csjuarez

In our hospital cord blood ABO/RH type and DAT are ordered when the mother is type O or Rh negative. If the DAT is positive we do elution ONLY if the positive DAT cannot be explained by the mother's serology. If the mother is group O and the baby is non-group O, that explains it. If the mother has a positive antibody screen, that explains it. So it's only if the baby is type-compatible with the mother and the mother's antibody screen is negative that we do an elution, which is in essence almost never. When we do an elution we use the Immucor Elu-Kit and test with screening cells and A1& B cells. This is most often negative since the most likely reason for the positive DAT in this scenario is an antibody to a low incidence antigen inherited from the father and if it didn't show up in the mother's antibody screen it is unlikely to do so in the baby's eluate since it's probably not present on the screening cells. Our neonatologists treat on the clinical basis, too, and the exact ID of the cause of the positive DAT is of only academic interest in most cases.

Our lab director is questioning whether we should continue to be AABB accredited, or should save the additional cost (and headaches) of two very similar audits since the CAP Transfusion Medicine checklist is now almost identical to the AABB. On the other hand, our Blood Bank Medical director thinks the additional cost is warranted in order to have the additional, well respected credentials for our Blood Bank and hospital. Is your blood bank accredited by CAP and AABB, or just one or the other? Have you recently (in the last several years) opted to discontinue AABB accreditation? What reasons did you have for your decision? Thanks!

Like many hospital Blood Banks, we have been handed the (shared) responsibility of storing and tracking bone and tissue. Our LIS is antiquated (hopefully we'll be upgrading in a year or two or three...) and cannot really handle all the new product types, so we're currently using manual logs. I've recently been given some information on Nu-Tracker (through Nutech) and was wondering if anyone else is using the system and if so what are your experiences. Thanks!

Personally, I really dislike group work in an educational workshop. I like group discussion, exercises, cases studies, etc. Of course, you'll almost always have a mixtrue of learning types and will almost never be able to please them all!

I would not be comfortable with that arrangement -- I would want my hospital to do the testing on which the transfusion will be based. In addition, there may be patient identification issues, and you should have a pretransfusion specimen available in case it is necessary to follow-up a transfusion reaction or other issue related to the transfusion.

I'm not sure what you mean by blood fractionation. Could you elaborate on what you're looking for? Do you mean preparing components from whole blood donations?

We also use the electronic crossmatch for units issued by Emergency Release. We pull a segment at the time of issue in case the serological results require serological crossmatching, but if the antibody screen is negative and we've performed the two required types, we will perform the electronic crossmatch just as we would if they hadn't already been issued. I don't see that a serological crossmatch would be required under those circumstances or that it would add any information or safety to the process.

If washing blood is a rare occurence (as it should be!) then it wouldn't seem to me to be worth the expense as well as the time and effort for validation and QC to get one. (Unless you're at a blood center, in which case you probably do need to have one!)

I can't say that I've heard of that particular situation, either. I think, though, I'd have to insist on some sort of armband with the required patient ID information. Perhaps a band of paper would be acceptable. In or facility we have 'EasyID' labels that are used for practically everything, so one of these attached to a makeshift paper bracelet on the patient's arm would probably do the trick. (We don't use a separate blood bank band)

Does anyone have a procedure for testing ficin treated cells? I get the Ortho Panel C which has both treated and untreated cells. Doing the testing itself is not the issue, but I'd like some guidance on when to use this testing and how to interpret the testing that I can put into a procedure which will make since to my bench techs Thanks!.

After documenting that the patient has received RhIg, we place a comment on the Anti-D result indicating this fact (de facto assuming the Anti-D is due to the RhIg adminstration). We do not perform additional testing to try to differentiate the passive anti-D from that actively produced by the patient.

I have had excellent service from Otho, and my sales rep makes regular visits and is very responsive to email and phone calls. He is even proactive in getting things done when I haven't viewed a situation as a special problem. I hope my experience is more the norm than some of these entries indicate!

We no longer use 3 of each cell -- just one A1, A2, and O cell plus typing patient cells with anti-A1.

For those of you who have totally discontinued using the cards, do you have another backup system to check patient history during a computer downtime?

