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?

 

 

 

 

 

Least incompatible.pdf

 

We do not use the term least incompatible anymore; it's kind of like being "a little pregnant".

 

The grading of your reaction does not correlate to what the clinical significance/impact to the patient will be.  If we are unable to rule out alloantibodies for a warm auto, it doesn't matter if the units appear compatible or not, we call them incompatible and have the physician sign.  We prefer they allow us the time to send it to our reference lab but they are usually too impatient.  grrrr....

 

See attachment for discussion about using least incompatible.

Edited August 30, 201410 yr by tbostock

I know, I know Terri.  We, who work in Reference Laboratories are awfully impatient!!!!!!!!!!!!!! :cries:...............but we have our uses! :lol:

haha Malcolm, I meant the physicians are impatient.  I'm sure you have the patience of a saint dealing with us crazy Blood Bankers. 

I would like to not use the term "least incompatible" but it is built into our computer system.  

 

As for 1+ being okay to give, I would give them the best blood I could with the time they allow me and explain the potential risks as best I could.  A 1+ in someone that I am pretty sure has no allo-antibodies would be a different decision than in someone who has or who I suspect could have allo-antibodies.

I agree with Terri. Those pts with autoabs I try to give Rh phenotype specific.

Least incompatible.pdf

 

We do not use the term least incompatible anymore; it's kind of like being "a little pregnant".

 

The grading of your reaction does not correlate to what the clinical significance/impact to the patient will be.  If we are unable to rule out alloantibodies for a warm auto, it doesn't matter if the units appear compatible or not, we call them incompatible and have the physician sign.  We prefer they allow us the time to send it to our reference lab but they are usually too impatient.  grrrr....

 

See attachment for discussion about using least incompatible.

Ditto re the reasoning.

 

However, we don't issue RBCs until we have completed the following:

 

If we cannot circumvent the auto antibody using other methods (which is more often than not) then we send samples to our local Red Cross Reference Lab for differential absorptions to determine if there are any underlying allo-antibodies. 

• If negative, then there is no 'clinically signficant antibody' and we crossmatch/issue RBCs Imm Spin. 
• If positive, we honor the identifiedantibody by selecting antigen negative RBCs but we still skip the extended crossmatch because we all know it's going to be positive no matter what we do.

If the Reference Lab work is inconclusive or there is no time, we issue antigen-negative RBCs if we can.  Most of our patients are known DAT Positive at the start so we perform extended typing on them if they are in a multiple transfused or building a Warm Auto situation.

 

If 'they' are too impatient to wait for us to complete our testing = As with every other situation, we issue 'Emergency Release', requiring the statement of need and requesting MD signature.  n.b. We haven't had to do this ... yet. (Did I just jinx myself?)