Tutorial for Transfusion Medicine Residents Regulatory Processes and the Blood Service.
Handouts Program... · 2020-06-15 · offering convenient blood donation opportunities and sharing...
Transcript of Handouts Program... · 2020-06-15 · offering convenient blood donation opportunities and sharing...
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Continuing Education
• PACE, Florida and California DHS
• 1.0 Contact Hours
• Each attendee must register to receive CE at:
https://www.surveymonkey.com/r/ImmunohematologyCaseStudies
• Registration deadline is July 3, 2020
• Certificates will be sent via email only to those who have registered July 10, 2020
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• Course content is for information and illustration purposes only. Immucor makes no representation or warranties about the accuracy or reliability of the information presented, and this information is not to be used for clinical or maintenance evaluations.
• The opinions contained in this presentation are those of the presenter and do not necessarily reflect those of Immucor.
Cami Melland MLS(ASCP)SBB
Immunohematology Reference Lab Manager
Q4 2019
Capture R to the Rescue!
Vitalant exists to help people realize their life-transforming potential by offering convenient blood donation opportunities and sharing our expertise in transfusion medicine. Founded in 1943, Vitalant is one of the nation’s oldest and largest nonprofit transfusion medicine organizations. We comprise a network of nearly a dozen community blood centers, each with its own rich history and legacy. Vitalant is an internationally known and respected leader that continues to push the boundaries to advance the experience, practice and application of transfusion medicine.
https://vitalant.org/
Immunohematology Reference Laboratories (IRL)
http://laboratories.vitalant.org/
• 15 staff members
• Provides services 24/7 for Colorado, Wyoming and South Dakota hospitals primarily
• Completes over 5500 patient workups, sends approximately 750 special platelets and 5000 antigen negative RBCs each year
Denver IRL
Patient
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Pre-transfusion testing for hip surgery on a 77 year old female reveals pan-
reactivity in gel. A cold screen provided by the facility was negative. The
sample was sent to the Denver IRL for testing. The patient had a history of a
warm autoantibody with no underlying alloantibodies 8 years prior.
Initial Testing
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• Weak, mixed field-like, refractile agglutination
exhibited with 60% of the red cells tested using
LISS enhancement at the AHG phase.
• The autocontrol was NOT positive indicating
that the previously identified warm autoantibody
is no longer showing.
• What’s next?
Anti-Sda Investigation
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• Weak, mixed field-like, refractile
reactivity at AHG is an unusual finding
and can often can be attributed to the
presence of anti-Sda.
• Anti-Sda is directed against an antigen
found in tissues, body fluids and on red
cells of more than 91% of adults.
• The antibody has been shown to have
little clinical significance.
• Patients with anti-Sda do not require
Sd(a-) blood for transfusion. Often
present with a cold autoantibody and/or
during pregnancy.
Urine Preparation
https://en.wikipedia.org/wiki/Dialysis_(biochemistry)17
•Urine neutralization has been shown to
neutralize anti-Sda.
•The AABB Technical Manual provides
instruction on how to prepare the urine.
•Pool urine from at least 6 individuals of known
Sda type.
•Boil it for 10 min and then cool.
•Dialyze it against phosphate buffered saline
(PBS) at 4C for 48 hours.
•Centrifuge and store at -20C.
Urine Neutralization
• Mix equal volumes of thawed urine and
patient plasma.
• Prepare a control tube containing equal
volumes of patient plasma with PBS.
• Incubate at room temp for 30 min.
• Test the control and urine plasma against
red cells.
• If the control is positive and the urine
plasma is negative anti-Sda was
neutralized.
• Red Cell Alloantibodies cannot be
ruled out using neutralized plasma!
Too dilute.
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Urine Neutralization Results
• What do these results indicate?
• Partial neutralization
• Presence of anti-Sda and another antibody??
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Weak Anti-Sda
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• Anti-Sda exists at differing strengths:
• Weak: Alloantibodies can be ruled
out with PEG and/or LISS testing
with reagent red cells.
