Massive transfusion with an antibody

[jcdayaz]

I don't know what it means either, but it conjures up the horrible thought of the limb being left dangling by a piece of flesh.

Yeuk!

:eek::eek:

Malcolm,

You never cease to amaze me with your knowledge and/or your ability to make me laugh! I'm laughing right now!

Histology, I know received multiple pieces of bone and flesh after her last surgery. I certainly don't know what was left, but suffice it to say it wasn't her first "partial amputation"(whatever that means). I wish the job would have been thoroughly done that time when we were actually able to have 2 liquid(not frozen) units for her here that were crossmatch(AHG) compatible.

The units for the last transfusion were located at some rural community blood donor center in New York. Not even a place our red cross would go to/accept blood from under normal circumstances. The patient's brother is a "big-wig" on the board of a large, well-known hospital in New York. He was able to get done what we couldn't. How sad is that?

[Malcolm Needs ☆]

What do you consider "seriously strong"? Do you foreign Techs:D have the same grading system we do here? As in 1+, 2+, 3+, 4+? If you do, what number is "seriously strong"?

Almost the same, but we go from 0 to 5+.

I wouldn't really wory unless it is a "strong" 3+ and above.

I don't know if that really helps without a diagram/photograph, and I haven't got one!

:redface::redface:

[galvania]

Malcolm,

. The patient's brother is a "big-wig" on the board of a large, well-known hospital in New York. He was able to get done what we couldn't. How sad is that?

In the worst case scenario, might her brother be able to donate for her? Has he been tested?

[jcdayaz]

In the worst case scenario, might her brother be able to donate for her? Has he been tested?

Thanks for the reminder. I feel retarded now. I never even thought of that!

We "inherited" this patient from a local hospital. I had conversation at length with the surgeon when we first got the patient about the possibility that we would not be able to find compatible blood. He knew of the "difficulty" (haha) of finding compatible blood from the previous hospital's blood bank.

I gave him directions on how to transport this patient back to the previous hospital!! Thank goodness he laughed!:D

[Eagle Eye]

we go case by case basis. I think out trauma surgeon thinks smAe way that we will provide waht is the best for the patient. During massive transfusion they do not want to think about antibody or even blood...they just keep transfusing what we send ...we have set amount of blood and ffp we sent every 25 mins.....in case of patient with antibody we(BB medical director) make the decision to give what is the best and available at a time.

[jcdayaz]

In the worst case scenario, might her brother be able to donate for her? Has he been tested?

I don't know all of the testing that was done at the previous hospital....the brother option just may well be worth pursuing.

Thanks again!

[jcdayaz]

Almost the same, but we go from 0 to 5+.

I wouldn't really wory unless it is a "strong" 3+ and above.

So, on our 0-4+ scale would that be 2+ or 3+ that you would consider "seriously strong"? We use gel testing , it is typically MUCH more sensitive than any tube testing techniques.

We often times detect antibodies that even our "Reference Lab" can't. Don't be offended, yes, I put "reference lab" in quotes on purpose!

[Malcolm Needs ☆]

Almost the same, but we go from 0 to 5+.

I wouldn't really wory unless it is a "strong" 3+ and above.

So, on our 0-4+ scale would that be 2+ or 3+ that you would consider "seriously strong"? We use gel testing , it is typically MUCH more sensitive than any tube testing techniques.

We often times detect antibodies that even our "Reference Lab" can't. Don't be offended, yes, I put "reference lab" in quotes on purpose!

I'm not in the least offended, as we use gel as our first line of attack, and I agree with you wholeheartedly that this technology is much more sensitive. The technology we use is DiaMed, and there are times when we cannot get a positive reaction that has been found by BioVueI or on an Echo. I have no problems with this, as techniques can be too sensitive, and detect antibodies that are totally clinically insignificant (even if they have a "clinically significant" specificity).

That all having been said, however, I was talking about a strong 3+ in the tube technique, as the sensitivity of the gel technology does tend to "enhance" reactions to such an extent that it is difficult sometimes to judge antibody strength.

:):)

[jcdayaz]

I'm not in the least offended, as we use gel as our first line of attack, and I agree with you wholeheartedly that this technology is much more sensitive. The technology we use is DiaMed, and there are times when we cannot get a positive reaction that has been found by BioVueI or on an Echo. I have no problems with this, as techniques can be too sensitive, and detect antibodies that are totally clinically insignificant (even if they have a "clinically significant" specificity).

That all having been said, however, I was talking about a strong 3+ in the tube technique, as the sensitivity of the gel technology does tend to "enhance" reactions to such an extent that it is difficult sometimes to judge antibody strength.

:):)

AH, You meant 3+ in tube. Now I understand. You are VERY correct in your comment about gel detecting clinically insignificant antibodies and enhancing their strength. We also start with gel on the Ortho Provue and then go to tube testing if we need specialized work to identify an antibody. Typically its in Cold auto antibody cases and we are doing a cold screen and/or a prewarm screen/crossmatch.

[Eagle Eye]

Gel is more sensitive but I try not to honor tube testing, just use it to see if there is a cold antibody. If I have inconclusive antibody panel with gel, I can sleep at night if we give gel crossmatch compatible units. THere are so many cases when we send specimen to "Reference Lab" they come up with no antibody identified. Our ref. lab performs gel to mimick our testing but do not go any further and come back with basically same answer.(inconclusive). Thier standard is tube with Alb, LISS & FIcin.

[jcdayaz]

Almost the same, but we go from 0 to 5+.

I wouldn't really wory unless it is a "strong" 3+ and above.

I don't know if that really helps without a diagram/photograph, and I haven't got one!

:redface::redface:

Re. Yta patient...

Guess what dawned on me at work today?! (Why did it take so long?) We crossmatched all the known E,c,K negative units we have in stock at the moment and found one to be perfectly compatible! We then sent segments from the compatible unit to our reference lab for Yta testing. I left work before we received any results.

It seems reasonable to think we just might have found a new Yta neg donor.! I certainly don't know, but it seems logical to me. I guess I'll find out when I get to work tomorrow.

I appreciate your advice on dealing with a Yta. We were gearing up to go with units untested for Yta, but it requires Pathology approval, the surgeon's signature on a special form, etc etc. Basically more trouble than we want to deal with IF it is avoidable. I do, however, have no doubt we will have to go that route for the patient's actual surgical amputation.

Hopefully there will be no flesh hanging from from any bone when the surgery is done!:D:D:cries::eek: