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  1. Malcolm Needs

    Malcolm Needs

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    David Saikin

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    AMcCord

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  4. John C. Staley

    John C. Staley

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Showing content with the highest reputation since 06/28/2007 in all areas

  1. Malcolm Needs

    Gold Medal.

    I am enormously honoured to announce that I am going to be awarded the Gold Medal of the British Blood Transfusion Society at their Annual Scientific Meeting in Brighton this year. It is awarded to an individual for their exceptional and long standing services to the Society and to the practice of blood transfusion in the UK. Sorry if this sounds egocentric, but I am very excited.
    33 points
  2. I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!! Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous. An antigen can be described as either showing homozygous expression, or heterozygous expression. That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we
    28 points
  3. Thanks to a very generous invitation from the organisers (in particular Phil Hoffman, aka Dr Pepper on this site, and Maddie Josephs, Chair) I will be attending and speaking at the 69th Annual Clinical Laboratory Science Convention - Central New England (ASCLS - CNE) taking place at the Rhode Island Convention Center between May 9th and May 11th 2017. I will be talking on Wednesday 10th May 2017, giving a lecture entitled, "An In Depth Description of the Kell Blood Group System." and then, after a well-deserved break for the delegates, and for those that can stand it, a second lecture entitle
    20 points
  4. Malcolm Needs

    31/10/16.

    Well, that's me finished. I am officially retired from work - but not from this wonderful site!
    19 points
  5. You could always irradiate the blood bag (as well as the blood), while the stupid nurse is holding it!!!
    19 points
  6. I'm afraid that may not work. We used to keep all of our "in-date" antisera on the top shelf, and our out-dated teaching antisera on the bottom shelf. This meant that, if any of our "in-date" antisera fell off the shelf into the out-dated teaching antisera, and we didn't notice, it didn't matter. Sadly, what I had not taken into account was the fact that one of our inspectors (I can't remember whether it was CPA or MHRA) knew much more about physics than did I, and explained to me, in huge detail, that the out-dated antisera must be kept in a separate fridge, in case the out-dated teach
    18 points
  7. I composed an answer to this yesterday and must have gotten 'sideswiped' before I posted it! Anyway, here's what I have to add to this conversation ... You cannot compare gel to tube testing. Aside from the 'sensitivity' issue (DAT could be positive in gel, negative in tube), gel has a totally different premise that needs to be taken into consideration. Gel: Slippery RBCs will make it all the way to the bottom of the gel column during a given period of time at a given centrifugal force.Tube: Cells must be agglutinated.1. Therefore, gel results are affected not only by coating of RBCs with a
    16 points
  8. John C. Staley

    QC on Panels

    I have never qc'd panels and will be ending my career with that same statement, mostly, because at my current and final employer we don't perform antibody id's. This discussion is not a new one and will continue to pop up with new inspectors and new interpretations of old rules. Frankly, there is not anyway to realistically QC a panel and have confidence that the every antigen listed is detectable. Frankly I am surprised at the number of folks responding that they do some form of panel QC. In my ever so humble opinion you are providing nothing but smoke and mirrors to pacify some inspector
    15 points
  9. SMILLER

    Confused about dosage

    From the My Two Cents Dept... I would just point out that it is important that people doing testing understand what and why they are doing what they are doing. I guess this goes without saying. I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing. I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation. Scott
    14 points
  10. I have a not-serious question on each of my med tech student quizzes. I thought I'd share a current student's response to "Describe in 80,000 words or less why immunohematology is by far the most interesting department in the lab." I usually get charming BS like "Because Phil is awesome!", but this guy got a little deeper: "While not as engaging as Micro, Immuno, Heme or Molecular on the surface, Immunohematology (aka blood bank) is much more mentally taxing. It requires one to think through a process logically, using the tools at one's disposal in the metaphorical tool box, to produce a res
    14 points
  11. Malcolm Needs

    e and C titer

    The thing is tkakin, that most examples of anti-C (anti-Rh2) are not; they are actually anti-Ce (anti-Rh7)! This is largely because almost every red cell that causes immunisation against the C antigen expresses both the C and e antigens as a result of having the RHCe gene, rather than both the C and e antigens as a result of having both the RHCE gene and the RHce gene (which is why both the DCE and dCE haplotypes are so rare). On the other hand, monospecific anti-e is comparatively common. So, your lady's plasma is more likely to contain anti-Ce and anti-e, rather than anti-C and anti-e
    13 points
  12. I would agree with mollyredone, but would go further, Not only do you need to record everything you say to him (and get him to counter-sign the record), you need to record everything you tell your own seniors, and get THEM to counter-sign what you have told them. THIS PERSON IS DANGEROUS. You, as a conscientious employee, should not have to take responsibility for this person, but, if the worst happens (and it well could), you want to make certain that you are not held responsible in law, but that the finger is pointed in the right direction. If you get your own seniors to counter-sign
    13 points
  13. tbostock

