1. Mayhem – Get More Information
Call the floor/or computer search of patient record
Pregnancy Hx? 4 children
Transfusion Hx? Never
Other Hospitals? None
Current Diagnosis Mitral Valve Relapse
Recent Drug History Vitamins, Lipitor, Aspirin
11/30/2018

2. Mayhem– Crossmatch for Compatibility
Take Group A units and XM by IS and AHG
Advantage:
Find units for procedure scheduled
If units are incompatible, then the incompatible crossmatch may aid in the antibody definition/characteristics
Disadvantage:
No clear answer to reactivity detected in the panel testing
One may not find compatible units, and this may have wasted tech time
11/30/2018

3. Mayhem– Crossmatch for Compatibility
Example
DIN IS
Echo
Interpretation
Unit 1
Compatible
Unit 2 1+
Incompatible
Unit 3
Unit 4
Unit 5
Unit 6
11/30/2018

4. Mayhem – XM and Call Unidentified
Calling an antibody unidentified
Advantage
All common alloantibodies are excluded on non-reactive cells
The AHG-crossmatch may be used as an indicator of transfusion safety
Disadvantage
That unidentified will stay in the patient’s record going forward
Always receive AHG crossmatch
Delay in provision of blood
11/30/2018

5. Capture-R® Ready-ID ® Extend I (D-Positive Panel) *= presumptiveRh
Kell
Duffy
Kidd
Lewis P
MNS Lu Xg
Cell D C c E e f* V Cw K k
Kpa
Kpb
J sa
J sb
Fya
Fyb
Jka
Jkb
Lea
Leb P1 M N S s
Lua
Lub
Xga
Echo 1 + 1+ 2 3 4 5 6 7 8 9 10 11 12 13 14 w
Pos Cntrl 4+
Neg Cntrl
Run Another Echo Panel
11/30/2018

6. Capture-R® Ready-ID ® *= presumptiveRh
Kell
Duffy
Kidd
Lewis P
MNS Lu Xg
Cell D C c E e f* V Cw K k
Kpa
Kpb
J sa
J sb
Fya
Fyb
Jka
Jkb
Lea
Leb P1 M N S s
Lua
Lub
Xga
Echo 1 + 2 3 4 1+ 5 2+ 6 7 8 9 10 11 12 13 14
Pos Cntrl 4+
Neg Cntrl
Re-evaluate the first panel after the second panel – Is pattern there?
11/30/2018

7. Mayhem – Panoscreen® *= presumptiveRh
Kell
Duffy
Kidd
Lewis P
MNS Lu Xg
Cell D C c E e f* V Cw K k
Kpa
Kpb
Jsa
Jsb
Fya
Fyb
Jka
Jkb
Lea
Leb P1 M N S s
Lua
Lub
Xga IS
LISS 1 + W 2 3
DAT is negative
Anti-M pattern suggested in the Echo panels verified in tube method
11/30/2018

8. Mayhem – Take Away Points
With weak reactions with Solid Phase or Manual Testing
Rule out, but look for a pattern
Testing options
The history indicated that this would be a naturally occurring antibody since the patient had no history of transfusion
Crossmatching and interpretations when all common alloantibodies
Advantages
Disadvantages
11/30/2018

9. Mayhem – Take Away Points (cont.)
Trust your process
Look to rule out the presence of clinically significant alloantibodies (per Standards)
Use the clues in the pattern of positives
History Naturally occurring since no transfusion
XM results IgM and IgG detected
Dosage Antibody demonstrates variability
Circle back to the initial ABS and panels to verify that the specificity is verified.
11/30/2018

10. One Night in the Blood Bank……
Sad But True Trilogy
11/30/2018

11. Trilogy
On Monday night in the Fall (after football game, of course), a sample arrive at the Blood Bank on a 40-year-old male
CBC Chemistries
WBC 16 x 103/uL Billi 2.0
RBC 2.8 x 106/uL Creat
Plt 110 x103/uL K+ 5.0
Hgb 6 g/dL Cl 105
Hct 18% Na 145
Gluc 100
LDH 200
BUN
11/30/2018

12. Trilogy Patient history Many years of a Kidney disorder
Anemia secondary to kidney disorder
Last transfusion was two weeks earlier
History of A Positive and ABS Negative. -A -B -D
A1 Cell
B Cell
Interpretation 4+
A, D Positive
Screen Cell
Results
Interpretation I 4+
Positive II
11/30/2018

