OPUS104

We only collect about 85,000 a year and do quite a bit of testing for our smaller hospitals. One of the major things we did for our on-call techs was to only come in for emergency work-ups. This can be tricky to determine what is "emergency". We usually let the hospital tell us what is going on with the patient and go from there. Ab workup call on Mon. night for knee replacememt on Wed. is obviously going to wait till morning. We always go for the more cautious decision. When in doubt.....come in. More info about what testing you do may make my answere more helpful. On-call is always a tricky subject. We have had hospitals lie a couple of times to keep the docs from being mad at them and that is always a problem. Love the avatar! Huge Calvin and Bloom County fan from the 80's.....I'm getting old.(sigh)

We also were seeing non-reactive complement check cells. We began only pulling the cells out at time of need and cleared the problem up. We use combo Ortho and dont seem to have a problem now.

Hello Mary.. simple answer is yes. You can look up MANY responses here on similar threads. There is a large amount of info for you to see. Good luck!

Mini-me- I contacted ISP (maker of rad-sure) and verified that I understood the interprtation of their insert. As it states, the Rad-Sure is not a quantitative device, it is merely a test to prove a radiation dose has been received. We use 25Gy Rad-Sure strips and they are used merely to signal whether the unit received at least 25Gys. It is only necassary to prove the strip is functioning as expected upon receiving. I'm sure your facility (as does our facility) has SOPs covering all of the possible scenarios that coluld occur during an abnormal reaction of the Rad-Sure during normal daily operation. The person I spoke with at ISP said each facility should determine their own procedure for receiving (typical response we all know) but since the device I use is indicator only.......proving it does what is designed to do upon receipt should be sufficient. I hope this answers your actual original question.

Are you saying no Ab screen performed? If so ...many possibilities ranging from warm auto to naturally occuring antibodies..more info please.

Does anyone know of any related rules/laws/'powers that be say so' items that relate here? Are you "allowed" to not retest if you have the capability? Rules that relate to "FDA typed" (does that mean unit tested by 2 techs every donation?) Just wondering. Bob....John...... where are youuuuuuuuuu..............

We perform many irradiations per day and verify the new lots exactly as Franklyn says. If you wanted to run a "minimum activation" dose, that would be good I guess, but I agree with Mr. Garland about the rest being covered in our annual dose measurements. We try to verify in the same conditions we test daily. (cannister almost never full, and always with some air gaps) Hope Franklyn and I didn't misunderstand the question. Good luk!

Hey Lara, Did your lot verification work when you received the questionable lot of panels? We use the same Ab sample to verify our screen cells that we do our panel cells and test them at the same time. Any major difference in reactivity between our screen or panel are communicated to our techs. Also, did you try a converted panel (3% to .8%)? We get significantly stronger reactions using our Panocell16 in Gel. Love your icon by the way. Hope this helps.

Hey cliff, We were given many outlandish examples ( we were the first in east TN to be inspected), but my 2 favorites were....What if they come running in with C-4 wrapped around themselves and blow up against the irradiator( to which I said "then none of what your saying will matter" and what if they back a dump truck through the window/wall and hook a chain to it and drag it away (I gave same repsonse). Too funny talking to this guy. We have not had a compliance problem with present personel as we gave them a reasonable dead-line and oppurtunity to do it and said "have it done or stay home".....worked rather well

Hey Mabel, We do the 3,3 and 3...... but we use donor cells that we have screened, not pooled cells. We go thru the whole mess with lectin and all to prove the anti-A1. (but we are a supplier so take with a grain of salt)

Like others....we do because insert advises. But the main reason is we get regular samples from our smaller hospitals that have both/all three screen cells reactive, but the two units they xm'd at the same time are compatible. We do a converted .8% ABS, prediluted .8% and auto control first thing with these samples. Regularly (and getting worse) we see reactions to some material in the reagent red cells suspensions. We also do a DAT in Gel at the same time, as your are not supposed to use DAT+ cells in Gel. (which I am sure you all know already) Auto control is also usually not going to be + with HTLAs either with pan- or near pans.....but dont get started on HTLAs, it'll make our brains hurt.

The only time our area Childrens Hospital requests age specific units from us is for exchange transfusions. (less than 5 days O neg. CMV=) When I worked at the only level one trauma center in this area, we had a "Pedi-unit" that we had pedi bags docked onto and used until expiration. We had a couple of doctors worry with this, usually after some chapter was read in a book, (like increases in ordered Sed rates when the interns get to the S section of their books) but never had a documented problem. K+ would be measured if a doc. thought something was fishy.

