Susan Betler

I have had physicians tell me that patients can't have transfusion reactions to autologous blood and that hypotension is not a sign of a transfusion reaction (even though there is a type named that).  I've seen them order irradiated blood because they think it is less likely to transmit infections.  If the patient has been spiking a temp for another reason and they write off this temp which is actually due to TRALI or a hemolytic reaction and keep giving more of the unit, they have done the patient harm.  If you can tell whether there is a reaction going on by playing the odds based on the patient's history and condition then why do we ever do the testing?  I've never had to let a heavily bleeding patient wait for a transfusion reaction workup.  If their life was in danger from bleeding the medical director would override the usual policy if needed.  I'm afraid, in my experience, the pathologists are more knowledgeable than the bedside physicians in may cases.

We require BB notification, and after prelim investigation, the Lab Medical Director makes the call whether it's ok  to continue for hives/itching, and whether additional units may be given. Hives category gets a clerical check and all other "Transfusion Reaction Symptoms" (as defined by AABB) require disconnection of unit and are worked up as reactions. The patient's MD does not make the call. We have a separate transfusion reaction categories for: 1) hives, itching 2) potential bacterial contamination and 3) everything else.

It is built in Issue Component.  I initially built it in Component Processing but wasn't happy with it for some reason that I can't remember at the moment.

The AABB TM, 18th edition, states in Chapter 22, Perinatal Issues in Transfusion Practice, Serology and Mechanism, "Administration of RhIG during pregnancy may produce a positive antibody screening result in the mother, but the titer is rarely greater than 4 and thus poses no risk to the fetus."
If we ID anti-D in prenatal sample, we perform a 1:4 dilution and if the results are non-reactive we have two statements in our report, "The antibody demonstrated a titer of less than 4 in saline at AGT indicating that it may be due to recent administration of RhIG."  and "Due to the recent administration of RhIG, the antibody may have been passively acquired. To establish this as the sole cause of the antibody's presence, repeat testing six months post-delivery should demonstrate a negative antibody screen."

Meditech users:
 
We have just installed a custom (not a rule but custom hard code) in C/S version 5.66 that causes all specimens to expire at 2359 regardless of the time of specimen collection.  It will not be generally available as a DTS.
 
If you want this feature, you will have to press Meditech for it.

Congratulations on finding that little lot - very impressive!
The Scianna Blood Group System is the 13th in the ISBT numerical system.  When I started out in this game, there were only three antigens in the System (Bua, Sm and Sc3), but things have changed!  Sm, a high prevalence antigen, has been renamed Sc1.  Bua, a low prevalence antithetical antigen to Sc1, has been renamed Sc2.  Sc3 was expressed on all red cells apart from those of the very rare null phenotype.  In addition, Rd, STAR, SCER and SCAN have been added to the System (Rd being low prevalence, and the three others high incidence).
Wra was originally called the Wright antigen, and is a low prevalence antigen antithetical to the high prevalence antigen Wrb.  These two antigens have now joined the Diego Blood Group System as Di3 and Di4 respectively.Wr(a+) red cells are very rare, but anti-Wra, which seems to be made with no apparent red cell stimulus (what used to be called "naturally occurring) is actually quite common.
He is antithetical to the 'N' antigen (NOTE - not the N antigen) within the MNS Blood Group System - N is expressed on glycophorin A, whereas 'N' is expressed on glycophorin B.  Sadly, it is not as simple as that.  About 23% of S-s- red cells are He+, but the He antigen is not a "single entity", but a "collection of antigens" that come about as a result of different variant glycophorins.
I hope that helps a bit, rather than "muddying the waters" further.

