Sandy L

We would only do an elution if there is history of transfusion within the last 4 weeks. I cannot find the refence now, but John Judd published a study (my recollection if in Transfusion and some time ago) regarding detection of alloantibodies post transfusion in eluates. His findings were that after 4 weeks the antibody that is recovered in the eluate is also detected in the plasma so that nothing is gained by doing an eluate beyond that time frame. That was there policy at UMich I think

We did something similar to Pat Distlers solution above since we are also preparing successive aliquots in syringes. We have built a 2 step process in Cerner Classic. When we get ready to make the first aliquot we convert the original RBC into a divided "parent" product. We transfer the entire volume into the divided "parent" RBC. This product is assigned division code A0. This product is relabeled with a Divide RBC product label and division code A0. We then immediately make our first syringe aliquot product from the divided "parent" product. Each syringe aliquot is successively assigned Aa, Ab, Ac... as it is made. These are automatically assigned by the LIS. This solves the issue of relabeling the original product when the 1st aliquot is removed and it assigns consecutive letters to the aliquots instead of having them jump from A0 to Ba between the 1st and 2nd. We did email this to Pat Distler before implementing this alternative solution. We also use this same scheme for syringe aliquots prepared for apheresis platelets.

We do QC on ABD reverse gel cards on ProVue. Our controls are A Neg and B Pos. Ortho does not provide a QC kit for ProVue QC so ProVue users must manufacture their own QC reagents. These 2 controls provide positive and negative reactions for ABO forward, reverse and anti-D. Our current manual test method is tube.

We also have noticed with EDTA specimens, that we need to spin for a longer time than we did for Non-anticoagulated Red top specimens. It is imporatant to get platelet-poor plasma for Gel testing and also if the EDTA samples are not well spun the incidence of rouleux is increased.

In the AABB forums in response to this question, Susan Wilson referenced 23rd edition of Standards: 5.7.5.12 Thawed Plasma….shall be prepared in a closed system from Fresh Frozen Plasma or Plasma Frozen within 24 hours of Collection. and then 5.1.8A #32 which specifies an expiration date of 5 days for thawed plasma So it looks like the expiration date for plasma frozen within 24 hours would be handled identically to FFP when thawed (24 hours) and then converted to Thawed Plasma, 5 days after thawing. Our supplier will start providing Plasma frozen within 24 hours (FP24) within a few months. My question is how to create this in our LIS (Cerner classic) without creating so many products. Our system requires a separate product be created for every frozen product that is thawed. So now we have (just for whole blood dervived plasma): FFP (frozen), FFP Thawed and Thawed Plasma and for FP24 we will need FP24 (frozen), FP24 thawed, and we can use the same Thawed Plasma. This is in addition to apheresis derived FFP (multiple sizes) and Divided pediatric sizes, all of which have their own thawed products and aliquot produts. We are getting overwhelmed by the number of products needed. Does anyone use a naming convention in their LIS that would cover both FFP and FP24? Does anyone thaw these products straight to Thawed Plasma, 5 day and skip calling it thawed FFP (or thawed FP24) for 24 hours? We currently find very few transfusion recipients that cannot get Thawed Plasma in place of FFP for their transfusion requests.

In the AABB forums in response to this question, Susan Wilson referenced 23rd edition of Standards: 5.7.5.12 Thawed Plasma….shall be prepared in a closed system from Fresh Frozen Plasma or Plasma Frozen within 24 hours of Collection. and then 5.1.8A #32 which specifies an expiration date of 5 days for thawed plasma So it looks like the expiration date for plasma frozen within 24 hours would be handled identically to FFP when thawed (24 hours) and then converted to Thawed Plasma, 5 days after thawing. Our supplier will start providing Plasma frozen within 24 hours (FP24) within a few months. My question is how to create this in our LIS (Cerner classic) without creating so many products. Our system requires a separate product be created for every frozen product that is thawed. So now we have (just for whole blood dervived plasma): FFP (frozen), FFP Thawed and Thawed Plasma and for FP24 we will need FP24 (frozen), FP24 thawed, and we can use the same Thawed Plasma. This is in addition to apheresis derived FFP (multiple sizes) and Divided pediatric sizes, all of which have their own thawed products and aliquot produts. We are getting overwhelmed by the number of products needed. Does anyone use a naming convention in their LIS that would cover both FFP and FP24? Does anyone thaw these products straight to Thawed Plasma, 5 day and skip calling it thawed FFP (or thawed FP24) for 24 hours? We currently find very few transfusion recipients that cannot get Thawed Plasma in place of FFP for their transfusion requests.

