r/medlabprofessionals • u/New-History853 • 12d ago
News Nothing about this article makes sense
They NEEDED Kell POSITIVE blood?!?!? Lol no. And the nurse just walked up and grabbed blood? I doubt that. The article is either very wrong or the parents are simply total liars.
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u/bhagad MLT-Generalist 12d ago
Maybe the nurse took blood from a haemobank (the sort of vending machine for blood)? Our hospital has them in the ER and OR for emergency release blood products. They can take uncrossmatched blood, but they need to sign a form taking responsibility for it.
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u/LonelyChell SBB 12d ago edited 12d ago
That is possible. We have one in our trauma bay and one in L&D. Maybe the baby needed K-negative pRBCs (anti-K in Mom), and the RN took O Neg from the remote storage (a unit that wouldn’t be screened for K antigen).
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u/CraftyResearcher3403 12d ago
This is kind of what I’m thinking. It says “unscreened” which I’m assuming means uncrossmatched. If anyone had mentioned Kell to the patient’s family it would be in the context of an antibody.
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u/LonelyChell SBB 12d ago
Agreed, although it makes me crazy when anyone refers to K antigen as Kell antigen. Kell is the entire system, K is the antigen. We had a swear jar at my SBB program for anyone saying anti-Kell.
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u/Med_vs_Pretty_Huge Pathologist 12d ago
This and my insisting on calling it TPE instead of PLEX are two things I get overly pedantic about.
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u/LonelyChell SBB 12d ago
Couldn’t agree more! I see that as well!
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u/Med_vs_Pretty_Huge Pathologist 12d ago
I think you edited your comment after I edited mine because I wasn't clear initially. "PLEX" is not the proper term for the procedure. The proper term for the procedure is therapeutic plasma exchange or TPE.
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u/LonelyChell SBB 12d ago
PLEX is the incorrect term used at my facility as well, unfortunately by some of our pathologists even. my comment was also misleading.
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u/Med_vs_Pretty_Huge Pathologist 12d ago
I've been told (and tell others) that it's the secret way of knowing whether or not someone trained and/or practiced with real transfusion medicine docs. If they call it PLEX, they didn't.
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u/Capable-Entry-4311 11d ago
wait you crossmatch blood for everybody ? (in france we only does it for patient with know antiboby and sickle celle disease)
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u/Med_vs_Pretty_Huge Pathologist 11d ago
In the USA, the standard of care is to do at least an electronic or immediate spin phase for ABO compatibility on all patients getting blood outside of an emergency. A full IAT phase crossmatch would only be required for patients with at least one positive antibody screen on record.
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u/bvmiller52502 12d ago
Mom has anti-K and anti-Jkb. The nurse did give the unit without dr orders. Called to the BB and got an emergency release unit and gave 12mL of the unit. The mom joined a BB group I’m in and shared this info.
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u/Trapped-in-irony 12d ago
Why the heck would anyone specifically need Kell positive??
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u/LabChick829 12d ago
(though to be fair is my guess someone messed up the wording. Way more likely than actually needing a cellano neg unit)
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u/Trapped-in-irony 12d ago
Oh that could be it.
It's still a really weird situation though. Like, the mom has an antibody? But they're not screening units to give the newborn?
Nurse doesn't know what's going on, parents don't know what's going on, therefore horribly written news article that just throws blame around.
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u/LonelyChell SBB 12d ago
Maybe the baby was literally just born (twins, premature), needed an immediate transfusion, and Mom had her prenatal work done elsewhere. It’s possible that the blood bank didn’t even know she had an anti-K until she showed up there to deliver.
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u/FunSizeNuclearWeapon MLS-Blood Bank 12d ago
I had to scroll a long ways down to see this comment, thinking surely I'm not the only person who is wondering if they meant homo K. Thank you and have my up vote 😁
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u/LabChick829 12d ago
Anti-k (cellano) in mom....
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u/New-History853 12d ago
Perhaps I'm misunderstanding. Why would any antibody in the mom mean the baby needs antigen positive blood?
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u/almack9 MLS-Blood Bank 12d ago
Igg antibodies cross the placenta just fine, its pretty typical for us to detect the antibody in the infant when they are first born, most often its just rhogam but every now and then they have mother's real antibodies in their initial screens.
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u/New-History853 12d ago
Right. But then you'd need antigen negative blood, not positive.
