dcubed

IMO, it is important to reconcile inventory on a daily basis.  It seems to become exponentially more difficult to fix something when more time has passed.

If current antibody screen is positive and Lewis antibody identified, do immediate-spin and anti-igG crossmatches, issue crossmatch-compatible random donor units.  If current antibody screen is negative and there is a history of Lewis antibody, do Computer Crossmatch with random donor units.

I would think that the freshest irradiated or unirradiated unit you have on hand would be suitable for a baby in a true emergency.   A full unit could be issued and tranfusionist would use what they needed and discard.   This plan should be discussed with all involved before it happens to make sure everyone is OK with this.  Perhaps a procedure should be written as well.     

I'd contact the manager of the collecting facility.  This does not sound right.  We also allow ours to sit for 10 minutes to an hour before placing on an agitator.

i agree with Cliff

Treat as a transfer between hospitals.  When we were asked to send product with a patient to another facility we would fill out a transfer form to go in the box and pack per our suppliers instructions.

We always let them rest for an hour and then on the rotator.  It's been a while for me also in dealing w plt donations.  It would be interesting to see the procedure as written by the vendor or the collection device, as opposed to what the inhouse procedure is.

Treat as a transfer between hospitals.  When we were asked to send product with a patient to another facility we would fill out a transfer form to go in the box and pack per our suppliers instructions.

LOL! I knew someone would mention that Malcolm!
Here we only would use a scope to differentiate rouleaux from a "true" weak reaction when getting very weak macroscopic reverse typings or on an IS crossmatch. I am not sure why anyone would think to use it for a DAT or IAT.
Scott

Why would you want to read either under a microscope?

Our fetal bleed screen kit (Immucor Rapid Screen) is only approved for postpartum testing with known infant type.  Antenatal bleeds and losses > 20 weeks require a KB in our facility.  Which screening kit do you use?

We perform a screen. Why would you give RhIg if the patient is already immunized to D? Or if they were recently administered RhIg?
We don't issue the RhIg either, it's in pharmacy.

According to AABB Standard 5.30.2 part 2; "the woman is not known to be actively immunized to the D antigen."  We perform an antibody screen, along with an  ABO/Rh on a current sample before issuing a Rhogam. This is for ED patients and LD patients.

It would seem that we are in the minority in that we perform a type and screen prior to ANY RhIG administration.  Hmmm.

Might be a rare IgG anti-A1 - you may not see in in the Reverse (presumably IS or buffer-only gel card), but is detected when you do anything with an antiglogulin reagent. You could try doing the Reverse by IAT. The DAT may just be a red herring, but it might represent a weird autoantibody that favors group A cells.

It COULD be that the patient is a secretor, and is secreting sufficient A substance, which is then adsorbed onto the group O red cells, for some very strong anti-A reagents to detect this adsorbed A substance (remember that the patient will still secrete A substance throughout his life, as the secretion is not affected by the bone marrow transplant).  This is a bit of a long shot, but I have seen it happen on very rare occasions.

If the current antibody screen is negative we issue electronically crossmatched units untested for Lea. If the current antibody screen is positive, we issue IgG-crossmatch compatible units untested for Lea

I need help understanding a strange phenomenon.  I have a D negative Mom by gel testing that has delivered  a D positive (3+) infant by gel testing.  A maternal post delivery sample was used for an FMH screen.  The FMH screen was macroscopically positive 1+w.   The Mom's post delivery sample was tested for weak D and was found to be 1+w.  The Mom's pre delivery specimen was tested for weak D and it was negative.  The sample was tested for FMH with a KB stain an no fetal cells were seen.  I was expecting the KB stain to reveal a large number of fetal cells. 

The first edition was one of the books I used to study for the SBB exam - mid-80s. 

You hit the nail on the head!  The K positive cells were also positive for Bg.  Went back and found D neg Bg neg K pos cells and they did not react.  Mystery solved.

Then it might just be due to the E. coli infection.
Just to square the circle, as it were, if you have any of that batch of RhIG left, it may be worthwhile testing it with a couple of rr, K+ red cells, just to check that there is no anti-K in it. The things is, all humans, being humans, are a bit awkward and don't all react as they should! It may be that the others have adsorbed the immunoglobulin at a slower rate into their peripheral circulation (see that the anti-K may not have been detected), whereas this lady adsorbed it quite quickly, and so you were able to detect the anti-K.
Just a thought.

1.  Baby was full term.
 
2.  Mom was treated for E Coli UTI.
 
3.  We have given this same lot of RhIG to other patients and have not noticed anything other than passive anti D when these patients come back to us.

We do the same thing here. One time I had to call five out of state hospitals to get the complete history on a patient. Having all that information was well worth it!
 
On a personal note, I have often said that if I ever developed an antibody, I would get a medical alert bracelet. I wonder why that is not a routine thing. That information is certainly as important to a patient's treatment as information regarding allergies, etc.

For reasons such as this, whenever I have a positive antibody screen on a new patient, I call the floor and ask if the patient has been transfused before and, if so, where.  I then call that facility and get their history.  In transfusion medicine, we have to be investigators who are willing to turn over every stone. 

I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient.
A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients.