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Malcolm, I found Kuziva (very easy between 2200 other people) and we had a nice talk about that "serology rules".

UPDATE: The results are in - and it is not what we hoped. Not issuing blood products in a plastic bag (when not issued in a cooler) was an indirect finding when we received our final Joint Commission report. They referred to: TJC Standard: IC.01.03.01 Primary Priority Focus Area: Infection Control: hospital identifies risks for acquiring and transmitting infections. So needless to say, we are now issuing all our blood products in a cooler or in plastic bags. We are using a clear plastic bag at this time. It is not opaque and it is not labeled as "Biohazard". A huge "Thank you!" to those have have responded. Beth Polstra, Transfusion Mgr., Children's Healthcare of Atlanta

Scott, I can tell you my institution would have sent samples to reference with those kinds of reactions. We actually had a patient extremely similar to that last week (reactions in gel/tube from w+ to 3+ but with no discernable pattern that anyone here could identify, as well as a bunch of negative panel cells with no discernable pattern) but the nurse wouldn't draw any more pink tops for us and the patient was discharged without being transfused.

Hi Scott, I can imagine you (and others) saying, "Well, he would say that, wouldn't he", but the answer is "Yes". The reason I say yes is because this sounds quite an interesting scenario. By that, I mean that the antibody appears to be strengthening, and it would be best to get the specificity sorted out now, than when the antibody finally decides to show its real muscles, just when the patient requires blood in an emergency. From what you say, the reactions appear to give a sort of "mixed-field" reaction, which suggests either an anti-Sda or something within the Lutheran Blood Group System (neither of which are renowned for being clinically significant), BUT, and it's a big BUT, it may not be. So you then have the problem that, 1. if it is, how do you know if there is, or is not, another, this time clinically significant antibody lurking under this clinically insignificant antibody or 2. if it isn't, and the patient needs blood urgently, what do you do, as this antibody specificity on its own may be clinically significant? From the Reference Laboratory's point-of-view, I can tell you that there is nothing that makes us bite through 6 inch nails more than a hospital that knows "there is something there", but hasn't sent it to us to identify, and then requires us to identify the antibody specificity in an emergency situation, when we could have identified the specificity (or, at the vey least, had a go at identifying the specificity) as a "cold" case. Just my slant on things!