Everything posted by rravkin@aol.com
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Patients with Sickle Cell Disease
Hey Terri B, I know your frustration!
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Patients with Sickle Cell Disease
Wow! Thank you for your responses. I am assuming that many practices that do address phenotypic needs seem to address mainly Kell and Rh. Is there any litterature that suggests a propencity on part of a patient with Sickle Cell Disease to readily develope antibodies of these two systems over other systems or are we working mainly with a convention in practice? Additionally, I have not heard of the practice to do a saline wash of the red cells before performing a phenotype of recipient cells when they have been transfused within the last three months. What is the theory behind this practice that now makes the results of the procedure more reliable?
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Patients with Sickle Cell Disease
Hi Everyone, I have been wanting to post this for a while. I have worked in two different facilities which provide blood products for the patient with Sickel Cell Disease. However, one facility did a full phenotyping of the patent upon entry into the services they provided and the other facility did not. The benefit for the patient where the full phenotype was done is that they would then be given phenotypically matched blood and avoid the generation of antibodies which may complicate any urgent blood needs. Tell me about your practice.
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Why do we xm?
Thank you TimOz for an eye opening post. But one question, the imediate spin xm will for the most part catch ABO discepancies, should each facility do some level of demographic analyis of the local population that they serve and compare to the demographics of the reagent screening cells in order to determine the need for routine IgG cross matches which would catch any other incompatibilities?
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Transfusion Reaction Cultures
Dear Scodina, Rasmi, and Malcolm, Quite a volly of posts here. I can say that I have never hard of a practice where the recovered blood bag from a suspected HTR was washed with saline and cultured. I would suspect that any fluid left in the bag would be cultured if deemed nessessary. As part of our work-up the recovered blood bag and any tubing is placed on the quarantine shelf until the physicians involved make thier discisions.
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Refrigerated Plasma
Are you allowing the specimen to come to room temp prior to use?
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Vital signs during transfusion
I wonder if it would be posible to place a patient being transfused on an automated bedside monitoring system during transfusion something similar to a telemetry monitor where there could be some alarm if something is going wrong. This way we could obtain a regular and objective monitor which would free up the nursing staff to the extent that they would not have to make regular and somewhat less objective trips depending on how busy they were. Does anyone know if such a practice is already in use?
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Cold Autoantibody
Dear KlSmith and Malcolm, Thank you for this interesting case and responce. As I have worked at several BB's I find the practice of running a selected cell panel (a D rule out panel) a much more efficient way of utilizing tech time, reagents, and overall expence. But I see that this practice takes away the experience of the situation that you present today. Question is, what is the clinical relevance of the Anti-H or Anti- HI in generating compatible blood products if this patient should have a need? Would your facility now be compelled to perform prewarm crossmatches as it has ID'ed a "Cold Agglutinin?" My concern is simply that you need only experience once an L&D patient going bad to realize how important it is to have the ablity to produce compatible products at a very fast pace. The practice at your facility, a practice that I have engaged as well, although thorough, is questionable when considering it's impact on our our ability to readily generate products for this patient if the need arises.
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Why the DAT is positive after 24 hours?
I am concerned that the platelet count was increased from 3000 to only 10000. Was the one unit a SDP? If so then the count should have increased some where in the area of 50000 to 70000. Is the patient recieving chemotherapy? If so, and the therapy is not considered to play a roll in the low increase in the platelt count is it posible that the patient also has an HLA incompatibility with the one unit of platelets that was transfused? Has the patient been HLA typed? i
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anti-e or not?
Just a couple of other questions. You state that the patient is diabetic with periferal vascular disease; does this combination, along with a more frequent need for blood products do to the GI bleed, provoke a more sensitive immune system similar to what is seen in patients with Sickle Cell disease? And, when performing the antigen typing of the patient specimen, what woud be the significance of mixed field reactivity? Additionally, how relevant are the results obtained from the antigen typing, given the fact that the patient was transfused one month earlier? Could they be relevant at all?
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anti-e or not?
