albaugh

Why are you even asking for a urine for an allergic rxn to platelets?

It sounds to me like you are doing everything that you should do, without either over-shaking the tube, or over-reading the contents.

I am extremely glad that you are not using a microscope, as, if you did, you would almost certainly see the odd couple of red cells "kissing each other", even if they have been incubated in isotonic saline.

The other thing is (and I speak with some 43 years of working in blood group serology) if the reactions in the tube are THAT weak, the chances of any atypical alloantibody that you might miss being clinically significant are absolutely minute.

If you are still worried, however, get a more experienced worker to read your tests as well, until you feel confident.  That is how I learned when I started.
I wish you the best of luck in your future career.

Well, the thing is John, when I first left school, I started to work as a VERY, VERY junior member of staff at the International Blood Group Reference Laboratory when it was in London.  At that time Dr Kenneth Goldsmith was the Director, but others working there were Dr Carolyn Giles, Dr Elizabeth (Jan) Ikin, and a VERY young Joyce Poole.  Across the carpark was the MRC Blood Group Unit, run by Drs Rob Race and Ruth Sanger, where Dr Patricia Tippett worked, along with Geoff Daniels, for a while Christine Lomas (before she went to the USA and became Christine Lomas-Francis) and, for a short time, Dr Marcela Contreras (before she became a Dame and a Professor).  Just up the corridor was another set of laboratories run by Profs Walter Morgan and Winifred Watkins (and the janitor was one Sid Smith - after whom the SID Blood Group System was named).

As you can imagine, with all those "NAMES" working in such a small area of London, it was like a magnet for all of the other world's greats to come and visit (I even met Dr Arthur Mourant and Dr Philip Levine on visits).

With all these people, ALL of whom were amazingly helpful to even me, as someone who had just left school, what else could I do but fall deeply in love with the profession, and count my blessings from day one until I retired 43 years later.  I have been one lucky man.

I'm afraid I still can't agree with this methodology, for a couple of reasons.
Firstly, antibody/antigen reactions are, largely, governed by the Law of Mass Action.  As a result, and given a steady state of conditions (e.g. temperature), however long the incubation time may be, once a state of equilibrium is reached, there will be no net gain of antibody coating antigens, however long the incubation time may be extended.
Certainly, LISS will increase the rate of association of antibody and antigen enormously, but this will apply equally to the auto-antibody as any allo-antibody that may be present, however, of course, some antibodies will only react visibly with red cells that have homozygous expression of a particular antigen, and, if such an antibody is present, it will be very difficult to detect in the presence of an auto-antibody, but can still cause a haemolytic transfusion reaction, albeit, usually a delayed reaction, but it can still cause damage to the renal system in particular.

For these reason, I would always perform an adsorption, to get rid of the auto-antibody, even if I had no intention of performing specificity tests on the auto-antibody (although, it goes without saying, I would go all out to try to ascertain the specificity of any allo-antibody detected).

I am trying to write a book at the moment, called "Human Red Cell Serology and Blood Groups for Beginners", and Chapter 2 deals with Serological Techniques.  I attach the draft copy, which also gives relevant references, the odd diagram and abbreviations I use throughout the various chapters.
Chapter 2 Serological Techniques in Routine Blood Transfusion and Red Cell Immunohaematology Laboratories.docx Chapter 2 Serological Techniques in Routine Blood Transfusion and Red Cell Immunohaematology Laboratories Figures.docx Abbreviations.docx

Does anyone remember the humorous/terrifying thread on here more than a decade ago of all of the insane things we had heard of?  "I can't hang this plasma on my patient, it's liquid and the doctor ordered FROZEN plasma".  Or, "I don't care if the plasma isn't thawed yet, I need to hang it stat! Send it up now!" "I ordered that blood culture stat and it's been 2 hours.  Why don't I have a result yet?!"

I've never heard of that.  While I can understand the rationale, I'm afraid that if there was enough of a fetal bleed to impact antigen testing mom there are bigger problems than just getting the antigen type right.  Just my thoughts.

