MOBB

Are you using tap water? You could switch to distilled water.
 

I think missing the antibody screen depends why it was missed?  Was it negative this time?  Was that an error? 
If the pt has a hx of an antibody, ag negative rbcs should always be provided (regardless of the absc result).
Since the unit was transfused without an ahgxm, without ag typing,  Biological Product Deviation report is required.
 

Once a specificity has been definitely identified, there is no requirement to "re-identify" it every time you receive a sample.  You may want to test to see if it is still detectable, but that can be done using a single red cell sample.  However, as screening red cell phenotypes tend to be complementary, I still contend that a panel should be performed (albeit, it may be an abbreviated panel), to ensure no de novo specificity has developed.

In answer to your last sentence Teristella - GOOD LORD YES!
Turning to your first sentence, the problem with performing an extended cross-match is that, if, for example, the patient has either sprouted a weak anti-Fya, or worse, has made an anti-Fya in the past (unrecognised), but has not been re-stimulated for a long time.  Either the units could both be Fy(a+b+), or one could be Fy(a+b+) and the other Fy(a-b+), and the cross-match may not detect it.  This is because the red cells in the antibody identification panel are in a preservative that maximises the expression of the red cell antigens, but NOT the oxygen carrying capacity of the red cells, whereas the red cells in the units are in a preservative that maximises the oxygen carrying capacity of the red cells, but does not maximise the antigen expression of the red cells (and the Duffy antigens are known for deteriorating upon storage (as are the Knops antigens, but they don't matter).  So, by cross-matching without performing a panel, you may be missing an anti-Fya, and if the screening cell that is Fy(a+b-) may have come from an individual who has the FYA/FY genotype, if these red cells have come from a donor of the Black ethnicities, but the human immune system is MUCH more sensitive than our tests, so you have a DHTR on your hands.
This, however, is purely a personal point-of-view.

I must admit that makes me nervous Teristella.

I would tend to agree with some of what Dr Gehrie was saying (although, of course, I wasn't there to hear the lecture), and I would reference a paper that I referenced in a different thread (Chou ST, Jackson T, Vege S, Smith-Whitley K, Friedman DF, Westhoff CM.  High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors.  Blood 2013; 122: 1062-1071; doi: https://doi.org/10.1182/blood-2013-03-490623), however, the experience in the UK is certainly that, if you can match the Rh type of the donor and the recipient (by that, I mean giving Ro donor blood to an Ro recipient; not rr blood to an Ro recipient, unless this cannot be avoided), then the formation of other antibody specificities is somewhat reduced.  This is partly due, of course, to the Ro type being far more common in both donors and recipients of Black ethnicity, which, in a way, takes care of both the Rh and K antigens (excluding mutations), but, almost by accident, also takes care of some other antigens and antibodies.  For example, the Fya antigen is only expressed on the red cells of approximately 10% of these donors, while the Jkb antigen, not the most immunogenic antigen one can quote, is only expressed on the red cells of approximately 49% of these donors, compared with the mid to high 70%s in most other donors.
I am not saying, therefore, that matching Rh and K types is a panacea for preventing antibody production, but we have found (both empirically and by more rigorous research) that antibody production is lower by adopting this fairly simple measure.  We have also recently genotyped many of our haemoglobinopathy patients, revealing those with, amongst other things, RH gene mutations.  What we have to do now is genotype our donors from the Black ethnic backgrounds, and then match the two, so that bespoke units are provided.  This is ambitious, but should be attainable, at least at a decent level, within the next few years.

Were you cited with a deficiency?  If not, I would ignore inspector's musings.
I dislike the term "retype", it seems ambiguous to me.  The last time I looked at CAP standards they required that the patient's ABO be confirmed or verified, but did not prescribe a testing protocol/method.

The wording on this one has changed several times since it first appeared in the standards - I'm sure they are seeking to  clarify the intent. And every time they change the standard it just brings another angle to the debate about what they mean. That's why we all love the checklist  (not!).
Reading back through the thread, I think if we talk about this as 2 different topics, it would help.
Confirmation of negative patient results with poly - David, thanks for inquiring on TRM 40200 and 40210. The package insert for the poly I use does not require the use of complement coated cells to confirm negative reactions for patient testing. IgG coated red cells are sufficient. Matches the response that David received from CAP. The package insert for the Anti-C3b, - C3d I use requires the use of complement coated cells to confirm negative reagents for patient testing. Also matches the response from CAP. Pretty straight forward. QC  - the All Common checklist requires QC  with a positive and negative control for every reagent, every day of use or following manufacturer recommendations . The package insert for the poly and anti-C3b, -C3d reagent I use does state that complement coated cells should be used to confirm that the reagents have sufficient anti-C3 reactivity - once a day. So, my interpretation of the standards for QC and the standards for patient testing are:
If you are using a reagent with anti-C3 reactivity, you will need complement coated cells for QC. This would include poly and anti-C3. Performed once daily, when used. If you are confirming a negative patient test and you have used poly, you must use IgG coated cells, but complement coated cells are not required. If you are confirming a negative patient test and you have used anti-C3, you must use complement coated cells.  
So ejani should use complement control cells as part of daily QC for the poly AHG used for patient testing, but only needs to use IgG coated cells to confirm negative patient test results.
 
