Liz

I still have this question, please: "what about the need to initially remove the autoantibidies from the autologous red cells before autoadsorption ?"

I am referring myself (yes myself) back to the thread below, when Dave gave some very helpful info. Thanks to all! http://www.pathlabtalk.com/forum/showthread.php?4463-PEG-Adsorption&highlight=autoadsorption

Oooh ok.

(your audience was expecting more)

yes malcolm. But how about the use of PeG: First: autoad with Peg Then run AbId. Is that the magic of not performing the ZZAP autoadsorp? what about the need to initially remove the autoabs on the autologous red cells ? Is that done away with???

jcdayaz, is this the procedure? AABB: "Procedure 1. Wash aliquots of red cells in large volumes of saline three times and centrifuge for 5 to 10 minutes at 1000×g. Remove all residual saline. 2. To 1 volume (eg, 1 mL) of red cells, add 1 volume of serum and 1 volume of PEG. Mix well and incubate at 37 C for 15 minutes. 3. Centrifuge the serum/PEG/cell mixture for 5 minutes and harvest the adsorbed serum/ PEG mixture. " after checking the serum for complete auto-adsoption we then test the adsorbed serum with a panel of cells. ? right? Liz

Yes, this must be what I read and am trying to understand. What I have is the PeG kit Immucor. How do I use it for autoadsorption.. (I think I am completely off) sorry.

"over-ride" meaning in my sentence do without....

hahahaha You have a good imagination. The tube I am holding will give me a headache; thus, as you assumed I know it has a warm auto. So I summarize: 1. I auto adsorb with WARM 2. I perform the Panel 3. I may repeat the Panel with PeG to enhance. Is this right? BUT: I read in this forum that Peg would by some miraculous way help me over-ride the auto adsorbtion step.... ??? Many said they stopped WARM and are now using Peg, yes it did not make sense to me, so here I am with my questions ... help.... help....please

Thank you for your reply and for confirming the persistence of a headache, so let me elaborate: I perform the panel without PeG, then if I have a positive AC I perform the panel again with Peg? Does this relieve me of autoadsorbing and the headache? or am I dreaming?

Hello again, WARM, Peg and ELU: I have the kits and read the inserts and all the literature. WARM is giving me a headache. So about PeG: at what step do I use it if I have Warm autos and want to detect and ID the allos (if present). Please start imagining me holding the tube of whole blood. which direction do I go: autoadsorb or what?? Thanks

hahahahaha, Indeed, truly amazing. So what amazes me now is when one actually stops, considers and then says "no, I'd rather wait"... great MD in my eyes. (then comes the thought...so what was the rush about??).

Are you searching for a compliment, Malcolm? You are a walking encyclopedia with no time to spare.

Good Luck. Anyone willing to give the time and expertise required for such a delicate and complex project deserves a huge pay in return. It is hard to find such a talented person with the time.

Thank you, this is very helpful as I meeting with the authorities soon, and I want to make the right decision.

KKidd who takes the cooler to and from the OR and who moves them to a fressh cooler if necessary/ thank you

Thank you David for your prompt reply. Is it best to change my Stone Age ways and go for igloos? Thanks

Who has ownership of the blood refrigerator in the OR? and who takes back the unused blood to the Blood Bank at the end of the day? Moreover, what are the steps from handover at the OR to patient transfusion and refrigerator storage in between? Thank you

The Ab may be in the serum/plasma while her sensitised RBCs may be lysed at the time of the draw, or as we know 25 to 100 Igs on a cell often do not give a positive DAT.

You are absolutely right, Mabel. We think that what we know is common knowledge and the physicians know it.... they don't.

Malcolm, Cliff did you know that one can thank oneself?? I was thanking myself for my references and it worked. How embarassing.. I removed it of course. I believe that no one would do it because it shows. ) Please Cliff leave it as is lest the thank you button gets spoilt. Thank you.

"Cephalosporins (primarily cephalothin) are the drugs with which positive DATs and nonimmunologic protein adsorption were originally associated" AABB Technical manual and Garratty G, Arndt PA. Positive direct antiglobu- lin tests and haemolytic anaemia following ther- apy with beta-lactamase inhibitor containing drugs may be associated with nonimmunologic adsorption of protein onto red blood cells. Br J Haematol 1998;100:777-83.

crisramirez , this is a valid question and I agree with looking at the strength of cell II on the screening cells compared to the panel. Malcolm, there are still spelling mistakes

Hello Mabel, This is the part about having two people identify the patient. The actual requirement for Patient identification is not in my post. It includes: two identifiers: the triple name and the patient's unique MPI (case number). Indeed, a patient may be in coma, so we depend on the wrist ID only. In case we have unknowns at the ED it is a whole other scenario. Regarding having patients with the same name, there is an announcement through the Medical Center, and at the Blood Bank we post this occurrence. We still go by the MPI. DOB is of course acceptable.

Please note that this applies to all patients.... to avoid confusion and save time, no need to check if the patient has a history with us, at this point. And it adds to patient safety (even if you think it is not needed, believe me it may be).