Sandy L

I know that, at least here in the US, Ortho will not guarantee homozygous expression of S and s antigens which is something we want. It does seem like with 3 cells we almost always get this. I am not sure we would get this with a 2 cell screen so we will not go there. Another consideration, 2 cell screen (R1R1 and R2R2) will not detect anti-f, although some feel it may not be clinically significant.

Just after reading this post I saw the following in the CAP "All Common" Checklist, COM.30350, Reagent Storage, that will need to be considered by your chemistry department. It has stipulations for use of frost-free freezers: "All reagents and media are stored as recommended by the manufacturer. NOTE: Reagents and media must be stored as recommended by the manufacturer to prevent environmentally-induced alterations that could affect test performance. If ambient storage temperature is indicated, there must be documentation that the defined ambient temperature is maintained and corrective action taken when tolerance limits are exceeded. A frost-free freezer may not be used to store reagents and controls unless either of the following conditions are met: 1) Reagent/control materials are kept in thermal containers and the laboratory can demonstrate that the function of these materials is not compromised; or 2) Freezer temperature is monitored by a continuous monitoring system, or a maximum/minimum thermometer. Patient samples may be stored in a frost-free freezer only if the temperature is monitored in accordance with (2), above. The use of automated (including remote) temperature monitoring systems is acceptable, providing that laboratory personnel have ongoing immediate access to the temperature data, so that appropriate corrective action can be taken if a temperature is out of the acceptable range. The functionality of the system must be documented daily."

We have always used the rule that the billing service date should be the date that the specimen was collected.

I was concerned about Mabel’s comments regarding the Ortho positive control. Has anyone else experienced this recently? We had switched to Immucor several years ago when the Ortho kit was recalled and then discontinued. When the Ortho kit was returned to the market we stuck with Immucor. Since we now needed to evaluate the new RapidScreen, we decided we should also look at the Ortho kit again. Since we are Ortho customers for our other reagents, there is a cost advantage to the Ortho kit. The techs performing the evaluation actually liked the appearance of the Ortho rosettes. They said they were a little larger than the RapidScreen rosettes and therefore easier to visualize. We had just made the decision to convert to Ortho Fetal Screen when we saw Mabel’s post.

We would never rely on a blood type from another facility as a 2nd ABO/Rh to qualify a patient for Electronic XMatch. We require ABO/Rh types performed in our facility on 2 separate samples. Until the 2nd sample is recieved, we would only crossmatch group O and would perform a serologic (Immed spin, if eligible) until 2nd sample is received.

We would never use a reference lab’s crossmatch. Our reference lab would perform antibody identification and antigen typing and may in some instances also pre-screen units for compatibility using the patient’s plasma. The units would come to us labeled with antigen typing results. If compatibility “screening” was done they would have a label saying that the unit must be crossmatched. We would enter the units into our inventory, perform unit ABO/Rh confirmation testing and would crossmatch the unit. The crossmatch may be incompatible in our hands (e.g. patient has warm autoantibody) and would be signed out as such. We would add a statement to the tag to state testing done by reference lab indicating for example “Warm autoantibodies present. Units are incompatible with neat plasma. No underlying alloantibodies were detected in adsorbed plasma at [name of reference lab]. MD notification complete to: __” or a similar type of statement when alloantibodies are present and units are antigen negative.

We have 2 Helmer 8 unit plasma thawers. Love them.

I think "Cerner" is referring to Cerner's Bridge application for scanning the patient armband and generating specimen labels at the bedside.

This was a recommendation from a CAP inspection stating that we were not treating our CAP survey samples as patient samples. We now do as Likewine99 and tbsotock. We assign an ISBT product number based on our Facility Identification number, year 99 and last 6 digits based on the CAP number and similarly register patients. This does create several extra units per year in our statistics. I think we will add a Final Disposition reason to our BB LIS to indicate that it is a Survey sample.

We would do a Computer Crossmatch without retrieving the specimen. We do use a separte blood bank armband and the BB band number must be scanned initially from the specimen bar code. Once entered the specimen is not required for additional Computer Crossmatches

We use the "Open System" E code that corresponds to the "closed system" E code of the original product. For example, E0181 (RED BLOOD CELLS|CPD/500mL/refg|ResLeu:<5log6) keeps the same E Code when divided in a closed system. It just gets the appropriate division characters. If aliquots are prepared in a syringe the E code becomes E0175 (RED BLOOD CELLS|CPD/500mL/refg|Open|ResLeu:<5log6) with appropriate division characters. For each E code that could be aliquoted we searched the ICBBA data base for the same description but “open”.

Also have you tried other B cells? Could be an antibody to low frequency antigen. Not sure if reagent B cells are pooled or single donor

In the U.S., the 1+ to 3+ requirement for positive control for QC of antibody screening cells came from a CAP requirement in years past. We use the Ortho Confidence Kit which has a positive control that contains a mixture of anti-D and anti-c. The antibodies will typically react 1-3+ with screening cells if doing manual tube antibody screen but will react 4+ in Gel testing. CAP has dropped the 1+ to 3+ requirement and we now use the positive control as provided.

Our cut-off to start doing Fetal Screen is also 20 weeks. Beyond 20 weeks Fetal Screen is required except for routine antenatal RhIg (e.g. at 28 week) without invasive procedure, trauma or bleeding. Rh type is required.

