klsmith

We used to start with O pos for males over the age of 18 and women past child bearing age, but we don't do that anymore. We have actually given quite a few patients (ironically the majority of them being male!) an anti-D. We went back to giving O neg to all trauma patients. If the patient gets to the point where they take up to 5 or 6 units, we then convert them to Rh positive, with pathologist consent (unless we have a type by that time, and then we give type specific).

Well you carry on doing just that then klsmith, seeing as you had ONE example where it came up with something that would have otherwise been missed, and you clearly think that that justifies it. Actually why not put up enzyme IATs routinely as well. But please do not complain when you have to put up panels on 90% of your samples and get inconclusive results on all of them I am not complaining, nor am I the tech who discovered the antibody by the means which you say are incorrect! I am just telling you what I have witnessed by a reputable tech. BTW, how do you know that this situation doesn't happen more frequently than you are aware of?? Sometimes you really do need to think outside of the box, perhaps not everything is as cut and dry as we would like for it to be....

Hi Blood Bankers! So I am wondering, if your facility misses a positive antibody screen, and fails to identify it, then fails to long crossmatch the units and gives one that is antigen positive (and it is transfused to the patient), is that an FDA reportable? Please inform if you can! Thank you!

I have to say that I disagree with the following statement: Members 728 832 posts Joined: June 13, 2007 Report post Posted Monday at 07:25 AM And never EVER , under ANY circumstances look at gel tests under a microscope or a magnifying glass - unless you want to call absolutely everything positive and waste everybody's time I have personally seen this to be untrue. I worked with a former colleague (a 30 year Blood Bank veteran) who used to inspect questionable gel card results with the agglutination mirror that is normally used for looking at tube testing results. She once had a gel card reaction that was nothing more than a little speck at the bottom of the card, and because she used the mirror to inspect the gel card, she saw the small speck, and decided to set up a ficin panel, which led to her identify an Anti-Jka.

Malcolm, Do you guys use Blood Bank armbands over there?

Malcolm, Thank you for your attempt at explaining this to me, you are awesome as always! I am actually shocked to hear that you have not stumbled across a B subgroup, as you have seen and done pretty much everything in the Blood Bank!!! ~KS

Malcolm, Here is the web address that I was reading the article on: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-84842016000300264 I was originally trying look up AML and the potential loss of blood group antigens on RBC's that could be associated with it, and I stumbled across this information. I had initially attempted to share my find with my best and most knowledgeable co-worker in my Blood Bank, but he was unable to access it through the web address. That being said, if you run into the same issue, then please let me know, and I can email the page to you, just please give me your email address.

I also want to just add, that the Provue used to give like 2+ reactions for weak D patients, but this IS NOT the case with the vision at all!

In my Blood Bank, weak D patients test strongly D positive on our analyzer, we use the Ortho Vision. The only way that we detect weak D's is when we perform a verification type on a separately drawn verification sample. We do this testing by tube method, so that is why we catch them. When we come across this, and the patient is pre (28 weeks+) or post natal, we give them Rhogam. Even though we call them "Weak D" (we do Weak D testing to verify this), we have no way to know if they are actually a D variant, so we err on the side of caution.

What state are you in? When I was working in NYS (which has super stringent rules and regulations) the pharmacy dispensed the Rhogam. In my lab here in AZ, The Blood Bank issues it. My current lab is JCAHO accredited, and we have never ever had an issue! Are you sure it is not a state thing?

Hi Blood Bankers! So I have recently come across information about B subtypes. The literature that I was reading talked about B3, Bx, Bm, and Bel. I currently know next to nothing about these subtypes, and I am looking to know more about them! (Malcolm, I am especially counting on your expertise here, "hint, hint!") Anyway, if anyone has any info to offer, I would so appreciate it! Thank you!

So Malcolm, Tell me more about anti-hr(b) and anti-hr(s). As much as you can if you dont mind. Thank you!

Malcolm, First off, I actually do feel like you are telling me that my antibody ID skills are not "up to scratch." If you didn't think it, then you would not have even said anything of that nature at all (subliminal thinking coming out maybe?). I am not an IRL Tech like you are (mark my words, I will be eventually), and my resources are not as extensive as yours either by any means. I do know however that we had a patient that had been transfused a month and a half ago, and now appears to have an Anti-C as well as an Anti-e. The last time he had a crossmatch done, he appeared to have an anti-D. He is Rh positive, and not receiving any kind of passive anti-D (we thought maybe an anti-LW?). That being said he got 2 units of O neg in August, but we phenotyped him anyway, just to see if anything would be negative. His phenotype indicates that he is probably an R1R2. I know his phenotype is not actually valid, since he has been transfused, but we were looking also to see if there were mixed field reactions in the Rh phenotyping gel cards, and there were none. It was a straight 4+ across the board. Anyway, the eluate uncovered a 1+ reaction on cell #3 of the screen (its a 3 cell screen, little f is positive on cell #3, in addition to the e antigen.) The original screen only reacted on cell#1, which fit an anti-C). Our concern is that he may have actually made an anti-f If he is in fact an R1R2), from receiving the O neg units. The reason that we are unsure of anti- f or anti-e definitively is because the "supposed anti-C" masks all cells on all panels we have that are e positive, f negative. We have no clue about the anti-C, so that is why we sent it to our reference lab. The anti-C just doesn't make sense and the whole work-up became confusing. Our reference lab suggests that when we suspect an anti-LW, that we give Rh negative units. But if there is a potential ant-C and anti-e or f, then what do you transfuse the patient with?? Rh neg units will be positive for the e antigen 98% of the time! No, I am not knowledgable about anti-hr(s) or anti-hr(b). I look to experts like you to inform me, just saying.....

