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    Malcolm Needs

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Showing content with the highest reputation since 03/03/2020 in all areas

  1. I just saw this seminar being offered by Bio-Rad with our own, infamous, Malcolm Needs as the presenter. I registered and thought I'd pass the word to all of us here. Here is the link:https://info.bio-rad.com/ww-IHD-transfusion-w-registration-lp2.html?elq_mid=48765&elq_cid=10201434&elqCampaignId=30837&utm_campaign=30837&utm_source=eloquaEmail&utm_medium=email&utm_content=Email 13ER EM-R-CM-385201-FY21-TCHS-AWEN_BR-JRNL-TRF News 19 Nov&elqTrackId=6ecbbea5f2bb46849981687404578a8e&elq=7c5f74470efa434dbd4351e512f7ae7a&elqaid=48765&elqat=1&elqCampaignId=3
    10 points
  2. Very proud to have received this through the post earlier this week, to go with being elected to Fellowship of the British Blood Transfusion Society earlier this year.
    10 points
  3. I have never understood this obsession with looking at reactions down a microscope in blood bank, except looking at things like a Kleihauer or when teaching, to show mixed-field reactions. The great Peter Issitt, not a bad roll model to have, wrote, many years ago now, a passage that I attach from page 69 of his "Applied Blood Group Serology" book, 3rd edition, 1985, Montgomery Scientific Press. That having been said, all reactions seen MUST be recorded, it is just that macroscopic reading is almost all that is ever required.
    9 points
  4. Ok, here we go. First is from a personnel stand point. When promoted from with in you are no longer "one of the guys". This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others. Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place. This does not have to be dramatic and should not be, but it is real. Some can do this and some find it very difficult. Now, when coming from outside your are exactly that, an outsider. Now the level of this can vary immens
    9 points
  5. I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.
    9 points
  6. I was immensely honoured to receive this through the post today (with a lapel badge).
    8 points
  7. Have you thought of hiding his glasses?
    7 points
  8. I agree with you that it does sound daft, but I am in the position to tell you why this is the recommendation, despite it apparently being contrary to BSH Guidelines, as I was still working when the decision was made (albeit, I don't agree with it!). The huge majority of hospital blood transfusion laboratories now use column agglutination technology (CAT) as their "first line of attack", and many of them use the CAT that uses gel in the column, rather than glass beads. This form of CAT is particularly adept at detecting anti-M in plasma by IAT, even though the anti-M may not actually be
    7 points
  9. I would not be performing one hour post-transfusion vital signs unless the patient has signs or symptoms that require assessment. I would not be reacting to one hour post-transfusion data unless they were consonant with a transfusion reaction. If fever was the only sign or symptom, it's probably not transfusion related in the vast majority of cases. Routine vital signs in the absence of a clinical rationale are a problem, not a solution.
    7 points
  10. Can I just point out here that no one serological test, or even combination of tests will detect all weak / variant Ds . And that includes women who test D+ but actually have a partial D and may make anti-D antibodies. It is SO important to know your reagents, and know what your anti-D reagents will and will not detect
    7 points
  11. What you are identifying is almost certainly a strong anti-H in an Oh individual. However, if the individual requires a transfusion, you will need to perform differential allo-adsorption (or something similar) to identify any other underlying clinically significant atypical antibodies (you can ignore any underlying Lewis antibodies, which are commonly also present).
    7 points
  12. Hi Rich, I am not a clinician but as far as I know IVIG can be given to obstetrical patient in diff. conditions (autoimmune disorders, recurrent pregnancy loss, ...). I thought about IVIG when I saw the DAT becoming positive plus additional reactions coming up over the time. Anti-A and Anti-B are indeed the most prevalent antibodies in plasma derived products but other specificities of low titre can be present sometimes such as anti-D, anti-K and a bunch of antibodies of undetermined specificity reacting with several to not say all RBCs. Just a thought that can be doublechecked
    7 points
  13. jojo808

    Transfusion Errors

    I think we need to add an OMG emoji to our selections!
    6 points
  14. galvania

    Micro only reactions

    to be fair techniques in the early 80s were not what they are today, neither for blood grouping nor for antibody screening/identification. Methods were not standardised. The number of drops of serum (almost always serum) to the amount of red cells could vary from 2:1 to 8:1. The concentration of the red cells could be anything from about 2% to almost 10% - and often pooled. And pooling was one of the main reason for checking under the microscope. Incubation time varied too - often depending on the length of your coffee break or lunch break. LISS was in its infancy. Washing was done by ha
    6 points
  15. A new tee shirt I gave myself for my birthday. I should have had a shave and lost about 70lbs first, but hey!
    6 points
  16. Malcolm Needs

