Brenda K Hutson

So are you reporting them out as Warm Autos or Panagglutinins (assuming the Panel looks like the Screen....or maybe you go straight to a Panel)??? Thanks Brenda

Ok, so it sounds like we are getting the same results as you guys....but then my question is, when you get all 3 tubes positive (with a negative Last Wash), are you then repeating it in Tube and going with your tube results? I guess I am just questioning the fact that it seems to happen more often than I would like and just haven't known whether to attribute it to "junk" in the eluate (granted the Last Wash is Negative, but you have continued manipulate the cells after that and add solutions; that is why I questioned technique), or, whether they are Warm Autos that GEL is just more sensitive to than Tube?? I guess the question I keep asking myself....is if we are getting that many that we have to repeat in Tube, should we just perform a Tube Screen with the Eluate in the first place? But sounds like you guys are saying no.....you just "deal with it?" We use the Gamma ELU-KIT. Thanks for all of your input!! Brenda

We have been having some problems with our Eluate testing with GEL. Trying to see if some of you have also encountered problems, and what solutions you may have come up with. The problem is that too often (maybe 30-40% of time ??), all 3 Screening Cells come up Positive with the Eluate. If we do a Panel, everything is positive. If we repeat it in Tube, often times (maybe 90%), it is Negative. I honestly believe that at least some of those are Warm Autos being picked up in GEL but not Tube. But I suspect that a fair number of them are related to technique and are not truly reflective of antibodies. Variables I have considered: Final centrifuge- we have switched to doing a hard spin X2; but that has not resolved all of it (may have decreased # of Positive, but hasn't solved extent of problem) We do not just make our stopping point when the Eluate starts to look blue; we actually measure the pH. But therein might lie another problem; the differences in the shades from 1 pH to another, is so subtle....so I wonder if sometimes people are interpretting them erroneously. Even if we were to make our stopping point when it is blue, and not use the pH strips....my experience tells me that there even seems to be a difference sometimes in what people consider "blue."Anyway, would love input from anyone else who has experienced this and come up with the culprit, and/or, anyone who just has other suggestions. Thanks, Brenda Hutson

Consider that a transfusion reaction workup has completed and no evidence of hemolysis was noted. The medical director or designee has been contacted and provided their evaluation and further transfusion is acceptable. If additional RBCs need to be issued for the patient do you...Coincidentally, I just recently sent an e-mail to a previous medical director where I worked, asking this exact question (because where I work now, does it differently). Continue to use the original type and screen for crossmatching RBCs? Yes, provided it was not a hemolytic transfusion reactionUse the post-transfusion reaction specimen for crossmatching? That is what we do where I currently work....but I am going to change thatUse the post-transfusion reaction specimen for crossmatching after it's had an antibody screen tested? If I am going to use the post-transfusion specimen for my crossmatch, then I would also perform a Type & Screen on that specimen.Any orther sort of scenario?Brenda

I was taught from Day 1 that a Cord Specimen should never be used for transfusion purposes; and that has been the Policy at the 6 Hospitals I have worked at. I believe the reaasons to be: Possible contamination Risk of specimen not belonging to that baby. I can atest to the fact that cord specimens are by far the most mislabeled specimens in a Hospital (I believe it to be due to the different workflow involved which increases this risk). While there can be a variation on this theme, it may play out something like this.....Cord specimen is obtained by Physician who then hands off the "unlabeled" specimen to someone else to label; this someone else may or may not even be present in L&D at the time; they then place the mom's label on the specimen; then they hand it off to someone (perhaps in the Nursery) who will have the baby's label once the baby has been registered. This leaves a lot of room for errors.Brenda Hutson

1. Do you have laboratory supervisors physically on-site 24/7 or do they take call on "off hours"? We do not have a supervisor on-site 24/7. We are M-F, Day Shift (though we used to rotate weekends). Do we "take call?" Define take... ..we are called at home (and with a lot of new Techs. right now, those calls are frequent, especially for me as the Blood Bank Supervisor; but we are NOT compensated in any way). PM Shift has a Lead Tech. and she rotates weekends. When Lead is not here (or on weekends), there is a Charge Tech. on each shift and I believe they do receive Charge Tech. pay (which is not much). 2. If they are on-site, is it as a supervisor or a working bench tech? When the supervisor is working, we do sometimes have to help cover the bench; but more often, not..... 3. If they are on call, is there a charge tech? See above Are they compensated extra to be "in charge"? Charge Techs. yes....Supervisors NO. 4. Do you have a supervisor for every department (micro, BB, chem, heme, phleb, etc.)? Yes 5. How big is your facility? About 185 beds All of that being said, I have previously worked in a number of Facilities and find that this differs from one to another. Sometimes as a Supervisor I have had to rotate weekends and Holidays (even in a very large Hospital), and sometimes not. I wish we got compensated in some way for the calls we take at home (for me, currently, can be 3-4 evenings a week; several times an evening; plus 0-1 nights a week; plus any shift on the weekend). If not "on call" pay, I think we should get Comp. Time. Brenda Hutson

One very busy day in the Blood Bank, OR called and i answered "Transfusion Reaction, May I help You?" They laughed....said, "well, it might be; but I hope not." Brenda Hutson

test....

