MERRYPATH

I am guessing that the rate mom was producing an early anti c, in respose to a c pos stimulation from baby, was slow enough that it was hemolyzed before it was detectable. When the baby was out of the loop the Anti c was no longer taken up by the baby cells and the mom was increasing the speed of production. I would guess that the anti c that reached the baby was all hemolyzed and that is why the DAT was neg. Maybe the question would be, is the baby nursing, how long does the mom produce colostrum that might contain anti c. Is it hours or days etc. if this is not an issue the baby can no longer get anti c passively so it should be fine with c untested. Our protocol is to do a BTYSC (baby type and screen that includes baby screen, baby front type, baby DAT) the only way I can see needing to give c neg is if the crossmatching is done with mothers blood to avoid unnecessary draws on baby, we would do this if we have an unident aby on mom. Now I am confusing myself. PatO at 60!!!

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

We scratch out the US license number when we attach a new label...our component label is a computer generated half label applied over the bottom half of the original product label. That half label has our Processed By: information with our FDA regustration number. We do not scratch out the original FDA Registration Number for the original supplier just the License number. In days gone by we had a separate sticket for each part as we relabelled components.

In the last 15 years we have had several people retire from our BB and go to work at the ARC reference lab part time. We are our own hospital systems reference lab so we are accustomed to very complicated aby pictures WITH the added pressure of completing our reference work while operating the usual BB duties. I think also that the older techs have a greater tolerance for misery and don't tend to quit if the pressure is to high. Our local ARC reference lab seems happy to get us even if part time. Many of us tend to stay on in the lab as well...I am soon to turn 60 and have no plans to stop, I like blood banking. The usual reason people have retired is the pressure to do venipuncture and cross-train(or rather to work other areas with insufficient training). As challenging as our Blood Bank and reference work is the venipucture here is also only for those with the "right stuff'. It is just not fun to have to do several hours of venipucture on very difficult sticks after 30 years of not having that as part of your duties. I would bet reference jobs in blood banking would welcome your experience and discipline...blood bankers show up.

In the last 15 years we have had several people retire from our BB and go to work at the ARC reference lab part time. We are our own hospital systems reference lab so we are accustomed to very complicated aby pictures WITH the added pressure of completing our reference work while operating the usual BB duties. I think also that the older techs have a greater tolerance for misery and don't tend to quit if the pressure is to high. Our local ARC reference lab seems happy to get us even if part time. Many of us tend to stay on in the lab as well...I am soon to turn 60 and have no plans to stop, I like blood banking. The usual reason people have retired is the pressure to do venipuncture and cross-train(or rather to work other areas with insufficient training). As challenging as our Blood Bank and reference work is the venipucture here is also only for those with the "right stuff'. It is just not fun to have to do several hours of venipucture on very difficult sticks after 30 years of not having that as part of your duties. I would bet reference jobs in blood banking would welcome your experience and discipline...blood bankers show up.

In the last 15 years we have had several people retire from our BB and go to work at the ARC reference lab part time. We are our own hospital systems reference lab so we are accustomed to very complicated aby pictures WITH the added pressure of completing our reference work while operating the usual BB duties. I think also that the older techs have a greater tolerance for misery and don't tend to quit if the pressure is to high. Our local ARC reference lab seems happy to get us even if part time. Many of us tend to stay on in the lab as well...I am soon to turn 60 and have no plans to stop, I like blood banking. The usual reason people have retired is the pressure to do venipuncture and cross-train(or rather to work other areas with insufficient training). As challenging as our Blood Bank and reference work is the venipucture here is also only for those with the "right stuff'. It is just not fun to have to do several hours of venipucture on very difficult sticks after 30 years of not having that as part of your duties. I would bet reference jobs in blood banking would welcome your experience and discipline...blood bankers show up.

