rravkin@aol.com

Also to prevent potential iron overload.

Just an additional note for future practice; if when retrieving the PC, upon issue, you can see that the unit has been antigen typed then I would suggest investigating the patient record to see if they have a ruled-in corresponding antibody and then look at the crossmatch record itself to see if the Coombs crossmatch was performed. This usually doesn't take very long to do.

YoungLove, I wanted to first offer my sympathy for you loss and having read through these very informative posts I was moved to speak with some of my colleages about your case. One of my colleages, who has four children, said that she miscarried the first time as well. Collectively, they stated that they have all experienced this either individually or through someone they new, and that full-term pregnancies afterward produced healthy children. So I hope that this experience, as sad as it is, does not cause you to lose hope in delivering many children; it can, and has been done, so keep trying. Best Wishes

Have you tried letting the tube rock for 30min to an hour after removing from the refrig?

Kareem, One way to titer Anti A and B would be to serial dilute the mother's plasma in paralell and test against the A1 and Bcells respectively. This is the same procedure one would use to titer a gestational antibody during the course of pregnancy. The only difference is that you would test with A1 and B cells respectively instead of O type panel cells.

Mabel, have you considered drawing a second specimen, at a later time? Have you considered performing full crossmatch in tube and testing all phases?

Scott, just curious to know the strength of the reactons.

Any recent history of bonemarrow transplant?

Liz, is it possible for you to post some seenic photos of your trip to the Vatican?? I went to a neighborhood church with my next-door neighbor for Christmas Eve Mas, when I was ten or eleven, and I have to say that this church was beautiful. It was the first time I ever saw the stain glass windows from inside the cathedral. I can only imagine how the Vatican would be.

Is it posible to incubate the reaction volume of Anti A/patient cells at 37C for a given period to see if the reaction will persist; also have you considered a DAT and follow-up testing if positive?

Four primary reasons for MCV delta are fliud gain/loss, and/or rcb transfusion, and/or mislabled specimen, and/or specimen contamination. We will call the floor and confirmed IV fluid gain, or loss; check BB record for recent transfusion; if necessary confirmed correct specimen with ABO type comparing to a previous specimen.

Hey Swede, let us know what happens.

Lara, we have been performing Verax testing for bacterial contamination for the past approx. 4 months. The testing takes approx 1/2hr and we do the testing prior to assignment. In emergencies we have an emergency release form which the physician has to sign, taking responsibilty for the product not being tested for bacterial contamination.

You can try looking at the AABB or NIH (National Institute of Health) web sites for direction if not answers.

Did you ask this doctor to explain how these studies should be done? I would be curious to know the practicle end of such studies. Maybe then he would agree with you and David.

Mohammad, the anti-M you ruled in is probably comprised of concentrations of IgM and IgG, which would account for it's reactivity at the different phases, and is most definitely clinically significant.

I had a case once where the mother typed as Rh- Pos but historicaly, from her doctor's office, typed Rh-Neg. She was currently delivering and had RHIG administered as part of her pre-natal work. She was currently Rh typed by myself and another tech at another time and with another specimen, and the Rh typing we generated was confirmed. After delivery the patient's doc continued with RHIG administration for this patient despite the Rh-Pos result obtained. I couldn't blame the doc for continuing with the RHIG given possible future litigation and the already high cost of malpractice insurance. The doses of RHIG the patient received pose no threat to her or baby's health; and as an interesting side note, when typing the patient's specimen for Rh you could see how the agglutinates were not as crisp and well defined as usual. They looked almost like visible fat globules in the aqueous solution which gave us a deeper understanding of how water is excreted upon the formation of the agglutinate such that clear and crisp agglutinates are generated. During the formation of agglutinates for this patient's rbc's water could not be fully excreted because the RHIG blocked bonding of the Anti-D, from the reagent used, to D antigen on the patient rbc's and therefore could not expell all of the water as the agglutinate formed giving raise to it's awkward macroscopic appearence. The water would have actually been trapped within the latus frame of the agglutinate. I would have to agree with the practice of erroring on the side of caution as our bench methods for determining Rh type do not differentiate between a weakly expressed D antigen or an altered or mosaic D antigen. As far as molecular testing is concerned; if the testing determines a weakly expressed D antigen will this knowledge ensure that the patient's immune system not generate an allo-D antibody? Is it a known fact that a patient's immune system will not generate an antibody against a auto antigen that is correctly structured but weakly express?

Just curious to know if you have a reference for your statement. I have always thought that isoton is very viable solvent for rbc's, but maybe 24 hours is truely a long time?

Just two side variants you may want to consider; actual Ambient temp of your Blood Bank and age and care of your in-date reagents in use. I know that we have experations dates on all of our anti-sera's but I also know that there is a certain amount of evaporatoin of water contained in these reagents upon standing capped at room temp. I had an experience where I was using an indated Albumen reagent to make cytosins of a CSF I was working on and after seeing that the number cells counted did not correlate with the number of cells recovered in the cytospin slide; and after several attempts using this same indated Albumen reagent, I finally didn't use this reagent and got the correlation I was looking for. I openened a new bottle of Albumen and my corelation was correct and my cells had better integrity. I realized that the original bottle of Albumen, although indated, sat at room temp too long with dehydration occuring such that instead of 22% concentration as the lable indicated the actual centration was high enough to form a film over the opening of the cytospin apparatus and therefore trap and prevent the cells from migrating to the slide. I did note this filme after the 2nd or 3rd attempt.

Margaret Ann, You may find some difinitive answers through researching the relative Ab concentrations of Anti-A from a B donor and Anti-B from and A donor, and also research the respective concentrations of IgM and IgG of each; in addition to availabilty of products where you are located.

Speaking from practicle experience, last time we did manual ID of specimen we had the phleb signature on the specimen as well as a witness, usually the patient RN or another RN; the witness would also recheck the data. As far as your practice with the RN coming to the BB to correct lable errors, I know in the past this was acceptable but I think currently BB practice is moving, or has moved away from this.

The only out-of-group consideration that we have is for O type platelets where we only transfuse a volume of <300 ml to non-O types and 300ml or greater to type O patients only; this is practiced do to potential a high titer anti A, B from an O donor. We do give Rh specific platelets.

So here "Maximum" is the number of presurgical blood products the blood bank will assign for a particular procedure at a particular hospital based on their own particular statistics of usage for this procedure in light of an inconsistancy amongst surgeon and/or physician orders in order to manage inventory. I guess in this light the term "Maximum" is applicable. Thank you Malcolm.

Why do they call it "Maximum?" It sounds as though this is all the blood that would be available for the procedure and this is not true. - - - Updated - - -

I do not know of such data however I do have practicle knowledge of two policies/ practices, PAT and MSBOS. The PAT practice is established to ensure out-patient blood bank needs are met prior to thier surgery. It consists of an established time frame from which the specimen to be used for crossmatching is drawn until date of the surgery; in practice I've seen thirty days and twenty days, with certain criteria being met; ie no transfusion during this time, no pregnancy, and negative anitbody screen. If any one or combination of these criteria are not met then the patient would have to have a specimen drawn the date of surgery; this policy would be understood and implimented by the out-patient surgical staff such that the surgery would be delayed until compatible units were assigned. The other policy/practice is MSBOS (I do not remember what this acrynim stands for), but this essentially is a minimum numbers of blood products needed for a specific surgical procedure and is established by your hospital surgeons and the blood bank medical director. This system is to ensure that a minimum number of blood products are ready for an in-patient surgical procedure. Both of these practices help to maintain blood bank inventory. I hope this helps a little.