    On call phone calls

    I'm on call 24/7. I tell them to consult the policy first. If you try and can't find it anywhere in a policy, ask your coworkers to show you where to find the answer. If nobody else on your shift can point you to it, THEN you call me. Do not guess! I get a lot more text messages than I do phone calls. Usually they already know the answer, they are just wanting me to confirm their answer. We have quite a few generalists on my eve and night shifts that are not very experienced with difficult BB issues, so I have no problem with them calling me. I would much rather that than a patient
    13 points
  14. But Malcolm, there is a very subtle but important difference between what is "possible" and what is "realistic". Personally, I would say that going through an exchange transfusion simply to prevent the formation of anti-D is not reasonable but then I'm married to a nurse who has an anti-D along with an anti-K and an anti-S so my view may be a little jaded. Oh ya, the D was provided by the birth of our son. Our daughter was effected by it to the point of needing a double exchange transfusion which, I should mention, is not quite as dramatic in an infant as it is in an adult. The daughter is
    13 points
  15. Many years ago, Peter Issitt stated that microscopes should be banned from Transfusion Laboratories (I think it was in the orange edition of his book) except for such tests where cells are being counted (such as the Kleihauer). Many years after his wise words, I still follow his advice, and have not (yet) been involved in a missed weak antibody that has caused a clinically significant haemolytic transfusion reaction (43 years in the job), and many of those tests were performed in opaque tiles and then, as we "modernised", tube techniques.
    12 points
  16. JHH1999

    saline expiration date

    Typically expiration dates are established by the manufacturer. They perform stability testing for the duration of the assigned expiration date to support it with data. Data shows the product is capable of performing up until the claimed expiration date. It may continue to function they just do not have data to support it. This should be done to support any "reagent" made that is not at least qualified in some way each day of use. Assigning an expiration date based upon the shortest dated component is not very good science. The different ingredients could be compatible with each other or
    12 points
  17. The point about warm auto-antibodies, even the ones that look exactly like an auto-anti-M, an auto-anti-Jka or a specific Rh antibody, such as auto-anti-e, is that they all tend to be mimicking specificities, and so, in reality, you might be fooling yourself by giving antigen negative units to the patient, but you will not be fooling the patient's immune system, and so the chances are that, in most cases, the antigen negative transfused red cells will last no longer than the patient's own red cells. "Cold" auto-antibodies tend to have true specificities, but, even if you can find antigen
    12 points
  18. I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to ca
    12 points
  19. We used some foam packing material and cut it into squares and they fit snugly in the channels of the rack. #boom
    12 points
  20. All this just reinforces my opinion that one should never, never, ever get sick, because then you can get treated and all sorts of bad things can happen!
    12 points
  21. I wish I had a dime for everytime I wanted to transfuse a patient just so I could get their antibody levels up to a point I could easily identify them!!! Never did but sure thought about it.
    12 points
  22. Malcolm Needs

    Anti-G anyone?

    Hi Sara, The first clue that the antibody may be anti-G, or anti-C+G, rather than anti-C+D, is indeed that the titre of the anti-C is higher than that of the anti-D, but the fact that the anti-C titre is higher than that of the anti-D is only a clue. It could be that you actually have an anti-C+D where, coincidentally, the anti-C titre is higher than the anti-D. It is absolutely essential, therefore, that you can prove that no anti-D is present. One way of doing this is to divide the patient's plasma sample into two. The first sample is adsorbed using Ro red cells treated with a proteolytic
    12 points
  23. Time for a little philosophy. I have often described healthcare as an upside down pyramid with everything balanced on it's weakest part. Generally speaking, and I really intend no disrespect here but, our entire system is at the mercy of the lowest paid, least educated areas with the highest turn over rate. You will rarely encounter a career admissions clerk. Their training generally consists of "see one, do one, teach one". Granted this is based on my limited personal experience but it is what I and my wife have both seen in our careers in healthcare. As to a solution, I'm sorry to say
    12 points
  24. This is not a popular concept but at some point we have to accept there are things we can not control. Once the blood leaves the blood bank we are at the mercy of other humans and as long as the human factor is involved there will be human error be it unintentional or intentional. Attempting to complicate a process will only provide inventive humans the opportunity of coming up with creative work arounds to circumvent your best of intentions. At some point you just have to step back, do your job and hope for the best. I had a corporate transfusion QA director who could not accept that huma
    11 points
  25. If you put a drop of blood on something like a filter paper, and then add a drop of 1M NaOH, if it is adult blood, after a couple of minutes it will turn a sort of yellow/brown colour, as the Hb is denatured by the alkaline, whereas, if it is blood derived from the baby (including cord blood), the red cells will stay red, as HbF is not denatured by the alkaline for much longer. It is rather like doing a Kleihauer, but by "bucket chemistry", as it is known!
    11 points
  26. THANKS FOR THE CHRISTMAS PRESENT! FRUSTRATION RELIEVER!
    11 points
  27. So, the easy questions first eh Mari?????!!!!!!!!!!!!! Personally, I think the IT guy gave you a poisoned chalice. The reason I say this is because we can all list antibodies that are not generally considered to be clinically significant, and then, all of a sudden, one comes along amongst these specificities that has not read the appropriate text books and goes ahead and causes a clinically significant reaction. Then what happens is that the person who said "anti-X" is not clinically significant, and this single example of anti-X turns out to be clinically significant, and you have to d
    11 points
  28. Malcolm Needs

