Sandy L

In the days before monoclonal anti-A and -B, we would dilute one of these reagents until we got a 1+, but found that with monoclonal antisera we REALLY had to dilute. Now we select a patient who is group A and run a titer against B reverse grouping cells. We select a dilution that gives 1+ reactions and then prepare a larger volume of that dilution. Of course using patient plasma, each patient will have a different titer, but usually we are not having to titer too far.

Donna, My only guess (and its only a wild guess) is that the Helmer must mix the cells better between cycles.

When we had Baxter cell washers (CW2) we had the same problems. We now have Helmer cell washers and they seem to do well with PEG.

rm thorkelson, Since we do not irradiate, we obtain irradiated RBC's from our supplier and reconstitute with non-irradiated plasma. As you said "since, "as everyone else has pointed out, there is no reason to irradiate FFP or Cryo." In scanning through the ICCBBA product database, I see lots ofE codes for frozen and thawed plasma and also cryoprecipitate products, so someone must be irradaiting these products. Not sure why.

Further researching of ICCBBA document for attributes for reconstituted RBC products (RBC plus plasma added): The document says “US Guidance”, so every one else can ignore this post. Leukocyte Reduction: IF both the red cells and the plasma are leukocytes reduced (or the combined product is leukocytes reduced), THEN in the Product quadrant label “LEUKOCYTES REDUCED” in Attribute line. IF Red cells are leukocytes reduced; Plasma NOT leukocytes reduced, THEN “Leukocytes Reduced” shall NOT appear as Attribute text. It shall appear as additional text. For example “Approx ___ mL Leukocytes Reduced Red Blood Cells from …” Irradiation: IF both the red cells and the plasma are irradiated (or the combined product is), THEN label “IRRADIATED” in Attribute line. IF Red cells irradiated; Plasma NOT irradiated, THEN “Irradiated” shall NOT appear as Attribute text. It shall appear as additional text. For example “Approx ___ mL Irradiated Red Blood Cells from … So, yes, I am using the wrong E code for Reconstituted RBC's.

We do not irradiate FFP and Cryo; only cellular products are irradiated. That being said, according to the ICCBBA requirements (may be USA only???) for ISBT labeling of the reconstituted product, you are not allowed to use the E code for an Irradiated reconstituted RBC product unless everything in the product (including the plasma) is irradiated. Go figure. So when we combine E0207 (Leukoreduced Irradiated CPDA1 RBC and Thawed Plasma) we label the reconstituted product with E6453 (RED BLOOD CELLS|CPDA-1/500mL/refg|Open|ResLeu:<5E6|Plasma added) and not E0219 (RED BLOOD CELLS|CPDA-1/500mL/refg|Open|Irradiated|Plasma added). Per ICCBBA ISBT128 Standards and FDA requirements, the system prints the following on the ISBT128 reconstituted red blood cell label: CMV negative, leukocyte reduced, irradiated, or IgA deficient when both the original red cell and the original plasma have the same attribute and Hemoglobin S negative or Washed if the original red cell is Hemoglobin S negative or Washed. Added changes: Now that I am re-reading this guidance, I think I have picked the wrong E code since E0207 is Leukocytereduced and I can only use that if both the Red Cell and the Plasma are leukoreduced??? This make my head spin.

We always check the specs before we purchase any electronic thermometers and pick the ones with the tighest tolerances. Some of them specify +/- 2C... definitely not accpetable for our needs. We want all of our Blood Bank thermometers to be within 0.5 of the reference thermometer. We verify on receipt for the temperature ranges in which they will be used and annually thereafter.

Our cord bloods are collected without anticoagulant in a sterile screw top conical tube. We do harvest an aliquot of free cells and serum, make sure there are no clots, and then run testing on ProVue.

So our negative control is just an unsensitized cell. This may be overkill as the QC we do with Positive and Negative antibody screen actually QC's the IgG reactivity of the gel card.

We also make our own positive and negative controls for KB staining, but this follows the manufacturer's recommendation. Since the instructions for use of the Fetal Screen kit are to use the controls cells provided in the kit, to do otherwise would be a deviation from the instructions. You would need to perform a validation in order to deviate from manufacturer's instructions and have it approved by your medical director.

We do run IgG DAT's on ProVue for Cord Blood testing. We make our own positive (O Pos donor cells coated with IgG) and negative controls since there are no manufctured controls for this. It seems like this is more in the way of QC'ing the method since Antibody Screen QC QC's the IgG reactivity of the Gel cards.

If in the U.S., here is from CLIA regarding QC of panel cells: §493.1271(a) Patient Testing (a)(1) The laboratory must perform ABO grouping, D(Rho) typing, unexpected antibody detection, antibody identification, and compatibility testing by following the manufacturer’s instructions, if provided, and as applicable, 21 CFR 606.151(a) through (e). Interpretive Guidelines §493.1271(a)(1) When condition level deficiencies in Immunohematology are in any or all phases of testing, use D5026. Negative There are no daily quality control requirements for reagent red cell panels used in antibody identification. Panel quality control is a combination of serological test results, such as: strength of reactions and patient phenotype; statistical probability, patient’s medical history; and laboratory standard of practice (i.e., how the laboratory handles compatibility testing for patients with unexpected antibodies). However, the QC requirements pertaining to new batch, lot, shipment of identification systems at §493.1256(e)(1) must be met.