I believe that r-set was discontinued a few years ago -- we had been getting it at the lab I worked at in Saudi Arabia, but had to make changes when it was no longer available. We currently are using gel, so also use the indicated (@) Rh-negative cells from the Ortho Panel A (or Ortho Panel C) in these cases rather than do a complete panel rule out. I think, though, that the Immucor Panel-10 also has a set of 3-4 cells marked to use as an Rh negative screen/mini-panel.

We have agglutination viewer and use it for all routine tube testing (most of our testing is in gel now). We use microscope only for Fetal bleed testing, DAT, and questionable readings. I see the agglutination viewer as an essential piece of equipment for tube testing -- it's much harder to accurately read the tubes without it.

No problems opening either file with Office 2003 and Windows XP Pro

I'm not the Cerner person in our BB, nor are we on Cerner Millineum, but we do have a ProVue interfaced to Cerner Classsic. The details would be different, but the two computer systems have similarities. ProVue has an ABO interpretation and a Rh interpretation, while our Cerner system has an ABORh interpretation (Group A/ Rh Neg vs. Type A Neg). What we did was have the details crossover to Cerner (i.e. results of Anti-A, Anti-B, Anti-D, Ctrl, A1 cells, B cells) and then let Cerner make the interpretation. Maybe this will help some!

We routinely rule out the "common" red cell antibody specificities with 2 homozygous cells. However, the case of the K1 antigen is one of the exceptions to the rule and is commonly ruled out with 2 heterozygous cells. Other exceptions are C and E in the presence of anti-D (2 heterozygous cells), S in the presence of anti-M (1 homozygous and 2 heterozygous cells if 2 homozygous are not available on the indate panels), and the "cold" antibodies Lewis, M, N where we use only 1 homozygous rule out. Though I've worked in labs where a single homozygous rule out was the norm, I'm not comfortable with that. As has been mentioned, it is very possible to miss something significant when only one cell is used for a rule-out. We are also gel users and I don't fear we are missing significant K, E, or other specificities due to the method. Any system will miss weak reactions from time to time -- none is perfect, but we are pleased with our experience with gel.

Seems logical to me, too. However, I have seen some cases where the poly was positive (most likely very weakly positive) and both the anti-IgG and anti-C3 were negative. If using the scenario above an incorrect conclusion might be drawn.

We use all four vials of the Alab-Q Check set for QC, though as some have said you really don't need all four to cover the necessary QC. It's just easier to set up the whole set. Maybe they did it that way to increase sales to us? Anyway, several of the US based respondents above have mentioned the IgG/C3 cards. I understood those were not yet available in the US. Are they being marketed now? I used them overseas (DiaMed) and am holding off on putting DATs on my ProVue until they're available. No one addressed how they're QCing these cards though to ensure reactivity of the anti-C3.

Can you clarify for us where to find that link? Thanks!

For those who are AABB Accredited, it would seem to me that two complete (forward and reverse) ABO types would be required for computer crossmatching. Standard 5.15.2.2 requires "two determinations of the recipient's ABO gourp as specified in Standard 5.13.1" -- that standard standard specifies testing the red cells with anti-A and anti-B and testing the serum or plasma with A1 and B cells. If you're not doing computer crossmatching, this probably wouldn't apply. However, testing the same sample has little value -- if it's drawn on the wrong patient or labelled incorrectly the patient could still get mismatched blood.

I am in the process of evaluating performing cord blood testing on gel. We perform ABO/Rh type and DAT on babies born to type O and Rh Negative mothers. Our current testing is by tube and the DAT is evaluated microscopically. I was concerned that we might end up with more positive DATs in gel, but I'm finding the opposite! Almost all of the positive DATs with weak (microscopic) reactions are coming up negative in the gel (IgG). If we convert to gel and "miss" these weak reactions, will that be significant? Do others read DATs microscopically? Are any of you doing Cord Blood testing in gel?

Ortho does now market a QC kit for the ProVue. It is called Alba Q-Check and consists of 4 whole blood samples: 1) A-neg with anti-D, 2) O-pos with anti-c, 3) B-pos antibody screen neg, 4) A2B-pos antibody screen neg. We use this for our ProVue QC only, but it could be used for your manual QC of the gel cards as well. We do not use the gel cards for manual ABO-Rh typing and we use Immucor's Cor QC for all the tube testing QC, using anti-A,B for the negative antibody screen control (gel).