() UNION HOSPITAL BLOOD BANK 500 LYNNFIELD ST. LYNN, MA 01904 POSITIVE DAT INVESTIGATION WORKSHEET SOP 7 For complete workup on potential transfusion candidates, post-transfusion patients, when hemolysis is present, or when a complete investigation is requested. Patient Name: MR# Diagnosis: () SALEM HOSPITAL BLOOD BANK 81 HIGHLAND AVE SALEM, MA 01970 Reviewed: STEP 1: INITIAL WORKUP SERUM / PLASMA COLOR: DIRECT ANTIGLOBULIN TESTS I.S. PS CTL IgG C3 Inc CC MTS Interp na na If there is complement on the patient’s red cells and serum is hemolyzed, perform Thermal Amplitude. ANTIBODY SCREENS IMMUADD™ 37C IgG CC Final Interp IS S1 S2 S3 DATE TECH Date TECH TECH 30oC II TECH Yes: ⇓ Go to Step 3. ⇓ No: Go to Step 3. ⇓ Yes: Consider the Coombs Profile Results: Is IgG Present on the patient’s cells? Yes: No: ⇓ ⇓ Prepare an Eluate and Run Antibody Screen. Go to Step 3. S1 S2 S3 AC* BC* DATE TECH Last Wash DATE TECH INTERP STEP 3: EVALUATION OF PATIENT SERUM Consider the original Antibody Screen, is it Positive? What/When?___________________________________________________ Has an Elution been performed since the most recent transfusion? ANTIBODY SCREEN using ELUATE PEG Interp MTS IGG CC CC III DATE Yes: No: ⇓ Is there an increase in reactivity? OR color change from the pretransfusion sample (icterus or hemolysis)? OR is there no previous sample or test results for comparison? IGG No Yes ⇒ Consider Donath-Landsteiner Test TEST COLD WARM ⇓ I Go to step 2. STEP 2: EVALUATION OF PATIENT RED CELLS Has the patient been transfused in the past 3 months? No: ⇓ Go to Step 3. 37oC S1 S2 S3 Auto I neg na Date 22oC In addition… Is the DAT is due to ONLY Complement and the Antibody Screen negative? *If transfusion of incompatible plasma products, test eluate vs. A and B cells as well. Is the Eluate Antibody Screen Positive? Yes: No: ⇓ ⇓ Perform Antibody Go to Step 3. Identification. ⇓ Go to Step 3. No: ⇓ Go to Step 4. Yes: Perform Additional Antibody Screen using ImmuAdd. Add results in LIS and write in Step One. ⇓ Is this Antibody Screen negative? Yes: No: ⇓ ⇓ Go to Step 4. Are all cells positive? Yes: No: Has patient been transfused with homologous RBCs? ⇓ Yes: No: Perform Antibody ⇓ ⇓ Identification. Go to Step 4. Perform Autoabsorption Then First Second Final ⇓ IgG CC IgG CC Interp Go to Step 4. Key: SC1 PS = Polyspecific Antihuman Globulin SC2 Auto = Autologous Cells PEG = Poly Ethylene Glycol Additive SC3 IMM = ImmuAdd (Low Ionic Strength) Control MTS = Micro Typing System, IgG Card Date Tech Is Antibody Screen using Autoabsorbed Serum positive? Yes: No: ⇓ ⇓ Perform Antibody No Alloantibody is present. Identification. ⇓ Then Go to Step 4. Go to Step 4. CC = Coombs Control Cells CTL = Control K1 = K1 Control Cell IGG = Anti- IgG C3 = Anti-C3b/d AC = A1 Cells BC = B Cell DAT = Direct Antiglobulin Test IS = Immediate Spin I neg = I negative Group O Cells Interp = Interpretation SC1,SC2,SC3 = Screening Cells STEP 4: CHECK PHYSICIAN’S REQUEST Is transfusion of Red Blood Cells requested or probable? No Yes ⇓ ⇓ No further Is this the first positive DAT this admission? workup. OR the first positive DAT within this series? OR is there a significant change in reactivity/antibody status? No Yes ⇓ ⇓ Is there autoantibody that cannot be absorbed? Consult with Supervisor. No Yes ⇓ Notify Medical Director ⇓ ⇓ Issue crossmatch compatible Consult with Supervisor. for evaluation and instructions. according to current policies ⇓ regarding presence or absence of Notify Medical Director clinically significant antibodies. for evaluation and instructions. Comments / Action: MEDICAL DIRECTOR’S CONSULT AND INSTRUCTIONS: (86077) Difficult Crossmatch / Irregular Antibody Consult: Signature: REVISED /11/21/03 Date: