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Guest Lynn R

Add on crossmtches

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Guest Lynn R

Hiow long can a specimen sit in the frig and still be able to add on crossmatches? Assuming the TS was done the day it was drawn, and the patient has not been transfused or pregnant within the last 3 months. This is for pre-surgicals that have come in early for lab work and then in surgery they decide to add a crossmatch.

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My transfusion service will use the specimen for up to 14 days from date of collection. The 14-day outdate was established by a previous Blood Bank Medical Director who sat on the board of CAP. Remember though, once the patient has been transfused, the specimen now "expires" on the third day following the transfusion.

On the other hand, I am aware of a facility (major teaching hospital) that will use the specimen for up to 30 days past collection.

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If of any help: From the UK BCSH guidelines for compatibility testing (www.BCSHguidelines.com)

4.7 STORAGE OF SAMPLES

4.7.1 Whole-blood samples will deteriorate over a period of time. Problems associated with storage include red cell lysis, bacterial contamination, loss of complement in serum and decrease in potency of red cell antibodies, particularly immunoglobulin M (IgM) antibodies.

The following are suggested as working limits:

EDTA whole blood

18–25'C Up to 48 hrs

4'C Up to 7 days

-30' C N/A

Edited by RR1
formatting

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If of any help: From the UK BCSH guidelines for compatibility testing (www.BCSHguidelines.com)

4.7 STORAGE OF SAMPLES

4.7.1 Whole-blood samples will deteriorate over a period of time. Problems associated with storage include red cell lysis, bacterial contamination, loss of complement in serum and decrease in potency of red cell antibodies, particularly immunoglobulin M (IgM) antibodies.

The following are suggested as working limits:

EDTA whole blood

18–25'C Up to 48 hrs

4'C Up to 7 days

-30' C N/A

I know that what you have posted is absolutely correct, Rashmi, but on the one hand our Guidelines are talking about EDTA whole blood (which, of course, has NO active complement) and on the other talks about loss of complement in serum.

It's about time the Guidelines got their act together (and I know that they have to account for all eventualities - but really!).

It is now almost unknown for us to receive a clotted sample (except, sometimes, when we are asked to perform a "cold" auto-antibody screen - and there is no logic behind this, because we only perform a thermal range [in most cases] or when asked to investigate a suspected case of PCH [which, again, defies logic, as we always perform an indirect DL test, rather than a direct, in case the patient's own complement is exhausted).

Time for a re-write of the Guidelines I think?????????????

:confused::confused::confused::confused:l

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Hi Malcolm...you know who they are- why don't you suggest this. Also, I hadn't noticed the actual wording until you pointed this out!!

Have to laugh..

Edited by RR1

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Assuming the plasma was seperated before refrigeration, two weeks to a month is not unreasonable for an immediate spin crossmatch on a patient whose antibody screen was performed AND whose medical history has not changed.

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I agree with you Bill (and others who have said this kind of thing) but this depends on the patient having a condition that precludes the possibility that they may have had a transfusion at another establishment.

For example, if the patient is coming in for a "cold" operation (non-urgent), such as a hip replacement, and is conscious when they arrive in the hospital (and are known to be compos mentis) then I see nothing wrong with this approach.

If, however, the patient has, for example, low grade sickle cell anaemia, and may, therefore, have had a transfusion elsewhere, I would be a little worried.

I am always worried, too, in the case of pregnant women, who may have had a "transfusion" from their foetus (even if they, themselves, did not know that they had been pregnant). Work published by Daniels, Hadley and Green (O {color:black;} a:link {color:red !important;} a:active {color:#FFCF01 !important;} a:visited {color:#3333CC !important;} Daniels GL, Hadley AG, Green CA. Fetal anaemia due to anti-K may result from immune destruction of early erythroid progenitors (Abstract). Transf med 1999; 9 (Suppl.): 16.) shows how early the Kell antigens are expressed (and so how early they can sensitized the mum.

Sorry about the change of font/font size and colour (I'm still having trouble with writing on anything more modern than papyrus).

:)

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Except we don't really want to encourage folk to separate plasma ...such a flaffy process with the potential for significant errors.

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Yes flaffy....it's "Rashmi speak" for something that's time consuming and gives little value ( ie not a 'lean' way of doing things).

This can also be used when describing documents that are over long and you fall asleep reading them.

I generally use this when describing observed behaviours, such as, ' they have been flaffing around with that sample/ analyser etc for hours'.

Hope this helps.

( DO NOT look this up on google!)

Edited by RR1

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We use a 3 day limit. Transfusion histories are not always accurate, the patient may be out of it and not be able to give you accurate answers, exposure to fetal antigens, etc. It's too time consuming to investigate the transfusion history. Faster just to get a new sample (and safer).

BTW, samples in the US must be stored 10 days (7 days past transfusion) and we always separate plasma from cells.

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We use Immucor reagents and the package inserts state that specimens can be tested up to 10 days after being drawn for refrigerated storage. (EDTA Samples) We also separate cells from plasma and store them labeled and banded together.

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Sorry, should have been a little more clear. We don't add reagents to IS crossmatch. We based the 10 days on the reagent inserts for the type and screen. After 10 days, they will need a new sample for the retype and we will do the IS crossmatch off of that sample. A repeat screen is not done if no preg/trans in last 3 months.

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