RR1

Hello Mau Feitio, it's great to have you on the forum. Tell us a bit of what Portugese blood banking is like, we are all very keen to hear of how our colleagues in other countries deal with various blood banking issues.

Possibly Hereditary Persistance of Fetal Hb (HPFH) ?

Hi Malcolm, QPulse is meant to be wonderful for all of this...but i'm not allowed to have it!!!- and have to put up with a system that is vastly inferior and time consuming.......... one day things WILL get better- I live in hope, but for the time being i'm even having to trade services to buy pipettes in my lab !! Don't even ask about the Typenex wristbands i've been trying to buy in for the last 5 months- trying to spend £150 is a nightmare......so if anyone wants me to map their fridges in exchange for lab equipment-feel free to contact me.

Hi dalene, do you have haemovigilance reporting there.....or is that still work in progress? It's really great learning how blood banks are progressing in other countries, some of the issues certainly bring back memories of the problems we encountered over the years.

We electronic issue - if screen neg and no previous history of antibodies, also require 2 x groups on LIMS. I would have thought that until you resolve your 20% incompatibility problem, you would need to carry on with performing this. How reliable is the testing (ABO, screening, etc) performed on your donor units...do you find many incorrectly labelled ones, or does the blood service have good donor unit tracking, from the point of collection to final bag labelling ? It's very interesting to learn of the challenges facing blood bank folk in other countries.

You don't need to go to extreme lengths to try and remove- its normal use. Does the label come off when you touch it during usual use- or are the edges peeling away. Do you want the label to come off cleanly- or doesn't this matter...in which case you don't need to test it. It's the KISS technique...Keep It Short and Simple.

Hi Marion, email Malcolm- he always knows the refs for good articles. Also the National Blood Service website and their quarterly 'Blood Matters' magazine is usually very good- you should be able to find some in your lab- or give your NBS liaison officer a call.

Hi Cliff, it can't be a complex validation.Just list on a matrix what materials and temperatures you are going to test them by e.g 1.Label on glass tube-room temp 2.Label on glass tube- 37'c 3Label on glass tube 4'C 4.Label on plastic- room temp 5.Label on plastic- -40'C........etc... and then on the top of the grid - what parameters you are looking at: 1. Smudeability 2.Staying in place after 48hrs 3. Staying in place when brought back to room temp 4. staying in placewhen centrifuged ...etc. If you state how you want the label to perform first (your acceptance criteria), then just compare the result. The validation shouldn't really be more than 1-2 pages. does this make sense?

Hi Malcolm..I'm definately not R1R1....but rr. What is even worse is I have the book...got it off ebay a couple of years ago-must get around to reading it!

You are saying that 20% antibodies are not being detected on your screen/ panel but are being picked up on crossmatch ? This is extremely high. Have you eventually identified these antibodies- and if so what were they (you mentioned they were clinically significant). In the UK we have a fairly diverse population, and have used the National Blood Service manufactured screens and panels (which I presume are mainly from caucasian donors)- had no noticable problems with transfusions in mixed recipient populations.

Looks good, the thought process is a bit more complex I suppose when you are trying to teach staff to assess on this basis. moderates : Missed training deadlines Delayed equipment maintenance Delayed document reviews Delay in testing/ blood provision (depending on the situation) i'll look through my QI folder tomorrow- and get back.

Hi Marion, the validation aspects have always been around, its just the tests and assessments staff had always performed prior to using equipment or processes were mainly in our heads or scraps of paper, rather than being formally documented in a structured way. The Blood Safety and Quality Regulations Act (BSQR) , changed all this (2005) and we all needed to implement proper quality systems- you don't really need to read this document yet. For your overview you could start with the usual transfusion history, improving safety, emergent diseases that affect blood donations, CJD - and difficulty in testing for this- and potential unknown effect this will have on the blood supply . This would lead into the need for robust traceability of donations and then introduce the BSQR and how this ties in with 'quality'- which basically means doing things (testing, teaching, maintaining, checking,... everything)- in the best possible way. Validation is just one of these aspects- to ensure systems are 'fit for use' This ALL leads up to improved patient safety and care.....which is what we are all trying to aim for. Good luck with exams!

