24 hour samples for clinically significant antibodies

[geni]

I was wondering if this is just a local policy or if there is a (BCSH) guideline stipulating 24hour pre transfusion is needed for the provision of blood for a patient with clinically significant antibodies.

I have worked in my hostpital for 18 and a half years and this is what has been followed?! It seems that there are a few places that think that this is not necessary. It would be nice to find out this information for my knowledge.

[Malcolm Needs ☆]

I was wondering if this is just a local policy or if there is a (BCSH) guideline stipulating 24hour pre transfusion is needed for the provision of blood for a patient with clinically significant antibodies.

I have worked in my hostpital for 18 and a half years and this is what has been followed?! It seems that there are a few places that think that this is not necessary. It would be nice to find out this information for my knowledge.

Apart from the time frames given in BCSH Guidelines concerning patients who have previously be transfused (particularly recently transfused), there are no such strictures in the BCSH Guidelines (and nor should there be).

Some antibodies (which, in any case, could have been stimulated by pregnancy) can last in the circulation for years and years and years, without further stimulation.

To test such patients every 24 hours would be vast overkill on the part of the laboratory and, I would think, from the patient's point-of-view too!!!!!!!!!

[David Saikin]

In the USA we require a specimen every 3 days for folks recently pregnant/transfused - with our without a history of sensitization.

[Malcolm Needs ☆]

In the USA we require a specimen every 3 days for folks recently pregnant/transfused - with our without a history of sensitization.

Reasonable!

[adiescast]

I was wondering if this is just a local policy or if there is a (BCSH) guideline stipulating 24hour pre transfusion is needed for the provision of blood for a patient with clinically significant antibodies.

I have worked in my hostpital for 18 and a half years and this is what has been followed?! It seems that there are a few places that think that this is not necessary. It would be nice to find out this information for my knowledge.

I wonder if the 24 hours was just intended to be a lead time recommendation, not a sample expiration recommendation. It would be good to have some lead time (when possible) to work up a sample with antibodies before they require the transfusion.

[Malcolm Needs ☆]

I see from where you are coming adiescast, but I really, really fear that this is not what is meant. Many of the Consultants in charge of Blood Transfusion Laboratories within the UK are NOT specialists in blood transfusion, but specialists in Haematology, and "do" blood transfusion on the side.

[geni]

Thank you all for your replies especially Mr needs since he works in the same enviroment in the UK as me. All i can say is we must be over doing things at our hosptial and i don't know where this policy came from and i don't see any change happening in the near future,i will be speaking to people in charge!! to see if there can be some change because it becomes very frustrating for transport patient and ill dialysis patients who rely on family to bring them in for their transfusion.

[Liz]

I agree with David, that is our policy.

The policy is to agree with Dave, just kidding. Our policy is 3 days as CAP and AABB required.

[Liz]

Question: we take new samples Q3 days for inpatients who require transfusions. We repeat the AbSc which will be positive again and so we repeat the AbId Q 3days for patients requiring transfusions. I believe this is right because Abs may be formed during that 3 day interval. Right my dear friends? It is in the AABB standards.

[Gkloc]

I believe your right on that Liz that you need to repeat the AbId, but you only need to do a select cell panel for patients who have an antibody history at your institution.

[adiescast]

The point is to check for new antibodies, not to reidentify the one you already know about, as gkloc says. I do usually include one cell for the known antibody (or separate cells for multiples) just to see which ones are still demonstrating. It may be overkill, but I don't like to report out "Anti-X present" on an antibody identification if I haven't demonstrated it currently.

[Malcolm Needs ☆]

The point is to check for new antibodies, not to reidentify the one you already know about, as gkloc says. I do usually include one cell for the known antibody (or separate cells for multiples) just to see which ones are still demonstrating. It may be overkill, but I don't like to report out "Anti-X present" on an antibody identification if I haven't demonstrated it currently.

I totally agree with what you write.

[Liz]

The point is to check for new antibodies, not to reidentify the one you already know about, as gkloc says. I do usually include one cell for the known antibody (or separate cells for multiples) just to see which ones are still demonstrating. It may be overkill, but I don't like to report out "Anti-X present" on an antibody identification if I haven't demonstrated it currently.

Yes indeed.

However if I cannot demonstrate the previous antibody, I still give Ag negative but how do you report that? "by history the patient has anti-K" for example?

[Malcolm Needs ☆]

I know this wasn't addressed to me Liz, but the way we do it is, for example,

"Alloanti-Jka previously detected by DiaMed gel IAT and enzyme technique."

and, like you, advise giving antigen negative blood.

[KKidd]

Our policy states that you are required to repeat the antibody ID on a known patient if: the screen reactions don't match the antigram, there has been a 2 grade increase instrength since the last screen or the antihuman crossmatched antigen negative units are incompatible. If it has been a long time since the patient has been at our facility we may repeat the ID. Same goes for those inconclusive results - we will repeat at a later date. We all walk a fine line between providing the safest blood for our patients and getting bogged down with extra testing that may not be necessary. For me it's doing the testing that makes you comfortable in releasing the blood (if that's what it takes!).

:whew::whew::wave::wave:

[jcdayaz]

Kudos to you KKidd!

I agree, except for the "2 grade increase" and the "been a long time since the patient has been at our facility" statements. I think "been a long time" is not objective enough. What one Technologist thinks is a long time might be vastly different than another Technologist thinks.

I have seen a couple of cases of Fya and Jka that presented themselves with only a slight increase in screen reaction strength. Certainly not a 2 grade increase.

(Totally not applicable to your post, but...)In the world of blood banking I have always been taught if I see hoof-prints I am to look for horses first. If a horse doesn't match the print then I look for zebras. It has served me well in my career. I hope it can help someone else!

[Malcolm Needs ☆]

In the world of blood banking I have always been taught if I see hoof-prints I am to look for horses first. If a horse doesn't match the print then I look for zebras. It has served me well in my career. I hope it can help someone else!

I agree with you jcdayaz, but in the world of the Reference Laboratory, particulalry in an area that has a high ethnic mix, sometimes the hoof-prints are not just made by the odd zebra, but, just occasionally, by a Bengal tiger wearing Wellington boots!!!!!!!!!!!!

:confuse::confuse:

[Liz]

Excellent Malcolm and in addition VERY true where Blood Banking is concerned, it just doesn’t follow the rules and that is why we are amazed by it and attracted to it!!

Great analogy!!!

:hooray::hooray:

[Liz]

I most certainly agree with you jcdayaz about the fact that one should not depend on:

"2 grade increase" and

the "been a long time since the patient has been at our facility" statements.

and also the screen reactions don't match the antigram, what if the screen does match it????

One must really be careful at the BB.

[Ellen Zeigler]

You may want to look at the package insert for the AHG that you use. Some have limitations that are specifically addressed to antibody screening, although there may be others that have/had limitations that would impact compatibility testing.

[Mabel Adams]

The standards don't require a repeat antibody ID on every specimen unless there is evidence of a new antibody, like an incompatible crossmatch, or new screen cell reacting. Most of us do a repeat ID of some extent but it is not strictly required by AABB standards. I believe U of Mich does not do one routinely.