aafrin

I agree completely with SMW and Malcolm on this. This doctor needs intensive training and should be reprimanded for not following protocol. You cannot just look at donor to certify him fit to donate, Hb has to be done and should be more than 12.5 gms/dl. plus other physical exams.
There are many disadvantages in copper sulphate method which makes it unsuitable especially in a camp or multi-donor settings. We also do Hb by Hemocue method.

I don't think there is very mucy that is "allowed" to be 100% - it is almost impossible when dealing with humans.  We demanded 100% for ABORh typing for our blood bank staff and HR said we could not have that . . . we asked them what % of pts we could kill by ABO mismatch - we got the 100% for that standard. 

Hi cswickard and Clarest,
 
1.  The Goa antigen is quite rare, being expressed on only about 2% of individuals within the Black population, and only then if they have the rare Partial D Category DIVa.  Therefore, you are correct in assuming that you will avoid Goa if you give your patient rr red cells.  However, if he is Ro himself, you can transfuse him with Ro blood, avoiding the C and E antigens, and, in 98% of transfusions, also avoid the Goa antigen.
 
2.  Unless the patient has anti-IgA, I would not have thought that he would require washed red cells (unless they are worried about the small amount of free Hb in the plasma adversely affecting his kidneys).  However, there may be another reason why they are giving washed red cells.  We would need more information.
 
3.  From what you write, it sounds as if he is receiving either partial or full exchange transfusions at his home hospital, and erthropheresis is just an automated method to achieve this.  It allows for a more controlled exchange, as there is little human intervention.
 
4.  The Fy(a-b-) phenotype is seen in about 68% of the Black population, but is also present in Arabs, Jews, Brazilians and Romanies.  It has only ever been found in about 5 individuals in the White population.  Most of the 68% of the Black population have the FYB gene present, but also are homozygous for a GATA-1 mutation upstream of the erythroid promoter region, and, therefore, the Fyb antigen cannot be expressed on their red cells.  However, the Fyb antigen is expressed on tissue other than red cells, and so the immune system does not recognise the Fyb antigen on transfused red cells as "foreign".  They will not, therefore, produce an anti-Fyb, or, come to that, an anti-Fy3 (rare individuals of this type have produced what appears to be an anti-Fy3, but there is a theory that this may be another Duffy specificity that mimics anti-Fy3).
Individuals who do produce an anti-Fy3 usually have the amorphic Duffy genotype of FY/FY, and once they have produced an anti-Fy3, should only be transfused with Fy(a-b-) blood, but this can be either of the GATA-1 type of Fy(a-b-), or the FY/FY type of Fy(a-b-).
 
Although Fy:-5 is more common in the Black population than in the White (by a long way!), most of these individuals are also Fy:-3.  It is till far more common for these individuals to produce an anti-Fy3 than it is for them to produce an anti-Fy5.  Anti-Fy5 is pretty rare.
 
I hope that helps.

I would suggest your best option would be to contact other blood suppliers and see what they are willing to do for you.  Most of us do not have the option of shopping around. 
 
I would love to get into a discussion about CFOs but I'm afraid Cliff would burn my membership so I think I'll refrain.

We purchased two ESCO deep freezers about half year ago. They are working great, absolutely no problems.

To answer David's last question, in my experience, solid phase on the ECHO is more sensitive then PEG (which happens to be our backup method.) We have had ?? reactions on an antibody screening that were stronger on a capture panel, and ended up being a real, significant antibody.
 
No matter what method you use, there will always be those patients whose specimens give a false positive. We just have to use our brains like we were taught oh so long ago.    
 
Beth

Great read but I guarantee that Hubbie will still roll his eyes around his head. We have friends who asked if platelets meant little plates......can't win'em all

Good for you! I had to bring my Mom into the hospital several years ago. I was mid-fifties at the time and in good shape. Mom was mid-eighties, small and shriveled, and at the moment looked like she'd been dead for a decade. The nurse asked me, "Are you her husband?" I said, "You know, if you were a waitress you wouldn't get a tip."

Wishing you a very happy & fantastic Birthday. God Bless You.

Wishing you a very happy & fantastic Birthday. God Bless You.

Malcolm, thanks for the wonderful explanation. Really great.

Malcolm, Please accept my condolences,,,what a tragedy.
If I may ask what happened? accident or???

I have not had any chance to meet Prof. Garratty, but have known his contributions in TM. My condolences to his family & friends. May his soul rest in eternal peace. Amen.