We perm. defer donors with positive sickle (we use Streck) due to the fact that they almost never filter properly and we are a 100% leuko-reduced donor center. Obviously no idea about SA engeekay, but that is why we defer.

I have been told by one of my hospitals that they were "dinged" by Joint commision for not repeating our antigen typing. I thought this was odd since most of our smaller hosp. dont keep hardly any antisera and some of our larger dont keep everything. Anyone know of any Joint Regs? Bob/Stan where are you?

Donor center answer...so beware! We test a pool of 6 donors. Pos. pool = breakdown run individual. (still in SP) Send to ref. (ours) the pos. donor. Gel first...if neg. then PEG....if neg then DAT in Gel and tube. Believe it or not, alot of these are DATs on our donors..(protiens, overcounter drugs?) Anyway, if all neg, release as false pos. Alot of these false pos. have a "funny" pattern or look like a robin egg speckle.

We only grade weak or strong with antibody detection.

We do this in-house. The process takes about 10 minutes start to finish when entering a new panel. We have all 3 panels we use on seperate sheets. You can select pos. neg or all for each antigen. We scan into microsoft then import into excel. Some corrections are needed (and well documented) then the scanned anagrams are printed and checked for match. The +, 0 is easy to check as we shade all +s and hold under an original anagram on a light viewer. Two techs check each step (edit and +,0) that did not do the entering. Entering/edit = about 10min. checking = about 4 mins each. We absolutely love it. Need cells that are E,c and S negative but Fya +, just click click print. We cycle out the outdated every 3 monthe when we throw the panels out.

Hey Mabel, Our 2 "disaster" patients are very exposed. One is a Beta-Thal patient and the other is a 54 yr old sickle patient. Our Beta-Thal just moved. She was 21 and has recvd products her whole life. Her % was 3 out of 10000 from random units. Obviously we did not start with "random units" each time but finding 4 for her every 3 weeks was a true challenge. Our sickler had a Fy5 on top of her normal and low-freaks. We have "mad scientists" theories that these people may be in states of hyper-sensitivity due to their conditions or drug regiments but it is a well known fact that we are just crazy.

Hey MJ, We received so many complaints (many from coaches) that we have a very colorful, very large poster with a picture of a "jogger" on it that states. "You should not donate if you are participating in an athletic event in the next 48 hours." Please speak to one of the screeners if you have any questions. These are used at all drives where it is conceivable that a competitive sport may be involved. ie High School, Colleges, Sport/Health fairs. This has been VERY effective and we have been thanked numerous times (usually from adult athletes) for this warning. Good Luck

Directed for corssover only. D (For now....lol) Disclaimer: BUT I AM NOT OUR ISBT GUY.

Just a curious question here..(being a blood supplier myself) What has your supplier done concerning anti-sera price increase to betray you? Is this in reference to an earlier reply that I've missed? Again.....just curious!

Hey Christopher, We are a small ref. lab (only serve 28 hospitals) and have seen a VERY BIG increase in non-specific reactivity. (Gel and tube) We do not like to drop to tube testing unless the Gel is a pan. and/or other results point to a possible interference to justify our drop in sensitivity. In general, we see a reduction in reactivity of a factor of 2 between LISS and Gel. ie 2+Gel = neg. in tube. Of course you always have exceptions. I spoke with a much larger ref. a couple of days ago to see if they were experiencing a similar increase in non-ridentified reactivity. They have also seen a large increase and only use Gel as a back-up,,,, never their primary. Almost all of our larger hospitals that do their own Ab IDs have contacted us with similar concerns. Several of these that we have forwarded to large ref. labs have comeback as "HTLA" groups. I fear that the prevailing transfusion policies (ie trigger point transfusions) are going to increase the current problem.

The pH is usually the culprit with us in Gel..... but on this last eluate from CAP (April/08) we had 1+ non-specific rxn on all of our cells except the antibody cells which were 4+ as usual for CAP sample. Requested new samples and retested yesterday. Same tech, same lots..... no extra rxns. We checked her pH on first eluate.....all ok. When we add the buffer we get a rxn of some sort sometimes. The eluate becomes hazy and you have to spin the formed particles out.... but this is very visible and I don't think anyone would miss it.

We only make distinctions if there is an obvious dosage difference between 1+ and 2+ strength and so on. We use strong or weak when distinguishing the difference 1+ superscript S. This is generally only possible with any degree of consensus with the Gel method.

Of course the Reference lab will simply forward the increase as well....but at lest you won't have to pay for the positive Ag results when looking for little c.