WisKnow

We ended up reporting it as non specific reactivity. Thank you guys!

No, he did not receive IVIG. That was the first possiblity that we looked into. But there's one thing that we noticed. The washed A, B and AB donor cells were stronger with patient's eluate than with the unwashed. I already mentioned that eluate was negative with both washed and unwashed O donor cells, also negative with unwashed A and B cells. So we will try to wash the A1 and B reagents cells and see what we'll get. We have a feeling that the reagent cells express antigens weakly and by washing may uncover more antigen binding sites.

Yes, all were performed using eluate PEG-AHG.

The PLT was A but the RBC was AB

This may sound a very interesting case. An old male patient was admitted to our hospital for elective spine surgery. His blood type is AB Rh Positive. He was requested for a unit of platelet pheresis and got transfused a day before his operation. After this, 1 PRBC was also transfused. Before the RBC unit was completely given, the floor called for possible transfusion reaction study. Post transfusion reaction was positive with poly, IgG and C3 but not with saline control. Eluate was negative with all cells tested including A1 and B cells. Pre transfusion sample was DAT negative. Since patient had anaphylactic shock, sample was sent to a reference lab for further investigation. The ref lab tested the eluate with A, B, AB and O donors. It turned out that his eluate was positive only with A, B and AB but not with O donors. Isn't this weird? Eluate was negative with cells tested including A1 and B cells but tested positive with donors: 1+ with A and B donors, 3+ with AB donors and clearly negative with O donors. Have you encountered a case like this?

I appreciate every reply. But my question really is, do you have to do all testing both with live specimen and prepared unknown samples? Does the regulation require that all tests be performed on both live and prepared samples in parallel?Thanks again.

Good day to you all! It's time for the AABB/CAP/JCAHO inspections again. Can you guys share your knowledge about competency assessment requirements? Any insights into the approach of direct observation using real specimens and prepared unknown samples for blind assessment will be highly appreciated. Do you perform all testing in parallel with direct observation and prepared unknowns? Please share your templates if you have. Thanks!

By the way, this patient received ONEG transfusion elsewhere a month ago that most likely induced his anti-c additional antibody. But from the time we got him and had identified the anti E, he's been transfused with E and c negative units. Surprisingly, the anti-c still came up weakly positive to 1+ with rr cells.

No further investigation need be done, is that what you're implying here Malcolm? Would you still care to do the DAT in this case even if the autocontrol was negative? Thank you

Hey folks! When do you consider an additional antibody to have caused a delayed transfusion reaction? The patient had anti-E last month and just developed anti-c. Since the autocontrol was negative, DAT and elution were not performed. Patient's sample was neither looking hemolytic nor icteric. This could be a DSTR but not DHTR. For this case, do you still retrieve the previously transfused units' segments to antigen type them and perform the rest of the delayed transfusion investigation?

Hi there! Is there any reason why a sample will only be positive with poly DAT but not with monospecific IgG and C3? Thanks

Thank you Heather.

Hey guys! Would you kindly share here how your competency assessment goes. In a teaching hospital, what should be essentially included in the competency assessment as required by CAP, AABB, FDA, etc?

How long can the PEG xmatch tubes sit after washing before the anti-IgG should be added? Sometimes you can't just get back to your tubes right away. Some say 30 minutes, others say add the IgG immediately after washing. Any reference on this?

I'm sure that most of you here are AABB Assessors. I want to apply as an assessor for Transfusion and IRL. Is it difficult to meet the requirements? One of the things that really is not so clear to me is this: "Must meet the requirements of a "supervisor" in the current edition of Standards for Immunohematology Reference Laboratories". Can anyone shed light on this? Any important advice? Thank you!

Thanks Malcolm! That was exactly what we were doing in my previous hospital but the hospital I am in now has an SOP in place that dictates we should be the one to do the inoculation process and submit the inoculated bottles and an aliquot for gram stain to Micro. I am not sure if this is a requirement imposed by the CAP, AABB or FDA because this hospital closely adheres to the accrediting and regulatory agencies' requirements. If this is not, how do the other hospitals do it? I am interested to know other hospitals' SOP on this.

Hello there! Should culture on units sent back to the blood bank post transfusion reaction be performed by a blood bank tech or be sent to Microbiology since Microbiology staff are trained better as far as blood culture aseptic technique is concerned?

Thanks for this discussion! Yeah, I have also heard some people teach that only those with partial D can make an anti-D, not the weak D. Which weak D types have been documented could make anti-D just as Anna said?