 

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!   

I'll apologize in advance for the lengthy answer.  
I had always been taught that matching Rh and Kell were helpful in preventing alloimmunization for SS patients, but I attended a lecture by Dr. Gehrie last week on this topic and he had a very different opinion. I'm looking forward to discussing this with my medical director-it's so different from everything I've previously read.
Dr. Gehrie said the 2014 NHLBI Expert Panel made a moderate recommendation based on low-quality evidence that RBC units that SS patients should include matching for C, E, and Kell antigens and that serologic antibody matching programs results were varied. He also advocated that only 30% of SS patients form alloantibodies which makes studies difficult-patients may not have made antibodies, but maybe they are part of the 70% that wouldn't make antibodies.
He shared the Chou et al 15 year retrospective analysis from Children's Hospital of Philadelphia. The patients were provided D, C, E, and K matched RBCs from mainly african american donors.
N=123 chronically transfused, N=59 episodically transfused.
58% of the chronically transfused and 15% of the episodically transfused were alloimmunized.
91/146 antibodies were to Rh antigens. 
The biggest takeaway for me was 87.6% of the patients had Rh variant alleles which help explains the  alloimmunization rate.
Dr. Gehrie's protocol at Johns Hopkins is to do nothing for SS patients until they form an antibody, then genotype the patient and provide matched products based on the genotyping.

lucky you if you know who the father of the baby is!!!!!  Minefield!!

This was a hot topic about 2 yrs ago.  The FDA came out and said that storage in blood boxes/coolers is considered storage NOT transport.  AABB/CAP might be mollified, I don't think the feds will think twice about a 483.  Unless you are putting the product in a BB refrig.
Check out posts from Feb, 2016

Staffing in NYS labs right now is reaching catastrophic levels.  Can't even find generalists.

CAP requires verification of all manual entries - this is in the All Common checklist. Every one of those errors should be documented with investigation and resolution - this is also something that a CAP inspection should be looking at with every inspection. Is the rest of the lab having as many problems???
 
 

No. All manual entry at our hospital is reviewed by a second tech for typos

No!

The patient takes loratadine. It doesn't look like brompheniramine or phyenyltoloxamine are ingredients and I see loratadine listed anywhere interfere with their reagents.
We diluted our 3% reagent RBCs to a 0.8% suspension with Grifols diluent and the gel screen is negative.

Sorry guys but you've got it wrong about the witches.  she was a witch if she DID NOT drown - in which case she was burned at the stake.  whether she had anti-D or not!

I read on the Internet that if a person sinks in water and drowns, they're proven to be a witch........

I always considered antibody identification both art and science with a little magic thrown in for good measure.  

Prof. Theirry Burnouf, Prof. Axel Seltsam, Sue Johnson and some English guy ay Cressier in 2015.

Probably not helpful, but there is not a shred of scientific or clinical evidence for the efficacy and safety of this time limit.  Totally expert opinion based upon a group of white haired males (like me) sitting around a table eating tuna fish sandwiches 60 years ago :).  We document such stuff for the two regulatory agencies and two accreditation groups we are inspected by.  How's that for efficiency? Four inspections.

People can be quite creative when it comes to finding an "easier" way to do their job.  That is one of the reasons I have always been a firm believer that complicating a process never makes it better or safer.  I know the rational behind the 2 types being required but I personally never bought into it being a practical solution the potential problems it is trying to solve because of the many more problems is has seemed to cause for the staff resulting in all the work arounds they manage to come up with.  For it to really work you would have to have 2 separate draws performed by two different people at different times.  (Both phlebotomists in the room drawing one immediately after the other defeats the purpose.) Then you need to have two different techs perform the testing, one for each sample.  This would be impossible in many smaller facilities, especially on evening and night shifts.  Of course the requirement came from people based in large, well staffed facilities.  I'm starting to ramble so I'll stop here for now.
I have one question, in the past the AABB rule was written that you had to have 2 sets of test results, the one you are currently performing and one on file to compare the current one to and if you did not have one on file then you needed the second test performed prior to issuing RBCs.    It that still the case?

As long as idiots exist in the world, they will thwart any solid plan we put in place to mitigate their recklessness.

Good laugh to start my day!