    Strange question

    I agree with exlimey. I once had an anti-E that reacted by LISS IAT, but try as we might, we could never get it to react with papain-treated red cells. We doubted the specificity, and so we sent it to Joyce Poole at the International Blood Group Reference Laboratory to have a look at it, and she confirmed both the specificity and the fact that it was non-reactive with papain-treated red cells. Anything is possible, as the antibodies refuse to read the damned text books! In the UK, it is almost a sine qua non that an "enzyme panel" is put up simultaneously with the IAT panel Joh
    6 points
  17. To this I will add, pick your battles carefully. Make sure they are worth fighting. If you came from outside the facility be very judicious when using the phrase, "The way we did it"! Changing something to the way you did it else where is not necessarily a change for the better just because it makes you comfortable. Make sure you understand your new facility's processes before trying to incorporate sweeping changes. As I noted above, much of my advise would depend on if you came from outside or promoted from within. This is just one golden nugget for you to consider.
    6 points
  18. When I first joined the wonderful world of blood transfusion, with particular reference to blood group serology, at the International Blood Group Reference Laboratory, when it was in London, my mentors were Dr Carolyn Giles and Joyce Poole. In those days, yes, we did use microscopes (albeit with very little magnification) and, given that we were using human-derived antisera, and the fact that I was anxious not to miss anything, I often got Joyce to check my sightings down the microscope. These were invariably "kissing cells", as you suggest, and Joyce christened them "Malcolm weaks", a term
    6 points
  19. Probably the primary stimulation was not the fetus, but previous pregnancy, transfusion, tattooing, needle sharing, non-sterile tattooing, etc. Pregnancy is a situation in which B cells are upregulated (type 2 immunity) and T cells down regulated (roughly speaking) and pregnancy may have increased B cell activity to the point where previously undetectable antibodies are now detectable. Just a theory ;).
    6 points
  20. It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record. Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would ju
    6 points
  21. When we first started using Gel, my techs would point out the shadows or 'jumpies' as they called them. I'd suggest 'Run the screen again using maxtime.' If they still saw the shadows, I'd just let them run a panel (maxtime) and go crazy with the results. After a while we all learned to ignore those reactions. Keep in mind, there are always a certain percent of any given cell population (especially stored reagent cells) that are just not going to make it smoothly to the very bottom solely because of steric hindrance (broken, aged, crenated, tagged for destruction, etc.).
    5 points
  22. Decades ago I worked w a tech who worked w Peter at NYBC. I had always looked under the scope (as that was how I was trained). I'd ask her to look at 2 or 3 or 4 cells stuck together microscopically. Her comment was always, "If you want to call that positive go ahead, but I'd call it negative." High anxiety to give up the scope but I did.
    5 points
  23. When tube testing was all we had, my moto was; "when in doubt, shake it out!" One of the first things I did as transfusion supervisor at a new facility was convince the medical director that we needed to stop using the microscope for routine testing. It was much harder to convince the rest of the staff. I couldn't remove the microscopes from the department because we were doing KBs at the time and I'm pretty sure a few of the "older" staff still used them for routine testing when I wasn't looking. Once again inertia is proven to be the most powerful force in the universe!
    5 points
  24. I have even gone so far as to tell the nurse taking care of the patient that when they learned the patient's name and not the room number to give me a call back and we will discuss the patient at that time.
    5 points
  25. Not sure about just one answer - We had a labeled Rh negative RBC from the ARC that retyped as Rh positive. Upon investigation, it was found the Immucor anti-D reagent we use for retyping had anti-Crawford while the ARC automated process for D typing used an Ortho reagent which was from a different clone. Not very unlikely but certainly more than one answer.
    5 points
  26. Beyond any shadow of a doubt - personnel will always be the greatest challenge. Not enough, not well enough trained, will they follow the SOPs (in spite of the continuous Competency - truly a pain!), will they show up, will they get along with each other........... Be prepared for that challenge and take advice from a good manager, if you are blessed with one. Always consider that mistakes may stem from a misunderstanding of what is written in the procedure or the procedure might need a tweak to eliminate a "process" problem.. Approach mistakes from the point of view - "Is it a process
    5 points
  27. There is absolutely no scientific or clinical reason that a vaccine could not be stored with frozen blood components. That doesn't mean you won't get some overly officious inspector who will decide it's a bad idea. But currently there are no regulatory or accreditation issues that I am aware of.
    5 points
  28. Maintaining enough staff. Too many people use a large facility as a stepping stone to another job for more money. Having Senior Management understand the difference between a Blood Bank and Clinical Lab - we're not the same. Maintaining inventory. There is always a shortage of something. Competency Assessment - huge pet peeve of mine. You go to a talk by _____________ and hear them pontificate on how we all make competency assessment so hard on ourselves. Then say something silly like, all you need to do is watch them do a _______ proficiency testing sample, they will be pro
    5 points
  29. The age old problem of how do you make people pay attention to the details...If you figure this out, let me know. I haven't yet. Do you not have an "IRRADIATED RBC" product in your dictionary that the physician could have chosen? That puts the responsibility on them, where it should lie. A comment is not an order and, if they are relying on that, they are forcing your techs into a position of failure. I would suggest you add an irradiated product order to your dictionary. If the physician wants that product, they must order that product that way.
    5 points
  30. Couldn't agree more, particularly, certainly in my own experience, many inspectors have a minimal amount of experience in the field (particularly Reference Laboratories), but feel they have to comment to justify their employment, even though they don't actually understand or know what they are talking about; not all, but far too many.
    5 points
  31. Inspectors are like a box of chocolates, you never know what you are going to get. I tend to agree with those who put forth do what you are comfortable doing for validation and/or QC. If you, your staff and pathologists are ok with your process then an Inspector (AABB or CAP) can have an opinion but they cannot tell you to stop or defend a deficiency. If your documentation has merit then you have a strong case of how you use your expired red cells or antisera for the care of your patients. We all do the best we can with what we have to work with.
    5 points
  32. I am a worker from/in the UK, but if TRM.40780 says, "Maternal RhIG candidacy assessment must include the identification of weak-D phenotype newborns", that is exactly what it means. It doesn't say "should" instead of "must", and it doesn't say, "until you give up because you are bored, because you have never found one"! Yes, such types are rare, but they do happen, and they can cause the mother to produce an anti-D (of sorts). These antibodies are not usually particularly clinically significant in terms of further pregnancies - but the word "usually" is the important one in that senten
    5 points
  33. Neil Blumberg

