OPUS104

Hey Liz, I often cant get online frequently and just saw your question. My situation is like what Malcolm is talking about.... we are a small ref. lab so our stock of rare cells is not near as impressive as his. We have been questioned a couple of times by our super about making sure the reactions are a pan even though the DAT and Auto are +. For us its a matter of CYA so we dont get second guessed later.

Just a question here Vic. Did your Gel reactions show the typical abnormal appearance often (though not always) seen with "cold antibodies" in Gel. We call them waterfall, though we have hear them call hazy through whole matrix. Just wondering.

I havent been on for some time now, so this may have been stated and I have missed.... We always make sure the original Gel reactions ARE a pan. We run all available high frequency negative cells we have, along with a standard panel. Check trans history, eluate, once satisfied it is a warm-auto we go straight to tube. Usually LISS or unenhanced.

We also have a couple of these sent to us each month. If they call before sending the sample we will remind them to DAT test in Gel before sending. MOST of these are due to + DAT. (at least here they are) Do those of you using Gel for ABO/Rh see many problems due to Gel? As a side thought, it surprises me how many hospitals use Gel and the ORTHO person training them didnt show them how to perform Gel DAT. Had a small hospital send us 3 samples one morning with positive screens. (they usually send us 2 a month) Called them before starting these and found out all three were 1+ on cell one. Told them to do DAT on that cell and guess what.... yep 1+.

When we have antibodies that we can only ID in one media, it doesnt bother me. (even if it doesnt make sense, like something neg. in Gel but 2+ in LISS) What bothers me, is 3 cells reactive out of 45 in PEG and EVERYTHING else is negative. Enzymes, LISS, Gel, 6 Coombs Xmatch all neg. Thats when I worry. My lack of knowledge and exp. (I have only been blood banker for 10 years) keeps me second guessing myself late into the evening sometimes. I notice many of the workups we receive that are only detectable on homozygous cells in Gel, are on older women (to me that is 75 and older) who have history of multiple pregs. I wonder how clinically significant these are when they get transfused on negative crossmatches. At some point I guess we just have to say, "we have done as much (within reason) as we can to make this transfusion safe " and pray HE will take care of the rest.

I think we can all agree that there is not a "catch-all, be-all" method. Having said that, we have seen quite a few samples come in as "just two very weak cells" in tube for us to work-up the next morning. Then when we call to tell them it is a straight-up anti-E that only shows on homozygous cells in Gel.... well thats usually not good when they transfused 3 "crossmatch compatible" units the night before. Do I have post-transfusion info? No. But I think we can all agree these can not be good situations. (I am aware of one fairly serious post-rxn involving a Kell)

This is from a small facility, (so take it for what its worth) we only use different media if the results aren't clear cut. Some people we talk to start with two medias at the beginning, but we have not seen the need if it turns out to be a straight up Kell or E. If we carried it to extreme, we would be doing full panels on every donor/pt instead of just screens. Having said that, it does seem to be an odd workup anymore that doesnt have at LEAST two medias.

Instead of pre-warming, how many ppl use the REST reagent? We basically almost never use pre-warming Terri.

I have seen several answers while reading over the years, but the answer I see most is 16 on 4 regions. Assuming that answer is acceptable, (and I'm not sure it is. LOL) lets stay with the D vibe. We have several donors who are D+ and have an apparent anti-D, I know thats not amazing, but its always fun. (I'm ez to amuse) What other antibody could be mimicking D on my Rh positive patient, and what can I test with to prove it is not there.

This is a pheresis product and requires an actual machine, just like the pher. platelets. As a collection center, I can say that the equipment is expensive, as is each kit needed per donor. (the unit is leuko-reduced during collection) Also, as someone mentioned, there is a whole different set of documentation for donors and a whole different set of daily and monthly controls and QC. Not to mention totally different training for both the phlebs and component ppl.

Well Adiecast, we had a 53 year old female sickle-cell pt with Fy5 that had Rh issues. I remember looking up what Fy5 was because it had been so long since we had even read anything about it.......going to get my book out now (again, sigh) something about null cells?

I vaguely remember its the Gerbich null, but not the antigens. (I only remember that little bit because I recently read something about it) so there is a partial answer. (If its right so far. lol) someone provide the antigens.

We are a small blood center (about 85K draw a year) and were just "dinged" by AABB for not performing QC on our manual nageotte chamber testing. So I guess THEY think it is necessary. We have to have most of our counts within a couple of hours for product release, so send-outs are not an option. We do not do enough of them daily to justify a flow either. I guess we will start with dmorissbb's reagent and see from there.

Same as Malcolm, 2 Homos whenever possible. Which generally it is.

I always enjoy your posts for both content and entertainment Malcolm! As a side question to this thread...... how old of a panel does everyone NORMALLY use?

