Brenda K Hutson

According to my math, it will be cheaper for us. But maybe it has to do with Tiers, etc.? We are starting with changing our unit re-types to tube; but patients will be next on the list. Brenda

The Title alone makes you want to look at it! Thanks! Brenda

That would be the Partial D with Anti-D which has been mentioned in some of the other responses. So yes, that is a definite possibility. Brenda

Ah yes, I know at some places I have worked with a LOT of Reference work, we have thought there must be a Warm Autoantibody Season! Brenda

That is an interesting thought...I will have my Tech. call the Physicians just to rule that out. I also know pregnant women can certainly get Warm Autos; but the one's I have seen have been non-specific and hitting all cells. Thanks Brenda

1. As others questioned, why perform GEL Crossmatches with Negative Screen? 2. 70 yr old Rh NEG woman; would not be "uncommon" for her to have Anti-D, Anti-C and possibly Anti-E if she has ever been pregnant (pre-Rhogam days). 3. Scenario 1 place I worked: Patient with history of "unidentified;" which usually translated to "possible Low Incidence." But not sure; the initial work-up was performed before I started working there. So, fast forward many years...due to history, AHG Crossmatches were performed (but current Antibody Screen in GEL was Negative). Tech. came to me saying 2 of 3 crossmatches were incompatible. Obviously, this would not "make sense" if possible Low Incidence. So, had him perform a Panel. GEL Panel showed a clear-cut Anti-Fyb. Why?? Not sure why Negative Antibody Screen (repeat Negative); but have heard of problems with Fyb and Jka in GEL (have seen it a LOT with Jka). Brenda Hutson, CLS(ASCP)SBB

Until coming to my current Facility, the other places I worked where GEL was used, only used the GEL technique for Antibody Screens and Antibody ID; all Blood Types (patients and units) were done by tube. In the place I am now (and have been for 8 months), they performed ALL Unit and Patient Typing by GEL; only a 2nd type on patients with no history, was performed in tube. With cuts in Healthcare these days, it is just too expensive for many places to use GEL for Blood Types. So, I just changed us from GEL to Tube for Unit Re-Types. The next "phase" will be to switch from GEL to Tube for Patient Types also. You are correct; it is a HUGE cost savings (sorry Ortho... I LOVE GEL but it call comes down to cost:frown:). Brenda Hutson, CLS(ASCP)SBB

Agree with many of the other responses....most units these days are drawn in Adsol; there is "for all practical purposes," no plasma left on these units (but may be a tiny bit so not for babies; but them many Pediatricians don't want Adsol units anyway). If drawn in CPDA-1, would wash them. Brenda Hutson, CLS(ASCP)SBB

Document all occurrences on your Facilitie's Deviation/Occurrence Report Form (whatever you call them); then Track and Trend the occurrences. If problems continue even after notifying the responsible parties, take it up a notch to your Facilitie's Compliance Officer (QA Director, Risk Management, etc.; again, whatever they are called at your Facility). I have also found it helpful when presenting the data, to include the $$ impact. That is kind of a universal language; especially with today's economy and Health Care Costs and Restrictions. Good Luck! Brenda Hutson, CLS(ASCP)SBB

Bottom line; it should NOT exceed 4 hours. To my knowledge, there is no "out" for a Physician to approve transfusion over a longer period of time. In some places I have worked, that has been 1 of the documents we have audited; completed Transfusion Forms that show when the transfusion was completed. But we would also look in our computer system to see when the unit was Issued; as the 4-hour clock (per my understanding; and I think there is at least 1 previous Thread on this), starts when the unit leaves the Transfusion Service; not when the Nurse decides to start the transfusion (i.e. if it sits on the floor for 30 mins. before they start the transfusion, they now have 3 1/2 hours to transfuse the unit). So, what I recommend if a transfusion was > 4 hours is that you document it on your Facilitie's Occurrence/Error/Quality Improvement Form (whatever you call them) and let them know that was against Policy and Regulations. Brenda Hutson, CLS(ASCP)SBB

It's true; you just can't trust those pesky little critters! Brenda

Ah, that's a good question! I will check into that. So then they are using it not "just" or "necessarily," for the blood warming aspects (although given that it is OR and those rooms are cold; that may very well be routine standard of practice), but also as part of their set-upf or other things? Brenda

We have 2 Hospitals and are merging into 1 new Hospital in about a year. With that in mind, both locations are starting to consolidate procedures. I received an e-mail from a Nurse at one location today, stating that one of the locations uses the blood warmer for ALL transfusions? I have never heard of that. So my questions are: 1. Do any of you work at Hospitals that do this? 2. Does anyone know of any "adverse" affects to this practice? Thanks, Brenda Hutson, CLS(ASCP)SBB

Well, I have seen my share of Auto Anti-D; and even a few partial D's with Anti-D; but 3 in a 2 week period? From a statistical standpoint, just doesn't seem right.... Brenda

No IVIg. Thanks Brenda

Wow, now that is interesting! I don't know of any such similarities (except that 2 of them are pregnant). We did perform a cold panel on 1 of the 2 we have not yet sent to the Reference Lab (since that was their conclusion to the one we did send); it was Negative. Thanks Brenda