Is anyone performing proficiency testing for warm autoadsorption? In our procedure we state "Samples prepared by this method are tested using antibody detection and/or identification procedures which are verified 3 times per year using the CAP Transfusion Medicine Survey". At a large academic hospital in town, which had previously taken the same stance, the facility was cited by during an AABB/CAP inspection for not having an alternate proficiency for this procedure. The supervisor suggested sharing samples between our facilities to accomplish this, but this would require drawing extra specimens from an anemic patient. In view of the volume of specimen that may be required to complete this test, I do not believe it would be right to set up split sample analysis with another facility or reference lab or duplicate blind testing. Before I suggest to the supervisor that she challenge the deficiency, I wanted to see if others have set up an alternate proficiency test.

We prepare 8% albumin to be used as a control in this instance. Ortho (primary reagent) recommends 6-8% as a control. ImmucorGamma, Series 4, (backupreagent) recommends 6-30%. In the commentary to CAP checklist question TRM.410150 regarding appropriate controls for D testing is the following: "Monoclonal anti-D reagents do not ordinarily require a separate reagent control. Incorrect assignment of a D-positive phenotype can be ruled out by observing negative reactions in any tube containing red cells and patient serum, or, alternatively, patient cells suspended in 5% bovine albumin." I'm not too sure why they recommend 5% when this is not quite what manufacturers recommend. Our LIS system is set up to require a control for sample that tests AB D+ or D+ in absence of concurrent ABO testing, so we would run with every patient typing in these 2 instances.

We also dilute our Ortho QC antisera for testing on Gel. We are currently diluting 1:30 and are usually getting 1+ with the D+ c- cell and 3+ with c+ cells. Our procedure includes instructions for preparing 1:20, 1:25, 1:30 and 1:40 dilutions, because some years ago the anti-D was the stronger antibody in the mix and a lower dilution worked better. This allows us to make an alternate dilution if we find that our 1:30 dilution no longer gets the expected reactions. Interestingly, a CAP inspector/AABB assessor stated that some sites she had inspected had been using the antibody neat and had basically gotten an "exception" from CAP to do this, based on the increased sensitivity of Gel testing. I'd be interested in hearing from anyone who had made this challenge to CAP. As an additional note, during our last FDA inspection, the investigator had some consternation that we were diluting the QC reagent, since the manufacturer's instructions for use states "do not dilute". This was in spite of the fact that we had validation to support our dilutions. After several phone calls to his superiors, he decided that what we were doing was actually "OK". I do understand that it would be impossible to make a QC antibody that would work for every possible antibody enhancement medium. Still, it seems to me since Gel is so widely used, that Ortho should provide QC material that mets the requirements of accrediting agencies.

John, In answer to your question, no, this is not a frequent occurence where we would retest an infant after we have started transfusing, perhaps once or twice a month. Most of our infants start on group O and stay there, so it only happens when we switch an infant back from group a group O to a non-O unit. Sandy

Our transfusion service supports a 60 bed level-3 NICU and our standard red cell transfusion is CPDA1 leukoreduced and group O. We do get some directed donor units other than group O so test the infants plasma for the corresponding anti-A and/or anti-B by indirect antiglobulin test in those instances. If we have transfused group O Red cells after the initial test for anti-A or -B and then get a "non-O" unit we repeat the test. We frequently see maternal anti-A or -B in the indirect antiglobulin test or causing a positive direct antiglobulin test. We have yet to see a DAT or IAT become positive after transfusing group O red cells.