Actually I want to run a few "totally unrelated" things by you:
What is your cut-off grade of D Reactivity for considering a patient a Rhogam Candidate?  At what strength of D Typing do you say the patient is Rh Positive and is not a Rhogam candidate; vs. what strength do you say she may be a Partial D so you give Rhogam to be on the safe side (or do you have testing performed to confirm one way or the other; molecular testing)?  We have a current patient who is 2+ which I am inclined to just report as Rh Positive....but that is the strength at which we have our machine flag our Rh Types as questionable. On a totally different subject.....validation of new Platelet Rotator/ Incubator.  Clinical Engineering did all of their checks and we are doing Alarm and Temp. checks.  I am also trying to procure expired platelet apheresis to "load" the rotator and ensure it maintains temp. with a full load.  Anything else anyone out there does for this validation? And on yet another note.....with your Donor Center Contracts, how many of you state such requirements as: % if Standing Order that can be cut/ month Requirement to never allow you to go below Minimum Levels of any given blood type % of RBCs that must be fresh (i.e. no >8 days old)? % of group O RBCs that must be fresh (may be higher than overall # for all RBCs above) What other restrictions do some of you list? Thanks,
Brenda Hutson, MT(ASCP)SBB

Just trying to find out if anyone is performing bacterial testing on their apheresis units in the Transfusion Service prior to issue.  Looks like the FDA is recommending that even apheresis units that are cultured by the blood supplier have a rapid bacterial test performed prior to issue on day 4 and day 5 of the shelf life of the unit.  Anyone following this recommendation?  If so, what test are you using?  I have used the Verax test before, but wondered if there are others available.

The use of the term "Optical aids", in this sense, is almost certainly referring you to an agglutination viewer.
The only time we use a scope is to verify the presence of that pesky rouleaux.
Scott

Hello! Would any of your meditech users care to share some of your rules and calculations? Meditech's knowledge base is sometimes lacking in what you need to build these things. A lot of the keywords have no explanation of how they're formatted when used. I'll start out with one I came up with.
Filling in that patient history was checked when the specimen is received.
I built a t-type test called PT HISTORY. It's default result code is "." without the quotes. This result code's text is "No History\FV".
The other result codes are AN, AP, ABN, etc. The text for these result codes is "History On File\FV".
The "\FV" files and verifies the result in case anyone didn't know that.
In the BB calculation dictionary the trigger test and the target test are both PT HISTORY. I assigned the label "B" to this in the calculation. The calculation is as follows.
;The system will check for patient blood type history.
IF{B=. [f bsp bt]};
In English it says: If B (PT HISTORY) is "." then fill in the blood type from the patient history. In this case if there is nothing in patient history then the "." remains and the result is No History. If there is a type, then that result is put in as the result and displayed as History On File.
This helpful for anyone?

Since all antibodies have a specificity, we don't use the old term 'non-specific'.  If we don't know 'its name', we report one of the following as applies to the workup:
Cold Antibody: Undetermined Specificity Cold Auto-Antibody: Undetermined Specificity Warm Auto-Antibody: Undetermined Specificity Antibody Detected: Too Weak to Identify at this Time Possible HLA/HTLA Antibodies Antibody Detected: No Identification at this Time

Hello: We just had an upgrade (?) and discovered that the HX Comments, if they are more than 4 lines, are printing NOT in the Patient Demographic AREA but after queries and reasons, etc.  Techs will have to scroll through pages to find the HC Comments. My laboratory is a generalist lab with techs floating between 3 departments. I put many "helpful" hints, etc in the patient HX Comments field.  Any comments for those with version 5.67?  Thanks

Yes, we have seen sporadic carryover, but only with a very strong Anti-D.

Yes - it seems like the phones are even worse than the food problem now.  But how are you going to know if they stop in the cafeteria on their way back upstairs unless you just happen to run into them there?  Hummmm - maybe that explains that slow start time on some of those units when we get the unit review back.....!!!

Thanks for the insight. I was also contacted by tech support and can't wait until this lot number for the screening cells is done!

The decision was made (among others) to go with TANGO solid phase because this method had much less unexpected reactions than the ECHO. We did expect "unexpected" reactivity to occur with the solid phase method. Unfortunately, there is no resolution with these patients, so far.