I was thinking more about the need for modern RBCs to be at risk if only out 30 minutes...or less. I wonder if the risk is so much less today that the 30 minute rule is only serving to waste a precious commodity. I agree that if the requirement is to keep the units under 10 degrees 30 minutes is the limit but if the actual danger zone is an entirely different temp range then the practice of the 30 minute rule is as obsolete as other practices we squirmed when we gave up...not looking micro is still hard for me. I think the 30 minute rule at least needs to be proven as necessary considering todays cleaner units. I think that using old practices as iron clad leads to stinkin' thinkin' as we know that there are contaminants that thrive at refrigerator temps as well as tropical temps.

I was thinking more about the need for modern RBCs to be at risk if only out 30 minutes...or less. I wonder if the risk is so much less today that the 30 minute rule is only serving to waste a precious commodity. I agree that if the requirement is to keep the units under 10 degrees 30 minutes is the limit but if the actual danger zone is an entirely different temp range then the practice of the 30 minute rule is as obsolete as other practices we squirmed when we gave up...not looking micro is still hard for me. I think the 30 minute rule at least needs to be proven as necessary considering todays cleaner units. I think that using old practices as iron clad leads to stinkin' thinkin' as we know that there are contaminants that thrive at refrigerator temps as well as tropical temps.

Isn't the very act of doing a panel also doing a kind of QC of the panel? Cells being positive or negative in a predictable pattern. When we get no reactivity or unknown reactivity on a panel we run a second panel to confirm the lack of a pattern or to find a pattern. With an allo we may confirm with an antigen typing. We are also confirming with xm of antigen negative units. The whole process of an antibody work up is check and double check.

I think that the 30 minute rule may be out of date for 2015...at least it seems to have been in 2013. I want to not toss units based on old practices. http://www.ncbi.nlm.nih.gov/pubmed/22845177

Isn't the very act of doing a panel also doing a kind of QC of the panel? Cells being positive or negative in a predictable pattern. When we get no reactivity or unknown reactivity on a panel we run a second panel to confirm the lack of a pattern or to find a pattern. With an allo we may confirm with an antigen typing. We are also confirming with xm of antigen negative units. The whole process of an antibody work up is check and double check.

AFP=APHERESIS FROZEN PLASMA

We run a BTYSC...a baby type and screen. It includes a type, and we do not do the backtype for babies, a screen, and a tube DAT. If we get a pos DAT we look at the mothers TYSC. If the pos aby screen or DAT can be justified logically by the mothers results we do not continue. If we do not have a TYSC for the mother we request a draw or research her results at another instutution. We will do the ABID on the mother if at all possible to save the baby any draws. In the rare occasion there is no way to compare the mothers type and current screen then we might request another draw of the baby and or pursue the baby workup. The most complicated workup I remember was a baby with multiple antibodies and a positive DAT. One of the legends of Blood Banking, Jane Swanson, happened to be visiting and I listed off the antibodies found and she immediately rattled off the name of the mother...whose name was not the same last name as the baby...it had been over 10 years of retirement and her mental index and boundless knowledge is sharp as the day she left. So even in her 80s she can still problem solve for Blood Bank. So ultimately if we can solve the problem we do not continue with the workup.
 
I forgot to mention that most BTYSC are done for the babies in the NICU or for babies with moms who are RH neg. Otherwise we may have the cord blood sent to the BB with no tests ordered...just in case.
 
We are also giving all babies type O or O neg fresh(less than 7 days) Irradiated and, if there is/or mom has an allo antibody, antigen neg. We try to keep babies on the same RBC unit, so to reduce exposure to multiple donors that might go over 7 days, as long as they are not using over 30 mls per transfusion, if they are transfusing over 30 mls we use fresh RBCs(<7days). The BTYSC is good til they are >4 months. Also we continue Irradiated RBCs until 6 months. In the rare instance there is a non allo antibody that requires xm we can xm with the mothers plasma on a current xm and we continue as long as the DAT is pos. Our NICU has a fulltime lab staffed with a BB trained CLS. 

