Discrepancies in Antigen Typing

[jcdayaz]

Nope....we get out blood from our supplier. Our blood supplier has "historical" antigen histories of donors. Rare cases of difficult antibodies crossmatches we have to rely on the ARC for units. They phenotype.

Clear as mud I know.

Oh, sorry I misunderstood your post. We have only 1 reference lab/blood supplier and they are the same company--ARC. I assumed this was standard. Perhaps another international difference??

[lehooke]

Malcolm,

You are correct. It was for C antigen typing. After speaking to the reference tech, he specifically said that when "he retested the patient using in-dated Biotest reagents...., he then got a weak positive result.

[Malcolm Needs ☆]

Malcolm,

You are correct. It was for C antigen typing. After speaking to the reference tech, he specifically said that when "he retested the patient using in-dated Biotest reagents...., he then got a weak positive result.

Thanks for that confirmation.

Yes, he would have done because, apart from the fact that he was originally using an out-dated grouping reagent (from what I understand) he was also using a reagent that contained a small amount of anti-C and a large amount of anti-Ce.

Of course, only the small amount of anti-C would react with an R2Rz red cell sample; the large amount of anti-Ce would not, and therefore the reaction would be weak.

I am not a vindictive person, but I still think that you should report this chap to his manager, as what he is doing is downright dangerous. If he were to use this out-dated grouping reagent to type units, he could end up giving C+ blood to a patient with anti-C. Goodness only knows what would happen if he were to use an out-dated anti-JKa. It frightens the life out of me.

:eek::eek:

[Brenda K Hutson]

Unless in exceptional circumstances, neither of there should EVER happen.

:eek::eek:

I don't know what their scenario was for the incorrect antigen typing from the Donor Center, but here is a possible scenario with the Donor Center we use. It primarily services a large Medical Center (which I used to work at; that is how I know of this process). When the Medical Center antigen types any of the units, it sends that information over to the Donor Center (via hard copy). The Donor Center then "manually" enters that information into their computer system under that donor. When any donor comes in, a white sticker is placed on the top of the unit (above the primary base label). It has the unit# and exp. on it. In addition, it lists the "historical" antigen typing results (i.e. E+, S-, Fya+, etc.). They are only considered historical, but they are at least a place to "start" if you need antigen negative blood (with the understanding that we will always confirm the antigen typing). There have been rare occassions where the phenotype documented on the unit was incorrect. I also recall 1 instance where the label stated the unit was E-e-. So, there you have it! But that is what you get when you have people manually transferring data from one system to another. Of course it is also possible that the Hospital did mistype the unit but I am more suspicious of the manual entry.

Brenda Hutson

[Brenda K Hutson]

Ah! They're a different kettle of fish. I believe a bloke called George Garratty works for them!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I think I'd believe something that came from them (with his backing)!

:):)

Well yes, but that "bloke" just works at 1 Red Cross Facility. This coming from someone who was a Reference Lab Supervisor at another Red Cross Facility (that is not to say "my" facility was bad; just to say that he cannot be held responsible for what every Red Cross Facility does).

And as an aside....he is a very nice, very approachable "bloke." I attended a lecture once where he spoke. It was in the city I was living in at the time (prior to my Red Cross experience) but not the city he lived in. I had some questions from his lecture but there were too many people around him for me to approach him (plus I was too nervous). When I got back to my Hospital, I had the "bright" idea that I would e-mail my questions to him! Day after day went by and I would anxiously rush to my computer to see if he had responded (while telling myself, "right, Dr. Garratty has nothing better to do than respond to my e-mails"). One day when my phone rang, I ran into my office to answer it. On the other end was none other than Dr. Garratty himself! I was speechless! Anyway, he answered all of my questions and never once made me feel like any of them were insignficant or stupid (in fact, even asked me if I was "free to move;" meaning come and work at his facility). Some years later I left that city and moved back to where I was from and became the Red Cross supervisor there. I put together seminars twice a year and he was always willing to come and speak (and of course, this drew large crowds). Even after leaving the Red Cross, I have called him from time to time when I had an interesting case and he has always been willing to discuss it with me (and even contact a patient's physician for critical issues).

