EDibble

I was the safety officer in my lab for over 10 years, and the thought of having to empty a blood bag gives me the shivers! Just too much opportunity for a splash and exposure, never mind the mess. Also, with tubing and hard plastic connectors attached to the unit, it really should be in a hard sided container. The connectors (we also call them spikes) could easily poke through a plastic bag alone.

I could "listen" to Malcolm explain stuff all day!!  

The antibodies didn't read our books???

For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so.. 

Most developing clinically significant alloantibodies still react at 37oC, and so trying to detect them at room temperature is more or less futile as, in most cases, all you will detect are antibodies that  you do not want to detect, such as cold-reacting anti-M, anti-N, anti-P1, etc, which would be a waste of time, reagents and, most importantly these days it would seem, money.
Most polyspecific or broad-spectrum AHG reagents these days are a mixture of anti-IgG and anti-C3d (particularly in the UK).  They do not contain anything but the merest hint of an anti-IgM (certainly, they would not be CE-marked for anti-IgM).  The other thing is that I am prepared to bet quite a lot of money that your laboratory is using EDTA-anti-coagulated samples.  This means that the Ca++, Mg++ and Mn++ ions are all chelated from the plasma, which means that the complement pathway cannot be initiated in vitro, so, even if the de novo antibody was capable of "fixing" complement, the anti-C3d would not detect such an antibody anyway.
Therefore, as the number of recently transfused patients who are developing antibodies not yet detected by normal serological techniques who have been fatally affected by a further transfusion hasn't been great (zero in fact) and the same applies to pregnant ladies, stick to trying to detect clinically significant antibodies at 37oC using monospecific anti-IgG.
GOOD QUESTION THOUGH - SHOWS YOU ARE THINKING!

In that case, I strongly suspect that Anna's (galvania's) suggestion about an antibody to a bacteriacidal additive used to suspend the screening and antibody identification panel red cells is correct.  Way back, I experienced this myself, and even if the cells were washed about 4 to 6 times, I could still not get rid of the positive reactions.
I always used to suspend my red cells in Dil2, until I was told to stop it by one of my bosses on the grounds that it was too expensive.  After that, we saw it more and more, and, of course, it actually cost us more to sort out the problem, than it would have done if we had continued to use Dil2.  Bosses who wear suits, rather than white coats, always know best though!

There are three types of people.  About 10 - 15% are non-responders, and never produce an antibody, however many times their immune system is challenged.  About another 70 - 80% are normal responders and, given sufficient stimulus, will produce antibodies.  The other 10 - 15% are super responders, and produce antibodies with the slightest insult to their immune system.  I once heard the wonderful Dr Ed Synder describe these people as being able to produce an anti-D after being given a "virtual transfusion".  When questioned as to what was a "virtual transfusion", he said that you showed a photograph of a D Positive red cell to such a person, and they produce an anti-D!!!!
I would suggest, Kathyang, that your mother was an extreme member of the first group.

Fascinating study. Thank you for sharing.

We recently had a patient who was in the process of making an anti Kell (at least that is what it appeared to be). We happened to have a KK cell on the panel when we first tested the patient, and the reaction was 3+ with that cell, and + with all the other K positive cells (hetero of course). Several weeks later, the patient returned and now all reactions were the same strength. This is the only time we have ever seen this here. Stuff happens!
 
As a previous BB director here used to say, "There are no guarentees in Blood Banking"
 
   

Forgot???? That is inexcusable.

I, too, know little or nothing (probably nothing) about microbiology, BUT, I would not, therefore, put my views forward on matters microbiological. Sadly, it is often the case that someone who knows nothing about blood transfusion think that it is their prerogative to give their views, as "blood transfusion is easy", with only 4 ABO blood groups and D+ or D-. These are also usually the exact same people who are unwilling to work in Blood Bank, because they fear killing someone!!!!!!!!!!!!

Malcolm to the rescue once again.!  

Dear Roland
I would like to totally agree with what Malcolm said above.  You are worrying about anti-A1 for nothing.  There is no risk.  If you think that the possibility of developing anti-A1 is a 'risk', then you should seriously consider doing a complete phenotype, confirming that with genotype, and then match blood 100% for all antigens.  Overkill?  Yes, of course it is.  but so is worrying about anti-A1.  If you want to use your group O blood because it's easier for your stock control, fine, but there's really NO scientific reason for doing this.
And actually - in this case, molecular testing would be an expensive unnecessary.
anna
 

We use the LISS tube IAT daily in my Reference Laboratory, and, in the right hands (i.e. those who are trained to competency, and are able to demonstrate continued competency, in the technique - which, before the advent of PEG, CAT and solid phase, used to be everyone!), it is perfectly safe.  As I have said before on this site, at one stage that was all we had, and the cemeteries were not full of people who had died of transfusion reactions!
In most cases, not all by any means, but in most cases, although the avidity of the auto-antibody is strong, the titre is not that high, whereas most, not all by any means, alloantibodies that are clinically significant, have a higher titre, even if their avidity is not much to write home about.
The technique is even more useful in cases of a cold AIHA, where the cold auto-antibody tends to have a wide thermal amplitude, but rarely can be detected by tube IAT at 37oC, but, of course, clinically significant alloantibodies will be reactive at 37oC.
Of course, in one way, this technique is safer than using alloadsorbed plasma.  There is no way that alloadsorption red cells would be negative for even one high prevalence antigen (such as Vel, Jra, Ata, etc), let alone negative for multiple high prevalence antigens, and so, if the patient happens to have an antibody directed against a high prevalence antigen underlying the auto-antibody, then the antibody directed against the high prevalence antigen will be adsorbed out, just as the auto-antibody will be adsorbed out, and, hey presto, you have a compatible cross-match, and a patient with (hopefully no more than) a delayed haemolytic transfusion reaction.

This is a fun drug (I really need a sarcastic font!).  We have added a order into the HIS order sets for multiple myeloma diagnoses to include a molecular genotype before the drug is initiated.  Hopefully, that will help!

We recently had a patient who was in the process of making an anti Kell (at least that is what it appeared to be). We happened to have a KK cell on the panel when we first tested the patient, and the reaction was 3+ with that cell, and + with all the other K positive cells (hetero of course). Several weeks later, the patient returned and now all reactions were the same strength. This is the only time we have ever seen this here. Stuff happens!
 
As a previous BB director here used to say, "There are no guarentees in Blood Banking"
 
   

Hi Terri,
We had our microwave installed yesterday and when I told the rep that I had gotten a validation document from someone that already had one, he replied "It must have been Terri Bostock".  Apparently he thinks highly of you!  I'm now in the process of figuring out how best to keep our smaller bags in the holders without having to buy the smaller holders.  Tried a couple of suggestions he had, and working on which one will work the best for us.

Forgot???? That is inexcusable.

Forgot???? That is inexcusable.

Forgot???? That is inexcusable.

It is not the lab staff I don't trust, it is other people.

As I understand it, Hugh Laurie did spend some time getting to know things prior to filming - but that does not mean that I would be happy to have him cross-match for me!!!!!!!!!!!!!!!          

No I don't think it is harsh.   I often wonder about hospitals validating reagents/tests off label becuase I don't think they even come close to the numbers/types of specimens that the manufacturer uses to validate and submit to FDA.  This is just my opinion.   I caution anyone using reagents for purposes other than those intended by the manufacturer. 

Yes it would however the majority of us small hospitals do not have the luxury of FLOW.

It is not the lab staff I don't trust, it is other people.