having a protocol in extreme emergency situations. After 100-200 units does it really matter as long as the transfused combo of FFP and red cells are ABO compatible? I'm not particularly worried about running out of O red cells units (our blood supplier has a very healthy stock), but at what point do you flip plasma to whatever type you have available? And when do you flip back?
Help with ABO Group
aafrin posted a topic in Case StudiesWe had a 46 year old male health check patient who has never been transfused before come for blood grouping. He knows his blood group previously as O Rh Positive. Our results were as follows: Tube Test BioRad Gel -A 1-2+ mf 0 -B 0 0 -AB 2+mf ND -D (igG+IgM) 4+ ND -D (IgM) 4+ 4+ A1 Lectin 0 ND H Lectin 4+ ND A1 Cells 1-2+ at RT, >2+ at 37 C w-1+ at RT & 37C B Cells 4+ 4+ O Cells 0 ND Autocontrol 0 ND A2 Cells 0 ND We repeated the blood group with two other manufacturer’s anti-sera. One anti-sera gave the same result as our tube test result, but with the other anti-sera the result with anti-A was negative. What should we report the blood group as? O or subgroup of A? Kindly help.
MinerJ posted a topic in Transfusion ServicesHi, This is a very silly question, but I think I have confused myself. Why is it that when Rh phenotyping, we do not require incubation step, but when looking for antibodies, we need incubation to detect Rh antibodies?
Presence of H antigen
MinerJ posted a topic in Transfusion ServicesHi All, I hope someone can help me with some clarification. I was reading about the presence of H antigens in different ABO blood group patients, but I am getting different answers depending on what I read. Transfusion Medicine and Hemostasis- Clinical and Laboratory Aspects- 2nd Edition mentions O > A2 > B > A2B > A1 > A1B with O having the most, whereas BBTS Introduction to Transfusion Practice-6th edition mentions O > A2 > A2B > B > A1 > A1B. Maybe it doesn't really have a big impact to my routine work, but it is still good to be in the know. Any thoughts would be welcome. Regards, Jermin
Typing Discrepancy Case Study
Mosaics posted a topic in Immunohematology Reference LaboratoriesI have an interesting case study for y'all that I had at work today. Patient results: Anti-A 4+ Anti-B 4+ Anti-D 4+ Rh control 0 A1 cells 3+ B cells 0 We have the patient history as a B positive in the computer. What do you think is the cause of these discrepant results and what would you do to resolve?
MikeB posted a topic in Case StudiesFemale Orthopedic pre-op patient. No history of transfusion. Cold reactive antibody identified only reacting at 18C (1+) and 4C (3+) including autocontrol. No reactivity at IS or 15' RT with panel cells. DAT (w+) with Poly and C3b/C3d. No reactivity at 37C or IgG. Anti-A: 1+ Anti-B: 0 Anti-D: 4+ A1 Cells: w+ B cells: 4+ Appears to be an A subgroup with an Anti-A1, however......... Anti-A,B: 3+ Anti-A1: 0 A2 Cell 'A' : 3+ (Expired 3/29/13) A2 Cell 'B' : 3+ (Expired 4/26/13) A2 Cell 'C' : 1+ (In date) O PoolCells: 0 Autocontrol: 0 Any thoughts on why are the A2 cells reacting so strong at immediate spin compared to the A1 cells?