jill

Were they able to obtain Lea and Leb typings? Was an eluate performed?

Yes. If Anti-A1 is rescting at IS macro the ABO reverse type when entered will require a user override. The overried is entered and the blood type A+ is entered along with internal blood bank comments.

We do the same. If an alloantibody such as Anti-Fya happens to react with a panel cell that has a low incident antigen we do not try and find another Fya- cell with that low incident antigen to rule out the possibility of that low incident specificity to be present. Units will be crossmatched through the AHG phase.

We result the type as A Pos and enter an internal blood bank comment that states patient is an A subgroup. The A1 Negative type is resulted into the LIS. If Anti-A1 is present an internal comment is placed stating how this antibody is reacting. If it reacts at 37C or AHG then grp O blood is x-matched.

We use an old fashioned printer also which generated 4 stickers per blood component.

We type out an internal surgery schedule on day shift for the next day surgeries. At this time, previous transfusions, available autodonors, antigen negative units needed, and samples are ready and frozen(we freeze up to 30 days prior) are all verified. The second shift gets the revised schedule and goes over the schedule made out on 1st shift to make any revised changes. 2nd shift faxes over to PSS the patients who still need a sample to be drawn. I believe the last 3-4 months of surgery schedules are kept on file (not sure exactly). freezing PAT samples up to 30 days prior does allow problems. Sometimes samples are frozen in wrong date, poured off from the EDTA tube incorrectly, or do not get poured off at all. Some facilities allow refridgerator temp samples up to 21 days long. So I was curious as to how many facilities separate the plasma from PAT samples and freeze them for the future OR date.

At our facility we run screens in solid phase. If screen is positive and the solid phase panel is negative we then test in Gel If Gel screen or panel is negative then we report out a positive screen and enter the ABID result as "CSRO" which stands for expands out to read "all clinically significant antibodies ruled out".

Very interesting.

At the facility I work at currently a second sample is not required. Where I worked at in 2008, we did. This facilty's name is Holy Family Medical Center in Des Plaines, IL.

[Most antibodies against high frequency antigens (if not all) are red cell stimulated. Could this 13 yr old patient have an antibody that is reacting with one of the constituents in Ortho's red cell reagent? Try testing the patient plasma with washed reagent cells to see if the agglutination disappears?

With a + reaction after 4C for 15 minutes this is most likely not a cold agglutinin. (Incubation time of 30 minutes at 4C is used in our lab.) Was the positive screen originally seen in gel?

Did you test the baby's plasma uing tube and/or gel. I have heard of a 20 day old infant making an Anti-K IgM in nature due to an E.coli infection.

We keep the last 3 months of 3% expired reagent red blood cells and the last 1 month og 0.3% reagent red blood cells to use mostly for ruling out and rarely for ruling in. We QC the expired reagent cell with the antisera that corresponds to the antigen we are using the cell for by testing the antisera with the reagent cell, a positive control and a negative control/

We check for rouleaux in the tube whenever we see all wells of solid phase reacting 3-4+. I have seen rouleaux to cause this false solid phase pan agglutination. Gel is our back up and we get negative with gel we report out negative results to the floor but like others enter in comments to alert the next tech who would get a future sample. If we see a nonspecific pattern of reactivity in both gel and solid phase and everything is ruled out in one of the methods we report out "CSRO" : all clinicically significant antibodies ruled out.

All of our coolers are validated once per year.

We do a type and screen on only on patients having a C-section. An "extra" pink top tube is drawn on every OB patient admitted.

We use both 24 hour plasma and 5 day plasma. We are a 500+ bed hospital in the state of Ohio.

Anti-LW does not react with 0.2M DTT treated red blood cells so you could treat some Rh Positive cells and test then with the patient's plasma. If no reactivity is seen then it is most likely and autoanti-LW. If reactivity is seen maybe you could absorb the the patient's plasma with Rh Negative cells, even though her plasma does not react with Rh Negative cells, to see if the autoantidody can be absorbed to exhaustion. This would indicate a mimicking specificity. Try and find out the patient's primary diagnosis. There are diseases states where autoanti-LW forms transiently due to antigen suppression on the surface of the patient's red blood cells.

For an AB patient you can use 2 drops of saline with one drop of the patient cell suspension as your control. We us a commercially prepared Rh Control reagent. This would be better to use than 6% albumin because the maufacturer puts the same material, minus the Anti-D, as what is in the vial of Anti-D. The Rh Control reagent can be QC'd daily with the other reagents used for typing.

The highest titer I have ever heard of due to Rhogam was 32. I would let patient's physician know of the 256 titer. He or she may want to monitor the baby since it is well above the critical titer for Anti-D. An increase in a repeat titer(not necessary since the titer is critical) would indicate the presence of an actively acquired Anti-D.

We QC each new lot of panel cells (gel and tube) prior to use using a positive reagent control and a negative(Monocontrol) on each vial. If we use an expired vial from a gel or tube panel to rule out or in we QC this panel cell by testing it with the appropriate anti sera.

The only Anti-Cob we identified was also present with 3 or 4 other alloantibodies.

The website Pub Med may have some helpful abstracts. Search for an article using Transfusion Trigger.

Anti-K appears in patient plasma often times when an antibody against a high frequency Kell system is present. Often times this Anti-K is a mimicking antibody. To see if it is a true Anti-K or a mimicking antibody one can absorb the eluate with a K- absorbing cell. If it is mimicking the antibody will be absorbed to exhaustion. If the Anti-K does not absorb out with the K- absorbing cell then it is a true Anti-K.

It's real possibility that the baby's phenotype is a result from donated eggs. Recently, I typed a cord blood as Group AB and the mom was Group O. The RN taking care of the mother said that she had IVF with donor eggs.