cbaldwin

What brand is the infrared gun thermometer, who was the supplier and how much did it cost? Catherine

In your lab, on Rh negative mothers with Rh positive babies, what testing do you perform with the fetal maternal hemorrhage screen? Do you perform a repeat ABO/Rh and an antibody screen? Thanks! Catherine

Thanks Malcolm for these references. How do countries with high frequencies of the D antigen handle weak D patients? Are they more apt to treat weak D patients as D positive? The frequency of the D antigen in Brazil is 92%, the frequency in China is near 100%, according to my Immucor Antigen Frequency chart. There is an article in the April 2014 Transfusion written by a group of Brazilian researchers entitled "How do we identity RHD variants using a practical molecular approach?". It describes an algorithm that simplifies molecular testing for D variants using just certain exons so that the process and cost is reduced. It's an algorithm that can be modified for other countries, other populations....They tested patients with atypical D expression, including discrepancies or reactivity weaker than 3+ in D typing. The authors state that in the Brazilian population it is important to differentiate between partial D and weak D in order to conserve stocks of Rh negative blood. I assume that in Brazil weak D patients are treated as Rh positive.... Weak D policies seem to be different in populations with high frequencies of D. Catherine

Well, There was a total of 626 D negative patients at the start.... 23 were excluded because they all ready had made anti-D 50 were excluded because they received D+ RBCs as well as platelets 45 were excluded because they received RhIG 16 were excluded because they were allogeneic HSCT patients who had D+ donors 354 were excluded because an antibody screen was not performed >4 weeks after transfusion (the range for the ab screen was 4-464 weeks with a mean of 76 weeks) ....so that left 130 patients in the study. I am pretty sure from reading the paper that the immunocompetent patients did not receive prophylatic anti-D. The authors state: "We sought to retrospectively determine the rate of anti-D alloimmunization after D-incompatible apheresis PLT transfusions in those patients who did not receive RhIG or D-incompatible RBC transfusions between 1/1/1997 and 12/31/2011.

Ha! Thanks Malcolm! Concerning weak D and partial D, compared to what I did understand, I understand a lot. Compared to all there is to understand, I understand nothing.... :confuse: and I hope your family is okay.... Catherine

There is an article on page 650 of the March 2014 Transfusion journal about a 14-year retrospective study at Beth Israel Deaconess Medical Center, Boston Massachusetts that looks at the anti-D alloimmunization rate in D negative patients who received D positive platelets. The article is interesting because it points out the low alloimmunization rate in these patients. For those of you without easy access to this journal, I will summarize: The article reminds us that most (85%) platelet units transfused in the US are apheresis platelets, and apheresis units contain less than 0.001 mL RBCs, whereas platelet units from WB typically “contain a few tenths of a milliliter of RBCs”. There is less exposure to the Rh antigen in apheresis platelets. In the study, of 130 D negative patients that received prestorage LR apheresis D positive platelets, none formed anti-D “as shown by negative antibody screens at least 4 weeks after the incipient transfusion.” The patients were 52% male and 48% female. 43% were immunosuppressed and 57% were immunocompetent. The study started with 626 patients but many had to be eliminated because didn’t conform to the study’s requirements. Of those patients that were eliminated, 354 patients were eliminated because an antibody screen was not performed greater than 4 weeks after transfusion. The antibody screen may not have been done because of death, discharge home, etc. The authors state that this population that was eliminated may have made a difference in the outcome of the study if an antibody screen had been done greater than 4 weeks after transfusion and the population included. However, their conclusion is that the findings “support the use of D+ apheresis PLTs irrespective of Rh status, D+ or D-, in all patient populations without the need for RhIG immunophophylaxis. I think this is interesting and so decided to make a post….

1. Complex policy difficult for generalists to remember over time - easy to miss one that "should have been done" 2. Hard to remember why a Fetal screen may be "very" positive when they no longer remember much about Rh neg (weak D positive). I can relate to the above comments. Everyone in my lab is a generalist. They work hard and do their best but it's easy to forget. I didn't understand weak and partial D until recently. (I think I understand now!) Fortunately we are small and there are not many of us so I can contact everyone with a weak-D policy in-service/mini-lecture. Some may feel this is a waste of testing - but it isn't very many pts anymore anyway and I would just rather "know" about these pts up front anyway. I would rather know about these patients too...