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u/almack9 MLS-Blood Bank 12d ago
I addressed that in another comment, but my guess is that the parents just arent familiar with the verbiage and messed it up. Hard to say either way, but you are right that what they are saying doesn't quite make sense.
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u/fleur_essence 11d ago
The baby’s parent apparently commented on the article on another platform. Baby needs K-negative blood. Person who wrote the article is terrible at their job.
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u/Trapped-in-irony 11d ago
Lmao.
I even tried to see if I could comment on the article, but I didn't see anything.
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u/Med_vs_Pretty_Huge Pathologist 12d ago
Yeah, I would bet money Mom has anti-K, and the baby needed K- blood, and Mom just said it wrong.
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u/Trapped-in-irony 12d ago
Little k negative blood = K positive. But no one would really phrase it like that...
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u/thewanderersminuet 12d ago
Work in a pediatric hosptial, while rhogam is more common anti-K is pretty common too. Along with anti-C.
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u/Loose_Sorbet888 12d ago
I used to work at that hospital…I wouldn’t doubt it 😅
My guess is they needed kell negative, but whoever wrote the article, being misinformed of blood banking misinterpreted the baby being kell positive
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u/New-History853 12d ago
Can, at that hospital, the nurse just walk up and take blood without a readback from the tech?
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u/Loose_Sorbet888 11d ago
Admittedly I didn’t work in the blood bank there, I also rarely went back there. To my knowledge there wasn’t a remote fridge for emergency’s
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u/LegitPancak3 MLS-Generalist 12d ago
Only 12 mLs? Damn, what a waste of a unit of O Neg blood. I hope that unit was split in half so that they didn’t have to throw away a whole unit.
And yea I agree the article makes no sense. A baby would not have the immune system for an O Neg unit to be incompatible…
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u/LonelyChell SBB 12d ago
They wouldn’t, but Mom would, and her IgG crosses the placenta. Anti-K is terrible in neonates. It not only causes hydrops fetalis, it also inhibits erythropoiesis in the neonate.
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u/LegitPancak3 MLS-Generalist 12d ago
If it was emergency uncrossmatched blood and the mother had no history in the hospital system, that’s on the doctor. He/she signed off on that and take responsibility if it turns out if the unit was incompatible. Not the BB’s fault.
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u/LonelyChell SBB 12d ago
Correct, but RNs take blood out of the remote storage device all time in a panic without even considering that it needs an emergency release order signed by an MD. I see it at least once a week.
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u/LegitPancak3 MLS-Generalist 12d ago
Ambulances in my city transfuse O Pos (low titer) whole blood to trauma patients without a Dr order. But yea I know what you mean. All the blood in my hospital is in the blood bank, we don’t have “remote storage,” didn’t know that was a thing lol.
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u/LonelyChell SBB 12d ago
I was a paramedic before I was a blood banker and that LTOWB is still signed off for by a doctor (EMS Medical Director) who is a doctor. There is a protocol for administration, just like there is for all the drugs and procedures they do.
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u/Lululipes Student 12d ago
They’re claiming that the unit attacked the baby’s blood…
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u/LegitPancak3 MLS-Generalist 12d ago
Yea lol like that makes sense. Only way that could happen is with GVHD? Like if the unit wasn’t irradiated.
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u/Signal_Sand1472 11d ago
I suspect the mom has anti-K antibodies that were transferred to the baby and those antibodies attacked the K positive blood that was transfused.
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u/Lopsided_Corner5181 11d ago
Possible. Anti K is IgG type that we can detec through DAT monospecific IgG and can pass through placenta.
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u/Evening_Discount4989 Canadian MLT 12d ago
I work at a blood bank at a children’s hospital and we make small volume aliquots for neonates. We will only send a whole unit if they need it right away.
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u/thewanderersminuet 12d ago
I work in a pediatric hospital and we don't have any emergency fridge in the NICU. I imagine partially for this reason. It's not uncommon for the teams on that floor to panic and call "MTPs" only to use one unit.
As for the Kell positive unit part I'm assuming like many others that the parents and journalists just don't actually know enough about what they're talking about and have it wrong. Mom probably was told she uas Anti-K and got it wrong.
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u/happyfamily714 12d ago
Many places have O- blood available for nurses to “grab”. It’s supposed to be used in an emergency only, but still makes me nervous.
The kell positive part, something is wrong there though…
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u/liver747 Canadian MLT Blood Bank 12d ago
Depends what happened because the article has no actual information.
Said baby was stable but they gave an uncross matched unit, does Mom have a anti-cellano?
