Antibodies Identified at Another Facility

[Rh-fan]

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....

 In the Netherlands since the recent guidelines, we have to select Rh fenotype compatible for al patients that have a (Rh, Kell, Jk, Fy Ss) antibody, to prevent these problems.

 

Maybe I have mentioned this before but we have now a almost nation covering database for the registration of allo antibodies, TRIX. Before transfusion a hospitol have to look in that system (mostly done by the LIS system) to see if the patient is known with antibodies. Since the introduction of the database I have heard a lot of stories (and seen publications) about patients with undetectable antibodies. I think the UK and the USA for sure are to big (to many hospitals) for such a system but in the Netherlands (100 hospitals) it is working fine.

 

Peter

[EDibble]

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. 

We do the same thing here. One time I had to call five out of state hospitals to get the complete history on a patient. Having all that information was well worth it!

 

On a personal note, I have often said that if I ever developed an antibody, I would get a medical alert bracelet. I wonder why that is not a routine thing. That information is certainly as important to a patient's treatment as information regarding allergies, etc.

[goodchild]

I'm planning on setting up an ID card for patients with special transfusion requirements one of these days, when I have extra time.
 
We put antibodies from other institutions in the system so that the checks/balances work (i.e. if you try to crossmatch a unit that's not negative for the antigen, it would alert you). We also put them in as comments so we know when/where the source of the information is from in case we ever question it in the future.
 
Do any of you use phenotype information from other hospitals? Do you also enter that into your LIS system?
Do you request faxed copies of the history so that it can be reviewed/verified? Or do you have someone do a callback verification later?
 
I ask because we've had a situation where a technologist documented anti-Jk(a) for the patient when the patient really had anti-Jk(b.) and it was continually missed for a long period of time. There was never an adverse event but it has perpetuated my high level of paranoia when it comes to blood banking.

Edited October 15, 2013 by goodchild

[KAPMT]

We would enter an antibody identified at another facility into the patient's history even if it was not currently reacting. We have a code that expands to previously identified and we add the antibody after that.

 

I am wondering how many issue cards or letters to patients when antibodies are identified. We are not currently doing this but I have looked through older BB records and found copies of letters we used to provide. I think the decision to discontinue the practice came about when we began using computers and the information was then stored for each patient. This is fine for patients that only are treated in our system but of course does not address the situation when patients are treated and transfused elsewhere.

[SMILLER]

For lots of reasons, this is one piece of medical data that patients should be aware of.  All testing facilities should provide the appropriate patients with a short letter that discusses atypical antibodies and a card that lists them when they are discharged.  We have had a few headaches here because this is not practiced widely.

 

(Of course, not all patients are going to remember to whip out a BB card every time they go in for a procedure, but unitl we get a universal computer medical record system this is the best we can do I suppose.)

 

Scott

[BBNBHM]

We put it in the comment section and write it on the ab card.  

[Malcolm Needs ☆]

We provide all our patients who have potentially clinically significant alloantibodies (which, being a Reference Laboratory, is the vast majority) - and some that I don't consider to be in the least clinically significant - with a card.

As Scott says though, what the patient does with them is another thing altogether!

[mollyredone]

I'm planning on sending out cards sometime this year.  We get cards from the Red Cross when they identify an antibody for us, and that gets sent to the patient with a letter, stating they can call for more information.  We recently had a patient who had 4+ in all screening cells, panel cells, as well as autocontrol.  We called the patient for her to come in for another draw to send to ARC.  We found out she had been at a hospital about 70 miles away in May and had a terrible reaction,but their screen was negative.  When we got the results back from ARC, she had a warm, C, K and e!  I sent her the letter and she called to ask about it.  We talked her into autogolous donations for her upcoming hip surgery.  I called the other hospital and faxed a copy of the ARC results to them.

 

The cards should have a name of a facility on them, so that should make it easier to confirm the antibodies.

[Byfaith]

We have an orderable test called "Antibody History" that places the results in the patient record, but it is clear that the antibody was identified elsewhere.

[L106]

We have an orderable test called "Antibody History" that places the results in the patient record, but it is clear that the antibody was identified elsewhere.