We run a BTYSC...a baby type and screen. It includes a type, and we do not do the backtype for babies, a screen, and a tube DAT. If we get a pos DAT we look at the mothers TYSC. If the pos aby screen or DAT can be justified logically by the mothers results we do not continue. If we do not have a TYSC for the mother we request a draw or research her results at another instutution. We will do the ABID on the mother if at all possible to save the baby any draws. In the rare occasion there is no way to compare the mothers type and current screen then we might request another draw of the baby and or pursue the baby workup. The most complicated workup I remember was a baby with multiple antibodies and a positive DAT. One of the legends of Blood Banking, Jane Swanson, happened to be visiting and I listed off the antibodies found and she immediately rattled off the name of the mother...whose name was not the same last name as the baby...it had been over 10 years of retirement and her mental index and boundless knowledge is sharp as the day she left. So even in her 80s she can still problem solve for Blood Bank. So ultimately if we can solve the problem we do not continue with the workup.
 
I forgot to mention that most BTYSC are done for the babies in the NICU or for babies with moms who are RH neg. Otherwise we may have the cord blood sent to the BB with no tests ordered...just in case.
 
We are also giving all babies type O or O neg fresh(less than 7 days) Irradiated and, if there is/or mom has an allo antibody, antigen neg. We try to keep babies on the same RBC unit, so to reduce exposure to multiple donors that might go over 7 days, as long as they are not using over 30 mls per transfusion, if they are transfusing over 30 mls we use fresh RBCs(<7days). The BTYSC is good til they are >4 months. Also we continue Irradiated RBCs until 6 months. In the rare instance there is a non allo antibody that requires xm we can xm with the mothers plasma on a current xm and we continue as long as the DAT is pos. Our NICU has a fulltime lab staffed with a BB trained CLS. 

We run a BTYSC...a baby type and screen. It includes a type, and we do not do the backtype for babies, a screen, and a tube DAT. If we get a pos DAT we look at the mothers TYSC. If the pos aby screen or DAT can be justified logically by the mothers results we do not continue. If we do not have a TYSC for the mother we request a draw or research her results at another instutution. We will do the ABID on the mother if at all possible to save the baby any draws. In the rare occasion there is no way to compare the mothers type and current screen then we might request another draw of the baby and or pursue the baby workup. The most complicated workup I remember was a baby with multiple antibodies and a positive DAT. One of the legends of Blood Banking, Jane Swanson, happened to be visiting and I listed off the antibodies found and she immediately rattled off the name of the mother...whose name was not the same last name as the baby...it had been over 10 years of retirement and her mental index and boundless knowledge is sharp as the day she left. So even in her 80s she can still problem solve for Blood Bank. So ultimately if we can solve the problem we do not continue with the workup.
 
I forgot to mention that most BTYSC are done for the babies in the NICU or for babies with moms who are RH neg. Otherwise we may have the cord blood sent to the BB with no tests ordered...just in case.
 
We are also giving all babies type O or O neg fresh(less than 7 days) Irradiated and, if there is/or mom has an allo antibody, antigen neg. We try to keep babies on the same RBC unit, so to reduce exposure to multiple donors that might go over 7 days, as long as they are not using over 30 mls per transfusion, if they are transfusing over 30 mls we use fresh RBCs(<7days). The BTYSC is good til they are >4 months. Also we continue Irradiated RBCs until 6 months. In the rare instance there is a non allo antibody that requires xm we can xm with the mothers plasma on a current xm and we continue as long as the DAT is pos. Our NICU has a fulltime lab staffed with a BB trained CLS. 

