sending patient samples to a reference lab

[aj2018]

How often do you send a patient out for an antibody ID to your reference lab? do you do it every time they come in and have a positive screen? do you do it on inpatients every three days and get a positive screen?

what about patients with colds or HLAs previously identified.  if you have two or three cells positive but can still rule out all significant alloantibodies, do u still send it out?

 

is there a rule or a standard that talks about the frequency a workup has to be done..

 

[donellda]

I work at a reference lab and yesterday someone sent us a specimen with a negative antibody screen in gel. I was skeptical at finding anything but I managed to identify a weak anti-Fya in PEG so maybe sending them when you feel that there is something there is actually worthwhile

[Malcolm Needs ☆]

Well okay, but would an anti-Fya (on this occasion I stress) be clinically significant?

[SMILLER]

Really Malcolm, I must be missing something here.  Wouldn't a transfusion of Fya blood to a known producer of anti-Fya, however weak, likely cause an increase in the anti-Fya titre?  Or are you suggesting that since the detection was only in PEG, that this may not be a Fya at all?

 

Thanks, Scott

[Malcolm Needs ☆]

Oh, absolutely it would probably increase the titre of the anti-Fya Scott, but what I am saying is that, as the anti-Fya was only detected using a very sensitive technique, giving Fy(a+) blood, ON THIS ONE OCCASION, would probably not cause a clinically significant haemolytic transfusion reaction - although it would cause a serological transfusion reaction.  It is, if you like, an extremely crude risk/benefit analysis on my part.

[Auntie-D]

We send a first ID and then from that point if the panel is consistent we just continue on our merry way. If the patient hasn't been transfused or pregnant, if the screen reaction and strength is the same, we only panel once every month.

Edited November 17, 2014 by Auntie-D

[John C. Staley]

Oh, absolutely it would probably increase the titre of the anti-Fya Scott, but what I am saying is that, as the anti-Fya was only detected using a very sensitive technique, giving Fy(a+) blood, ON THIS ONE OCCASION, would probably not cause a clinically significant haemolytic transfusion reaction - although it would cause a serological transfusion reaction.  It is, if you like, an extremely crude risk/benefit analysis on my part.

 

I wish I had a dime for everytime I wanted to transfuse a patient just so I could get their antibody levels up to a point I could easily identify them!!!  Never did but sure thought about it. 

[seraph44]

_{If you get a type and screen and have a positive ABSC that needs to be sent out due to panagglutination, do you send out if the patient gets discharged? or if the doctor confirms no blood will be needed? We are for profit hospital, and I expect sending it to the ARC will cost somewhere >$3K. What is your input or practice for this scenario?}

 

_-Thanks

[tbostock]

_{If you get a type and screen and have a positive ABSC that needs to be sent out due to panagglutination, do you send out if the patient gets discharged? or if the doctor confirms no blood will be needed? We are for profit hospital, and I expect sending it to the ARC will cost somewhere >$3K. What is your input or practice for this scenario?}

 

_-Thanks

Depends on the patient/situation.  For example if it was a patient with sickle cell disease that lives locally and we know they will be coming back, we would send that out for a workup.

 

An ER patient that came in with ankle pain and was discharged, probably not.  We would attach a note in their computer record though for the future.

[Malcolm Needs ☆]

From a Reference Laboratory point-of-view, Seraph44, I can assure you that we would rather have the sample to work on properly, in our own time, as it were.  The next time the patient comes in could be a real emergency, and then the Reference Laboratory has to work under undue pressure, on a case that they should have known about before.  It is under these circumstances that mistakes are made.