Can someone help me? Antibody screen is positive

[trisram]

Here's the scenerio:

I got an order for 2 units of blood. I do a ABORH and then an Ab screen. The screen is positive. What do I do next?

Can you tell me if my steps here listed are correct?

1) First I do an antibody panel

2) After I do my first panel, I still have a few antibodies not ruled out, but I have one antibody that I have ruled in Anti-K

3) Then look into our inventory to find two units there are K antigen negative

4) Then I crossmatch the 2 units and do Ab screens on both of them

5) as the units screens are incubating, I do a 2nd Ab panel with prior used panel reagents to rule out all the antibodies I didn't rule out the first time

6) Then I keep doing this until I ruled out everything

7) as soon as all my rule outs are done, then my units will be ready to issue.

Does this sound like an efficient way of going about this problem? Or is there something I can add or correct to make this as quickly and efficient as possible?

Thank you for your time.

T. Ramon, MT(ASCP)

PS.

Usually, I work core lab and microbiology, but they have me working in blood bank, and I am still trying to work out stuff. Thank you for your time.

Edited October 20, 2009 by trisram

[Malcolm Needs ☆]

Hi Tristram,

Please could you tell me what you were able to rule out with your first panel, and what you were trying to rule out with your second?

This is quite important information to know before making any suggestions.

Thanks.

[David Saikin]

I guess that works . . . I try to do all my r/o before I select my units. A lot depends on the urgency of the request.

[John C. Staley]

Why are you doing antibody screens on the 2 units of blood? Was that not performed at the blood supplier?

[Malcolm Needs ☆]

Why are you doing antibody screens on the 2 units of blood? Was that not performed at the blood supplier?

I missed that bit John.

I agree with your obvious worries about this.

[L106]

Your Step #4 has a problem, but I think it may just be how you worded it. For Step #4, instead of saying "do Ab screens on both units", did you really mean "do special antigen typings on both units to make sure they lack the antigen" (if you did not have donor units in your inventory that were already tested as K Negative)?

(It is not necessary to perform antibody screens on donor units that have already been tested by the collection facility.)

[Packer Banker]

4) Then I crossmatch the 2 units and do Ab screens on both of them

5) as the units screens are incubating, I do a 2nd Ab panel with prior used panel reagents to rule out all the antibodies I didn't rule out the first time

6) Then I keep doing this until I ruled out everything

7) as soon as all my rule outs are done, then my units will be ready to issue.

At step four, the units need to be Kell typed and crossmatched. At steps five and six, just a few cells can be picked out that rule out all other antibodies. Usually patient is Kell typed as well, to verify that he/she is in fact Kell negative. (This step only if they haven't been transfused in the last 90 days and may have donor blood in their system) Then when your ag neg units are crossmatch compatible, you're done!

Hope that helps--

Jennifer

[trisram]

Yes, wow, your answer is excellent! Thank you! I am just trying to get a clear picture in my head, just in case, I ever get into this type of situation.

[trisram]

Hi Tristram,

Please could you tell me what you were able to rule out with your first panel, and what you were trying to rule out with your second?

This is quite important information to know before making any suggestions.

Thanks.

Well, I just needed to get a general idea on how to go about issuing donot units if the patient/recipient has a positive Ab screen. So far I haven't caused any hemolytic transfusion reactions ... Thank you

[trisram]

Thank you so much!

[Grippy]

>to verify that he/she is in fact Kell negative. (This step only if they haven't been transfused in the last 90 days and may >have donor blood in their system)

Thanks for this info. I had been asking some coworkers about this and have an answer now.

[L106]

Yes, wow, your answer is excellent! Thank you! I am just trying to get a clear picture in my head, just in case, I ever get into this type of situation.

Oh..........you will, you will....

[rosieshaw]

Hi Trisram,

You have probably sorted out this issue by now, but I have a question.

At what point did you AG type the Patient for K?

I may have missed that in the described scenario.

[Annadele]

Disclaimer: I'm new to BBing as well.

I discovered recently that antigen typing can also be helpful even if the patient has been transfused in the past 90 days. A couple of weeks ago I ag typed a patient for three antigens as a routine part of identifying new antibodies in our laboratory. (I can't recall which but I think that one was anti-c.) I was having trouble obtaining probability for two of the suspected antibodies and wasn't aware until after I performed the typing that the patient had received a transfusion about two months prior. The ag typing was clearly negative for one ag and mixed field (with a small positive population) for the other two. I was able to not only feel confident that the patient was probably negative for those antigens, but also able to presume that the transfusions they'd receive were positive for those antigens - bolstering the possibility that they were now forming those antibodies. The sample was later also sent for a bioarray to get a complete antigen type by molecular methods and I left the results open until they'd been reviewed by a specialist. I probably wouldn't have ag-typed had I known about the transfusion but now I think that those results were helpful at that moment in trying to decide if that patient needed to receive units that were negative for those antigens.