    Positive DAT

    In my opinion, this very much depends upon the underlying pathology. For example, if the patient has an auto-immune haemolytic anaemia, the chances are very strong that the DAT will be positive before as well as after the transfusion, and that any eluate will be positive with all red cells tested (of normal type). The chances of detecting a new antibody specificity on the DAT positive red cells under these circumstances is disappearingly small. Therefore, if the sample is sent to a reference laboratory on a regular basis, your manager will be 1) showing a degree of ignorance that should
    11 points
  29. Att All: On behalf of pathologists and laboratory professionals, ASCP is urging the laboratory community and other interested individuals to Sign the Petition urging the Centers for Medicare & Medicaid Services (CMS) to reconsider its position that nursing is a biological science for purposes of performing laboratory testing. We ask that you forward this petition to all of your colleagues. http://cqrcengage.com/ascpath/app/sign-petition?0&engagementId=239813 Here is the link to sign this important petition!
    11 points
  30. David Saikin

    Changing Venue

    Just wanted to comment that starting 6/27/2016 I will become the interim Blood Bank Manager for the Cottage Hospital system in Santa Barbara, California. Looking forward to the challenges and opportunities this will bring my way.
    11 points
  31. If the information is required, then it is required. If the nurses can't be bothered to fill it in, go down the disciplinary route. If the information is NOT required, then ditch that bit of the form.
    11 points
  32. Well, there are two reasons. The first, and main reason, is that we don't want to detect cold antibodies in the first place, because, unless they react at 30oC or higher, they are most unlikely to be clinically significant. Therefore, detecting them, and then having to investigate them for specificity is a complete waste of time and reagents - and staff time is the single most expensive thing in the laboratory. Secondly, it is highly unusual that you would only detect an IgM antibody by the presence of activated complement (not impossible, but highly unusual) and, therefore, the fact that
    11 points
  33. Just read this month's AABB News and saw Heather Vaught's name, a member of PathLab Talk: Heather Vaught, MLS(ASCP)SBB, director of technical operations at Indiana Blood Center in Indianapolis, was recently recognized as one of the "Top Five" in the 40 under 40 list from the American Society of Clinical Pathology. Congrats from your PathLab Talk friends!
    11 points
  34. Hi Amy, My first thought was, why did the overnight person give group A blood, rather than group AB? But, perhaps you do not carry group AB in your stock. Between 1 and 2% of the random White and Black population are A2B, and of those, only 25% produce an anti-A1. An anti-A1 that is clinically significant (reacts at 37oC) is disappearingly rare, so I wouldn't worry about it, but why switch to group O? The ABO antigens are not direct gene products, but are the result of the action of transferase enzymes that ARE direct gene products (give or take a bit of post-translational jiggery pokery!)
    11 points
  35. Dr. Pepper

    Bit of a rant....

