This is a question posed by my Laboratory director:

 

Given this scenario, "Patient with a history of anti-Jka whose current antibody screen is negative.  Two units of RBCs are ordered for transfusion tomorrow evening." 

 

1. Does your blood bank crossmatch random donor units and issue crossmatch-compatible donor units?

 

    or

 

2. Crossmatch Jka- donor units  and issue crossmatch-compatible Jka- donor units?

 

    or

 

3.  Do you think this is a trick question?

 

I'd appreciate as many responses as possible.

 

Thanks,

 

Dan

We do #2. We find antigen negative units for Jka first, then would perform the AHG crossmatch.

Number 2 for sure. Why could it be considered a trick question?

#2

# 2 ...there is no doubt #1 is no no.

 

& not a trick question.

Number 2 without doubt.

 

Anti-Jka is renowned for causing anamnestic haemolytic transfusion reactions and is implicated in many, many cases in the UK's SHOT Haemovigilence Scheme every year.

#2

#2 only

We also do the #2 scenario.

Number 2 definitely

I have a question for you. What is your lab director's blood bank back ground? I had a lab director once and his only qualifications for the job was a BS in business (long story). He would ask these kinds of questions. 

No trick or treat....#2 is the only answer.   

I have a question for you. What is your lab director's blood bank back ground? I had a lab director once and his only qualifications for the job was a BS in business (long story). He would ask these kinds of questions. 

He is a CLS

He is a CLS

  A bit scary, but I guess if you don't have a blood banking background it's an understandable question right.

Edited October 28, 201311 yr by Justina

Why did he ask the question?

 

Scott

#2

That should go without saying, if you have a history of ab then you would give Ag negative units.

#2. Why would he even be asking?  

2. Crossmatch Jka- donor units  and issue crossmatch-compatible Jka- donor units.

Number 1 is WRONG as following this procedure will lead to possible anamnestic response*. 

 

Number 2 is the RIGHT PROCEDURE to follow to prevent possible anamnestic response*. 

 

Number 3: This is definitely NOT A TRICKY QUESTION. 

 

Anamnestic Response: An accentuated antibody response following a secondary exposure to an antigen. Antibody levels from the initial exposure may not be be detectable in the patient's plama until the secondary exposure, when a rapid rinse in antibody titre may occur. This may lead to haemolytic transfusion reaction. 

#3.

 

The fact that the question is being asked is the trick.

#2. 

_{Number 2 for sure.}  

As bloodbanks become increasingly digitized, less and less qualified people become associated with them. We withdraw in horror at the prospect of choice number one  being even a choice on the table.

However, we must get accept the fact that as experienced blood bank staff retires and replacements are chosen in "cost-efficient" manners, as one would chose a nut or a bolt, the consequences of

inappropriate choices will become more frequent. Smaller hospitals and rural hospitals which cannot

compete for the needed staff will evince the most errors. I can't speculate on the number of errors, but

my feeling is that percentages are now rising.

As bloodbanks become increasingly digitized, less and less qualified people become associated with them. We withdraw in horror at the prospect of choice number one  being even a choice on the table.

However, we must get accept the fact that as experienced blood bank staff retires and replacements are chosen in "cost-efficient" manners, as one would chose a nut or a bolt, the consequences of

inappropriate choices will become more frequent. Smaller hospitals and rural hospitals which cannot

compete for the needed staff will evince the most errors. I can't speculate on the number of errors, but

my feeling is that percentages are now rising.

I agree with Pavel and thank goodness most of us have computer systems that would not allow #1. 

Edited October 30, 201311 yr by R1R2