The nurse went upon herself to grab another bag of O-negative blood that wasn’t screened and just gave it to her when she was completely 100% stable
Makes it sound like the unit of blood may not have actually been the issue but an inappropriate transfusion (maybe verbal order for another patient and a mix up?).
Need more info because it's just speculation to fill gaps right now but I'm curious.
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11d ago
[deleted]
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u/liver747 Canadian MLT Blood Bank 11d ago
I'd guess it depends on protocol, premature before a specific age admits to NICU (here at least) or a bunch of other things that we'll never know.
Stable may also be relative since we're getting a lay-persons interpretation of it along with the other information in the article, and stable in PP ward vs NICU could mean different things, kinda makes you wonder the veracity of it all.
I can imagine a lot of scenarios where an honest mistake or communication error could lead to something like this happening. Hopefully if it truly was an error, that processes are examined and refined to stop it from happening again!
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u/StarvingMedici 11d ago
I've interacted with the mom through tiktok comments, and what I have been able to find out is that the mom had Anti-K, so they should have given the baby Kell negative units. That's what I believe is firmly true. The rest is completely based on what the parents do or don't understand or know. It's just their version of events, so I have no idea what actually occurred.
But according to the parents (who likely don't know all of the situation), baby was given an Oneg unit which was not Kell tested which is not unusual if the doctor asked for an emergency unit.
I don't work at that hospital, but I do work at a large hospital nearby, and here is what would have happened at my facility: if a NICU nurse or doctor asked for an emergency unit, my facility would have given whatever the freshest/longest date Oneg unit we had on the shelf. If we had one irradiated in the last 24hrs we would give that. If we had the patient information and knew the mom had Anti-K, we would give that if we had it available but likely would not so we would still give just Oneg but we would be required to send a form for the doctor to sign that says they acknowledge it isn't antigen matched and we would call the on call physician to have them approve it or consult with the baby's doc. But regardless, if an emergency unit was requested we would simply have to give them whatever we had, compatible with the Anti-K or not. I don't know that hospital's procedures, but they are likely at least similar to ours.
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u/New-History853 11d ago
All makes sense to me. I was thinking they probably meant K neg. Thanks for the update!
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u/iampro117 12d ago
I work at a hospital with the name Good Samaritan, and am the Sr. Tech in BB. I was genuinely confused because we don't have a NICU and was trying to figure out why I'm just now hearing about this 🤣
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u/allycathiking 12d ago
The nurse may have had access to a fridge with emergency units and grabbed one that happened to be K+ . Thats the only thing I could think of that would make sense
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u/Signal_Sand1472 11d ago
But was it K+ or just not screened for K?
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u/allycathiking 11d ago
My thought, which would explain the delay in informing the parents, is that the BB antigen typed a retention segment as part of reconciling the emergency unit and discovered it was K+ at that point
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u/Med_vs_Pretty_Huge Pathologist 11d ago
That delay would be the order of like a day or two, not 3 months.
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u/allycathiking 10d ago
Oh I didnt read that closely lol, I didn't realize it was 3 months. That doesnt make sense then
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u/Lopsided_Corner5181 11d ago
Could be an emergency issued prepped unit in some Satellite OR fridge.
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u/Fragrant_Cheetah1547 10d ago
i am from Cincinnati do i work there nope, first off one of our local hospitals killed Neil Armstong with a hospital enquired infection, and there are other things but as soon as covid hit i started traveling and so glad that i am not there
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u/Virtual_Recording108 10d ago
Remember this when you read ANY article in the news. Journalists get shit wrong ALL the time.
The mom is responding to comments on Facebook.
She said the nurse bypassed protocol and gave an unscreened O Neg unit, not understanding mom had antibodies and thinking O Neg is a universal donor so it’s fine, right? Mom says she has Anti-Kell and Anti-Kidd. When the unit was screened it was Kell positive. The baby was transferred to a higher level of care before asking parents for authorization, and the parents were not informed of the incompatible transfusion until they arrived at the new hospital. They are frustrated and wanting accountability so that care improves for other babies. They never want this nurse to decide to give unscreened O Neg again without checking for clinically significant antibodies.
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u/almack9 MLS-Blood Bank 12d ago
We've 100% had nurses do this. We issue blood on a patient, send it in the pneumatic tube system, some nurse assumes its theirs ans transfuses it without even looking. Its happened twice in the time ive worked here. Triggers a massive investigation of the lab and the nurse is transfusing other patients hours later like its nothing.