Ajac

Gel seems to pick up Knops system pretty well. (We saw a lot more Sla than I would have thought.) Also, some strong versions of Sda will show up as 1+ by gel.

I would worry about the REST removing the IgM portion of an apparent Jkb and rendering it weak enough as not to react anymore. I know there are several reports of it removing clinically significant antibodies like Vel too. Also, I wonder if the panagglutinin seen originally was the patient building the c,K, and possible Jkb. We used to see that type of reactivity and then like magic, a few weeks later a "new" antibody with a specificity would appear and panagglutinin would be gone. I would try to get a full phenotype on this patient. You may need to send her off for molecular typing since she's tranfused. It sounds like she's going to continue to build.

We had them done in-house. I think they are just "door" name tags though. Look up single slot door labels. I will check and see what kind of tape they used. I thought it was really handy to be able to switch labels readily as needed.

Where I worked before, we had some single slot slide-in "hard" labels made. These came with holders that we affixed using double sided tape. I think the tape came with the holders. It was black and would stick to ANYTHING including fingers! This system was very handy, because if we needed an extra drawer for O's, we just slid in an O label. You could change things fairly easy. A little expense on the front end, but so worth it.

There's a good review on Duffy in this issue. IMMUNOHEMATOLOGY, Volume 26, Number 2, 2010

While I agree that the reactions to the plasma containing products are rare, I think it is important to keep it in mind. Several years ago, I listened to Dr. J. M. Moulds give a striking lecture over Chido-Rodgers along with some descriptions of reactions. I think it was at AABB in Miami. I think the most important thing is to be aware that a reaction could occur and to be prepared in that event.

Perhaps it is reagent related. New bottle versus older opened bottle. QC typically will show 4+, but you may see variation when looking at individuals who express much weaker. Also, if one typing sat longer, even slightly at either RT or 37, it could affect typing of a weaker expression. Just out of curiosity, did you do any other Rh phenotying on these patients? I have seen this type of thing when they were E+ with a really weak D.

1 file cabinet and a large plastic bin at home. 2 piles and a file cabinet at work. I say keep it all! Last time I "down-sized", less than 2 weeks later I needed something I threw away. Go figure. Glad everyone else does that (I feel much better!)

My vote would be go for it!!! Sit back and soak up the wisdom. He is an excellent speaker.

I would agree to get more history on this situation. However, being one who has always loved the zebras as well as the horses- I guess the mother could have bleed into the fetus giving the baby a normal to elevated HCT at birth. As time went by, infant's immune status became sound allowing it to mount a response to the maternal cells present. Was any of the typing mixed field?

Baxter used to have a product called NeutrAB, but I think they no longer make it. If no one comes forward, call Ortho tech support. They might tell you a vendor. They added it to some of their rare antisera. I know this because I used some reagent for a student problem and the backtype neutralized repeatedly. Called Ortho to ask and they confirmed. (They sure were concerned as to what I was doing with that antisera. I had to laugh.)

I think David is right about the large syringes. I've seen one therapeutic phleb that used vacutainer tubes. I can tell you it is SLOW going with lots of tubes being required.

I think it will be a while before the US will see this type of product because of FDA requirements for diagnostic tests. Interesting, however, is a rapid ABORh test was recently cleared, but can only be used for information and education. Cannot be used for transfusion or dispensing of Rh immune globulin as far as I could tell by reading the FDA page. (see Micronics ABORH card)

This may be a stretch, but your patient isn't developing PNH are they? MDS patients sometimes end up with PNH.

I thought that gorillas typed as group B. (see articles by Kominato et al) Maybe newer technologies/testing have changed that thought.

You might speak with University of Mich. (http://www.pathology.med.umich.edu/bloodbank/index.html) I seem to recall JJudd mentioning doing extended testing by gel in some article before he retired. If so, you can bet they have the validation and correlation studies to back it up too. Another option is to screen using patient samples, then confirm with approved antisera using appropriate method.

I had read somewhere that the Kidd antibodies were being missed (especially Jka) because often these are mixtures of IgM and IgG with the ones that fix complement almost always having an IgM portion. IgG Gel card matrix used to contain Dextran (not sure about now or not) causing IgM antibodies not to be picked up as much. The remaining IgG portion may or may not be enough to react with all Kidd + cells.

Just a question. Has something changed in your shipping practices? Overnight delivery versus 3 day? Also, do shipments have cooling packs or at least some sort of insulation?I have seen that happen when shipments get a little warmer than usual. We had that happen with shipments of complement coated cells. As far as the original question about PEG and check cells, I have seen numerous problems with check cells not working when dealing with patients with elevated protein. PEG precipitated the protein (sometimes turned white as milk) and then you could not wash it away.

It is not okay to irradiate a second time. Why should you anyway? FDA doesn't like that sort of thing if you are in the US. Q2: Yes, it is possible for that type of thing to occur. Look up Matuhasi-Ogata phenomenon. I have seen this type of non-specific binding before when testing eluates, although it is rare. I would certainly investigate the chance that the patient had been elsewhere and received E+ unit. Has this patient's antibody always been that strong? If antibody was no longer detectable, bingo. Just curious, did you E type them again? If transfused, they might be mixed field positive.

We used to do lots of warm autoadsorptions. As far as procedure, it pretty much followed package insert of enzyme/DTT reagent we used. We had a large population of chronically transfused patients with lots of antibodies. Our particular patient population often had lower retic counts. We finally started using molecular typing and pheno matched cells as much as possible. Rarely did autoadsorptions or alloadsorptions after a point. Not in technical area now, so don't know if anythings changed or not.

Very sorry for your loss Rebecca. Your family is in my prayers. Ann

I do not feel you are being too strict. If the results are released to floor, it is too late. Since corrected reports have to be sent, I think you are obligated to document errors and your follow-up. I would be very concerned at the number of these errors. Have you done a route cause analysis? What about retraining with documentation? I am assuming that no blood products have been issued on these mistyped patients.

I find this to be a difficult situation to put into black and white terms. It really is dependent of your particular patient population, frequency of transfusion, and blood supplier. I believe in a perfect world, the best product would be an exact match for ABO/Rh. Group O patients receiving out of group product often don't get a good rise. Group A or B getting group O may be have risk of hemolysis. Rh negatve patients can and do build D's from Rh Positive platelets, although not frequently. Whether or not to give RhIg may need to be handled on a case by case basis. Just my opinion.

We always gave our babies washed cells for intrauterine transfusions back in my blood bank days. We incorporated a 5 min spin at the end to pack cells to acheive high HCT. Sorry I don't have access to procedures any more. I assume that you don't really mean intrauterine "exchange"?

I worked in Transfusion Service at UAMS.