Ok, I digress.....sorry

Brenda Hutson, CLS(ASCP)SBB

Brenda Hutson

[Brenda K Hutson]

This is true, but it does not mean that it does not happen. We have had times when we ordered antigen negative blood, say Jka negative and received blood that was Fya negative. We have had the labeling go both ways. Sometimes it was accurately labeled for what they tested (even though it wasn't what we ordered). I only recall one occasion where it was not accurately labeled.

We thought that having a computer based order system would relieve these problems (of not getting what we ordered) because we thought they might be verbal miscommunications, but at least one of these mishaps has occurred despite the computer ordering system. It seems to be very difficult to get a fool proof process. What is the saying? "Nothing is foolproof for the clever fool?"

Ah, you also need to take into consideration for that scenario that in many Donor Centers, it is the distribution staff that are looking for antigen negative units in the blood supply. And some of them are capable of that; and some......not so much! I too have received units that were negative for the incorrect antigen.

Brenda Hutson

[Brenda K Hutson]

WHOA!! Seriously?? NO NO NO!! You are being supplied by a donor facility that does not confirm "historic" types on each donation?? RUN RUN RUN away from them...if you have the option. If you don't, then you should be confirming antigen status upon the unit's arrival in your BB.

Sorry to be so forceful, but this practice is just plain wrong.

Perhaps I am missing something here. Our donor center also has units with historical typings. That being said, given the process by which these typings get into their system (explained in one of my other responses), there is always the "infrequent" possibility that something was entered incorrectly. But for that reason, we ALWAYS reconfirm the antigen typing when it reaches our Institution. We do not assume anything....

One advantage of this historical typing (given the fact that it is rare that what is listed on the unit is erroneous), I have had some occassions over the years when a patient with historical antibodies presents in the ER needing uncrossmatched blood. It is at least a "little" better to be able to given them historically negative, uncrossmatched blood than random blood for which you have no idea of the history.

Brenda Hutson

Brenda Hutson

[Malcolm Needs ☆]

Well yes, but that "bloke" just works at 1 Red Cross Facility. This coming from someone who was a Reference Lab Supervisor at another Red Cross Facility (that is not to say "my" facility was bad; just to say that he cannot be held responsible for what every Red Cross Facility does).

And as an aside....he is a very nice, very approachable "bloke." I attended a lecture once where he spoke. It was in the city I was living in at the time (prior to my Red Cross experience) but not the city he lived in. I had some questions from his lecture but there were too many people around him for me to approach him (plus I was too nervous). When I got back to my Hospital, I had the "bright" idea that I would e-mail my questions to him! Day after day went by and I would anxiously rush to my computer to see if he had responded (while telling myself, "right, Dr. Garratty has nothing better to do than respond to my e-mails"). One day when my phone rang, I ran into my office to answer it. On the other end was none other than Dr. Garratty himself! I was speechless! Anyway, he answered all of my questions and never once made me feel like any of them were insignficant or stupid (in fact, even asked me if I was "free to move;" meaning come and work at his facility). Some years later I left that city and moved back to where I was from and became the Red Cross supervisor there. I put together seminars twice a year and he was always willing to come and speak (and of course, this drew large crowds). Even after leaving the Red Cross, I have called him from time to time when I had an interesting case and he has always been willing to discuss it with me (and even contact a patient's physician for critical issues).

Ok, I digress.....sorry

Brenda Hutson, CLS(ASCP)SBB

Brenda Hutson

I totally agree with you Brenda (well, not about the "Ok, I digress.....sorry" bit) but about your assessment of George.

You could not wish to meet a nicer person and, as you say, he is so free with his knowledge, and so good at putting it across, that he puts some others I know to shame.

:D:D:D:D