Dear Bmarooto and Malcolm, Thank you for this very interesting post and response. I was wondering why we had what appears to be inconsistant reactivity with the 3 cell Ab screen, with and without the use of PEG. With Chido/ Rogers should we not have seen all three cells positive in both cases? Does the ABS reactivity have to do with the apparent newness (lack of better word) of the antibody? Also, has the Anti-e been clearly ruled out with the non-reactive Ficin Cells?
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Volume Reduced PRBC
Thank you bb03.
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Volume Reduced PRBC
Thank you Malcolm. I would ask then why is this product even in use for neonates if the manitol is hapatotoxic? At our facility and at other BB's I have worked the policies for Neonatal transfused state a requirement that PRBC's be less than seven days old (avoids hyperkalemia), Irradiated (avoids GVHD), CMV-Neg and HbS-Neg (for avoidence of passive aquisition). What are your practices and why if you don't mind me asking?
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Auto antibody
Maybe the term Auto-agglutination causes less anxiety for nurses and physicians when considering potential tranfusion complications for patients in need.
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Volume Reduced PRBC
BB03, What is a SAGM unit? Is it Irradiated, CMV-Neg, HbS-Neg, and less than 7 days old when initialy used for aliquot prep? Are you using a sterile docking device for preparation of aliquots?
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How much is enough to change antibody screen from Positive to Negative
This message is a repeat of the response to ConwaySBB I made ealier today. I was understanding the problem as being able to reverse an initial positve ABSC to negative and what might be involved. I was wondering if the same statistical annalysis could be applied to this situation as when we bring in a new non-historic Ab. To bring in a new Ab we need three positive cells and, of course, rule out everything else. I am not sure if statistically this is the same situation nor am I sure I would overturn an initial positve ABSC even if we could, at least statistically.
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Advice for Newbies
Adiescast and Malcolm and LisaM, I guess if we assume that the CAP survey specimens are designed to check our complete testing protocol they are falling short of the mark. I wonder if there is some sort of production issue with the CAP organization where they have to submit specimens and receive results in a certain format so they can grade in large quantities; sort of like a standardized test for college addmission.
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Advice for Newbies
Hey Lisa, I recently joined this site myself. I will say that it is a God send. The site is extremely thought provoking and informative; and addictive. It is the best addiction you will ever have. Good luck and enjoy.
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How much is enough to change antibody screen from Positive to Negative
In this case here apparently the microscope was a pertainent device in the detection of this very weak reaction which apparently lead to a transfusion reaction (well not directly) the details of which we have yet to see. I wonder why the PeG repeat did not bring about a macroscopic positive result?
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How much is enough to change antibody screen from Positive to Negative
Without the microscope in the BB how are we going to result FMH screen and KB for that matter? I know that we can find nusence artifacts and ratal our brians with justification. But which is the lesser of two evels a false negative or the microscope? Its not easy!
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Specimen for Fetal Screen
Malcolm, H&H= hemoglogin/hematicrit.
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Specimen for Fetal Screen
Thank you Malcolm. But why is it that we have this convention in practice that a blood specimen for H&H should be drawn 2hrs post transfusion? From what I understand there is typically a two day time frame for which the injection of RhoGam is to be administered post delivery. This may account for the testing lag time at some facilities and may account for floor staff practice in aquiring the specimen as well.
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5 day plasma, the debate still rages!!
John, Three facilities utizing 5 day plasma are The Hospital of the University of Pa, Temple University Hospital, and Christiana Hospital in De. All are Level 1 trauma centers.
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Economy's effect on your hospital
The hospital that I am at had pay freezes only for no-union employees, hiring freezes, desolving positions through attrition, and very careful watch of overtime. It seems that union rep employees recieved thier raises as per their contracts and our hospital CEO's also recieved significant salary increases; talk about a slap in the face. Is it me or is this country heading back towards pre- French Revolutionary times?? I do feel lucky however at the moment because I was able to aquire full-time employment with a salary increase.
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Accepting RBCs with alloantibodies
What is the frquency of occurance of PC's containing allo-Ab's in the donor pool? And of those that do contain allo-AB's of what type are they? I think we need to get more information about these units, about their ability to cause transfusion reactions, and see if they can be beneficial for a recient population before we go ahead and discard their use altogether.