Brenda K Hutson

We have been using it since 2008. I will fax a copy of our Form. The top of the form has a "sticky" label. The primary information (Patient NAME; MR #; ABO/Rh; Unit #; Unit ABO/Rh; etc) Prints out on the top portion. We then peel off the label and put it on a Tag card stock. That is attached to the units with plastic ties. Under the sticky label, the same information prints on the Form below it; which also lists on the bottom half; patient antibodies; unit attributes; signatures at Issue; et al. The Form is paperclipped to the hang tag. I will put the name and model of the Printer on the Fax coversheet. Brenda Hutson, CLS(ASCP)SBB

You are correct regarding your comment about Low Incidence Antibodies. That being said, Low Incidence Antibodies do not show up on most adult Antibody Screens either; but we don't therefore perform a complete panel on all patients hoping to catch that Cw, V, Kpa, Jsa, etc etc. Brenda

Wow...sounds like your Medical Director is not quite up to date on current standard of practice?? Not that your facility is the only one doing this; I imagine we could come up with about every possible scenario if we asked every Hospital. Brenda Hutson, CLS(ASCP)SBB

At least with babies it is easier to get a transfusion history; it is a little more difficult with elderly patients (and often their family is not sure either). Brenda

You have reminded me of the fact that I have also seen anti-K in patients who state they were never transfused; but then I have seen a number of antibodies in patients who say this. What I have also come to learn though is that patients "absolutely" do not always know they have been transfused (i.e. in OR; during war; etc). It is alarming to me that Physicians would not tell patients this (but then perhaps some of them are elderly and just don't remember). Anyway, all of that to say that I have tended to believe that these "surprise" antibodies actually indicate patients have been transfused but did not know. But you raise an interesting point; one that I will certainly be more likely to consider going forward. Thanks! Brenda

Hmmm...I am learning a lot from this post! Thanks, Brenda

Interesting; had not heard any of that. It is true (as many have pointed out) that it is not difficult to obtain K- blood so better to be safe than sorry. But as Malcolm pointed out, this "could" occur with a more frequent antigen than K. While I appreiciate your comment about this perhaps not being the fault of the Tech., sadly, this is a Tech. that I would really like to get out of my dept (but she is 1 of many Generalists who rotate through given this is a medium size Community Hospital). But since I see no way to determine what really occurred, I will just leave it in. Thanks, Brenda

You make a good point in that if they are jaundice, they will put them under the lights anyway. Brenda

All good points but the mystery still remains that my repeat of her screen (same specmien) did not yield the same reactions. Brenda

Yep, gotcha... Brenda

What a coincidence; same diagnosis! My experience has been that anti-K is usually very stable and hangs out for awhile. But that is why I posted this; wanted to see if others (like yourself) had different experiences. Thanks Brenda

Yep...been there done that.. Brenda

Ah, see that my recent post on Process Flow for 2nd Specimen was addressed in this Thread last year. Something I would know if I could be on the website more often. Sorry for the duplication...I am trying to get on more often. Brenda Hutson, CLS(ASCP)SBB

You are correct; and that is the direction I am leaning. Just wanted to see if there was something I was just not considering. Brenda

Yes; did that in another place I worked but that protocol was already set-up by my predecessor so I just left it. Have thought about it a couple of times here.....might be a good time to think about it again. Thanks, Brenda

Thanks for "the straws!" We do not perform Retic Separation (I have done it before, but not recently; and do not have a proper tool here to score the microhematocrit tubes). The Reference Lab we use does not have any staff that ever performed that procedure (believe it or not). But even if the patient was K-, from a statistical standpoint, that would not be helpful; it would only be helpful if they were K+. And yes, the Policy here is that they must have 3 cells that are Positive for the identified antibody (and negative for any other identified antibodies; which is N/A in this situation). I can check the testing that was performed by everyone that evening to see if anti-K would have been out anywhere; but it would have had to fall into the patient's specimen to cause this given that the Antibody Screen was performed first; then the Panel (and the chances of anti-K contaminating the pipette in 2 different scenarios, seems like a long-shot to me). The Antibody Screen I performed was only 10 days after the initial identification. Of course they were given K- RBCs once it was identified; but that would have allowed 11 more days for the antibody to "strengthen." Your idea about the K being IgM seems the most "plausible" (though uncertain). So, still don't know whether I should remove anti-K from the patient's record. My 27 years of experience has taught me to be extemely cautious in removing antibodies unless it is on a current work-up (and this is a discrepany between a previous specimen and the current; and the previous result itself but 11 days later). Thanks again Mabel! Brenda

No, in fact, her last transfusion before this specimen (from 04/25) was 04/11; and she did not even end up getting transfused on 04/25. Brenda

One thing I have not done yet is check the Lot numbers of the screening cells and Panel to see if they were the same. But in looking at her panel, still do not see even a hint of anything else the positive cells have in common. But yes, exact same method. Brenda

Yes, at 28 weeks here also.. Brenda

Are you looking for a hand-held seeler, or a benchtop? I just ordered a Sebra Hand-Held sealer. Have used it other places and like it. I can't recall the name of the table-top I used elsewhere (which I liked) but could find out if that is what you are looking for. Brenda Hutson, CLS(ASCP)SBB