A question for our hospital friends> When you receive an antigen negative unit, what do you get to verify that the unit is negative for the antigens you need? Paperwork? What kind? A tag? sticker? One of our hospitals is being inspected today and the inspector thinks there should be paperwork from our computer system linking the donor to the unit and the Ags that are negative to the donor/unit. Do any of you get this kind of info with each unit? I think at most, people usually get a "tagged" unit listing the antigens tested and MAYBE a piece of paper listing the exact same information. Thanks ahead of time for your input. Havent worked in the hosp. enviroment in quite a long time and maybe I'm out of the times more than I think.

We currently use our expired antisera only as a screening tool. We only record our positive results in the donors permenant record and we note "old" to know we used outdated. Negative results must be confirmed with in-date. We also do this with diluted antisera when mass screening, with applicable QC and so on and so forth. ALL reported results are with in-date except the instances of like Bga where we have used non-lic. antisera, and these are labeled as such per AABB guidelines.

(Collection center answer) Do you mean for example, if we are to do 25 alyx QC per month, we do 25 per machine? If so...no we do not. If we are required to do 50 QC per month, we make sure that some of our units are from each machine. We do not want an inspector to later say "How do you know you have QC'd each machine". We start off each new period with the instructions to draw one from each machine. We are worried that someone may say we are "picking" our units, but the instructions are "The first unit of the day" from that machine so we will see in the future how that goes over. If we randomly pull units as they come in, we couldnt make sure each unit is being QC'd.....so what do you do? Nice to see other replies on this as we are not 100% happy with our solution. Hope this helps.

Hey J, we also use a very old meter that is only being kept for us. We only do about 50 pHs on it a month, but the upkeep is very minimal as well as the QC material lasting for over a year. This is for monthly QC only. We use the BAC-T for our bacteria detection. (collection facility)

Has anyone received their CAP plt pheresis BAC detection results yet? The wording of the first paragraph in the Discussion section is priceless! The number of participants who missed the bacteria present was truly alarming.

We get regular calls about smaller hospitals not getting valid Gel ABO's. They want to send them in for workup because they dont have the reagents or experience to deal with basic ABO problems. I have never used Gel for ABO and dont plan on it here. (Blood center, not hospital) I can do an ABO in about 2 minutes so I'm not sure what the trauma references are about. (I'm sure theres a situation in the hospitals I'm not aware of there) How are anti-Ms handled? A or AB subroups with anti-A1? I personally dont like the lack of basic blood banking knowledge needed to push a button and put on a sample. NO I dont want to mouth pippette, but it would be nice if I roll into the ER to think the tech in charge of my life can solve a simple ABO dicrepancy.

We hear, on a regular basis, techs telling us that the sample they are sending us was positive on three of 11 cells but went away when they pre-warmed. We arent allowed to tell these facilites what to do, but we cringe everytime. We have started trying to get everyone to study CURRENT literature about the very present dangers of random prewarming. There are only a few times that we see a (I cringe to say justified) reason to even think about this "tricky" technique. Many of the seminars I have been to set out pretty strict criteria to meet before even thinking about this. I think many of our smaller hospitals are being taught the "thats how we've always done it" way of dealing with results that dont match up perfectly. Unfortunately this is another one of those subjects that everyone has their own opinion on. Good Luck to all who run into it, but for us it is not a usual choice at all.

Ditto with Heather.

Amen on the Yta.... Dont forget there are also several ways to also help determine "HTLAs" (notice the quotes, we also dont like that term) Plasma inhibition and chemical treatments are also some tools. We never use Gel in these titers. Also, by "other reactivity" do you mean 3 out of 11 cells reactive or all 11? USUALLY (we all know that is a dangerous word in BB) these antibodies are on a very high % of cells. Very foggy subject and we often send our samples to a larger Reference Lab that is smarter than us.

Guys.... I almost didnt put this in, because I really hate getting involved with these potential arguments. Having said that, take this or leave it. AABB Tech Manual says "Whenever possible, red cells units selected for transfusion to a patient with a potentially clinically significant antibody should be tested and found to be negative for the appropriate antigen." It says to save cost "units can first be tested with the patient's serum. The absence of antigen, in nonreactive units, can then be confirmed with the commercial reagent." It then lists very specific criteria to use patient serum to screen cells at a later date. It does list some Abs that typing of units MAY not be necessary and the patient's serum can be used.... but these are like M,N,P1...and so on. I dont see how routinely not screening units with commonly availble commercial antisera can be acceptable. We use donor/patient serum to first screen quite often (following the criteria stated in the AABB Tech Man). We also use it to label as "unlicensed antisera" units screened with patient/donor for rare ones like Lua. (we just froze a patient's serum today for Lua as a matter of fact) I am not trying to step on anyones toes here...but I believe the AABB is pretty clear when they say basically, whenever possible units should be tested with licensed antisera. Hope this helps instead of stirring up trouble.