I have a question about reporting 1+ or 2+ Rh reactions on the Provue as Rh positive. Page 4 of the 2005 AABB “Guidelines for Prenatal and Perinatal Immunohematology” states: "Only when prenatal tests for Rh are unequivocal and clearly reactive (=/>2+) should the woman be considered Rh-positive.” Dr. Joe Chaffin, The Blood Bank Guy, also states a similar opinion in his excellent podcast "Weak in the D's". Here is a link to his podcast: http://www.bbguy.org/podcast/1012/1012podcast.asp The podcast is 41 minutes long, and if you don't have 41 minutes, skip to 34.12 minutes into the podcast. That's where he starts talking about OB patients. At 35.30 minutes into the podcast, he says that transfusion services should consider a lower threshold of positivity for calling Rh negatives--some places call a 1+ reaction or lower in tube testing Rh negative and a 2+ reaction or lower in gel testing Rh negative. The risk here is giving Rh negative blood when Rh positive blood can be given, but calling these weak Rh reactions Rh negative lowers the risk of immunizing the patient. I am interested in this because last week I realized I didn't have a weak D policy, except that we only perform weak D testing on cord bloods if the mom and baby test Rh negative. Last week we reported an OB patient as Rh negative, using tube testing with Ortho anti-D bioclone. The patient's physician informed us that the patient was determined to be Rh positive 2 years ago when the patient had her first child. I called the lab that performed that testing and found it was a 1+ reaction on the Echo Galileo. The lab reported that the patient was “Rh Positive by Weak-D test (formerly Du). RhoGam is not indicated for this patient”. We use the Ortho MTS gel cards for ABO/Rh testing (manual method) as well as tube testing with Ortho reagents, so we repeated the patient's testing using the gel method, and saw a 1+ reaction for the Rh. When we performed the tube weak D test, we also saw a 1+ reaction. (An aside--we are a small lab, performing about 100 type and screens per month, about 40 crossmatches per month, 10 cord bloods per month. I have been trying to phase the MTS ABD Reverse cards out. The tube method is more versatile, it is faster in emergencies and according to a cost analysis I did, the tube method is ½ the price of the gel ABO/Rh method. However, the lab is staffed with generalists, and I have been told it’s better for generalists to use the gel method—no chance of forgetting to add the reagent and more consistency. We perform antibody screens using the gel method because it is more sensitive (although I realize the gel antibody screen method has its pitfalls such as being a LISS method and possibly missing anti-E and anti-K sometimes, etc.) Anyway, I have come to realize that I need to write a weak-D policy, and I am thinking of including these points: Perform weak D testing only on cord bloods when mom and baby are Rh negative, on Rh negative moms when the FMH screen suggests the mom may be weak D positive, and when investigating discrepancies such as the OB patient last week. Calling Rh results less than 2+ in gel and less than 1+ in tube, Rh negative. When the Rh results are less than 2+ in gel and less than 1+ in tube, reporting the Rh as negative and including a comment that indicates the Rh type is weak and atypical and if the patient is a blood donor, the patient would be considered Rh positive, but if the patient is an OB patient or a recipient, the patient should be considered Rh negative.There is a CBBS posting about when the AABB changed the weak D regulations in 2002. Dr. Judd is quoted as saying that, when it was decided in 2002 that weak D testing was no longer needed to be performed on OB patients, all of a sudden, patients that had been D positive, were suddenly D negative, and this was in the same facility. Dr. Judd is quoted as saying that these patients were informed of their options...that is, where previously they were D positive and did not require RhIG, they were now D negative, and they could opt to receive RhIG or not...they needed to sign a form.......I hope I remember that correctly.... I would like opinions! Thank you! Catherine

A pathologist I have worked with, and whom I admire, has asked me to spread the word about two job openings. The first is a Blood Bank Supervisor position at White Memorial Hospital in Los Angeles. Here is the description: The Lab Supervisor is responsible for ensuring the effectiveness and efficiency of all respective departmental operations. Accountable for supervision of departmental support staff personnel, including client relations, couriers, front desk secretaries, phlebotomists, processing personnel, and file clerks. Also responsible for managing supplies and inventory, developing, reviewing, and revising laboratory support area policies and procedures, and ensuring laboratory compliance with all regulatory bodies, including CAP, state, federal, and Joint Commission. Requirements: Baccalaureate degree in Clinical Laboratory Science. Current/valid state license as a Clinical Laboratory Scientist. Minimum five years’ experience as a Clinical Laboratory Scientist in a hospital setting. Supervisory experience in a laboratory preferred. The second position is a Regional Blood Bank Specialist for a group of hospitals. Here is the description: The Regional Blood Bank Specialist is responsible for the overall operation of the blood bank departments at Glendale Adventist Medical Center, White Memorial Medical Center, and Simi Valley Hospital in consultation with and under the direction of Medical Directors (Pathologists) and the Regional Clinical Laboratory Directors. Responsibilities include selection of the appropriate instrumentation or test methodologies, developing and maintaining appropriate quality assurance program, monitoring testing and QA processes including recording and reporting of results, ensuring program compliance with applicable regulations and safe working environment, working with staff in their respective sites and develop training and competency for testing personnel. Exemplifies the AH Southern California Region Consolidated Lab mission, vision and values and acts in accordance with AH-SCNCL policies and procedures, including complying with all AH-SCNCL Customer Service Standards. Qualifications: Ability to multitask and meet deadlines; ability to prioritize projects and workload independently required. Ability to work effectively in a complex environment required. At least five years’ experience in a laboratory management or supervisory role required; documented equivalent experience may be considered. Bachelors of Science in Medical Laboratory Science (MLS) or equivalent science field required. Current California Clinical Laboratory Scientist license. Demonstrated proficiency with Microsoft Office Suite, particularly Excel required. Excellent analytical, organizational and communication skills required. Experience with developing and maintaining budgets and understanding and interpreting financial reports required. M.B.A., M.P.H., Master’s in Health Systems Management (HSM) or MS in MLS is highly preferred. SBB certification highly recommended. Strong interpersonal skills with the ability to work with individuals at all levels in the organization required. To apply for or learn more, go to https://www.glendaleadventist.com/jobopenings. Search under "laboratory". Catherine