The Title of this Thread sounds like that new reality show on TV... Anyway, just wanted to throw out a scenario that recently occurred here for which I am still trying to decide what to do. A couple of days ago, I received a Type and Screen (and crossmatch) on a patient who is frequently transfused as an outpatient. Her Antibody Screen has been negative 19 times (with many transfusions). Towards the end of April, the Tech. obtained a Positive Antibody Screen and Identified anti-K (1+ in GEL). When reviewing her work-up, everything looked accurate. So here we are about 11 days later. Given her recent POS Screen, I went ahead and set up a Panel along with the Antibody Screen (and knowing that anti-K is sturdy and certainly would not be gone in 11 days). My Antibody Screen and Panel were clean Negative. Uh oh.... So, I pulled the specimen on which she had identified the anti-K and the Antibody Screen was clean NEG. So then I became concerned that perhaps she had mixed up specimens. She had only performed 3 screens that evening so I repeated the other 2 also; clean NEG. This Tech. has always been one that concerns me working in the Blood Bank; however, her errors are not usually serologic errors like that. Also, it just doesn't make sense. Had she identified anti-Jka (for example) and it was now NEG (and even the repeat of her screen being NEG), I would not have been surprised; but not K. So what I am now trying to decide is whether or not to remove the anti-K identification for that patient. I know it is not difficult to find K- blood, but, why leave something if it is not accurate (not to mention the cost of screening units; etc)? Or perhaps there is something that is just not occurring to me about this? WHAT WOULD YOU ALL DO? Thanks in advance for your replies... Brenda Hutson, CLS(ASCP)SBB

All good points! And even seeing that you get a "few" discrepant times a year sounds an alarm in my head! It makes me wonder how many we have had that have just not been caught. All the more reason to go to the 2nd blood draw in my mind; so I appreciate you sharing that! I suspect that more difficult than the logistics of when/where/how the 2nd draw will take place, will be convincing Nursing and Physicians that we must do this for patient safety (the Phlebotomy Manager is already on-board with the idea; must to my surprise). Brenda

You made some very good points that I had not thought of. 1. As far as pre-surgical patients, the one Institution I worked at that did collect the 2nd blood draw, followed this protocol for those patients: Each evening 1 of the Techs. or Lab Assistants would go through the surgery schedule for the next day and look to see if we had specimens and/or orders on any of the surgeries that might require transfusion. They would then indicate which patients we would need a 2nd specimen on. The list was then sent to OR. When OR wanted to pick up blood on a patient needing a 2nd specimen, the transporter brought the 2nd draw with them at that time (drawn in OR). The transporter waited while the Tech. did a quick type (forward and Rh only). This is similar to what "Generic" above does. 2. We only give O Negative "Dry Packed" RBCs to Neonates (the Donor Center we use produces this product which is CPDA-1 and almost all Plasma is removed; they service a large Medical Center I used to work at with a huge Neonatal population so they do a lot of Boutique Blood Banking as we called it). Anyway, I would be comfortable then with only 1 type; unless of course there was a Directed Donor for the baby that was not O NEG Dry Packed. 3. As far as the legal issue....I am seeing the regulatory agencies "move in the direction of" the 2nd blood draw. Done right (meaning not same phlebotomist staning in room and redrawing a few minutes later), it does seem to be the best system at this time. But your point for "exceptions" is true. However, for me, I would not let that deter me but rather would just give that as the reason why we must have the 2nd draw in all situations (and in the rare situations where they could not draw a 2nd specimen, they would be limited to O NEG, Dry Packed until we could get another specimen; which would have to be soon so we did not waste that supply). We are also moving towards a different method of patient identification. First, a barcodeable armband. My only problem with that here is that patients are not banded until they are admitted (either for Outpatient Transfusions, or for Surgery; we have had too many issues with patients cutting off their armbands if forced to wear them home). Also, some of the OR Surgeons are stating emphatically that they will cut the armband off for surgery (heart surgeons; nice that we can all "work together" for the safety of the patient, right??; NOT). They are supposed to place them back on the patient at the end of surgery, but we had a recent case where the previous patient's armband was still in the OR when the next patient was brought in! Plus, in my mind, anytime an armband is not placed on the patient at time of draw, you are opening up the system to risk (however great or small that may be) that the wrong armband is placed on the patient when admited (you have to rely on the Nurse following protocol for identification). A process I am told is in trial at my Hospital is a palm scanner (not sure if that is the correct term). So the person's palm is scanned when their blood is drawn; then again when they are admitted. Not sure if the palm scan at time of draw is in some way then connected to the specimen; but it certainly is a sure-proof way to identify a patient. Anyway, thanks again for your input; much appreciated! Brenda

Nope; suspect Weak D due to Positive Fetal Screen but Negative KB. We do not perform Weak D Testing on pregnant women. However, we do often find out that they are Weak D because we end up with a positive Fetal Screen. Also, the Positive Fetal Screen due to Weak D will be macroscopic and a fetal-maternal hemorrhage with that many Rh POS cells (resulting in a macroscopic reaction) would not be compatible with life of the newborn. A positive Fetal Screen due to fetal-maternal hemorrhage will be microscopic. Brenda Hutson

Now how did I do that?! I could have sworn I clicked to Post Quick Reply to your message; not my own initial posting!! I think it is one of those days where I should just go back to bed..... Brenda