Thanks Malcolm! (and everyone else who is trying to assist with this enigma) So here is my direction at this point: 1. I am having a Tech. perform a Cold Panel on 1 of the 2 patients we have not sent to the Reference Lab (just so that if we do end up sending it out, I can know for myself whether there is a Cold Agglutinin there). 2. We "can" perform an eluate; I'll give that some thought. 3. I am having my Lead call Ortho Technical Support to see if they have any "words of wisdon." And these are not weak antibodies; we are talking 2-3+. Very strange. Brenda

Ok, so now you are using "big words;" I will concede! Brenda

I recently posted a Thread under Case Studies which is continuing to be problematic; so thought I would try it here also to see if I get any other "thoughts." We have just added yet another patient to this mystery! In just the last couple of weeks, using Ortho GEL technique; we have had 3 Rh Positive individuals (typing strongly Rh POS) who appear to have Anti-D; all other major Allos ruled-out. 2 of the 3 have a Positive Autocontrol; but negative DAT with IgG and C3. We sent the 1st one off to our Reference Lab and they called it a Cold Agglutinin?? So, I have not sent the other 2 yet as this does not make sense to me (and as I have always taught my staff anywhere I have worked, "things should make sense."). I'm not saying their conclusion was incorrect; just that there is something strange going on. I would not expect that many Anti-LW's (1 person's suggestion; but anything is possible), anymore than I would expect 3 Anti-D in Rh POS patients in that short of a time-frame. Auto-D Mimicking D 3 Partial D patients with Anti-D And since 2 of them have been pregnant women, I cannot just settle for transfusing Rh NEGATIVE RBCs; I need to figure this out. I think I will call Ortho Technical Support today also. HELP MR. WIZARD..... Brenda Hutson, CLS(ASCP)SBB

Yes, I concur. But in part, I was basing that on the 3+ strength of reactivity; not something "I" have seen much with Lewis Antibodies...... Brenda

Hey Malcolm, I keep sending you e-mails; but I think I must be doing something wrong (I can be computer-compromized at times)? Because I would still love to have your input also on my Thread recently submitted on Case Studies.... Thanks, Brenda

When I start out by performing a complete phenotype (I think I described this on a Post in Case Studies once ??), I have to admit, I do not type for P1, Lea, Leb, M or N. Not that those could not be there; but rather than I am usually fortunate in coming up with the answer without having to bother with those (may have to rule them out later; but take a chance in my initial analysis). Then I take that phenotype and find 1 Panel Cell that is Negative for all the patient lacks (so if patient is E-K-Fyb-s- but positive for everything else; I would just look for a cell that is E-K-Fyb-s-; everything else could be NEG or POS; doesn't matter). If the reaction is Negative, you are likely dealing with Multiples; if Positive, more likely a High Incidence. But I have also frequently been fortunate in information that just the phenotype provides; i.e. patient may be Jka-Jkb-; then I test for Jk3. Or patient may be S-s-; then I think U; etc. Just some things to think about... Thanks, Brenda Hutson, CLS(ASCP)SBB

Right; if it was a non-pregnant woman (or even a woman who was not of child-bearing age), I would probably just say to give Rh Negative rather than go to the expense of a work-up. But the pregnancy issue changes things. Brenda

Thanks. So what is running an O NEG Cord going to do for me? :tongue: And yes, I too have had "those days" where things are suspiciously similar. Also, I think I forgot to mention; the Reference Lab said they had received another work-up )from somewhere else) that came up with the same thing (except they could not rule-out the Anti-C or Anti-E on that one). Brenda

We have had 2 patients recently (which is already too high of odds for me) which have shown: 1. Rh Positive Patient (3-4+) 2. Appears to be a clear-cut Anti-E (1+ Reactions on 1 patient; 3+ Reactions on another patient). 3. First patient had a Negative Autocontrol; 2nd Patient has a 2+ Autocontrol (DAT Neg with IgG and C3). 4. We sent the first patient out to our Reference Lab to see if they could identify a Partial D with Anti-D. First, they do not carry that special D Panel. 2nd, they obtained Negative results in GEL, LISS and PeG; weak in Ficin (which they prewarmed away). They performed a Cold Panel and said it was a Cold Agglutinin. 5. So, I am sitting here with this 2nd one in front of me (pregnant woman); with 3+ on all D+ cells and a 2+ Positive Autocontrol with Negative DAT. I could also perform a Cold Panel here, but I am just not convinced that is what is going on here. If we send it to them again, they can send it to the National Reference Lab to determine if it is a Partial D, but that would be expensive (and we would give D- RBCs anyway). In talking to the Reference Lab Supervisor, she said they had another similar patient recently. So, I am just wondering if anyone has heard of anything unusual with Rh POS patients appearing to have Anti-D, just in GEL (though we did not Test this 2nd patient in any other method yet). This seems like too many either: Partial D with Anti-D, or Auto Anti-D Patients in a short period of time, given the size of our Institution. Thanks for any input! Brenda Hutson, CLS(ASCP)SBB