I speak as a Blood Banker on evening shift. When we have a STAT type and screen and we have a positive screen, either previously pos or a new pos, we have a worksheet Antibody Screen Positive-Evaluation Form. The form asks a number of questions to determine if a new workup is required. We notify the nurse of the Critical Result and document. We also answer if there is a STAT RBC order present...Were emergency units offered to the PCU...Was the Blood Bank Physician notified...These questions are intended to involve the BB Doc at the time the patients team is deciding if they need to transfuse in an emergency. As often as they are afraid to transfuse with the presence of an antibody they are also without fear to transfuse if the are thinking emergency in their minds. It can be foolish either way. We get the BB physician involved to be the go between...with two blood bankers on evening shift we have to stay on task and get as much information as possible advanced as quickly as possible in the work up so the BB Doc needs to step in to evaluate what is happening.  In the past we did not necessarily involve the BB Doc and our bigger problem was that the patients team would not communicate an emergency need once we said "antibody" They might wait when they needed to  transfuse. We don't often have a true exsanguinating emergency with no prior history. Our emergencies will happen more commonly with ORs gone bad or sudden changes of status on the floors or a patient coming back in via the ER. When we do have a Code Red called in ER we send 2 O negs with our Emergency Release. The beginning of a Massive Transfusion Protocol with an antibody patient may begin with 2 uncrossmatched units if we do not know the name of the patient. Once we know the name we we can alert the team to an antibody history. Alert the BB Doc. Start looking for a tube to begin a workup with. I have gathered antigen negative units...we often have a variety of antigen negative units in inventory..to meet the emergency needs of a previous anti E with an Anti Jka for example. I can pull units that are set up on other patients as well. Then I have the option of untested RH negative units to make a best chance at E negative. We copy the faces of the units and pull a couple segments for later typing and crossmatching. I have had the local ARC and our own Blood Bank inventory entirely typed over a long night. You do the best with what we have both in personnel and blood supply. One night a man with 5 antibodys and compatible with less than 1% of the populations got close, closer, closest units available with the thought of saving the 7 units negative for his antibodies til the end of the procedure...when they were least likely to be bled out. He survived and made 2 more antibodies. 

I speak as a Blood Banker on evening shift. When we have a STAT type and screen and we have a positive screen, either previously pos or a new pos, we have a worksheet Antibody Screen Positive-Evaluation Form. The form asks a number of questions to determine if a new workup is required. We notify the nurse of the Critical Result and document. We also answer if there is a STAT RBC order present...Were emergency units offered to the PCU...Was the Blood Bank Physician notified...These questions are intended to involve the BB Doc at the time the patients team is deciding if they need to transfuse in an emergency. As often as they are afraid to transfuse with the presence of an antibody they are also without fear to transfuse if the are thinking emergency in their minds. It can be foolish either way. We get the BB physician involved to be the go between...with two blood bankers on evening shift we have to stay on task and get as much information as possible advanced as quickly as possible in the work up so the BB Doc needs to step in to evaluate what is happening.  In the past we did not necessarily involve the BB Doc and our bigger problem was that the patients team would not communicate an emergency need once we said "antibody" They might wait when they needed to  transfuse. We don't often have a true exsanguinating emergency with no prior history. Our emergencies will happen more commonly with ORs gone bad or sudden changes of status on the floors or a patient coming back in via the ER. When we do have a Code Red called in ER we send 2 O negs with our Emergency Release. The beginning of a Massive Transfusion Protocol with an antibody patient may begin with 2 uncrossmatched units if we do not know the name of the patient. Once we know the name we we can alert the team to an antibody history. Alert the BB Doc. Start looking for a tube to begin a workup with. I have gathered antigen negative units...we often have a variety of antigen negative units in inventory..to meet the emergency needs of a previous anti E with an Anti Jka for example. I can pull units that are set up on other patients as well. Then I have the option of untested RH negative units to make a best chance at E negative. We copy the faces of the units and pull a couple segments for later typing and crossmatching. I have had the local ARC and our own Blood Bank inventory entirely typed over a long night. You do the best with what we have both in personnel and blood supply. One night a man with 5 antibodys and compatible with less than 1% of the populations got close, closer, closest units available with the thought of saving the 7 units negative for his antibodies til the end of the procedure...when they were least likely to be bled out. He survived and made 2 more antibodies.