kirkaw

Hi All, A rheumatologist ordered a DAT on a patient last night. The Polyspecifc, IgG and C3 were all positive. The patient's last transfusion was in Jan. 2012. The antibody screen is negative. The eluate yielded a sort of mixed field panagglutinin in gel. From previous posts, it seems like the most likely reason for the mixed field is junk. This patient has an elevated sed rate and a positive RF. The rheumatologist has ordered a bunch more sendout tests, including anti-double stranded DNA. So, I am thinking this is most likely an autoimmune thing. Would you recommend any further testing? If so, what? Is there evidence that a patient with these sort of processes going on would have a positive DAT? Is it considered clinically significant? Thanks!

Hi, Is mixed field a valid result for an antibody screen done by gel method? If so, under what circumstances would that be reported? I found an older thread regarding the degradation of antigens on stored reagent cells yielding such a reaction, but these were relatively fresh screening cells. Thanks, Amelia

I use a spreadsheet system too, but it's paper and stays in a notebook. On the spreadsheet, we record the date of receipt, lot #, expiration and date put in use. The notebook is managed by all staff since supplies come in on different days and new reagents may be pulled on all/any shifts. I have been reviewing the spreadsheets and have noticed that for the past 3 months, we have been slack about filling out when supplies are put in use. Is this an AABB requirement? CAP? JCAHO? Thanks

We recieved a specimen on an Rh negative patient who had recieved RhIg. Her antibody screen was positive, but did not match a pattern for anti-D. A panel was run. The cell yielding the stronest reaction was Cw positive. Everything else was ruled out except the (passive) anti-D. I could not find a Cw positive, D- cell on any panel. I could not find references in the Technical Manual to the prevalence of the Cw antigen being present on D- cells. Is Cw always on D+ cells? Thanks.

I had a case today, where a patient had a known anti-M identified previously at another hospital. Our tech had already set up a panel before we found out this information. The panel showed various reactivity...not something that I attributed to dosage. She had ruled out anti-S using 3 heterozygous cells. I asked that we pull an S homozygous, M- cell for rule out. Is this overkill? Thanks!

Is QC'ing outdated reagent red cells for ruling out required by AABB as well as CAP?

Thank you David. I agree. I was just trying to make sure that I wasn't being overly cautious because I am new to the supervisory role. I am trying to catch on new methods, technology and philosophies.

We use GEL technology for routine antibody detection. Our policy is not really clear on what to do when you have a positive antibody screen. I would prefer to have my staff do a panel in GEL but my predecessor allowed them to do tube screens. Also, suppose we do the antibody panel in GEL and it is negative. Again, my staff is used to doing a tube screen. Is that necessary? In the past, when the GEL panel and tube screen are negative, they do immediate spin crossmatches. I'm not sure I'm comfortable with doing immediate spin crossmatches following a positive antibody screen, regardless of method. Comments? Thanks, Amelia

Brenda, I would like some more information on the idea of switching an O negative male to O positive during surgery. We had a situation this past weekend where we had an emergency heart surgery on an O negative male who ended up using several units. The OR took 4 and requested 4 more. Our normal O neg inventory is 12 units (if we can get that many!) At what point would advocate switching this patient to O positive? Should it require medical director approval? If we do switch to O pos, when do you offer RhIg and how much do you give? Thanks, Amelia

I am a new BB supervisor as well, and new to this forum (Hi Everyone!) I am in a ~300 bed, 3-hospital system in North Carolina. I have been a Med Tech for 25 years. I worked in a tertiary care medical center for 9+ years in the blood bank at the beginning of my career. Then I took a hiatus from blood banking and came back to it part-time in 2004. As a new supervisor, I am anxious to make sure that everything is done 'by the book'. I am finding that compared to the big medical center where I worked years ago, our smaller hospital is procedure deficient. But as several others suggested, I am reticent to make big changes quickly. My 2 previous predecessors were SBB's but I am not. As I get more familiar with this forum, I am sure I will have lots of questions for this group. Regards, Amelia

We are not CAP certified either. Only AABB and JCAHO.

We have a computer system that tracks ABO reconfirmation of donor units and we do not put labels indicating such, on the unit itself.