    Auntie and others, we share your pain. If I may add to the list of pet peeves: 1. Starting weekly temperature discs on fridge/freezers on the wrong day and/or time. Then 5 days in a row 5 different techs document that the scribe is OK. 2. Not recording medical record numbers and dates on panel scoresheets. Record keeping in general. 3. Not printing copies of panel scoresheets on both sides so you get the extended antigen typings on the the back. Not changing the scoresheets when you open a new panel lot. 4. Filing QC records etc. with bloodstains (hopefully reagent but you never know)
    11 points
  36. 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
  37. 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
  38. Bb_in_the_rain

    Mock-up cases

    For those of who works in transfusion service laboratory and would like to learn more reference cases, I can post some mock-up cases here. If you would like me to do it, please hit the "heart" button on this post. If enough folks want to practice case studies on reference lab cases, I can post mock-up cases here weekly or so..
    10 points
  39. R1R2

    CAP survey data entry

    Found early mornings and evenings are best. A martini in hand doesn't hurt either.
    10 points
  40. Yay, the Christmas lights are back! Smash 'em while you can!!
    10 points
  41. Dr. Pepper

    Retirement

    I am winding up 43 years of blood banking on Friday. I will still drop in to PathLabTalk from time to time but I'm not sure how frequently that will be. I would like to thank all of our BB Talk family for sharing their knowledge, insights, advice, hints, constructive criticism and everything else that makes this site so wonderful to us BB geeks. I would particularly like to thank Cliff, without whom this site would not exist, and Malcolm, for being himself, a consummate blood banker and consummate gentleman (even when he's dressed in my pajama bottoms - but that's another story!)
    10 points
  42. Hi Kelli, Reid ME, Lomas-Francis C, Olsson ML, The Blood Group ANtigen FactsBook, 3rd edition, 2012, Academic Press, states that anti-Ytb causes neither haemolytic transfusion reactions, nor HDFN. Daniels G, Human Blood Groups, 3rd edition, 2013, Wiley-Blackwell states more or less the same (but does state that monocyte monolayer assays do predict the possibility that some examples of anti-Ytb could cause premature red cell destruction, but not a clinically significant haemolytic transfusion reaction). It should be noted that the MMA is no longer performed, to any great extent, in t
    10 points
  43. SMILLER

    Questions about FFP

    I believe TOCO is an anagram for COOT, where TACO is an anagram for INDIGESTION. Scott
    10 points
  44. Thanks everyone! We have had an incredible outpouring of support. They are calling one of the injured victims a hero for rushing the gunman and saving people-he was shot 5 times! After the first three shots, he fell and told the gunman it was his son's birthday and was shot 2 more times. Roseburg is also the home of one of the Americans who stopped the terrorist on the train in France. He works at Costco here. People are amazing!
    10 points
  45. Dr. Pepper

    The 30 minute rule

    There are always things that make you scratch your head a bit, that you dare not go above 6o for a second during storage, but that 10o is fine during shipping. Or that you cannot send RhIG through the pneumatic tube because it might be subjected to undue turbulance, but the shipper can kick the hell out of it and throw it in the back of a truck with bad shocks to jiggle along a bumpy road on its way to you.
    10 points
  46. I'm sorry Whitney Poplin, but I disagree with your post. Just because the antibody screen is currently negative does not automatically rule out anti-C and anti-K, for the very reason that it does not rule out the known anti-e; that is also not detectable at present. From the logic of your post, you could, therefore, also rule out the known anti-e, and give e+ units. No, the anti-C and anti-K should have been ruled out properly in the first place in my opinion. Now, because this was not done, you would have to honour the potential anti-C and anti-K, in case either of these "phantom" antib
    10 points
  47. I would agree that there is no correlation between the strength of the DAT and the severity of the HDFN (ABO HDFN quite often has a negative DAT), but I would thoroughly disagree with the comment that a weak DAT means that there was a smaller foetal bleed. There is very little correlation between the amount of the foetal bleed and the strength of the maternal antibody. There is much more correlation between the immunogenisity of the foetal antigen and the strength of the maternal antibody.
    10 points
  48. Auntie-D, I certainly didn't set out to insult anyone. I was simply commenting from my experiences and those I have heard from others. The tone of your response was certainly accusatory. One of the things I appreciate most about this site is the openess of the members and I hope it stays that way to encourage conversation. Confirmation bias does not mean that someone was intentionally careless, it is often subconsious. There is also plenty of use for 2nd checks (we use several), but it should not always be the answer without an investigation of the process. Unnecessary checks can bog do
    10 points
  49. I am somewhat surprised that you "often" see patients with these subtypes as, working in a very large Reference Laboratory, we see no more than about 2 or 3 a year. That having been said, with the advent of avid monoclonal grouping reagents, it is now almost impossible to assign a specific subgroup to an individual, without the use of molecular techniques. The old way of assigning such subgroups is somewhat defunct, as the reactions we get with these modern monoclonal antibodies are so much stronger than those seen with human-derived polyclonal reagents (and even then, the "strength of the
    10 points
  50. I have always trained my staff with these words, "Record what you see, not what you think it should be." In other words, proceed based on observations, not expectations.
    10 points
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