Magnum,
I'm just currious how many times your MTP notification states whether or not the patient has a uterus!

I, too, know little or nothing (probably nothing) about microbiology, BUT, I would not, therefore, put my views forward on matters microbiological. Sadly, it is often the case that someone who knows nothing about blood transfusion think that it is their prerogative to give their views, as "blood transfusion is easy", with only 4 ABO blood groups and D+ or D-. These are also usually the exact same people who are unwilling to work in Blood Bank, because they fear killing someone!!!!!!!!!!!!

Why did you test it with A1-lectin in the first place?

True SMILLER, but, if the system forces you to scan the patient's arm/ankle band, so that there is bedside printing (or whatever) it more difficult to fool the system (although, I am absolutely certain, not impossible - human beings will find ANY way of getting around things). There is a lovely saying, "This system is fool proof, but it is not idiot proof"!
I fully concur Malcolm; for I have noticed it many times that ---
"Foolproof systems do not take into account the ingenuity of fools."

I fully concur with you Malcolm; for I have noticed it many times that ---
"Foolproof systems do not take into account the ingenuity of fools."

I fully concur with you Malcolm; for I have noticed it many times that ---
"Foolproof systems do not take into account the ingenuity of fools."

Shortcuts! Don't forget the shortcuts some techs take to complete work - it's as if somebody has put a gun to their head and no one is going to come in next shift to continue further. They will shorten incubation time, not follow SOPs and give proper hand offs to incoming techs. I keep on streamlining work, make checklists and logs, but to no avail. I think with complete automation, technician errors will at least be taken care of with test procedures (hope???). I always tell everyone, at least use your basic commonsense, but then "commonsense is not very common".

Cliff, Thanks for the snowflakes - 3 different varieties, but I still miss last years' smashable bulbs

Yes, there are Techs. like that everywhere (and it seems to be becoming even more difficult to find experienced, knowledgeable staff with a good work ethic).  So, what I resorted to years ago (and about 3 Hospitals ago) is a little thing called "accountability."  You don't do your job (or don't do it correctly), and you get written up.  You get written up enough....and there will be consequences (and though it is extra work on my part, I manage to find ways to track almost every/any aspect of a task that is supposed to be done).  Once staff know you can track things back to them; and once they know there are ramifications....sadly, for "some" people, that is the only thing that will get them to do their jobs correctly.  And I can tell you this in all honesty (not at all meant as a reflection on me)....but when I have started at a new place (in-charge) and seen all of the above....and "forced" improvement (sometimes with kicking and screaming from some staff); I can say with all honesty that in every place I have left, the staff honestly thanked me at the end for "raising their standards."  They may have fought me all the way....but they could see the difference in their work performance after time and were actually proud of themselves.  That makes it worth it!  
Another problem I have encountered is people who are just trained "how" to do something (or "what" to do); not the "why" or theory behind it.  I always teach by principles because my philosophy is that if someone understands why they do things the way they do, they are much less likely to forget steps; to recognize when something is not right; and to be able to trouble-shoot problems when they do encounter them.  People that are just taught "what" to do, are errors waiting to happen (and will not understand when you try to correct them, because they were never taught that way in the first place).  But again, there are 2 types of workers; those who may have been taught that way but have the motivation to want to understand what they are doing and to do a good job; and are willing to learn and understand what they were never taught; and those who just want a paycheck.
 
And unfortunately, they don't teach work ethic much anymore.....do they?  
 
Brenda Hutson, CLS(ASCP)SBB

Shortcuts! Don't forget the shortcuts some techs take to complete work - it's as if somebody has put a gun to their head and no one is going to come in next shift to continue further. They will shorten incubation time, not follow SOPs and give proper hand offs to incoming techs. I keep on streamlining work, make checklists and logs, but to no avail. I think with complete automation, technician errors will at least be taken care of with test procedures (hope???). I always tell everyone, at least use your basic commonsense, but then "commonsense is not very common".

Shortcuts! Don't forget the shortcuts some techs take to complete work - it's as if somebody has put a gun to their head and no one is going to come in next shift to continue further. They will shorten incubation time, not follow SOPs and give proper hand offs to incoming techs. I keep on streamlining work, make checklists and logs, but to no avail. I think with complete automation, technician errors will at least be taken care of with test procedures (hope???). I always tell everyone, at least use your basic commonsense, but then "commonsense is not very common".

Maybe it would have been a good idea to consult you first?????????????!!!!!!!!!!!!!!!!!!!!!!!