Abraham

Worst thing is answering the phone "Blood Bank" when you're home.

Thanks guys.  Your support means everything.  I accepted a Blood Bank manager position at a well-known hospital and University.  I will continue seeking your support and guidance, as this forum is the great gift that keeps on giving.  My 2015 pledge is to be more visible here instead of behind the scenes.  I look forward to breaking the Christmas bulbs again.  Please,Please bring them back  
 
Respectfully,
 
Connie

Standing by your principles is hard enough, but when it impacts your family's income it has to be a very difficult choice to make. I applaud you.

Connie, I have huge respect for you over this.  I think you are absolutely correct to stand by your principles.

Not only not reactive by IAT, but the P1 antigen not expressed well at birth.
 
I would say that the request for the titre is a conservative 100, 000%!!!!!!!!!!!!!!!!!!!!!!!!

We use the 2 and 2 rule.
 
The way I understood the math is that 3 and 3 rule = 0.05 p value if you're running only 6 cells total. We use a three cell screen and an 11 cell first-line panel. You should be able to get an acceptable p value based on those numbers of cells tested. On that note, there's a lot of discussion about the relevance of p value in the first place.
 
Kanter, M. H., Poole, G. D. and Garratty, G. (1997), Misinterpretation and misapplication of p values in antibody identification: the lack of value of a p value. Transfusion, 37: 816–822.
 
We use one homozygous cell for rule outs, with some exceptions.

Hi cswickard and Clarest,
 
1.  The Goa antigen is quite rare, being expressed on only about 2% of individuals within the Black population, and only then if they have the rare Partial D Category DIVa.  Therefore, you are correct in assuming that you will avoid Goa if you give your patient rr red cells.  However, if he is Ro himself, you can transfuse him with Ro blood, avoiding the C and E antigens, and, in 98% of transfusions, also avoid the Goa antigen.
 
2.  Unless the patient has anti-IgA, I would not have thought that he would require washed red cells (unless they are worried about the small amount of free Hb in the plasma adversely affecting his kidneys).  However, there may be another reason why they are giving washed red cells.  We would need more information.
 
3.  From what you write, it sounds as if he is receiving either partial or full exchange transfusions at his home hospital, and erthropheresis is just an automated method to achieve this.  It allows for a more controlled exchange, as there is little human intervention.
 
4.  The Fy(a-b-) phenotype is seen in about 68% of the Black population, but is also present in Arabs, Jews, Brazilians and Romanies.  It has only ever been found in about 5 individuals in the White population.  Most of the 68% of the Black population have the FYB gene present, but also are homozygous for a GATA-1 mutation upstream of the erythroid promoter region, and, therefore, the Fyb antigen cannot be expressed on their red cells.  However, the Fyb antigen is expressed on tissue other than red cells, and so the immune system does not recognise the Fyb antigen on transfused red cells as "foreign".  They will not, therefore, produce an anti-Fyb, or, come to that, an anti-Fy3 (rare individuals of this type have produced what appears to be an anti-Fy3, but there is a theory that this may be another Duffy specificity that mimics anti-Fy3).
Individuals who do produce an anti-Fy3 usually have the amorphic Duffy genotype of FY/FY, and once they have produced an anti-Fy3, should only be transfused with Fy(a-b-) blood, but this can be either of the GATA-1 type of Fy(a-b-), or the FY/FY type of Fy(a-b-).
 
Although Fy:-5 is more common in the Black population than in the White (by a long way!), most of these individuals are also Fy:-3.  It is till far more common for these individuals to produce an anti-Fy3 than it is for them to produce an anti-Fy5.  Anti-Fy5 is pretty rare.
 
I hope that helps.

Yikes! In past years antigen typing sera could be used beyond expiration as long as there was a policy for QC. We consider them to be "rare" partially as an expense. Yes they are available from the manufacturer, but they are very expensive. Private Lear Jets are also readily available from a manufacturer, but they are rare because few people can afford them!
We will be eating some expense to get our rack in-date within the next few weeks. Our CAP window will be opening soon.
We also use expired panel cells for rule-outs.....in fact a recent CAP Survey we had to use expired panel cells to identify an anti-U....nothing in-date was helpful.
Sounds like another case of a non-technical person making rules they don't understand.

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.