 

All, I am about to blow your mind....
Our plasma freezer is down and so is our backup. The freezer will not get colder than -18 C. I was preparing to move all the products into boxes with dry ice until I had a conversation with my 87 year old dad, a retired blood banker from University of Chicago. He said to me, do not take the plasma out of the freezer and put it in boxes, PUT THE DRY ICE IN THE FREEZER, IT IS THE BEST STORAGE BOX YOU HAVE!!!!
MIND=BLOWN!!!!
I did that. Our freezer is currently reading -25.1C and getting colder. Furthermore, the probes in the freezer continually monitor the temp in the freezer so you don't have to record temps every 4 hours, the chart is doing that for you!!!
Isn't that cool? That perfectly illustrates the difference between wisdom and knowledge there. I wish we could hire my dad.
I just had to share this here.
PS. Freezer is now at -26.4C.
 

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.
Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

The first, and most important, thing to remember is that ABO antigens are "carbohydrate-based" and are not, therefore, direct gene products (not that any antigens are, as every one of them undergo post-translational changes).  The direct gene products are, of course, the A,  B and H transferase enzymes.  At birth, it is incredibly rare for the enzymes to be "working" at its optimum/maximum, so that it is rare for the ABO antigens to be expressed maximally (or anything like) at birth.  I am certain that you know all this already, so that I am probably "teaching my Grandmother to suck eggs", as the old (and in this case, almost certainly, insulting) adage goes.

As a result of the above, however, unless you can perform A, B and H typing by molecular techniques (NOT to be recommended - see Geoff Daniels book, Human Blood Groups), you either have to decide to ignore all serological cord ABO types, and call all of them O, or, you have to use serological methods that will enhance the antibody/antigen reactions.  Herein, there are inherent problems.

Firstly, whatever enhancement you use, you MUST use a suitable negative control.  It is fine (in my opinion) to vary the incubation temperature from RT to 4oC, but, to so do, it is very necessary to use another cord blood from a known group O cord sample (i.e. where both parents are KNOWN to be group O themselves, and so an A or B subtype in terms of the control is not a problem).

Similarly, the same can be said for enzyme-treating the baby's red cells, as long as the control cells are also treated in EXACTLY the same way with the proteolytic enzymes.

Finally (at least for now!!!!!!!), it should be remembered that we routinely use monoclonal ABO antibodies these days.  These are extremely avid, which is fantastic, but are also VERY specific, which can be a drawback.  By this I mean that the old polyclonal human-derived ABO antibodies we used to use (when I was middle-aged, and Karl Landsteiner was a young boy) had the single (and probably only) advantage that they were not quite so specific, and would, therefore, detect ALL (or most) ABO antigens, including those that the monoclonal antibodies would not necessarily detect.  For an explanation of this, there was a recent paper in Vox Sanguinis (Cripps K, Mullanfiroze K, Hill A, Moss R, Kricke S.  Prevalence of adsorbed A antigen onto donor-derived group O red cells in children following stem cell transplantation: A single-centre evaluation.  Vox Sang 2023; 118: 153-159.  DOI: 10.1111/vox.13386) talking about the A antigen being adsorbed onto the surface of group O red cells in vivo.  One of the references they use is the first peer reviewed paper that I ever wrote, concerning A and/or B substance being adsorbed onto the surface of donor-derived red cells in vivo.  What I failed to say in this paper was that this phenomenon was far easier to detect with polyclonal ABO reagents than monoclonal ABO reagents (36 years, and I still regret this omission!).

Anyway, IF I HAVEN'T SENT YOU TO SLEEP YET, my point is that, as long as you use suitable controls, particularly NEGATIVE controls, there is no reason why you should not use any modification to any technique (GIVEN THAT IT IS IN YOUR SOP, with all the qualifications given above), and, even then, if you feel it safer, GIVE GROUP O BLOOD.

I'd go up the food chain ladder and consult with this inspector's supervisor. 
Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."

I know I'm old and been out of the world for a while but I have to ask, what is this DL you are referring to??  

"The bottom line was, if the treating physician wanted to use up the entire inventory trying to save a life, we could not deny them the blood, even though it places other patients at risk. "
I would call this some combination of cowardice and insanity, speaking purely personally.  Taking responsibility for difficult decisions is why physicians get paid well, and avoiding decision making is irresponsible.

What a waste of expensive phenotyped blood.

Do you think it too passive aggressive to ask if you are required to QC ALL the low and high incident antigens on the panel especially those that you have no antisera for (or the cells to QC that antisera)? You could also ask them if and how you should QC the antigen variants on each panel!

If the unit if leukoreduced, as all red cell transfusions should be, there is no need for CMV negative in my view.  

I would use the Autoprint functionality with caution as having unsolicited labels print remotely easily leads to misidentification of patient samples. 

My Medical Director still has to approve this switch.

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around.