Edited November 10, 2013 by L106

[3cardmoe]

Just out of curiosity....how many of you issue antibody cards to your patients?

[SMILLER]

We do.  I wish everyone did.  I believe there is a recent thread where we have discussed this a bit.

 

Scott

[AMcCord]

I'd like to, but haven't had the support of the pathologists. We have a new medical director coming soon - I plan on hitting him up about that.

[goodchild]

Anyone that uses antibody/special transfusion requirement cards, would you be willing to share a blank template?

[Malcolm Needs ☆]

We do.

[dragonlady97213]

I work for the American Red Cross in Portland, Oregon and we send our customers cards on patient's who we have identified antibodies.  I designed my template for business card stock (Avery 8871 or similar depending on your printer) and just used the label function in Word.  I include patient's name, blood group, antibody/-ies and date the card was completed.  If we don't detect an antibody reported by a customer, I note on the card that anti-whatever was ID'ed by XXX Hospital.  I've had patients contact me and ask for additional copies of the cards, so I think they are making their way from hospital to patient.

Edited November 27, 2013 by dragonlady97213

[Mrmatch]

Yes that result is is entered in as an antibody  and referanced to the site who reported it  .

It is critically important that all clinically antibodies previously reported are taken into account when determing compatibility.

Antibodies may become undetectable over a period of time but when exposed to the offending antigen the immune system will respond more rapidly and virulently .

This will result in a transfusion reaction either immediate or delayed.  

Edited December 6, 2013 by Mrmatch

[mollyredone]

We get the antibody cards from ARC in Portland and mail them to the patient with a letter stating that they can call us for further information.  We plan on making our own cards and mailing them out with antibodies we identify.

[LCoronado]

An antibody reported by another facility (other than our own reference lab) is not entered directly into the patient's history.  However, we use Cerner Millennium and were able to build Transfusion Requirements which warn the user to select units negative for one or more antigens. This is also useful  in situations where phenotypically matched red cells are appropriate, even though the corresponding antibody has not been identified. 

 

[Changezi]

we put ABI result in our computer system which will blink at the time of entering XM and where we must inter for the DONOR that the donor is negative for that Antigen .

 

for example Anti-K is present , so at the time entering XM for that patient we must enter Negative FOR KELL (our code is NKEL) with the donor nubmer other wise it will not accept the compatibiity .

[Mabel Adams]

We used to send out antibody cards for our patients but the doctors didn't want them anymore.  They evidently weren't giving them to the patients and we essentially never got them presented to us when the patient presented at one of our area hospitals.  We continued to send letters to primary providers for a few more years but now we add interpretive comments to the Ab ID result and send a (usually electronic) copy of that to the primary provider.  They are all getting EMR's in their offices now so it seemed like it would fit better in their system than paper letters and it is way less work.

 

I still think that the patient themselves should get a card and that it should tell them (and the nurse they might show it to) what to do with it.  I had devised a card template where I used to work.  I will attach it here and try to put it in the Library under forms in case anyone wants to modify it for their own use.  I haven't convinced the pathologist that it is a good idea where I currently work.

 

For those of you that send out antibody cards directly to patients, do you just look up their address in Registration and send the card with an explanatory letter?  Who signs the letter?

 

 

Ab card master generic 2013.doc

[Malcolm Needs ☆]

Document23.pdf

I kept forgetting I promised to attach a copy of our antibody card. Head like a sieve!

[John C. Staley]

Malcolm, sieves are just fine as long as they keep the big important stuff in and let all the little trivial stuff out!  I like to tell people that my brain is full and if I learn anything new I have to forget something.  The problem is, I don't get to pick and choose what I forget.

[mollyredone]

Patient Antibody Letter.docWhen we send out the letters to the patient, our front office looks up their address on record.  The letter is signed by the Medical Director, but follow up inquiries are referenced by me.  Here is a copy of our letter. 

[EDibble]

I know I am late to the party, but just last week, we had a new patient (to us) admitted. The nurse called us to say, "her daughter is with her and says she has an antibody, an f y something." :-)

Sure enough, I called a nearby hospital and they had identified the anti Fya, which was NOT currently reacting.

 

We used to give out cards, but do not anymore.