Pathologist comments on antibody identifications

[jagsmith]

Do your pathologist(s) make comments about antibody identifications? Ex. Significant or insignificant

[BloodBankGuy]

Our pathologist does not have input in the identification of antibodies and they do not review the records after.  Significant/insignificant is made by the supervisor (Me) if there is any question as to whether it is or not.  Granted it's easy as 98% of antibodies are significant that are identified on a daily basis.  But as I said no pathologist comments on antibody identification.

[Dansket]

Our pathologists do not make comments in the computer system regarding antibody identification. Within Meditech, there is a antibody database and a field which defines antibody as clinically significant or not.

[Karrieb61]

Zip! Our pathologist does not have a strong BB background so I think he knows his limits. We have a Trans. Medicine medical consultant available to us for those problem identification issues as well as a Reference lab close by too as backup. But the part-time Pathologist we have does not get involved.

[goodchild]

We developed an index of clinically significant/insignificant antibodies with the medical director's input and current literature recommendations.

 

The index indicates system, specificity, a rough classification of risk for htr/hdfn, the % of random US donors who would be compatible, whether Ag Neg units are needed, recommended or not required and special instructions/notes.

 

In general our pathologists would defer to the senior technologists with a difficult antibody problem.

[Malcolm Needs ☆]

Our Pathologists are pretty clued up on antibodies, etc (as you might hope, working for the Reference Laboratories of The National Health Service Blood and Transplant in the UK!!!).

 

That having been said, we always write the reports ourselves and sign them out, except in clearly defined circumstances.  Even within these clearly defined circumstances, we write the report, and then send it to the Pathologist to change (if necessary) and to sign out.  I cannot remember the last time they changed a single word.

 

They have certainly NEVER changed an antibody specificity (woe betide them if they tried!!!!!!!!!!!!!!!!!!!!!!!!!!!!).

[goodchild]

One of my coworkers here used to work at a facility in Virginia where every single antibody identification study was reviewed by a pathologist. I was (and still am) amazed at that sort of practice.

[Dr. Pepper]

We use Meditech too, but the "significant or not" designation is internal and drives some QA aspects(warnings for allocating unscreened units, EXM eligibility etc) and does not get reported. I would bet that there's only a small fraction of physicians who actually understand what we do and are talking about; the rest trust us in varying degrees to take care of "that antibody business".

 

Our pathologists  trust us and don't review or comment.

[SMILLER]

Here, its simular to Goodchild's situation, above.

Scott

[Malcolm Needs ☆]

I wouldn't trust any machine/computer that decides what is clinically significant and what is not.  For example, anti-Lan was thought to cause transfusion reactions, but not to cause severe HDFN - until a recent paper described severe HDFN caused by anti-Lan!!!!!!!!!!!!  I bet the machines/computers have not been updated.

[David Saikin]

Have never had pathologists get involved with abid's unless there were going to be difficulties obtaining rbcs or rarely to discuss the ramifications of WAIHA and transfusion.  Mostly they just wan to know "what's interesting".  Have actually had some cases brought up at rounds - my pathologist comes out of a large teaching hospital and is only here 1-2 half days/week (if I'm lucky).  I will also discuss transfusion to pts with anti-M esp if the ab appears to be insignificant - I wan them to know (and tacitly approve) that we are going to give xm compatible rbcs not necessarily M negative.

[Auntie-D]

Our haematologists are always that busy running clinics and reviewing nonsense films that people have put through for consultant review that they never set foot in blood bank. It's hard enough trying to get hold of them for a new leukaemia...

[Malcolm Needs ☆]

Keep it that way Auntie-D!!!!!!!!!!!!!

[Maureen]

Our pathologists do not review, comment or report on patient antibodies.

My prior Transfusion Medicine Medical Director, at a large academic medical center, did review new antibody identifications, and issue a formal pathology report.

[tbostock]

Our pathologists do not review any panels; they have limited transfusion training/experience.

[mcgouc]

Our pathologist takes no interest in Blood Bank.  Our computer has warnings for clinically significant antibodies, but the techs can override them.   Our policy has a list of antibodies with their clinical significance.  The techs are trained to call our Blood Center's Reference lab for any antibody not on the list or if they have any questions regarding whether antigen negative blood is required or not.   Realistically, if we have an unusual antibody, the Reference lab probably identified it and gave us their recommendations which we documented in the computer. 

[AuntiS]

Our pathologists do not have anything to do with the Blood Bank here, either, let alone comment on antibodies.  The least senior pathologist got stuck with being on our Transfusion Committee....

[AMcCord]

We've got a new young pathologist who's thinking about making a statement about significance, % of compatible donors, time needed to provide blood, that sort of thing. He's interested in Blood Bank and has a good knowledge base. We are still in the 'playing with the idea' phase. He is concerned with making the information readily available in the EMR so that physicians can be forewarned that their patient's crossmatch may take longer (or a lot longer) that usual. Work in progress at this point.  

[Likewine99]

I wouldn't be surprised in those rare instances where Pathologists do an interp on an ABID if they might be able to charge a professional fee for the interp?

 

In my many, many, many, many years in Tx Medicine I've never had a Pathologist who knew or cared about an ABID workup.  

[goodchild]

Yes, it's CPT 86077: difficult cross match and/or evaluation of irregular antibody(s), interpretation and written report.

 

I wouldn't be surprised in those rare instances where Pathologists do an interp on an ABID if they might be able to charge a professional fee for the interp?

 

In my many, many, many, many years in Tx Medicine I've never had a Pathologist who knew or cared about an ABID workup.  

[kate murphy]

I'm in a teaching hospital and have the luxury of a board cert Trans Med Hematologist as our Medical Director.  She is actively involved in reviewing all workups, and teaching path residents at the same time.  It's a group effort sometimes!  That said, there is no special documentation in the computer system.  Techs interpret and enter results.  Our medical director is involved (through the residents) to communicate to ordering docs (more residents) of extended delays in screening for compatible rbc, or teaching all residents when to defer transfusions. 

[swansch]

We use Meditech, and our medical director uses Pathology reports for (nearly) all of our antibody workups and suspected transfusion reactions.  The report is formatted like other path reports; sections for findings, comments, and a final interp.  The text is typically some variation of available canned texts.  The findings section (filed by BB techs) includes the blood type, previously reported antibodies, current antibodies, and possibly the type of testing performed during the investigation.  The comments identify the likelihood of clinical significance for transfusion or HDN, whether antigen-negative blood will be provided for transfusion, and the percentage of donors likely to be compatible.

[Eagle Eye]

our pathologist reviews and writes MD comments for every panel/antibody we work on and also bill for it.

[mollyredone]

My medical director is not involved in antibody IDs. She does review all MTPs and transfusion reactions.

[EDibble]

Have never had pathologists get involved with abid's unless there were going to be difficulties obtaining rbcs or rarely to discuss the ramifications of WAIHA and transfusion.  Mostly they just wan to know "what's interesting".  Have actually had some cases brought up at rounds - my pathologist comes out of a large teaching hospital and is only here 1-2 half days/week (if I'm lucky).  I will also discuss transfusion to pts with anti-M esp if the ab appears to be insignificant - I wan them to know (and tacitly approve) that we are going to give xm compatible rbcs not necessarily M negative.

We have had similar experiences here David. There are times when a physician will only accept an answer they don't want to hear from another physician. "What do you mean we have to get blood from across the country for my patient?" et. al.

 

Beth