6 minutes ago, Malcolm Needs said:

I agree that almost all of them are considered to be either clinically insignificant or, at best, of dubious clinical significance.  The only couple of which I may take notice, and that would depend upon the strength of the reactions, would be anti-Js^a and the anti-Do^a.

Definitely Jsa!

1 hour ago, R1R2 said:

Before switching to immediate spin crossmatch from AHG crossmatch on everyone, we would find many of those antibodies, that you mentioned, Dan87.  We did not blink when we switched to immediate spin (and then electronic (sorry Malcolm) crossmatch).   We are a large urban hospital system with many sicklers.   We knew that we would miss the occasional low freq ab that could not be detected on the screening cells.  (One note, many of our sicklers require full AHG crossmatch due to history of clinically significant antibody, but they would get IS XM if they qualified)   I have not seen one incident of a HTR due to the antibodies you mentioned.   I am sure that they occur, but rarely, and not a reason to stick with AHG XM for all, IMO.     One document that I love to review is the FDA report on fatalities due to transfusion.   It is always a good read.   https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/

I absolutely agree with you, R1R1. The value IS / EXM bring to blood bank work flow out weighs doing AHG XM on every single patient; but it would be a herculean task to change the conception of our leaderships.

On 3/13/2017 at 8:20 AM, SMILLER said:

By "full" crossmatch are we talking doing it through AHG here?  We have never done that here for all patients and I have been around since 1988.  

Does anyone really still do this?  In an era where everyone is switching to electronic crossmatches for most patients?

Scott

I would dearly love to switch to electronic, but first I have to have a BBIS. I've been wishing for one for Christmas since the '90s. Santa doesn't love me...........

 

(P.S. We do use IS whenever possible.)

16 minutes ago, AMcCord said:

Santa doesn't love me...........

WE DO!!!!!!!!!!!!!!!!!!!!!!!

Dan87 do you get reimbursed for all of this "extra work"?  

I haven't done complete XMs since the early 1990s and have worked in a variety of places, large, small, adult, pediatric.

Change is hard but it really is time to drop the "unnecessary" testing, imho! 

 

I only know of one lab that still does AHG crossmatches on every patient.  Waste of time and resources.  The resistance to change is always scary to me, after all, we're scientists.

On 3/14/2017 at 10:37 AM, Dan87 said:

While I have personally identified antibodies like Kpa, Jsa, V, Cw; our facility have identified antibodies like anti-scianna, anti-Wr(a), anti-henshaw, anti-Do(a), VS.

Scianna antibodies, Wr(a) and henshaw are the antibodies I have never heard before.

Me too!  Had one yesterday.....3 cell screen negative and one unit was incompatible.  The DAT on the unit was negative too.  Patient had an antibody to a low incidence antigen.  Would it have killed them?  Who knows, but I don't want my initials on that crossmatch tag!  Yes, we are still "dinosaurs" at my facility and do full AHG crossmatches on all orders.  Our transfusion reaction rate is VERY low!  I hope to retire before we do immediate spin and heaven forbid, electronic xm! :o)

23 minutes ago, BldBnker said:

Me too!  Had one yesterday.....3 cell screen negative and one unit was incompatible.  The DAT on the unit was negative too.  Patient had an antibody to a low incidence antigen.  Would it have killed them?  Who knows, but I don't want my initials on that crossmatch tag!  Yes, we are still "dinosaurs" at my facility and do full AHG crossmatches on all orders.  Our transfusion reaction rate is VERY low!  I hope to retire before we do immediate spin and heaven forbid, electronic xm! :o)

Oh dear!  And do you still do an RT cross-match and reverse cross-matching?

Edited March 24, 20178 yr by Malcolm Needs

No, Malcolm, we aren't!  We are prehistoric but not that prehistoric! Ha! Just a 1 tube (glass tube, by the way) enhanced with LISS (Immucor ImmuAdd) and AHG.  We also do crossmatches on the Immucor Galileo Echo. 

On 3/18/2017 at 3:25 PM, Likewine99 said:

Dan87 do you get reimbursed for all of this "extra work"?  

I haven't done complete XMs since the early 1990s and have worked in a variety of places, large, small, adult, pediatric.

Change is hard but it really is time to drop the "unnecessary" testing, imho! 

 

Likewine99, I am sorry. I donot know the answer to your question. I do agree its completely unnecessary task. When I started here, I was pushing for EXM; but seeing the resistance, I have started to advocate for IS XM at least for now. 

We discussed this on one of these threads years ago, but it is actually surprising how few transfusion reactions we have seen after switching to IS (or E) XMs.  Statistically we would have expected more.  The only transfusion reaction I have ever seen to a low incidence antibody was when the tech who did the AHG XM did not read it correctly and called it negative.  The patient had about 4 other known antibodies so we had to do AHG XMs.  After that, we added a 5th antibody.  I can never remember if that 5th one was a Co b or Cw.  I'm pretty sure she had both by the end.

On 08/04/2017 at 3:59 AM, Mabel Adams said:

I can never remember if that 5th one was a Co b or Cw.  I'm pretty sure she had both by the end.

A high titre anti-Co^b is more likely to cause a reaction than a high titre anti-C^w.