bmarotto

We do electronic crossmatch and do not physically retrieve the sample each time more units are requested.

I absolutely agree with what Malcolm, Dr. Pepper, likewine, Mabel, Seven B and others have said. I would not lose much sleep if I was told I could only use saline IAT. Sometimes I wonder if all the new and improved enhancement methods cause more trouble than benefit. How many panels and tech hours have been utilized chasing down positive gel antibody screens without identifying a clinically significant antibody? One of my favorite saline IAT tricks was to start with a dry cell button and use 3 or 4 drops of plasma with a 45-60 minute incubation. I have detected many ant-Jk(a) antibodies this way. On the other hand, we all know there is no single method that is going to detect every clinically significant antibody. As Dr. Pepper said, a low-titered antibody not detected by a given method is unlikley to cause a serious problem. True in the vast majority of cases, but there are exceptions. Case in point is a patient who had several immediate intravascular hemolytic reactions with no demonstrable antibody using gel, PeG, LISS, saline, albumin, or ficin. This patient never had a positive DAT. Red cell phenotyping of the patient and all the units he received pointed toward anti-C. It was not until we sent a sample to George Garraty's lab for Polybrene testing was anti-C identified serologically! As said by someone in a previous post, we have a lot of tools we can use. We have to find the method or methods that are the best fit for our lab. Many factors enter into this decision. What I select for my lab may not be best for your lab.

Currently: We do an auto control with antibody ID only (manual gel or PeG tube). We will be automating to solid phase (TANGO) in the next few weeks. We will use PeG tube as our secondary/backup method. TANGO panels do not have an auto control. BioRad said we can "run a direct coombs". I always felt an auto control should be run under the same conditions as your test cells. We decided we will not routinely run a DAT with TANGO panels. If, however, we detect a new antibody in a recently transfused patient or if all panel cells are positive we will perform a DAT.

With all due respect labgirl, you asked for opinions. It appears you only want to hear opinions that are in line with your way of thinking. Differing opinions are healthy. Sometimes we come to see things differently and sometimes we have to agree to disagree. It is a shame this thread will probably end now that you have decided to take the discussion elswhere. :disbelief

Symptoms? I wonder if they were real or imagined.

Thank you everyone. We are continuing with our current practice of one badge on the wall next to the irradiator.

You mean you couldn't find an ISBT-128 code for hosed blood? I thought they had EVERYTHING covered! :disbelief

Without centrifuging is the way I interpreted it but others think differently. Makes it hard for the procedure to be uniform if the directions are open to interpretation.

In the summary of the uniform procedure for tube anti-A titer it says: First incubation at room temperature for 30 minutes +/- 1 minute and read without additional augmentation. Does this mean do not spin or is it referring to the use of a visual aid? .

I would like to get a feel for current practice for sites with a Cs-137 blood irradiator. We do not wear badges but our previous Radiation Safety Officer had us keep one attached to the wall next to the irradiator. It has read nothing more than background. There is a meeting with our new RSO in a few weeks to discuss badges for areas that use them and I would like to suggest we discontinue ours if most places do not use them.

I hear you....I have been guilty of that myself. We'll get to the bottom of this once we have all the information.

You said crossmatches were done in gel. What method did you use for your antibody screen?

That is a relief Malcolm. I had visions of you hunting down little bunnies and making your own.

We have red cell orders print a requisition in Blood Bank. We then have control over where to place the order in Softbank. Sometimes there is a red cell order on a patient that already has blood available, e.g. left over from a surgical procedure or massive transfusion episode the previous day. They don't bother to check to see if blood is available before they place antoher order.

The DTT treated plasma was negative in gel. The dilution control was 2+ vs 4+ with undiluted plasma. It looks like it is an IgM anti-E.

Is anyone aware of any data regarding the clinical significance of these gel only Rh antibodies?

John, we are detecting it in gel (4+) but negative with PeG and Tango. Immediate spin tube is w+. I still think it may be IgM. Tested the screening cell lots used and all the R2R2 cells typed strongly E positive. Maybe we will try DTT treatment then test the treated plasma and a dilution control with gel. I have a tech in an online SBB program....a nice little project for her!

I forgot to add that we got interrupted by a near computer system crash but are going to do tube testing at room temp and 37 degrees today.

We are working on the PQ of two Tangos. We ran a batch of screens that had been tested using gel. One sample had a 4+ anti-E in gel first identified on March 9th. The patient had been transfused in November 2011. Both Tangos gave a negative screen result. Obtained a new sample and got the same results with Tango and gel. We then tested using PeG tube and that was also negative. I expected to find some differences since no method detects everything...but from 4+ to negative? Any thoughts...maybe an IgM antibody???

We love Softbank! We were on another system for 16 years before moving to Softbank in 2008. We are much happier with Soft.

We are in Phase 1 testing of Eclipsys (now Allscipts) SCM. It is it set up so all the physician will order is the blood product transfusion and date/time needed. The system will check for a current Type & Screen sample (within 3 days prior to transfusion for red cells or once per admission for non-red cell products). If there isn't one, the physician will get a pop-up message and in one click the Type & Screen is ordered. A reason for transfusion will be required for all products. Indication for irradiation (or no irradiation needed) will be required for red cells and platelets. Their order screen lists all the indications for irradation so they have to either pick one or select "irradiation not indicated". All product orders will print a requisition in Blood Bank. Red Cell orders will NOT populate our LIS (Softbank) but the other product orders will. I insisted on that to prevent duplicate red cell orders when red cells may already be available. We just started integrated testing last week so I am sure there will be tweaks to get things to work. As the Order Set stands now, there is no way to request products to be on hold. It has not even come up for phase I.

Same as David here. Even starting from room temp they cool down pretty quickly but we still like to see a full 24 hours pass.

We get two surgery schedules a day....a preliminary one for the next day around 10-11 am and a final one mid-afternoon (although nothing is ever really "final"!). The blood orders are on it from the MSBOS. It does help us manage our inventory and is especially helpful when there is a patient with antibodies on the schedule. We antigen type and have units ready for crossmatch in advance. For patients with multiple antibodies, we can preselect a selected cell panel to expedite things. This little bit of work the day before greatly reduces stress the day of surgery. The OR is responsible for placing the order in the computer and sending us the sample; we do not babysit them and remind them if a sample is not sent. Schedules change and procedures get canceled.

We keep 10 ahead thawing plasma for these cases so the plasma has been in the fridge for a while prior to packing. When things get really bad, the plasma is used at a 2:1 ratio to red cells so it is the first thing they use and yes, at those time we often send a separate cooler with the plasma.

Attention Clifff....can we have a category called "Cold Cases"?