A pathologist I have worked with just asked me to spread the word about a BB supervisor position that is open. Is it okay to post a job opening on this site, and if so, where would it be most appropriate to post it? Thank you! Catherine

Hi Mabel, IgA can activate complement via the properdin or alternative complement pathway. JoAnn Moulds reminded us of this at the "Who DAT" session at the 2013 AABB meeting in Denver last October. At this session Patricia Arndt spoke about negative DATs in patients with clinical hemolysis. Patricia Arndt mentioned more sensitive methods that can demonstrate antibody on RBCs in these patients. These methods include cold LISS wash DAT method, flow cytometry, direct Polybrene test, also testing with anti-IgA and anti-IgM reagents. Anti-IgA and anti-IgM reagents are not commercially available in the US, but Pat's lab has these reagents for research and special cases. But Pat also mentioned that anti-IgG reagents that are not heavy-chain specific can pick up IgA and IgM because these reagents may have antibodies to kappa and lambda light chains and can react with IgA and IgM light chains. Pat presented a case of a 5 year old with clinical hemolysis (Hgb = 6.4, bilirubin high, LDH high, etc) and a negative DAT. It turned out this 5 year old had IgA on his RBCs which was detected using anti-IgA reagent, but an anti-IgG reagent that was not heavy chain specific also detected the IgA on the cells (weakly). The cold LISS wash DAT and the Polybrene agglutination did not demonstrate the antibody in this particular case. The 5 year old was treated with steroids. Catherine

You can attend the "Last Chance Review" on-line through a live Webinar...that's what I did last year and it worked very well. That will save you time and money! Catherine

Thank you! I did not know this survey existed and I see it has useful information. Also, now that I have started this thread I see there have been similar threads in the past few years so I will read those. Thank you! How do you monitor correct patient ID? I can only think of observing whether the phlebotomist or nurse asks the patient for name and DOB, but my presence would have an effect on this process. Also, how do you monitor patient consent? The patient may sign the consent, but were they fully informed and did they have a chance to ask questions? And thanks to tbostock, Dr. Pepper and Eoin for your input--it is helpful. I will read the previous threads on this subject before I ask more questions!

I have been working with our hospital's new QA person to fine tune Quality Audits and Quality Indicators in our Transfusion Service. The QA person asked if I could find "benchmarks" for my Quality Indicators--other facilities that are monitoring the same Quality Indicators so that I have something to compare our facility to. It makes the data more meaningful. I looked through the AABB site for such information but found none. What do other facilities do regarding assessment of Quality Indicators? Does anyone use "benchmarks" for comparison? Thank you! Catherine

Hi Nick, If you can attend the Last Chance Review Webinar February 8th and 9th, do it! It is a great review. If you cannot attend, purchase the notes and use them as an outline for your studies. Here is the link to the Last Chance Review: http://www.giveblood.org/services/education/sbb-last-chance-review When you are going over the Last Chance Review notes, if you have questions, post them here. I studied those notes in detail before I took and passed the SBB exam in November 2013 and so I understand them pretty well. I took the 2 year SBB course that is sponsored by Blood Systems Laboratories. I thought it was excellent. These are the books I used when I studied for the SBB exam: AABB TM (of course), Harmening's Modern Blood Banking, Harmening's Laboratory Management, Harmening's Clinical Hematology (especially the coagulation part), Hilyer et al Blood Banking and Transfusion Medicine, Daniels' Human Blood Groups, The Blood Group Antigen Facts Book, and Stevens' Clinical Immunology and Serology. Catherine

. Try this: RCF (in G forces)= 1.118 x10^-5 x RPM^2 x radius (in cm)

