Winter

See my Library file "Meditech Unit Confirmation".

Of course it is, it would be an honor to have it added here.

I'm so glad to hear that you will not be retiring from this site. I always appreciate a response from you, even (especially) if I have posted something that was incorrect because I consider you to be one of the great minds in the Blood Bank World! Thank you for being willing to share your vast knowledge with the rest of us!

I'm so glad to hear that you will not be retiring from this site. I always appreciate a response from you, even (especially) if I have posted something that was incorrect because I consider you to be one of the great minds in the Blood Bank World! Thank you for being willing to share your vast knowledge with the rest of us!

I'm so glad to hear that you will not be retiring from this site. I always appreciate a response from you, even (especially) if I have posted something that was incorrect because I consider you to be one of the great minds in the Blood Bank World! Thank you for being willing to share your vast knowledge with the rest of us!

It is the policy at our facility to give E=c= RBCs when patient has anti-E and types also as c= or if c pheno is unknown or cannot be done due to very recent transfusion, but we do not type the units for E when patient has anti-c only. In this case, we only give c= units.

We give all patients with Anti-E, blood that is c antigen negative. Until a few months ago, we had several patients who were chronically transfused that required both E, c negative units so we stocked two at all times. The 18th Edition of the AABB Technical Manual, p. 331 states: "When seemingly compatible E negative blood is transfused, (to a patient with anti-E who most certainly has been exposed to the c antigen as well), it is most likely to be c positive and may elicit an immediate or delayed transfusion reaction. Therefore, some experts advocate for avoiding the transfusion of c-positive blood in this situation."

we do like Liz but always wanted to change to what you are doing.   There is a lot of literature out there that you could share with your pediatrician about recommended cord blood testing.   Maybe you need to get your pathologist involved.  

Your new Pediatrician should treat on symptoms, rather than laboratory results, but order laboratory tests to prove the symptoms.  It would be a lot cheaper, and would also show that the "Pediatrician" actually deserves the title.

In Meditech C/S, I created a test called Extended Crossmatch that includes both immediate spin and gel (or tube Coombs). I replace the crossmatch in the BBK History using the       Replace Crossmatch Test with the Extended Crossmatch for all patients with known antibodies. I check for newly identified antibodies regularly. 

In Meditech C/S, I created a test called Extended Crossmatch that includes both immediate spin and gel (or tube Coombs). I replace the crossmatch in the BBK History using the       Replace Crossmatch Test with the Extended Crossmatch for all patients with known antibodies. I check for newly identified antibodies regularly. 

Our phlebs are limited to 2 tries. A second person also has 2 tries, but they are not supposed to attempt unless they think there is a reasonable chance they can get it - no blind poking in hopes they get lucky. If #2 strikes out, a third person can evaluate the situation and attempt. How many attempts is kind of determined at this point by how badly the specimen is needed. If the patient is in bad shape and its a test that is really important, the phleb or tech may try more than twice if they think they have a chance of getting it or the specimen may be collected arterially with physician consent. Other than that, it's a case by case decision. Sometimes we get cancellation orders, sometimes the patient needs hydrated before we try again, some patients get a line but that's not generally done just for lab draws. Thankfully we have some very experienced phlebs with exceptional skills so we don't have to deal with this very often.

Is anyone using the Mapping Dictionary in Meditech's MIS Applications to automatically order extended crossmatches for patients with a history of clinically significant antibodies? As I understand the "Best Practices" information, this will automatically order an extended crossmatch once an intervention in MIS is performed (the Replace Crossmatch Test routine is used to associate the Crossmatch Test Map with a patient history.)

Winter - in the case of DARA patients, the DTT is use to treat (panel or screening) cells rather than the serum.
SMILLER - do you enzyme-treat your own cells ? If so, have you determined their stability ?

I have it working in test, but I wondered if there were any downsides other than the extra step to map the test change once an antibody is identified. We just started doing only immediate spin crossmatches on patients that qualify, and I don't want to see any techs omitting the XM Gel when it is needed. (I know- welcome to the 21st century!!!!!!)

We use an Algacide by Polyscience.

We wouldn't cancel the Immediate Spin procedure. The map will replace the immediate spin order with the  extended crossmatch order which does includes an immediate spin.

I think that guidance was established based on titers performed in saline and not Gel.  As a reference lab, we are a bit conservative and report out (paraphrased) "anti-D demonstrating a titer of less than 4 in saline indicating it may be due to recent administration of RhIG.  To establish this as the sole cause of the antibody, repeat testing six months post delivery should demonstrate a negative antibody screen."

Maybe my post was a little too brief. I was only thinking of testing the 1:4 dilution after performing a screen and testing the selected Ortho cells designated with the @ symbol on a post delivery sample of a mom who has received ante natal Rh Immune globulin since the AABB says that "passively acquired anti-D rarely achieves a titer above 4.

We're working on one too; here's a few that should help you.
Warfarin Reversal Guideline 2012.pdf
Warfarin Reversal article.pdf
Warfarin_Reversal_Vitamin_K.pdf
Coumadin_Warfarin_Therapy_Reversal_in_Patients_with_Risk_for_or_Actual_Extracranial-Intracranial_Hemorrhage.doc

Is the patient Rh negative and has she received Rh Immune Globulin? I had a close relative who had a very weak anti-E following her Rhogam injection, and it soon became undetectable. At that time the product insert stated that other antibodies could be passively acquired by this injection. (I can't find the statement in our current product insert.)