Our 4-channel traceable digital timers comes with a calibration due date on the back and are good for 2 years. We just purchase new ones when the timer recalibration comes due. We had an FDA inspector site us for not reclaibrating at the due date.

We've seen at least 2 anti-E's in the past that react like this, 4+ in Gel and negative in tube testing or weak direct agglutination after 37 incubation so at least some IgM present; one that I recall was an Obstetric patient. Currently we have a 3rd case, also an OB patient, who has anti-C and anti-e. She initially presented with R1R1 cells reacting 4+ and rr cells reacting 3+ in Gel and was negative in tube LISS and Peg. By the third prenatal sample the anti-C was reacting weakly in tube LISS at 37 and AHG but the anti-e is still detected only in Gel.

In the U.S., only FDA approved adhesive is allowed for labels that attach directly to a blood product, so I understand that if you are going to attach to the unit directly you must be sure to use an approved adhesive (like what the blood bag manufacturers use). At our facility we use a 2 part pre-printed Transfusion Record (i.e. top copy carbons through to the back copy when you write on it. Our Blood Bank computer system prints 3 Compatibility adhesive labels with patient/unit information. One of the labels is placed on a tie-tag which is attached to the unit with cable ties. The other 2 adhesive labels are attached to the 2 copies of the transfusion record which are designed to accompany the unit. When we upgraded computer systems we went to this system of printing 3 labels in order to get away from a transfusion record that was printed on a dot matrix printer. In our old system we also used a 2-part pre-printed form, but we had to use a dot-matrix printer to get the information to carbon through when the system printed it. The old from had a peel off sticky label which we also adhered to a tie tag. The up-side of our new system is getting away from dot matrix printers and going to a Zebra-style label printer. It prints the 3 labels quicker than our old system would print a transfusion record. The down-side is that now we have to manually attach the label 3 times, once to the tie tag and then to each of the 2 copies of the transfusion record so product compatibility labeling is a slower process; before we just had to peel of one adhesive label fro the tie tag.

Trauma patients at our facility are being identified with a trauma name plus a Medical Record Number plus a visit number. We also use a blood bank armband number. When the patient name is changed to their real name we still have MRN, visit number and BB armband number, i.e. 3 identifiers to match at transfusion. Currently, if the patient had a previous MRN, the new trauma MRN is merged in to that one after discharged. In the near future, MRN mergers are going to happen prior to discharge. The agreement is that the merger will not take place until the patient is stable. Our plan is to re-collect a new Blood Bank Specimen with new BB band and repeat testing once the merger happens, because otherwise we would be down to only one identifier the BB armband number.

We allow pre-op patients to be drawn up to 10 days before surgery. The blood bank armband is placed at the time of specimen collection. They must complete a transfusion history card, answering 2 questions about transfusion or pregnancy within the past 3 months. It includes a notice statement "I understand that loss or removal of the Blood Bank arm band will result in having to have my blood redrawn." They sign and date the completed card. If they are admitted on the day of surgery without the BB band, we redraw and repeat all testing.

We use the 2 terms interchangeably. Our blood supplier used to call them “Directed Donation”, “Donor Directed” or “Donor Specific”. These terms are used for blood donated by a friend or family member of the intended recipient and tagged for that recipient. A few years ago our supplier decided that the term was not accurate in that it sounded like the Donor was directing the unit to the recipient. Since the supplier required an order from the recipient physician and the recipient must supply a list of acceptable donors to the blood supplier, they now call it a “Designated” donation, i.e. the recipient is the one who designates, vs. the donor directing where it goes.

Regarding the use of clotted samples for blood bank testing. In the US we have been a little slower to adopt automation in the hospital transfusion service. In our lab we used manual tube testing until 1997 when we started using manual Gel and did not automate until 2005. Before 1997 virtually ALL of routine blood bank testing was performed using clotted samples. I think use of a clotted sample was pretty much the standard in the US before that time. Even a well clotted sample when centrifuged will yield enough free cells at the bottom of the tube to the forward typing.

For those in the USA and complying with CLIA standard 493.1271 (QC requirement for immunohematology), here is the CLIA interpretive guideline that I found and it addresses antibody identification: §493.1271(a)(1) Guidelines: 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.

Ocassionally we see this phenomenon and think it mat be due to cryoglobulins precipitating in the cold. Re-spinning the sample before testing will clear up any problems.

We also use Gel as our standard method and quite agree that tube methods are less sensitive for most clinically significant antibodies than gel, (we use tube LISS as a backup). We would only prewarm when we have demonstrated a strong cold agglutinin (positive Immed spin/room temp in tube method. Most clinically significant antibodies that are 1+ in Gel will be negative in Tube LISS and many that are 2+ in Gel will be negative by tube methods. Prewarming reduces the sensitivity even further, so techs are insructed to consult a supervisor before using this technique. We use tube testing only in very selected instances, e.g. warm auto antibodies, potent cold auto antibodies, also those pesky antibodies that we used to call "HTLA" .

We have interfaced (uni-directional) ProVue to Cerner Classic and plane to interface to Cerner Millennium when we transition in 2010 (planning on bi-directional). I would strongly support an interface. i would not want to manually transfer the results as that could increase the risk of clerical error. One of our main justifications in automating was reducing risk of error.