Sorry, I need to clarify.....I am asking with regard to the ARK Bio Microwave (I see from reading that the Tropitronics Microwave does have various sizes of bagholders available). Thanks, Brenda

For those of you who use this microwave, do you know if there are any "options" in the size of plasma carriers? Or larger straps to hold a larger unit inside of the carrier? Or, is it just 1 size fits all (such that if you are receiving large FFP from your supplier, they may not fit into the carrier)? Thanks, Brenda Hutson

We won't take the unit back at that point (> 30 mins. and/or out of temp. range), but do point out to them that they have 4 hours in which to transfuse it; so if they think they can, they should keep the unit; otherwise, send it back to us for discard. Brenda Hutson

At 1 place I worked, we would restrict a patient like this (ABO mismatch transplant) to group O RBCs until 2 consecutive types in which they had forward typed as the new type (and they should not reverse type in this case; unless they relapse; they are being immunosuppressed due to incompatible transplant). At least that is all as I recall it.....we get very few transplanst where I work now (and like you, find out the hard way.....not because someone was kind enough to tell us that information up front). Brenda Hutson

Regarding GEL and antibodies not hitting on all cells.... 1 person referenced Jka. The Kidd antibodies are something to definitely watch out for in GEL; I have even given lectures on this. You may think you have ruled everything out; even using homozygous cells. But then look back and see what your positive reactions all have in common. If they are all homozygous for Jka or Jkb (even if you have other homozygous cells that were negative), type the patient for that antigen (if they have not been transfused in past 3 months). If they are negative.....if you have other potentiating media like PeG or Ficin, go after the Kidd. If you do not, err on the safe side because I am telling you I have seen it enough times to know it is a very real phenomenon in GEL.....give the Jka or Jkb negative! If they have been recently transfused, try other potentiating media to pull it up more clearly or send out to a reference lab if that is what you do. I was a reference lab supervisor at ARC at one point and we used to receive such specimens from Hospitals who only had GEL. But don't let this one get by you! Brenda

That is interesting that your supervisor would get upset with you for "thinking" it was Anti-E (perhaps biased), but then telling you to only run those 3 cells in Ficin. You should always do parallel testing (I suggest, even running the same panel by each methodology) or that too is biased testing. Brenda

You said you "suspected" Anti-E....was that based just on your Antibody Screen? If so, that is what I like to call, "biased blood banking." That may be why your supervisor was upset with you; because you based your panel on what you expected it to be (and I have seen people call negative reactions, positive, because they expected that cell to be positive; so biased blood banking can also be dangerous). So what was your final conclusion? While antibodies "don't read the book," it still seems a little odd that it would be Anti-E if only SCII was positive but both panel cells negative (unless perhaps you used a different methodology for the panel)? I do see that you said it came up in Ficin. Also, not sure if the outdate of your Screening Cells is different than the outdate of your Panel (i.e. perhaps panel cells were old.....but in general, would still expect them to react unless Antibody Screen was really weak). Just some of my thoughts. Brenda Hutson

We just recently switched to the blend....did not have this problem before then. Brenda

Thanks a lot Mabel....we just got another one. I purchased another Manufacturer's Anti-D and it was Negative at I.S. and AHG; but Quotient is coming up 1+ at I.S. but Negative at AHG. I will call as you recommend; had not heard that. Brenda

Addendum: Heelstick sample on this 2nd problem cord specimen, was clear-cut Negative. So wondering about tubes cord blood is being placed in? Maybe different lot#?? More investigation to do.... Brenda

Thanks everyone for your suggestions/thoughts. Baby is no longer here (was transferred) so cannot do healstick. Cells were washed (many times) prior to testing; so do not suspect Wharton's Jelly. Interesting that one of you mentiioned Quotient in that we use that Manufacturer for our tube testing Antisera (and it changed recently....hmmmm). I think I will order a bottle of Anti-D from a different Manufacturer because we "just" got another baby that typed like this. We reported it out as "unable to determine." Had the baby stayed here, we would have given O Negative RBCs anyway. Thanks again! Brenda

Well, this is one I haven't seen before..... We were asked to perform a Cord Blood Type on a newborn who was being transported to another Hospital. The Mom is A POS; the Baby is A....but the Rh is now undetermined. It shakes off rough and you can see some heavier red dots. When you look microscopically, there are a lot of agglutinates. However, the Control is Negative; Weak D Testing showed only minimal clumps microscopically; the DAT is Negative. We recommended to the receiving Hospital that they perform a heelstick. I can only think the Baby is Rh NEG and has some of the mother's cells mixed in the Cord Specimen; but the Weak D does not make sense compared to the Immediate Spin. Thoughts?? Thanks, Brenda Hutson, CLS(ASCP)SBB

One can practically teach themselves to use HCLL; and the Reports for Blood Bank are much better than Sunquest. I have used a number of systems; both Laboratory and Blood Bank only; and HCLL is my favorite. Brenda

I am not sure what Hemosafe it?? But I have used both HCLL and Sunquest; and have to wonder....why would you switch? I LOVE HCLL....but have never found Sunquest to be Blood Bank user-friendly. Just my opinion. Brenda Hutson

NOTE: Added File of Tag in the Library if anyone interested.... Brenda