StevenB

See: Transfer of antibody via mother's milk, Van de Perre, P Vaccine, vol. 21, issue 24, 28 July 2003.

Be thankful that you don't encounter Kpa or Jsa on your screens cells and add them to your list of things you don't worry about. :cool:

"Because of the time sensitivity of Type and Screens..." I was wondering if you could explain this statement. Are hospitals held to a different standard, than...say...Reference Laboratories? As far as I can tell, there is not a separate section in the AABB standards that says "if you work in a hospital, Type and Screens are only good for X amount of days in the patient not transfused, or pregnant within the last three months and must be repeated after said time." If you Type and Screen a patient, and they do not fall into the 3 month issue, that Type and Screen result IS GOOD until the patient gets pregnant, or transfused, regardless of how long that time period is. In the untransfused/not prego patient, there is ZERO reason to repeat the T & S. Performing a Crossmatch on the individual who comes in on day zero for a T & S, and returns on day 20 (for example) for surgery is a whole other consideration. The question of whether the sample collected on day zero is still good to use on day 20 is impacted by couple of things (at a minimum): Can you tie-in the original sample with that patient and does the manufacturer's insert allow testing on a sample that old? Perhaps I am just misinterpreting the question. But if it is standard policy in the hospital setting to repeat T & S's on patients just because some arbitrary time frame has been established, then, in my opinion, there is a whole lotta unnecessary testing going on out there. Now, I do not work in a hospital blood bank, so I guess there may be some "standard" that I am not aware of. If so, I'd appreciate it if someone could give me a quote or reference so that I might educate myself.

Increasing the serum to cell ration when using the saline tube technique is, in itself an enhancement technique. This could mean the difference between resolving a warm auto problem at your own facility within an hour or two using two drops of serum/plasma or shipping it to a reference lab and delaying patient care because four drops of serum/plasma were used along with an extended incubation. I liken this to when a facility uses LISS/PEG/Gel to test whether their warm autoadsorption worked only to find that it hasn't...a bit self defeating. Issitt/Anstee made a statement in Applied Blood Group Serology, 4th Edition, that the saline/IAT test can be equivalent to LISS/PEG/Polybrene methods only if increased serum:cell ratios and extended incubations were used....otherwords, it becomes an enhancement technique; not what you want to use when trying to eliminate reactivity due to a warm autoantibody. My recommendation: two drops serum/plasma to one drop cells, 30 minutes at 37C and on to AHG (obviously with a wash). If nervous...extend to 60 minutes but do not increase the serum:cell ratio.

Be thankful you have a negative antibody screen and move on...

Mollison (Blood Transfusion in Clinical Medicine,11th edition, 2005) refers to a few studies that reported the presence of either anti-A or anti-B in the cord sera that were not of maternal origin. In one report, this occured in 8 of 192 samples studied, 7 of 33 in another report and 8 out of 44 in the last. Mollison states "they are IgM, synthesized by the fetus". So, while what you are seeing is unusual, it clearly is not unprecedented.

An anti-K PN titer of 1:16 in a saline titration is anything but "wimpy" and should elicit a serious response from the mother's physician in regards to monitoring the well being of the fetus. As far as the usefulness of the saline technique, it is a valuable tool in the hands individuals who are confident in their abilities. I've worked in a reference laboratory for 24 years and have total confidence in the technique. If the need arises, I will not hesitate to drop ANY of the enhancement methods available to me and move to saline tube testing. I can't think of a single common clinically significant antibody that I haven't identified using saline techniques at one time or another. I'd like to say that for all clinically significant ones, but the opportunity just hasn't occured . Dr. Pepper has some wise observations with which I'm in total agreement.

Mabel's comment "we feel like they think we are incompetent" seems to have hit a nerve based on the responses. While her staff may "feel" that way, that perception could not be further from the truth. Mabel's staff is held in high regard, alway has been, always will be. Every effort is made to duplicate reactivity seen in hospitals throughout the region and Gel techniques are routinely used in that effort. Customer service is a top priority; again...always has been, always will be. Anything less is not acceptable.