    Brain Cramp

    The answer is a bit more complicated. If there is no target for %S, there is no need to test for hemoglobin S in donor blood. In other words, if the transfusion is purely for anemia, not treatment of acute chest syndrome or prevention of stroke, there is usually no target %S being used by the treating physician. The reason for testing for S in the donor is not the risk to the patient, but because transfusing S containing blood can confuse the calculation of % S overall. It's probably unnecessary because the %S contribution of a single unit of S heterozygous red cells in an exchange transfus
    5 points
  34. Malcolm Needs

    Need Help

    Anti-Lea CAN be clinically significant, but it is very rare for it to so be, and it tends to be self-limiting. For it to be clinically significant it has to be IgG and/or complement activating, and it is self limiting because, of course, the Lewis antigens are soluble. This means that they will be in any plasma remaining on the red cells in the unit, and these soluble antigens will inhibit the patient's anti-Lea in vivo. You can usually continue to transfuse the same unit that caused the problem after a while, with no further problems. MIND YOU, you have to be ABSOLUTELY CERTAIN that it wa
    5 points
  35. Malcolm Needs

    Need Help

    exlimey, I would most certainly agree with your first comment. In the VERY old days, when I was merely middle aged, and we only had access to tube tests and reagents, including AHG, and techniques (such as tile techniques), we didn't kill patients by the thousand, so techniques that are a little less sensitive than are available these days, will not necessarily condemn the patient to a certain and painful death, despite the deafening shouts of those who are gainfully (and, in many cases, VERY gainfully) employed within the neo-science of quality for quality's sake (we needed to pull up our so
    5 points
  36. Malcolm Needs