Like rrcc1974 and several other posts, we would always result a negative antibody screen as negative and add a comment about the previously detected antibody. We have a separate test we can order called "Blood Bank Info". It is added automatically to any antibody ID and we can also order it ourselves when the antibody screen is negative but we want to provide the information about the previous clinically significant antibody. We have a number of canned comments but can also enter a freetext comment for any information we want the MD to see.

"... and then another 20% of the D Negative population who, it would appear, produce an anti-D when shown a photograph of a D Positive red cell (the super responders)" Loved the thought, Malcolm! It does seem to be that way sometimes

Not in the UK, but our policy is the same as Scott's. Must have a blood type on the current admission. We use a secondary blood bank armband, so the BB sample for blood type must be drawn and labeled with the BB band that the patient is currently wearing.

Look at the post above from Aunti-S with pictures of digital thermometer probe inserted into a gel card

We do similar to dmpollock. We have an informational sheet with the same type of information plus a few other things like no food or drink in the lab. First time transporter we hand them the sheet and review the salient points and then have them sign the clipboard.

For blood bank antisera and reagent cells QC, we do lot to lot comparison using QC material. The comparisons do not need to be the SAME day. We use Ortho Confidence kit and we stagger the shipments so that we are not putting new lots of reagent cells and QC material on the same day. So when bringing in a new lot of antisera or reagent cells we perform QC using the SAME lot of QC that we used YESTERDAY to QC our previous lot. So yesterday old lot was QC'd with in use QC kit and today new lot QC'd with in use QC kit. This is no extra work as you obviously have to QC the new lot before putting it into use anyway. We drew the line at doing this for our rare antisera which we may not have used for days/week/months so no way to run the same control material and I am so glad to see CAP is not requiring this. Eluate kit parallel is a real bummer though!

To meet CAP COM.30450, we parallel new lot vs old lot for both Fetal Screen and Fetal Stain kits. Fetal screen: "Perform testing of the new lot using controls from the current "in use" lot and the new lot." Fetal stain: We prepare our own positive and negative controls. When we parallel we use the same set of positive and negative controls and test the new and current "in use" lot against the controls.

You might find this article form John Judd to be of interest: Judd, W.J., et al, The Evaluation of a Positive Direct Antiglobulin Test in Pretransfusion Testing, Transfusion 1980; 20:17-23 In this University of Michigan study, an analysis was performed of 879 samples with positive direct antiglobulin tests. Eluates were performed and 83 were reactive. Most were autoantibodies and a few contained penicillin/Keflin antibodies and a few contained passively acquired anti-A. In only 11 of the 879 cases allo-antibodies were detected in the eluate. After 14 days allo-antibodies detected in the eluate were also detected in the plasma in all but one patient sample that eluted anti-K 17 days post transfusion. The article states, "One of the six patients whose red blood cells eluted a transfusion-induced alloantibody, but in whom the eluted antibody was not detected in the serum by routine pretransfusion screening tests, had been transfused 17 days before a detailed serological evaluation of the DAT was performed (case 4, Table 3). The red blood cells from this patient eluted anti-Kell. This isolated instance does not warrant an extension of our definition of “recently transfused” to a post transfusion interval beyond 14 days, for to do so would only increase the number of samples requiring evaluation with very little corresponding gain in terms of significant serological findings." The University of Michigan established a 14-day cut-off for "recently transfused" when determining if an eluate needs to be performed. We have chosen 28 days as our "recent transfusion" cutoff to perform an eluate. If the DAT becomes positive within 28 days we will perform eluate, if greater than 28 days since transfusion we will not perform eluate. The article was written in 1980 and the automated testing methods for antibody detection widely in use today are likely to be more sensitive than those used in the study.

We do have the nurses report mild urticarial reactions to blood bank and order a Transfusion Reaction workup. We do not draw a sample or do any testing but we do chart the pathologist interpretation of an urticarial reaction so that it is in the patient's record.

Our standard protocol for transfusing neonates under 4 months is to transfuse group O Red Cells and AB plasma products. We do not require a 2nd sample to confirm ABO/Rh for this patient population. On occassion we get a Directed Donation RBC unit for an infant that might be other then group O. In this infrequent instance we require a second sample to reconfirm the ABO/Rh and will also perform the antiglobulin test for passively aquired maternal ABO antibodies in the infant plasma.

We review Special Transfusion Requirements and unit attributes at dispense with the person picking up the blood. This is an AABB requirement (5.23#4, 29th edition). It is also a requirement for RN to check that “Special Transfusion Requirements are met” at the bedside (5.28.3#4). There is no requirement to review Antibodies/Antigens at dispense or at bedside check if you are following AABB Standards. The Blood Bank LIS system verifies Transfusion Requirements vs unit attributes and patient antibodies vs unit antigens at time of dispense but the antibodies are not part of the verbal check.

We do have a "Blood Bank Information" test that is added to Antibody ID. We have some pre-approved canned comments for the commonly encountered antibodies that are resulted out. The comments include clinical significance (whether reported to cause hemolytic transfusion reactions or HDN) as well as % of compatible donors. They also will include a warning when it would take a while to get blood (eg.if we need to get units from blood supplier, R2R2, etc). We are a multi-hospital system. At one of our hopsitalss, the pathologists want to review if it is the first time the antibody is identified for a patient. At that site the Clin Lab Scientits reports the 1st time ABID then it goes to the pathologist and finally the Blood Bank Info is reported after Path review. The rest of our sites, the pathologist do not review the ABID workups.

If you have access to Transfusion journal, John Judd published an article comparing different anti-D reagents including which reagents will react with which partial D. Sorry I don't have it at my fingertips.