tupton

Revisiting this.
I now know that in order to get this to work you need to create an INPUT RULE in the BBK-BARCODE-TERM Dictionary. If there are any customers that have this working, can you cut and paste the rule you have defined?
Thanks
Tom

Contaminated diluent should have been discovered when running QC

In this situation this would be a one-time scenario for K-neg units.  However, as Galvania posted, because this patient has already formed 2 antibodies, her chances of forming another are greater.  Thus, giving phenotypically similar units would be advantageous, if at all possible.

Tom, I agree your decision was practical and timely.  Given the situation, there are 3 questions that come to my mind:
Who is paying for the IRL testing?  I hope not the patient because this testing seems to have been done in hopes of an EX-supervisor "scoring" points against a newcomer. Has it been established that the patient is Kell negative?  Have you talked with your director to ascertain why he or she felt your decision couldn't be supported?  Your director has established a potentially bad precedent for your transfusion service.  best of luck.

FYI- we recently had an anti-K that did show dosage and did only react with the homozygous cells.  We have a reference laboratory here.  We recently just changed our procedures to include ruling out on two heterozygous or one homozygous cell. 
 
We are a 1250 bed, tertiary level 1 trauma center.
 
Thanks!
Jen, MT(ASCP)SBB

I agree with Mabel ... you did 'the right thing'.  What did he/she really expect a reference lab to do with this anyway?
 
And, as she reminded, we do 'rule out' clinically significant antibodies with one homozygous (with exceptions, such as Anti-K which doesn't show much dosage anyway) every time we have a negative Antibody Screen.

I agree, I think you did the right thing re: you patient's antibody workup.  I don't agree with your Lab Director stepping in and "siding" with the "other tech" who just happens to be the previous supervisor.
 
Your patient received high quality service from your blood bank, your lab manager however did you and the rest of the blood bank a terrible disservice by intervening in a discussion between 2 staff members.  
 
He/she has basically allowed the former BB sup to continue to make decisions that are no longer in their scope of responsibility.  YOU are the supervisor now.  You get 10 Blood Bankers in a room for a discussion and what do you get, 10 different answers
 
Mabel is correct, turf wars with ex-supervisors stepping back into bench positions are difficult so be careful.  I do have to ask though, does your lab director make it a practice to help the other depts make pt care decisions?

If it counts for anything, as a Manager of a Reference Laboratory in the UK, I think you did exactly the right thing.
 
I say this because those that work in a Reference Laboratory (at least, on this side of the pond) do exactly the same exams as those working in Hospital Blood Banks (there is nothing magical about us), and so you probably know as much about serology as do those who work in a Reference Laboratory.  The only difference is, perhaps, the experience of seeing unusual cases, and the availability of far more reference cells and sera than are available to the average Hospital Blood Bank staff.
 
If you are confident in the results you have obtained, why send them to a Reference Laboratory for confirmation?  Think about it.  If you were not confident, then you would send all of your samples that give a NEGATIVE screen to a Reference Laboratory as well (and, if any of the hospital staff that my Reference Laboratory happen to read this - don't get any ideas - two or more samples with nothing in at all, and you are struck out!!!!!!!!!!!!!!!!!!!!!!).

I would have done the same. You were cautious without with causing undue delay in treatment.

I would have done the same as you. In fact I did this week on a patient with anti-E, -K -HLA (historical) and only the K cells reacted on straight panel in gel. E reacted with ficin-treated only. 2 extra E, K neg cells reacted but everything ruled out and E, K neg units were full XM compatible.

Thats basically what I would have done. Do you only have one panel? Do you save outdatedd panels for selected cells, so that you could find more than one "rule-out" cell. That is a great help, as long as you run appropriate QC.

I agree with the others.  Besides being an unnecessary expense, sending this one to a reference lab would result in a delay of having blood available.
 
Scott

I would have done the exact same thing under the circumstances you described. Sending a sample to the reference lab seems like a waste of their (reference lab & patient's) time and an unnecessary expense.
Ortho was just talking about "antibodies of undetermined specificity" with gel testing on their webpage this month and how it is the most commonly observed antibody. At our institution we result any AUS-related results as Inconclusive so we can have a record that there have been serological problems with that patient.

If this policy is defined in your SOPs you should follow them.  In my opinion, what you did was entirely logical and safe.  It may have even prevented a presumably K neg patient that is known to make antibodies from being exposed to the K antigen and making anti-K as well.  If you had a patient with multiple antibodies even the IRL may not be able to rule out everything and may suggest using antigen negative units for specificities that they can't rule out.  Lastly, you give blood every day to patients that have had anti-K ruled out using only one single dose K pos cell, because this is the case with every patient with a negative antibody screen.  They don't even get the advantage of an AHG xm (most places) which your patient got.
 
You could also check with your IRL and see how many K+ cells they require to rule it out.  They may require only one.
 
Afterthought: be careful of turf wars with ex-supervisors.    Look for ways for everyone to save face.