    Need Help

    This is an almost impossible question to answer, as it is ALWAYS the responsibility of the physician looking after the patient to perform a risk assessment as to which he or she thinks is the higher risk - viz is it a higher risk to go ahead with the transfusion, or is it a higher risk to leave the patient without a transfusion? He or she will take advice from such professionals as the Pathologist, but, in the end, only they can take the decision. That having been said, it also depends whether any or all of those antibodies listed are detectable in the present sample, or whether some are
    5 points
  37. Yes indeed different pH, different suppliers may explain such a behavior (some anti-M are enhanced with acidification of plasma). In addition, Anti-M often shows dosage effect but I believe you have antigen M double dose cells on your panel too. What are the phenotype of the 2 cells reacting in screening and the one not reacting? Is your patient antigen M negative? It also exists the anti-M1 (the M1 antigen belongs to the MN CHO collection) that reacts with some M positive cells and stronger with M/N positive cells (M1 is expressed on M positive cells) and it can be, though
    5 points
  38. It sounds remarkably like one of your screening cells is expressing a low prevalence antigen that is not expressed on your panel cells. Antibodies directed against low prevalence antigens are actually quite common, but they are rarely detected because red cells expressing the cognate antigen are so rare. I wouldn't expend too much time or energy trying to sort out the exact specificity. In all cases of such an antibody, as long as you cross-match by the same method as you used in detecting the presence of the antibody in the first place, it would be quite safe to give cross-match co
    5 points
  39. I have been thinking about this and I have come, more or less, to the same way of thinking as Neil Blumberg. The first pregnancy almost certainly could not have caused sensitisation of most of the common antigens, as some would not be formed on the foetal red cells at 10 weeks of gestation, while, even with a huge foeto-maternal haemorrhage (FMH) (in terms of the ratio of the total foetal red cell mass), the actual volume of foetal red cells transferred to the maternal circulation would not be sufficient to cause sensitisation in anyone but a person who is a "super responder". The se
    5 points
  40. I've been searching for the powerpoint I made of the occurrence I wanted to share but I must have stored it on an external hard drive that crashed and was unrecoverable. (That's my excuse anyway.) Consequently it was long ago and my memory is fuzzy on the details but in this case the details is not the point I'm attempting to convey. Bottom line was that 2 units of blood were sent via pneumatic tube to ICU for 2 different patients. No, the units were not in the same tube, they were sent 10-15 minutes apart. The units went to the wrong patients and the proper patient identification protocol
    4 points
  41. For all I have said above, and I think I have said this before on here, when I was first working in Red Cell Reference, when the International Blood Group Reference Laboratory was in London, and the Department was run by Carolyn Giles and a very young Senior Technician by the name of Joyce Poole, I also had the problem of seeing "weak agglutination" that wasn't actually there (totally negative, in other words), and Joyce coined this as a "Malcolm Weak". This was way back in the early 1970's. I understand that, now and again, some 50 years on, the term is still used in the department for ove
    4 points
  42. My personal system was virtually identical to yours except for the the reverse type I used JH-RA and JH-RB. In the facilities where I was the Transfusion Service or Blood Bank supervisor my tube labeling requirement for the staff was that anyone in the department could set down an take over the testing and know who and what was in each tube.
    4 points
  43. We understand what happened. We received the patient 12 hours before this transfusion. Despite having denied previous transfusions, we contacted the health service of origin who informed us that he had transfused platelets in pool (600 ML) the group O. Therefore, we believe that the reaction after red blood cell transfusion was a coincidence, and the anti-B of the transfused platelets must be the cause of hemolysis.
    4 points
  44. This scenario doesn't explain why the donor red cells react with the serum from most patients. For this to be a "low incidence antigen" issue, ALL of the patients would have to have an antibody to (probably) the same low incidence antigen. That is very unlikely. As Malcolm suggests, this sounds like an abnormality of the donor's red cells. I believe Hemo bioscience have a lectin kit, but it may only be available in the USA.
    4 points
  45. I think it more likely that the donor is expressing an antigen, such as T, Tn, Tk, Cad, etc, possibly as the result of a subclinical infection if this has not been seen before with his/her blood (which would rule out Cad). Have you tried testing it with a lectin panel?
    4 points
  46. Neil Blumberg

    Brain Cramp

    Patients with sickle trait do not have sickle crises at all, except in very rare cases when they become seriously hypoxic. There are rare cases reported in military personnel and athletes. It's not clear whether they are sickle crises in some cases or just similar symptoms seen in non-sickle cell patients. These are truly rare cases, and usually at higher stress than an altitude of 8,000 feet, which really isn't terribly high. No personal experience. In extreme circumstances, patients heterozygous for S may be slightly more susceptible to symptoms like mountain sickness, just like everyon
    4 points
  47. Neil Blumberg

    Brain Cramp

    People heterozygous for hemoglobin S have no clinical level problems with transporting oxygen, so there is no need (except for being overly cautious) to provide hemoglobin S tested blood for newborns, or, as I mentioned above, anyone who is not being monitored for % S. Another one of those "it seemed like a good idea at the time" but not evidence based approaches.
    4 points
  48. See my comment of September 16th 2012, and the comments of Peter Issett I quoted.
    4 points
  49. I couldn't agree more with you YorkshireExile. At a stretch, and I mean, at a stretch, it MAY be relevant to such tests as quantification and titrations, where you are giving a result involving a measured number, ascertained with red cells that may express different numbers of antigens, which may themselves involve protein or carbohydrate substitutions, but that is all. How on Earth your inspector thought that this was remotely relevant to blood grouping, with all the positive and negative controls used to ensure the antisera are working properly, and the temperature mapping of everythin
    4 points
  50. Anti-Vel is such a nasty antibody, I would give units that are known to be molecularly tested (SMIM-1 Negative), unless the cross-match is performed by 2-stage IAT with monospecific anti-C3d on a clotted sample, as it is renowned for complement activation, even when virtually undetectable by normal serological techniques - not that I want to be sensationalist!
    4 points
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