There is an article in Transfusion, "How We evaluate Panagglutinating Sera" on page 1540, volume 49, August 2009. The authors present an algorithm for panagglutinating sera. Are you familiar with the information in this article and how does it relate to this patient? I am curious about this situation and it completely baffles me, and hope you don't mind answering these questions... Am I correct in thinking that if, in your workup, the patient's serum reacted with 8 of 11 cells, then this is not really a panagglutinin? The definition of a panagglutinin, as presented in the aforementioned article, is an agglutinin that reacts with all red cells tested. Also, you mention that in a later workup the sera was nonreactive at 4C and RT, so doesn't this mean that this is not a cold agglutinin? You mentioned that in an earlier workup it looked as if a cold agglutinin might be developing. What is the explanation for the nonreactivity with enzyme-treated cells? Is this an antibody to a HFA or a HTLA that is denatured by enzymes? In the aforementioned article, in the flowchart presented on page 1541, there is a step where the autocontrol is negative or weaker than the reaction with panel cells, there is persistence of panagglutination after auto- and alloadsorption, there is no reactivity after papain treatement, and the flow leads one to think maybe there is an anti-HFA or anti-CH/RG..... Why are the PEG/IgG crossmatches all compatible, and are they incompatible without the PEG? I would like to understand this situation better, and hope you don't mind my questions... Thank you!

This review for the SBB exam is fantastic and is scheduled for February 8-9, 2014. You can attend "on-line" and if you do so there is no problem hearing the speakers or asking questions. Here is a link for information: http://www.giveblood.org/services/education/sbb-last-chance-review

I just took (and passed!) the SBB exam. There were several questions on the exam I wondered about, here is one. Any ideas on what is going on here? This is a serological problem, in which anti-Fya is adsorbed onto cells and the eluate is tested. The results are compared to an eluate made from Fy(a+) cells that were also incubated with anti-Fya. I don’t remember all the details but this is my best: Patient cells/anti-Fya eluate tested with patient cells: 3+ Patient cells/anti-Fya eluate tested with Fy(a+b-) cells: 0 Patient cells/anti-Fya eluate tested with Fy(a+b+) cells: 0 Patient cells/anti-Fya eluate tested with Fy(a-b-) cells: 0 Fy(a+) cells/anti-Fya eluate tested with patient cells: 0 Fy(a+) cells/anti-Fya eluate tested with Fy(a+b-) cells: 3+ Fy(a+) cells/anti-Fya eluate tested with Fy(a+b+) cells: 3+ Fy(a+) cells/anti-Fya eluate tested with Fy(a-b-) cells: 0 The question asked was whether Fya was present or not, or if you needed more information. I said that Fya was not present, but I wasn't sure. Why is the eluate from the anti-Fya/patient cells reacting with the patient cells? I think there is something other than anti-Fya on the cells that ends up in the eluate, and when tested with patient cells, it, of course, reacts with them. Or is something more complex going on?

Hello Emwilson7, I have a question about the material in these notes. (Thank you for sending me a copy!) On page 101 there is this remark which confuses me: "To provide a safety margin in calculating RhIG dosage, the following approach may be used: When the number to the right of the decimal is less than five, round down and add one dose of RhIG. When the number to the right of the decimal point is 5 or greater, round up to the next number and add one dose of RhIG, i.e. 2.5 doses (calculated) requires 4 doses. DO NOT ADD A DOSE ON THE EXAM." I participated in The Last Chance Review last February, and there it was stressed that the dose should be added when making calculations for the exam. What is your opinion? When calculating the RhIG dose for problems on the exam, should we add or not add a vial? Thank you! Catherine Baldwin

Thank you! That will work. I think also it would be good to demonstrate that once the unit is >10C, the temp indicators don't change when the unit is returned to the BB refrigerator. I am thinking of units in the ER or OR that might be removed and then returned to an ER/OR refrigerator or storage container. I am thinking of leaving a glycerol unit out until the sticker indicates it's >10C, then putting it back in the refrigerator and documenting that the indicator didn't revert back to an "OK to Issue" status.

I found one post from 5 years ago with a method for validating HemoTemp II stickers. It involved obtaining an expired unit of blood, applying a temperature sticker to the unit, and laying the unit in a 1C degree pan of water, a 5C pan of water, etc. (Keeping the sticker dry) Does anybody have another method for validating these stickers? Thank you Catherine

Amelia, I'm sure you've read page 590 in the AABB TM, ed 17? It states that PCCs in the US need to be given with FFP because of the low level of FVII. Why do you suppose PCC in the US has little factor VII? Is it a safety issue, a manufacturing issue, or an economic issue? Catherine

What is the title of the article? I'm interested in reading it but didn't see it in the May 2012 issue. Thank you!

After I posted I noticed there were many threads with information on 5 day thawed plasma. I now realize many many transfusion services use 5 day plasma. I also saw Cliff's post about getting labels from Shamrock--that is helpful. So thank you everyone! I am still a BB newbie and appreciate this site! I will obtain the pathologist's approval, the transfusion committee approval, write a policy and order labels....