Mosaics

Hi, everybody. I have generalist medical laboratory scientist training, but for over 2 years I have been specializing in Blood Bank. Although I like Blood Bank, I have often have an "itch" to switch over to Microbiology. Can you offer tips to "wow" a prospective interviewer so I can specialize in something new? My previous experience in Microbiology was as a student 4 years ago. Thanks!

What are your procedures particularly for an intended transplant? Do you ask if it is a solid organ or bone marrow transplant? Or do you give irradiated blood products to all patients with a history of cancer? Thanks!

So the other day, I had an interesting question from a neonatologist. Her question (and I am summarizing, not directly quoting) was in regards to a microscopically positive DAT and if there is less antibody present. Her concern was how aggressively she needed to treat the baby, because the baby was jaundiced at less than 12 hours. Mom was O pos, baby A pos, and had microscopically positive DAT. So there was some ABO incompatibility I wasn't completely sure how to explain this, but my co-worker said there was a smaller fetal bleed. Today, I was reading a text that stated "the strength of the reaction does not correlate well with the severity of the HDN." The text was Modern Blood Banking & Transfusion Practices, 5th edition, by Denise Harmening, page 389. So in your experience, does the strength of a reaction correlate with the severity of a fetomaternal hemorrhage? How should I explain this in the future? Thanks y'all.

The population of the USA is much greater than the UK, so that is an educated guess as to why the population of HIV is greater than the US.

Does anybody know of websites (other than Immucor or American Red Cross's SUCCESS) that have interactive case studies for working up antibodies? The inner nerd in me is itching to antibody puzzles frequently.

As far as I know she hasn't recently been transfused. She needs to receive O negative blood if necessary.

We do not have monoclonal anti-A,B where I work.

Nope. I perused them carefully and nowhere did it say that. Do yours say that?

We use monoclonal reagents in gel. Then it was tested in tube with monoclonal anti-A and was microscopically positive. Our supervisor suggested testing it with a type B patient (possesses anti-A). Do you use this method? This method didn't seem to change the results, as it was still microscopically positive even after incubating for 10-15 minutes at room temperature.

ANTI-A ANTI-B ANTI-D RH CONTROL A1 CELLS B CELLS 0 0 0 0 0 4+ Today, we had these results on a labor & delivery patient with history of type A negative, weakly reacting with anti-A. I am just curious as to your facility's procedures to resolve this discrepancy in comparison. Thanks!

For instance, would you consider a reading of 1+ (in tube, anti-IgG) least incompatible, provided no other units were found to be weakly positive or negative, or would you consider it incompatible and keep looking?

New question: Do you see rouleaux frequently in patients that are type AB? My trainer said she sees this often.

Yep. I have had previous anti-E's that would react "as expected" in gel, but this is the first antibody where all cells were negative on the original panel.

You assume correctly. We use gel. Very interesting that you have seen similar results.

I was advised by my supervisor to run cells 1, 3 and 6. I will keep in mind to do a full ficin panel.

We used gel for antibody screen and panel. Then, used cells 1 (negative for E), 3 (homozygous for E) and 6 (heterozygous for E). All were in-dated.

Yep and cells 3 and 6 were 3+ positive.

Note: Cell 3 had homozygous expression for anti-E and cell 6 was heterozygous for anti-E. Have you had negative reactions show up during a panel for something you suspected was anti-E?

I have 9 months of recent experience in Blood Bank. I am more confident now than when I started, but think I have a way to go. At your facility, are questions well received from new employees?

I had one antibody panel that I did that I suspected was an anti-E. It came up 2+ in gel during antibody screen, but negative on cells 3 and 6. What is your hospital's procedure for following up on testing? Reason I ask is that it didn't come up as expected, and I got criticized by the supervisor, and it is bothering me. As my co-workers and boss say, "antibodies don't read the textbook."

Just out of curiosity.

What is your facility's procedure for crossmatching patients with a history of anti-Bg? For example, do you use gel crossmatch or another method? Our location doesn't have antisera for antigen typing.

I asked the supervisor if a DAT needed to be done. She said no.

Ding, ding, ding! He had a transplant with AB cord blood

Patient had history of multiple typings as a B positive. We use monoclonal reagents. Patient is Hematology-Oncology patient.