OPUS104

Yes, we (unfortunately) also see some "anti-something" patients who only react with Ortho or only with Immucor etc. I'm mainly concerned with all of my anti-sera and have my crack QA dept. (they are the best) double checking everything for me reg wise. Thanks for the quick reply. Shannon

Hey Anna, Not being silly, (dead serious question) Do you mean to say that you should have a single indepentent control for every reagent that is in use in the Ref. lab? I dont think I have refrig. space. What regs. state this? I may need to get in compliance if this really applies to me! We have always used the insert (which the AABB Tech Manual suggests) and there is not always a specific % mentioned.

Same as babs.....we use 10% and try to do it about every other week. We always do it when the saline cube we are using expires (we have exp. on a piece of tape on the side of the bottles) and we open a new cube.

Hey Mary, I've worked in one lab where they had performed some validation study before I started work there to prove that straight saline gave the same results as 6% Albumin for the same reason(wasteage). Where I work now (donor center, only 85k drawn per year) We currently use a suspension of the patient's cells with autologous serum per the Technical Manual. It's free and you don't have to get up and make anything. Hope this helps.

I'm afraid I don't have any ideas....but had to tell you how much I LOVED the "Vanderjagt" comment! GO COLTS! Went to UT with Peyton.....good luck!

The Anti-D that we use states in the insert that no Rh control is necessary due to the protein levels...... what does your insert say? We do not use "commercial" controls to perform QC on our reagents each day. I can't imagine how many we would need to match all of the protein levels and antibodies present in the large number (and variety) of reagent panels, cells and anti-sera we use in one day. The FDA (we are a collection center) has never had a problem with the QC and they have looked at it specifically one at least one visit. Maybe we just got lucky! Hope this helps.

Donor Center: We use solid phase to test 6 sample pools of our donors. Pos. pools are broken down and tested individually in solid. These samples are then sent to Ref. for Gel I.D.. We have several donors a week that are pos. in solid phase (many times husband/wife donating on same day) and neg. in Gel and tube(PEG). We are not automated for either system. We have a good deal of "false +" samples from solid and sometimes do not detect donors with 3 year history of antibody until posting. But this can be said about Gel now as well. As usual......everything has its + and =.

Has anyone seen an actual study on % inactivated by irradiation with 25Gy?

As a donor center we test using Gel, poly, IgG and C3b. Overkill? Probably! But it's just easy to set them all up as we do our work-up. In our reports we list all four results.

We have our Tags custom printed for us.

Heaven help u Linda, because this may confuse u more than help! Donor Center: We enter our testing results (Second testing and first, two techs) into donor antigen history page. Entry is checked by second tech. We print: product page (which has unit and donor number on it) and the member antigen page (which has member number and all Ag testing). When we label: 2 techs have the 2 printouts, the antigen label/tag and the actual unit. The numbers are all crosschecked to match the right ag.s to the right label to the right unit. Confused yet? It's much easier than it sounds, but I hate it for the poor trees. We both initial the ag. label/tag and the 2 printouts that are stapled together documenting that we hopefully have married the right info to the right unit. We keep the printouts for about 3 months just for our records in case there is a discrepancy anywhere. This has evolved over about a 15 year period of oops how can we keep that from happening again. Elaborate and maybe overkill.............but we have not had a mislabeled ag unit go out in a very long time ( so far as we know). The only exception is if we are screening for something easy (just BE) and we just label off of the testing sheet where we just tested one behind the other.

