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I'm not as concerned about whether or not I'm running a "full panel" as to whether or not I'm running enough cells to exclude antigens to the commonly encountered alloantibodies. Usually manufacturers will designate the 3-5 cells on their panel that may be used in the presence of anti-D - these cells are usually appropriately homozygous for Kidd, Duffy, MNSs, Lewis and include heterozygous C and E. I would be more concerned about the quality of the cells that are being run, rather than the idea of the "full panel". If the selected cells cover all bases, then that should be sufficient (I'm of the old school that likes to see 3 positive cells to call the antibody so still require a 3rd D+ cell to conclude that it is anti-D - passive or immune - matters not!) We run antibody identifications on all antepartum OB patients - yes, most often it is a full panel because we do use the Galileo - but for those samples that come in and can't be run on the instrument - we will do the workup which doesn't require a "full panel" but we have to run sufficient cells to cover all the antigens with the required zygosity. Hopefully this helps....

My experience with reactions in patients that have received multiple products, making it difficult to determine which product or product(s) may have caused the reaction, would be to investigate all the potential products. We've had trauma patients in the OR where they had a "suspected reaction" and all products were investigated. It's difficult but not impossible. Our investigation of plasma/platelet products is limited to clerical check and culture of the bag if patient had symptoms suggestive of bacterial contamination.

We routinely tube all products except for cellular therapy products or tissue. We had some issues with syringes breaking or leaking under pressure, so now use a special tube that has a solid foam insert to prevent the syringe from banging around or accidentally putting pressure on the syringe plunger. We routinely tube platelet pheresis products with no problems (I have noticed that they are foamy after the process). All products are in a sealed plastic bag just in case of leakage. One tube system goes to our newer building which is 3 blocks away (tube runs under the street) All tubing was validated before use and so far inspectors have been satisfied.

Are transplant facilities charging for storing stem cells (marrow or apheresis products - NOT cord blood) beyond the initial time period after collection? If so, what are you charging and are you sending a bill (annually, quarterly, monthly?) from the lab? Our agreement states that the fee after 5 years is $100 but may increase without notice and the hospital financial staff says that "everyone charges a lot more than $100" so I'm trying to find out what labs are actually charging for storage and how it works for them. If you like, also let me know how long you store products for...

We're looking into getting another freezer as well - no money, no space - this sounds very familiar. It would be great if FACT would remove the requirement to offer alternative storage facilities since they don't seem to exist. Hopefully someone will read this thread and come up with a solution or relief to the requirement.

For single adult transplants, the MDs request 3 million CD34 per kg (ABW). Myeloma patients the endpoint is 6 million. Our docs have worked out an algorithm for the requested endpoint and circulating CD34 to determine when to start collections. It generally works well except for the infrequent poor mobilizer. Peds generally want 3-5 million unless it's for a neuroblastoma patient - that usually means 10-15 million per kg. Most kids mobilize very well so the higher dose isn't a problem.

We are an active transplant facility transplanting approximately 140 patients per year - allogeneic, autologous, unrelated - PBSC, marrow and cord blood. We've run out of storage room for frozen products which consist mainly of autologous peripheral collections and aliquots of CD3 cells for potential DLI. We are accredited by FACT, CAP, and AABB and need to rework our storage policies so that we can continue to grow with the program and have room for new patients. What are other facilities using as their storage duration and how do you get the physician to agree to discard after the storage period is up (even when they signed the agreement initially and the patient wants to discard)? FACT requires an option to transfer the cells to another facility for storage after the storage period is over - where is this magical facility? Does anyone have any information about facilities that offer long-term storage for stem cells (hopefully accredited?)? Looking for ideas and help.

We've done it that way and it seems that the calculation multiplies 5 fold any inherent "errors" in counting - so it's easy to go out of the 2 or 3 SDI that they use for "passing". That's why we suffer with the 50,000 cells/ml which is only multiplied by a factor of 2 even though it is more difficult to read. We have a better track record doing it that way.

It warms my heart to know that other real people have problems with these tests, too! I cringe every time we send results in - we've done both CAP and StemCell technologies and of the two, StemCell Technologies seemed to be better since we followed their instructions. The difficulty for us is that the results are reported as colonies per 100,000 cells - we plate at numbers much lower - 20,000 cells - because it makes the plates easier to evaluate and enumerate. For the PT samples, we try not to plate lower that 50,000 cells per ml. We cannot plate at 100,000 cells/ml or the plates would be un-readable. There's a reason that it takes 6 months for CAP to post the evaluations- there seems to be little concensus for CFU. This probably didn't help you with your problem but it sure did make me feel a little better.