• ABO group compatible units can be
provided for transfusion. The
crossmatch results may or may not
be compatible.
Strong Anti-Sda
• Strong: Alloantibodies cannot be ruled
out using PEG and/or LISS
enhancement
• Patient phenotype obtained if possible
• Phenotypically matched, antigen typed
red cells provided for transfusion
• Crossmatch will be reported as incompatible
• If the patient has been transfused
recently, molecular testing suggested
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Manual Capture R
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• Solid phase added to the Denver
Immunohematology Reference Lab (IRL)
tool box in 2016
• 62% of clients used solid phase testing and
wanted the IRL to be able to replicate
reactivity
• Long expiration dates
• Ability to create your own monolayer with
any red cells
• Add saline and red cells to well
• Spin and wash-VOILA!
• Test
• Add LISS and patient plasma
• Incubate at 37C and then wash
• Add indicator cells and spin
Troubles Detected Using Tube Methodology
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• Cold autoantibodies (IgM) carrying
through to the antiglobulin (AHG) phase
of testing
• Antibodies previously known an “High-
Titer Low Avidity” (HTLA-like) reacting
with nearly 100% of cells at AHG
• Anti-Sda
• Antibodies to reagent red cell diluent
• These examples are generally not
clinically significant and not picked up by
manual solid phase
Capture R to the Rescue!
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The End
• Now we can rest easy knowing that the
reactivity is not due to an underlying
alloantibody.
• A full patient phenotype is not required.
• Antigen matched units is not required for
transfusion.
• Money, time and special red cell
products saved.
25
References
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Technical Manual. Current ed. Bethesda, MD: AABB, 2011: 433, 477
Issitt PD, Issitt CH. Applied Blood Group Serology. 4th ed. Montgomery Scientific Publications Durham, NC. 1998: 814-818.
Mollison PL. Blood Transfusion in Clinical Medicine. 8th ed. Oxford: Blackwell Scientific. 1987: 265.
Harmening, D. 2012. Modern Blood Banking and Transfusion Practices. 6 th Edition. Philadelphia: F.A. Davis Company
Immunohematology Methods and Procedures. 1st Edition, 1993. Rockville: American Red Cross National Reference Laboratory.
Issitt, Peter D. and Anstee, David J. 1998. Applied Blood Group Serology. Fourth Edition. Durham: Montgomery Scientific Publications.
Judd, JW. 2008. Methods in Immunohematology. 3rd Edition.
Wallace ME, Green TS, eds. Selection of procedures for problem solving. Arlington, VA: AABB, 1983: 120-1.
Questions?
27
vitalant.org
Thank you
Anti-Jka in Capture
Louanne Shannon BS, MLS, MT(ASCP)SBBTransfusion Service Section Chief
CASE
• Patient History:
• Anti-D
• Cold antibody of unknown specificity
• Ready Screen
• Cells I and II positive
• Cell III negative
• Technologist :
• New Generalist on duty in Blood Bank
Previous Anti-D & Cold Antibody
Ready ID on the ECHO
Rule Outs Needed
When the tech could not rule out on the ECHO:
• Anti-Fya,
• Anti-Jka ,or
• Anti-Lea
A tube panel was performed using PeG.
Negative Tube Panel
Positive ECHO Crossmatches
New Technologist
Suspected antibody towards stroma
Crossmatched with PeG
= Crossmatches compatible with PeG
Ready ID on the ECHO
Supervisory Review
Suspect:
Anti-Jka on ECHO ReadyID Panel
Ruled Out:
Anti- Fya : patient sample (Fya+)
Anti-Lea: tube panel
Confirmed:
Anti- Jka : Patient sample (Jka-)
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Continuing Education
• PACE, Florida and California DHS
• 1.0 Contact Hours
• Each attendee must register to receive CE at:
https://www.surveymonkey.com/r/ImmunohematologyCaseStudies
• Registration deadline is July 3, 2020
• Certificates will be sent via email only to those who have registered July 10, 2020
39All Content © Immucor
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Thank you!