I do apologize Ensis01, but I am not picking up what you are putting down! Not all screen cells are positive for the f antigen. Aren't all little f cells positive for little e? I guess i am just not understanding what you are trying to say......

Hi All, This post actually relates to my very last post about antibody I.D.'s. So if my SOP states that I am not to re-identify previously known identified antibodies (this meaning only setting up panel cells that are negative for the known antibody) then wouldn't I miss something like say, an anti-f? So for example, lets say that I have a patient that I initially identify what looks like an an ant-e (but in all actuality it is an anti-f!). Then 8 months later, that same patient comes back to my facility, has a type and screen done, and I see that the antibody screen is positive, and that we have previously identified an anti-e. So, per my SOP, I only set up e negative cells on my panels. Wouldn't I miss the anti-f???

Hi All, I was just wondering, when you work-up antibody identifications, how do you do it? We just got a new supervisor at my hospital, and he has recently changed our SOP. It is very different from the way that we have always been working-up antibodies, so I am trying to find some kind of validation from Blood Bankers all over the world about this new process (if that makes sense). Anyway, our "old" process was that we would set up the Ortho panel A and B initially, whenever we would get a positive antibody screen (kill two birds with one stone). If we were still unsure of what the antibody was, then we would set up a panel C and possibly a ficin panel (if we suspected something that the ficin panel could assist us with, which is normal). We also have the Immucor Panocell 16 that we can use, which we use as a last resort panel since it does have a nice extensive phenotype available for it's cells. With our new policy, we are only allowed to set up a panel A. If that panel is positive, and we think we know what it could maybe be, we are then required to set up only the negative cells for the antigen that we think we have the antibody against (again, I hope this makes sense) on panels B and C (as opposed to setting up the whole panel). We are also required to perform a DAT on every patient that has a positive screen as well (regardless of the autocontrol). Our new supervisor says that this is how reference laboratories perform antibody I.D.'s, and I am just wondering if anyone can vouch for this and tell me if it is correct. All the tech's in my Blood Bank are upset about this change, and I figured that this was the best platform in which to reach out and get feedback and information. Please advise if you can, any and every Blood Banker. All input is so super helpful and needed!

Was the patient transfused within the last 3 months?? Anti-C and Anti-D are actually an Anti-G. What is the Rh type of the patient?

Hi Janet, It seems to me that perhaps you are having an issue with having to perform DAT's. Please take into consideration that the hematologist knows what that he/she is doing. I am not trying to be difficult, but I guess that I do not see what the issue is. Hematologists are Hematologists for a reason, and we have to have faith that they know what is going on with their patients, so that we can provide the best and most accurate results for them! Just saying... ~KLS

Thank you Malcolm for the information. So I am wondering then, when is it truly appropriate to prewarm, if in doing so, you can miss clinically significant antibodies?? How can you prove it is a cold beyond a doubt?

Ok, so I am looking for answers, please inform if you have them! If you suspect that a patient has a cold autoantibody after performing a panel, wouldn't warming it clear it up? even in a gel card? or does that make a difference? And when you perform a DAT, wouldn't it be be positive for C3d? If not, then is a true cold? If you warm everything, and repeat the panel in a gel card, and it does not not clear the reactions, (or only reduces the reactions a little) what does that mean?? It just seems like my blood bank tends to lean a lot twards "cold autoantibodies" when panels and screens are inconclusive, or strongly positive across the board, that and prewarming is just the best answer. Could someone please give some feedback on this? I would like to find out as much information as possible on these cold autoantibodies. Many Thanks!!

I am wondering, can an antibody to a major blood group be present but not react with all homozygous cells on the panel?

Hi All, I am looking for any help that I can get on an inconclusive work up that we had in our blood bank the other day. A patient came in through the emergency dept. and a type and screen was ordered. Screening cell #2 on the absn was 1+ positive. We set up an ortho panel A, and only cell #9 was 1+ positive. We then set up panel C, ficin treated and untreated, and cell #3 was 2+ positive, cells #6 & 9 were ever so slightly positive. The ficin didnt seem to have any effect on it. According to our records, the patient was transfused in 2008, and was pregnant a few years prior to that. On the panels, we were able to rule everything out homozygously, and are now at a loss on where to go with it. Any suggestions or ideas would be appreciated!

I have a question. We have a patient in our hospital who has an anti-CSa. This antibody was identified by the red cross, when we sent the patients specimen out to them. I am just curious to know, how exactly is an anti-CSa identified? I mean, are there actually panels out there that you can rule out HLA antibodies on? Is there antisera for such antigens? Please share any info if you know!

Malcolm Needs, Thanks so much for your answer, it was very helpful!

Hi there, I am new to this site, so I hope I am posting this in the right place. I guess I am looking for some insight. A few weeks ago, in the blood bank which I work, we recieved a type and screen on a labor and delivery patient. The patients type was A negative, and the antibody screen was positive, both cells 1&2 reacting weak 1+. The tech set up an ortho panel C ficin treated and untreated. The untreated panel reacted weak 1+ for anti-D (which was rhogam), but the ficin panel reacted 4+ with all cells, except the auto control which was negative. When a DAT was performed, that was negative as well. After conferring with the lead tech and the supervisor, it was decided that this patient had a cold autoantibody. This sort of puzzles me, as I thought that in a cold autoantibody situation, the autocontrol will be positive, as will the DAT for compliment. I understand that ficin can enhance colds, but I guess I am just not totally convinced that this was in fact a cold. Has anybody ever come across anything like this? I would really appreciate some helpful input! Thanks so much!