Mabel Adams

I know of a place that did a test on all cord specimens to verify that they were entirely cord blood and not partly maternal blood (a fetal hgb test of some sort--kind of like the old APT). A mixture of mom and baby's blood could also give some interesting results at times. I bet it's pretty rare. I hope my techs are paying attention to the mom's blood type--certainly in RhIG situations and if DAT is pos.

Cliff, I just tried to cut and paste the pertinent part, not do it as an attachment so that is why I failed I'm sure.

The most recent thing I read said to bank it with a public cord blood bank as a donor and not with the private cord banking companies. I believe that Presbyterian Hospital in NY was one of the pioneers. Their website probably has info.

It seems to me only one manufacturer makes the C3d alone. We use the combo.

If the mom is O and the baby is AB with a pos DAT, I guess there could be more than the usual circulating antibodies involved--both anti-A and anti-B (or more probably anti-A,. I guess it's more a matter of the same antibodies having more antigens to attack and the techs wondering if there is a specimen mix-up. Also, a baby can be homozygous for an antigen the mom has antibodies to if she is not the genetic mother. That's about all I have ever heard of about it. It might be more difficult to find units for an exchange transfusion that are compatible with the baby as well as the mom's antibodies--but that happens with genetic moms sometimes too.

I'm just glad that most of the antisera I keep are monoclonal and don't require AHG testing. Sidesteps the problem for all but anti-Fya. (We only keep common antisera.)

Thanks. This is what I was remembering about it being rescinded. I tried to paste the content of the FDA letter here, but it won't let me--probably because it is a pdf file. You have to scroll down the page of the geocities site to find the FDA letter link.

We do a visual check of our MTS diluent daily. We had a dispenser get contaminated with yeast--very hard to eradicate. We replaced it. Now we clean the diluent dispenser weekly with sterile DI water and a few other tricks to minimize contamination. We run a pos and neg plasma sample with a unit made up in the diluent so it mimics the reagents used in patient crossmatches.

A ballpark price I got for the Echo was ~$95,000.

I agree this is not a problem for tranfusion services but is for donor centers. Do US donor centers always do DAT or Auto control as part of donor testing?

I thought the FDA rescinded that. There was a big discussion of it on here or the AABB site a few years ago and someone got to the bottom of it with the FDA, I thought. Where is Bob Currie when we need him? Out playing with his trains I guess.

I have only heard of cases where the baby has a blood type that makes it appear that it can't be its mother's child. For us it would be so rare that it is only worth a mention in the Notes section of the SOP.

http://www.shamrocklabels.com/ They have an online catalog that you might be able to get label samples from. The expiration labels on it are JAN 2010 so might work for frozen red cells or if your system doesn't limit future expirations.

We thought about doing it but determined that the adhesive didn't stick well at refrigerator temperatures so we decided to attach the label with a tie-tagger and leave the backing on it.

Our panel sheets have outlived at least 3 computer systems. Sometimes there is detail there not available in the computers. I still have panels from the 1970s in our files--and sometimes we get a patient that hasn't been in again since then. This community has a very stable population. We have space for this degree of overkill, but I agree that 5 yrs is adequate.

We do it when it comes out of the water bath.

I like the gun scanners. We have gotten quite adept at covering the other codes when scanning or holding it just so to miss them. Maybe the new wands are better than the last ones I used, but it was no match for the guns. We have one cordless gun which is kind of a nice idea.

But Ag typing wouldn't use reagent red cells. Wow, let's charge out our screens and panels for each reagent cell tested!!! Could this be for additional cells beyond the first panel?

I think my supplier charges the same for poly and IgG for what that is worth. We do only IgG on babies although many years ago I did find a cord sample that was positive with complement. I don't think it meant anything. We dropped poly when the companies required that we buy it in large quantities and tons of it would have expired since we used it only for adult DATs at the time. Now we do both IgG and C3bc3d on all adult DATs with their appropriate check cells.

Since Dan provided us with that great codabar font for use in Word, I have been wondering too if there would be an equivalent for ISBT. I suspect that the licensing of the data structure forbids it. I guess I would ask ICCBBA. Compu-type makes a scan-one/ print one printer that is cheaper than a full-fledged printer. They also advertise smaller quantities of product labels more customized than some of the other pre-printed label sources. I am waiting for an answer to my email asking them if this service will be ready for ISBT, because the website only shows codabar labels.

Yanxia, I agree that it is amazing that we can have a product that has a shelf-life of 7/10 of the lifespan of the product constituent in the body. (I was taught that platelets survive 10 days.) Does storage actually prolong the life of the average platelet? Does anyone know? The old bell-shaped curve would say that a certain portion of the platelets collected are already near the end of their life-span and more would get there as the product aged. Years ago the FDA approved platelets for a 7 day outdate but quickly changed it back to 5 days because there were a lot more bacterial infections among recipients. With the advent of bacterial testing of pheresis plts, that concern is smaller so they could allow the longer outdate.

Do you ever think about how we recheck the types of Rh neg OB patients over and over, but if we made a mistake and mistyped someone it would be the ones that are thought to be Rh pos that need to be rechecked to make sure we got it right. Nowdays with the double-typing system this is probably less of a risk.

Have any of you changed reaction reporting forms or protocol to try to better capture cases of TRALI and appropriately manage them when you find them? We have used a protocol that divides reactions into classes based on initial signs/symptoms or on our testing results. Class I is allergic, class II is FNH, class III is hemolytic. The signs of TACO and TRALI are kind of vaguely lumped into class III but it doesn't make sense to do a huge serological workup for TACO or TRALI. Do I add a Class IV or just go to a flow chart? I need to make this easy for nursing as well as techs and our generalist pathologists. Has anyone already invented this wheel? Thanks for any procedures or info you can share.

Scientists discover a new chemical process conducted by hemoglobin. Science Daily (11/6) reports that researchers have "discovered a previously undetected chemical process within the oxygen-carrying molecule hemoglobin," according to a study published in Nature Chemical Biology. Investigators discerned "how hemoglobin, through a catalytic reaction that does not change its own chemical properties, converts nitrite salt to the vasodilator nitric oxide." They also noted "how the nitric oxide activity harnessed by hemoglobin escapes the red blood cell to regulate blood flow and how the process...relies on the oxidized...form of hemoglobin, previously associated only with diseased states." Previously, researchers knew that "n the bloodstream, iron-rich hemoglobin consumes, on contact, any free nitric oxide released by the blood vessels, so the idea that hemoglobin participates in forming nitric oxide had seemed implausible." There is quite a lot of information on Hemoglobin research to be found at the Science Daily site. http://www.sciencedaily.com/releases/2007/11/071105091931.htm

Thanks for trying John. I guess I knew this was impossible. I think I have figured out a way to make the new expiration print an extra time on our compatibility label on a small extra label so it will be harder for the techs to forget to use it to cover up the original exp., more legible and not prone to tech's not knowing what day it is. My current techs are more reliable than some of the dregs of techdom we were forced to hire a few years back so maybe I should be more trusting.