We were JC inspected this past fall and the inspector asked me to pull the package insert for our Ortho Panel A 0.8%. He pointed out that it stated that the panel should be tested periodically with weak antibodies. We do QC our panels whenever we receive a new lot # and I was able to pull the folder to show the inspector we were in compliance. We use  Ortho Confidence Antisera 1:40 dilution for the positive control and
Bio-Rad Solidscreen II Negative control. We perform QC using these controls for both our gel panels and our 3% panels QC'd on the TANGO for all new lots received. 

In the case of anti-Jka-ish looking reactions, if it sort of looks like a duck, sort of quacks like a duck and the patient is negative for Jka (or Jkb)...call it a duck or in this case anti-Jka. This is what I've done with tube, PeG and now solid phase because Jka antibodies can be such sneaky little buggers and the chance of a reaction (at least delayed) is there if it truly is anti-Jka.
 
When I validated our Echo 7+ years ago, I found a lovely anti-Jka with solid phase that was totally non-reactive with PeG and gel. The Jk antibodies really do like solid phase best. Over the years we've seen other antibodies that react in solid phase, but not PeG and actually saw 3 in total that didn't react with gel during validation (anti-Cob, -Jka and -c). The reference lab will say they saw nothing, because they most likely didn't use solid phase. When I've done method comparisons for CAP requirements, I've  see antibodies that were clear cut and that reacted 2+ or greater on the Echo, then saw them react microscopically only with PeG and not at all with LISS. It's the nature of different methods and something to be aware of when working on these types of problems. Doing method comparison gives you a pretty good picture of what those varied reactivities could be.
 
BUT - before solid phase we did IDs for years with only LISS or PeG or gel and we didn't see all kinds of transfusion reactions delayed or otherwise. The only 2 reactions I saw, that we missed with a non-reactive antibody screen, were anti-Jkas that did not react with the method we were using at the time. Moral of the Story: Do the best you can and use your best judgement when deciding where to draw the line ( and it makes me more comfortable to call the Jka-ish antibodies - Quack Quack).

I use my 3 times yearly Automated Transfusion Survey specimens (5 specimens X 3 times/year), record the results from the Echo on a Yearly Method Correlation form I cobbled together and then test the same specimens on both tubes (all ABORhs) and 2 ABSCs and on manual Capture (3 ABSCs) - our two bench methods - and record on same form. Seems to work OK and is easy to document. :cool:

As expected, I was recently cited by AABB/CAP for not being able to change the alarm activation setting on my 20 year old BB Refrigerator to 2.5C (from 1.5C) because of the storage of RhIG. The alarm temperatures are factory set and cannot be changed.
Does anyone know where I can I can purchase a separate alarm system, to augment what I currently have, that will satisfy the citation??? 
 
thanks,
Susan

This is definitely an AABB citing because RhIG is a derivative (manufactured product).
It does not matter if you have never had temperature go below 2C and have statements on the refrig....The alarm settings do not "match" the recommendations of the products. I understand what the citation is about....
I am looking into a NIST certified small and inexpensive min/max digital thermometer with an alarm. This is generally used in micro labs.  The probe can be placed in a small bottle of liquid (approximately the amount of volume in an RhIG syringe). There is a wire attached to the probe that can fit "between" the door jamb (without compromising anything) and the thermometer can "stick" on the side of the refrigerator.  Should be able to write protocols and also alarm testing procedures for this.

As expected, I was recently cited by AABB/CAP for not being able to change the alarm activation setting on my 20 year old BB Refrigerator to 2.5C (from 1.5C) because of the storage of RhIG. The alarm temperatures are factory set and cannot be changed.
Does anyone know where I can I can purchase a separate alarm system, to augment what I currently have, that will satisfy the citation??? 
 
thanks,
Susan

Good to hear from all the other Meditech BBK package fans. It did indeed take a while to do the historical conversion. Sunquest hired seasoned blood bankers to make, modify, instruct on and implement their LIS module. They knew exactly what their customers' needs and concerns were. Meditech primarily hires computer geeks straight out of college who learn the system by playing with it and guess what their customers need. Our initial Meditech instructor told us he never had a chemistry or biology course in college. Another used anti-A as an example of an unexpected antibody. I guess you get what you pay for.........