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Antibodies Identified at Another Facility


kmmoton

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If you find that a patient has an antibody history from another facility, of course you honor that antibody, but do you actually put it into the patient's history so that it becomes a part of that patient's record or do you just put a comment?  Also, is there an AABB or CAP standard that mandates that you DON'T enter this as a part of the patient's history?

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Same here. I would put it in as an antibody, not just a comment, so the computer safeguards will kick in if you try to allocate non-screened units, etc.

I would also prefer same way as just putting comment can be missed... we are in computer world so we need our computer to stop us from making mistakes!!! :)  :)  :)  

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I'm curious, if a patient tells the nurse they have an antibody, they even go so far as to identify it by name, Anti-K, (not anti-Kell, just K), it that good enough for you?  Let's assume your antibody screen is negative, how far would you go.  I know there is no "right" answer to these questions, just wondering how far you would take it.  :begone:

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I'm curious, if a patient tells the nurse they have an antibody, they even go so far as to identify it by name, Anti-K, (not anti-Kell, just K), it that good enough for you?  Let's assume your antibody screen is negative, how far would you go.  I know there is no "right" answer to these questions, just wondering how far you would take it.  :begone:

 

I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient.

A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients. :)

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I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient.

A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients. :)

For reasons such as this, whenever I have a positive antibody screen on a new patient, I call the floor and ask if the patient has been transfused before and, if so, where.  I then call that facility and get their history.  In transfusion medicine, we have to be investigators who are willing to turn over every stone. 

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We had a case recently where a patient came in through the ER, she gave the nurse an Antibody card for a Jka that was identified years ago in Texas. When we called to get more info we were told that the patient was not coherent and no family was available.  We did the screen (positive), and antibody Id and found a E, K (no sign of the Jka).  2 units were set up(E,K,Jka neg) and transfused.  The next day they ordered 2 more units, a nurse from the floor called to say that the patient was insisting she had another antibody card that she could not find.  I spoke to the patient and she told me she had 2 cards from different hospitals, she was also able to tell me all (or at least several) of the hospitals she had been transfused at.  I proceded to call all of them and found another hospital in Texas that had identified E, c.  We antigen typed the units she was given and 1 was c positive.  Post transfusion had a lovely c.

 

Morale of the story...Always listen to the patient....

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Getting an atypical antibody card to every patient should be a concern for all testing facilities.  Unless and until we get a universal database for medical information on all patients, that little card becomes very important in some situations!  You can't rely 100% on anything to make sure that every possiblity for an incompatible crossmatch is "covered".

 

(Then again, it is common for many hospitals to routinely transfuse O Pos to untyped males and non-child bearing age females in emergency situations, due to a local shortage of O negs!)

 

Scott

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Thanks for the responses.  I've discovered over the years that blood bankers love to live in the land of "What If".  You can be confident that I own a large home right in the middle of that land.  :crazy:  

 

I'm finding that patients are taking a more direct hand in their care and are much more knowledgeable than they were 30 years ago.  While info from a patient should be confirmed if possible, much more often than not they are reasonably correct if not complete in their info. 

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When talking to patients also be sensitive to their situation.  Many, many years ago as a young BB'er I found an anti-D in a 30 year old woman which, I thought, was likely a passive anti-D.  According to our policy I went to her room to collect a history.  She had a couple of visitors but I went ahead and asked about recent pregnancies or situations that might have called for RhIg injection.  She denied everything.  I returned to the lab ready to document it as an active sensitization.  Shortly thereafter her nurse called and said the patient wanted to talk to me.  I returned to her room and found her visitors gone.  She admitted to a recent pregnancy, it's termination and subsequent dose of RhIG.  The visitors present at my earlier visit were her parents and were unaware of the situation, so she had lied.

That taught me to be a little more discrete with my interrogations, and reinforced the realization of the value of patient interaction.

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When talking to patients also be sensitive to their situation.  Many, many years ago as a young BB'er I found an anti-D in a 30 year old woman which, I thought, was likely a passive anti-D.  According to our policy I went to her room to collect a history.  She had a couple of visitors but I went ahead and asked about recent pregnancies or situations that might have called for RhIg injection.  She denied everything.  I returned to the lab ready to document it as an active sensitization.  Shortly thereafter her nurse called and said the patient wanted to talk to me.  I returned to her room and found her visitors gone.  She admitted to a recent pregnancy, it's termination and subsequent dose of RhIG.  The visitors present at my earlier visit were her parents and were unaware of the situation, so she had lied.

That taught me to be a little more discrete with my interrogations, and reinforced the realization of the value of patient interaction.

In the States, we are constantly trained on the matter of HIPPA security.  If, on rare instances, I go to speak to a patient directly, the first thing I ask is are you comfortable discussing your care with visitors in the room.  I don't begin any discussion if they answer no.  That may not prevent this type of issue mentioned above but it covers my butt from and inadvertant HIPPA violation.

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I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient.

A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients. :)

Excellent post!!

 

I do the same as everyone else.  Especially Id the antibody in the system to the proper checks are made.  I follow up with a historical comment documenting what facility and the individual I spoke with.

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