I'm not going to spoil this...but I think it begins with ....H.

Hi Lara, who would take responsibility for the training of staff handling the tissues ie thawing femoral heads etc ? Also, I presume you would have to be the main focus of your tissue regulators and undergo their inspection process/ compliance reports and fees? Do you have sufficient storage capacity and also will the surgery dept help with the cost of maintenance, repair and replacement of equipment...and what else can you get from them before you agree to anything?!! In the UK tissues are regulated by the Human Tissue Authority (HTA)- you might find some useful info there- but i'm sure the US has adequate info on their site.

Hi Ovrwkd....I have to admit your forum name always makes me smile....wish i'd thought of it ! Of course you do need to be careful- if your manager finds out about your insomnia they'lll probably not believe you are overworked, and give you some more!

I forgot to add that this effect is observable using IgM (rapid spin) anti-D antisera.

Hi David, Things are obviously a lot easier for us in the UK than it is for you folk. We are very lucky to have the National Blood Service (Now called the NHSBT), who coordinate all donor collections, testing and selection for the hospitals together with reference work. So, many of your hospital labs are also perform donor testing - I suppose this does make the work more varied and interesting- but it must be tough on you folk to have to deal with this all. I'll try not to complain about my job anymore! Thanks for info

Thanks Dalene, it must be constantly hard work for you to trying to implement better clinician understanding. What guidelines and testing requirements do you follow for screening the units?

Thanks LM1 and Franklyn- you have given some very useful tips and info. I'm scheduling a full check every 2 months (red cells, FFP , cryo), as I don't think we could currently cope with the additional workload to perform daily/ weekly. However I suppose if I did this more frequently it would probably be easier each time...will have to re-consider.

Yep ....far too easy for you guys! The maternal anti-D antibodies had blocked the D antigen sites of the Rh D positive baby cells (as aakupaku said it's known as the 'blocking effect'). This prevented the anti-D reagent sera from reacting and agglutinating the D+ cells, resulting in a false Rh D - type. I'll think of a harder one for next week !

Case study scenario 1 1. Mum presents as group O RhD negative (rr) with immune anti-D detected, quantitation of 6 IU 2. At 32 weeks her anti-D level has risen sharply to 90 IU 3. In this time period no IUTs have been given 3. Baby delivered, severely anaemic, Bili increasing +++ 4 Baby groups as O Rh D Negative, DAT strongly positive 5+IgG coating. Questions: 1. Explain the above results I am sure you'll all get it easily!.....may be someone else could post the next case:)

Further to this question- some very helpful folk have told me that if I decide to put this on an audit schedule it's not a problem, but stock inventory checks need to be performed more frequently than annual audits. I think that if a lab performs this routinely as part of their stock check- then this activity can be included in the normal day to day workfiles. I just know that if this process is not scheduled for my lab ...then it may get forgotten....so for now I will include it on my audit schedule. Thanks for the info!

Thanks I will do...but it would be much more fun to hear it from the US folk and staff from other countries themselves.

I've really enjoyed learning about the similarities/ differences in blood banking between the U.S vs UK . How are your blood donor centres managed?- are they all part of the hospital blood bank- or run as independent organisations? It would also be nice to hear from others around the world as to the set up of their hospitals and donor centres too. Thanks

Hi aakupaku, its good that you check your results. No technique is infallible, as long as we can explain why a previous antibody is no longer detectable (possibly due to a recent transfusion of antigen negative blood), then re-screening is not always necessary. However, I like to think of patients that have known antibodies as being an additional, random 'positive control'. If these are not detected when they should be- then the full process- whether automation or manual, needs to be checked thoroughly.