John C. Staley

I've been pretty much off the grid for the past month and thought I would check in. We're driving around Alaska enjoying retirement. Hope all you folks are holding down the fort. I'm sure you are doing a great job.

Wish I could be there. Have a great time while passing on your wealth of knowledge.

Ok, I may be missing something here but my first question is, what testing are you seeing this in? Is this happening in the crossmatch or the antibody screen or both? It may not make a difference but it is important information.

I'm not trying to get too political but in my humble opinion, this is a prime example of unqualified bureaucrats forcing decisions where they have no knowledge or experience just authority while ignoring input from those who really know what is going on. The decisions they are NEVER held accountable for making.

Some how I missed this thread when it first came up. One of my previous employers chose a person with a BS in business to be the director of the lab. The guy was running a soccer store at the time. This person was chosen over a current lab employee who had been the interim director for a number of months and was more than qualified with a BS in Medical Technology and a MS in personnel management and many years of experience. The business guy was hired because he was a golfing buddy of the VP doing the hiring. In the process they ignored all of the requirement posted on the the job description. The guy was a disaster!!! The toughest part of my job became the dumbing down of my answers to his questions so that he might have some vague idea of what I was saying. Those questions usually came from someone else and then he would go and make a rather miserable attempt at repeating what I had said. He was in the position for a number of years and was finally promoted out of the lab. The person who replaced him, while more qualified on paper, was even worse but that's a story for another day. Needless to say, the last one was the reason I left that fine establishment. What I am getting at with this little story is that, as I see it, the government / nurse organizations are attempting to force the rest of you to live through what a very poor upper management team forced on us. I hope this never happens to any of you but if it does you have my heart felt sympathy.

Kate, there is a phone app that will calculated down to the second for you. My wife used it to drive her co-workers crazy. Nurses can be evil when the urge strikes.

Welcome to the wonderful world of the gainfully unemployed.

Malcolm isn't the first Kell antigen also referred to as K1 or is that another Kell anitgen?

We always found one or two patients with a new anti-K every year. The good thing is that K= blood is easy to find. Oddly enough my wife, a nurse of course, has an anti-K which was one of the first antibodies I identified while still in school. Luckily I am K= so that was never an issue with our children. Her anti-D on the other was a much more significant bother. Her anti-S has not been an issue either. Some how I suspect she is what we fondly refer to as a "responder".

We initially switched to a 3 cell screen because it made the transfusion service medical director more comfortable when we went to the immediate spin crossmatch. That was a long time ago and I don't know if the facility is still using the 3 cell screen or not. I suspect they are since inertia is the most powerful force in the universe which explains why blood bankers find it nearly impossible to change once the course is set. (This of course, was typed with a partial smile!)

If I remember correctly we did not require an antibody screen if we had a record of a negative result during the current pregnancy. Otherwise one was performed. At least that's what I seem to remember.

It was the early '90s when I first went to immediate spin crossmatches. In '96 I went to a new facility and my first order of business there was to move them to immediate spin crossmatches. I met with a fair amount of resistance initially but supplied the supporting documentation to the transfusion Medical Director. We were the first in that state wide corporation to do so. Much to every one else's surprise our patients did not start dying right and left from transfusion reactions. The one thing I did do to make the transfusion service medical director more comfortable was to switch from a 2 cell antibody screen to a 3 cell screen. There is a great deal of documentation supporting both the IS crossmatch and the electronic/computer crossmatch (sorry Malcolm). I know John Judd and his group at the University of Michigan were among the first and you should be able to find their papers in issues of Transfusion from the '80s if you are interested.

I'm curious. What benefit do you see in retesting the same sample?

This topic keeps popping up periodically and I find it both interesting and frustrating. My personal view, as stated in previous discussions on the topic, is that what ever you do is little more than smoke and mirrors in an attempt to pacify some regulator. I'm sure that's also why the manufacturer puts such nonsense in their package inserts. They claim specificity for many antigens yet it is acceptable to confirm the reactivity of a select few!! I'm sure that can be rationalized but it still makes no sense to me.

I seem to remember a talk on this subject the last year I was able to attend the Blood Bank meeting in Ann Arbor, MI, by someone in the military. He made a very convincing argument for the use of whole blood in a trauma situation. This would have been about 10 years ago, give or take a couple. One of the many problems I see and you alluded to it Scott, is the availability of whole blood at all, let alone in the quantities needed in a massive bleed/trauma situation. I wonder what the response would be from the major suppliers if a few of you started requesting whole blood on a regular basis.