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We are a Level 1 adult and Peds trauma center.....we don't have a limit............ We will give any MTP patient O POS (leuko reduced) LTWB until our supply runs out. We will give Oneg to peds - but if we run out of Oneg - they will get Opos. Our facility is currently involved in several studies using WB in the trauma setting. In the words of our Medical Director and manager..........."They have to live to have a problem" Might sound crass to many - but, it's true. For all the patient's we have transfused out of group WB to - we have had VERY FEW delayed reactions - maybe 2 anti-A's in the eluate and a few anti-D's - but all were males. Our 1st concern is saving the patient.........

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We only run QC if we are diluting an expired cell. (we run QC on any expired cell - whether we dilute or not) We performed a validation before beginning and validated that the dilution worked if incubated for 40 minutes which is the longest allowable time to incubate per the IFU.

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We use Ortho-Vision Max and manual gel techniques. During our validation for manual testing, we found that we sometimes missed reactivity in the IgG card when cells were diluted to 0.8% and incubated for only 15 minutes. The reactivity was then present when incubation was extended to the maximum allowable time for the IgG cards so that's what is now in our SOP.

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Looking for a "paper" Case Study antibody ID exercise for our staff to use as a competency exercise. We are a large academic medical center and transfusion service and we perform essentially ALL of our own testing......except molecular testing. Our staff needs to know how to ID antibodies, know next steps to take, what needs to be R/O, and how to do it...... I can make up "simple" ABID exercises......but seem to be having a mind block when it comes to figuring our how to create something that may have more "steps" for conclusive ABID. This would be given to all staff - on paper most likely - to work through and turn in for management to assess. Can anyone help? @Malcolm Needs?? What I'm looking for may already be here......somewhere......but, I haven't been able to find it - so, if you can help point me in the right direction - that would be appreciated!

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Well, maybe......but we find quite a few positives and it seems to make them "happy".......... and our medical director happy....... By the time the babies are 2+ days old - they've gone home (unless there are extenuating circumstances) and in the doc's eyes - it would be "too late". For those who develop jaundice due to apparent ABO HDFN after discharge - they treat it on a case by case basis.......usually by doing nothing..... I have family in Germany,...........and if the UK is anything like it - the medical "system" seems to be much different than here in the US.

We perform IgG gel DAT (on Vision Max) on every cord received. If positive, we perform acid elution. A screen and x3 ABO specific cells are run on the eluate if the mom is O. (meaning - O mom / A baby, 1,2,3 screening cells and x3 A1 cells or B baby, 1,2,3. x3B cells.) On occasion, if Mom is also RH neg and has received RhIg, we find anti-D alone or Anti-A + Anti-D; or Anti-B and Anti-D in the eluate. We do this at the request of out Neonatal clinicians. They WANT this information.............and they want it STAT so they can assess the infant properly.

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yes, that's what we wait for...........and we usually get behind and don't end up handing them out until we've already received the results.

Our students are not allowed to do anything in the computer in our BB - they just watch that part. New Employees - yes, they get their own log in.

We use our "old" CAP samples........... Once they've been turned in and reported, we assign them to techs using our "other" methods. SOP is gel/Ortho Vision Max Additional testing then would be manual gel, Peg, LISS, Saline. Same for titers and DAT's Seems to work pretty well for us!

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At our facility, the Trainee has their own log in. The Trainer is responsible for assuring that all results are entered correctly. Should something be wrong, we would hold both responsible.

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DAT? I would do a panel, IS, RT incubation, 4C incubation......in tube. I say this because this is where the discrepancy is happening. I see you use Vision - have you done a regular panel on the instrument? Curious if it shows clear cut reactivity - or junkie, up the side-like reactivity? I would also do an ag type on the patient - even though they've been transfused......its' only 2 units, so, IF the pt is M neg, you should see MF if the units were M pos. ( we do this but don't report......it just give you an "idea" of what may or may not be going on......) If they type 3-4+ M pos with no MF, - you can - with a decent amount of certainty - eliminate M as a possibility. Remember...........M isn't the only trouble maker in the "cold". Could be one or both Lewis's, P1, I've actually seen a K react at RT - so, ya never know!

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We do an AC in gel with every new ABID panel we have to run. (just with the first panel....not with EVERY one ) Our SOP also states to do a DAT on all patients with new antibody ID's. There are times when the plasma is only 1-wk2+ on all reagent cells that the AC is negative. That's where the DAT comes in.....if the DAT is positive, (our gel Poly and IgG DAT's are often positive - but if we run the same test in tube, it will often be negative) we make an eluate and run it......which is often positive with all cells. Again, I'm not sure of the "science" behind the "why" for the negative AC - my old brain simplifies it to thinking there may be some sort of dilution factor with the AC (addition of plasma and saline to make the suspension) causing it to be negative???

actually - that should have said anti-A1 in the eluate....... we did some adsorption and elution studies "off the books" as that's not in our SOP - but it worked!

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Came to say the same thing as @Malcolm Needs We actually just had a patient a week or so ago with a long standing history of being B.....and then all of a sudden we had weak reactions in gel with the anti-A and Anti-A1 in the plasma...... Sent it for ABO genotyping and they were indeed (A)B ! pretty cool stuff - this Blood Banking!

Our SOP is to start with testing in gel (we use Vision Max) - if screen all pos, do panel, auto control and DAT. if DAT is pos, do eluate - also tested on Vison Max. if everything consistent with warm auto, we will then test patient plasma in LISS. Often times the reaction is negative with LISS. Apparently it has something to do with LISS and the sensitivity of the test......I don't know the exact science behind it, but, if there are underlying clin. sig. ab's, they show in LISS where the warm auto does not. If patient has been transfused in the last 120 days, we also will test the eluate in tube / LISS