Isn't outside Ag retesting required by JCAHO? I haven't worked in a hosp. in years,,,,, but have been told this is true by some of our hospitals. They have told us if they have the antisera there.... they are required to confirm our Ag testing. We do not send units to our hospital labeled crossmatched. We actually have a sticker ( big bright red one!) that says uncrossmatched blood on each unit we send out from a work-up. The samples we get are not banded samples. Do you send your banded sample to the ref. lab? What do you use to crossmatch any units if you need more with in 72 hrs? We would never take on the extra liability that the sample went thru (and the unit would return thru) ump-teen hands and end up correct. But we are bigh fat chickens...... different strokes and all that stuff

John, I'm a firm believer in K.I.S.S. and always having chicken feathers falling off of me. Having PRN people and generalist that work in BB twice a month on graveyard is a recipe for disaster if the 3 day rule has "exceptions". (Of course WARMS dont count)

Hey J! We also have the 90 day rule. Several have mentioned at area hospitals that the Ab should be detectable in the plasma after 30 days.......but we have ran into quite a few antibodies that are completely clean in neat and 2+ in eluate after the 30 day mark. The titer (we think) is still so low that all produced Ab is still bound onto transfused cells. I have seen this alot with Ca. patients. We will not change our policy unless there is some very good data present.

Hi Mabel! We have had 2 cases of Co b alone and 2 of with. Oddly enough our 2 alones came in a one week period as well. One was a donor sample and another was a work-up from a small hospital that had a neg. Ab screen and one reactive unit at crossmatch. Both were only found after we "converted" 3-5% immucor panel 16s to .8%. We do this almost everyday to use the extended typing.

MJ, By chance do you work at the ARC at 313 mack?

If we get multiple positives when testing coombs....yes. If we only test one antigen and stop if it is positive,,,,,,,no. We are not real concerned about a single "false" positive. Having said that, we are currently reviewing this policy with our QA dept. Any data from any other donor centers would be appreciated.

Hey bb..... In that situation I don't see how it could be bad. No long time record and no chance of patient harm........

Hey BC! We had two more units tagged "did not filter, no clot visible" today....... both were Hgbs +. Hope your enjoying the RR!!!!!!!!

Dumb Question from me here. Are we talking for immediate transfusion in a hospital....or permenant donor record in a donor center......or "this unit only" record in a donor center?

We have seen a decent amount of "scratchy" Gel reactions turn into very strong E,K and a very few Fya's. We have ran into this enough that if we get a negative Gel screen on a unit that tested + in a pool with solid phase, then we do a PEG tube screen. The usual difference we see in strength is Gel reactions are stronger than tube by a factor of 2. (1+ tube= 3+ Gel) These missed Gel antibodies are just a typical case of "no testing method will cacth everything". (We are a donor center by the way.)

This is a big debate with our QA dept. right now. Often when looking for multiple antigen negative units we (of course) quit testing a unit if the first antigen is pos. Most antisera inserts state that a DAT must be performed to verify the positive result.........................crazy for us to do for one Fya result,..........but we record pos. results in donor history. Thus the fight with QA. This is another case of company CYA in the inserts that causes us untold hassle with QA.

We are 100% leuko-reduced...... if a unit does not filter and there is no visible clot or there is an extended filter time for no apparent reason we perform a sickle test. All donors destroyed for clot are coded and anyone that codes numerous times are also tested. These donors are contacted by letter from our Dr. and ENCOURAGED to please call for more info. They are made perm. def. as we are a 100% leuko-red. facility and they almost never filter completely/correctly. We have caught two donors that filter but had high WBC counts during our routine QC.

We are unfortunately beginning to defer donors on a regular basis due to positive DATs found at crossmatch with Gel cards at the hospitals we supply. The usual difference we find between tube and Gel is usually a factor of 2.(i.e. 1+tube=3+Gel) These donors (many of them VERY regular, long time donors) have no tube results at all.....but when the hospital Gel crossmatches the unit it is 1+ positive. This is very frustrating to both us and the donors. Many of them become upset over being defered and want us to explain IN DETAIL what the DAT means. You can imagine the long confusing conversations from here on....... the most important question is the one you posed, is it clinically significant?????????? We of course don't know so the donor gets defered.

My only experience with hospice was with my mother and step-father. They were both placed in hospice during their final days fighting cancer, so I thought that what she was talking about must be a little different than their situation. Just wondering, (little devil's advicate) are there storage/transportation records that must be kept?