13. Trilogy – Next Steps Direct Antiglobulin Test (DAT) DAT and eluate
Yes, since the patient was transfused two weeks prior this will investigate the potential immune response to transfusion
DAT and eluate
Yes, DAT is helpful but only test the eluate if the DAT is positive
DAT and antibody panel
Yes, DAT will investigate the IgG coating the cells and antibody panel will investigate the antibody detected
DAT, antibody panel and autocontrol
Yes, best answer
Investigate reaction on cells (DAT and autocontrol) and serum with panel testing.
11/30/2018

14. Trilogy – DAT Testing DAT Testing IgG DAT
Anti-Complement (Anti-C3b,d) DAT
Interpretation
IgG coating the cells but not complement
Mixed-field indicates patient and transfused donor cells present consistent with transfusion reaction
IgG DAT
DAT Control
IgG DAT Interp.
Anti-C3b,d
Anti-C3bd Control
C3b,d DAT Interp.
Patient
2+mf
Positive
Negative
11/30/2018

15. Trilogy – Eluate TestingRh
Kell
Duffy
Kidd
MNS P
Lewis
Cell D C c E e f V Cw K k
Fya
Fyb
Jka
Jkb M N S s P1
Lea
Leb
AHG 1 + 2 3 3+ 4 5 6 7 8 9 10
Last Wash Pooled Cell
11/30/2018

16. Trilogy – Panel and AutocontrolRh
Kell
Duffy
Kidd
MNS P
Lewis
Cell D C c E e f V Cw K k
Fya
Fyb
Jka
Jkb M N S s P1
Lea
Leb
AHG 1 + 2 3 1+ 4 5 2+ 6 7 8 9 10
Autocontrol
2+ mf
11/30/2018

17. Trilogy – Panel and AutocontrolRh
Kell
Duffy
Kidd
MNS P
Lewis
Cell D C c E e f V Cw K k
Fya
Fyb
Jka
Jkb M N S s P1
Lea
Leb
AHG 1 + 2 3 1+ 4 5 2+ 6 7 8 9 10
Autocontrol
2+ mf
11/30/2018

18. Trilogy – Selected CellsRh
Kell
Duffy
Kidd
MNS P
Lewis
Cell D C c E e f V Cw K k
Fya
Fyb
Jka
Jkb M N S s P1
Lea
Leb
AHG 1 + 1+ 2 2+ 8
Antibodies are proven with 3+3 rule
3 E+Jk(b-)
3 E-Jk(b+)
3 E-Jk(b-) and all other allos are excluded with non-reactive cells
Mixed-field in autocontrol and DAT correlate
Consistent with transfusion reaction
11/30/2018

19. Trilogy – Provision of Blood
ABO/Rh identical fully antigen matched
ABO/Rh appropriate fully antigen matched
The patient was transfused 2 weeks ago
Cannot verify full phenotype without additional testing
ABO/Rh identical E-Jk(b-)
ABO/Rh appropriate E-Jk(b-)
Both are acceptable, but ABO/Rh appropriate is the only requirement for provision of blood.
E-Jk(b-) units are required.
This patient should not be transfused
The patient’s testing indicates that transfusion would be helpful.
11/30/2018

20. Trilogy – Screen for Units?
Screen units for E antigen and then the E- units for Jk(b-)
E - 71% 7 of 10 units
Jk(b-) 26% 2 of 7 units
Screen units for the Jkb antigen and then the Jk(b-) for E-
Jk(b-) 26% 2 of 10 units
E 71% <1 of 2 units
Call the donor center for E-Jk(b-) units
This is the most efficient
.71 x .26 = 18.5% in population
Suggest anything less than 25%-50% call and request matched units
11/30/2018

21. Trilogy – What happened?
Summary
Finalized as delayed transfusion reaction stimulated by the transfusion two weeks earlier
Anti-E in eluate and serum
Anti-Jkb in serum
Proactive measures
A full molecular genotype was completed
Physician was made aware of potential delays in provision of blood for this patient due immune response
11/30/2018

22. Story Summary
We have used stories and shared experiences to discuss problem solving for
Blood Types
Massive Blood Transfusions
Problem solving instrument results
Antibody Identification
11/30/2018

23. Story Summary
Identify Options for responses to case study scenarios presented
Apply deduction an logic to resolve a case study from the Blood Bank
Review and respond to the case study material for serologic trouble shooting and provision of blood
Blood
Bank
Stories of Glory
11/30/2018

24. Closing – Follow Up Questions?
11/30/2018