Sandy L

Oops, sorry about that Auntie-D.  That was 1998!  Dyslexia strikes.

Another reason for the slow adoption of automation in the U.S. has to do with the slow process for FDA approval of automated instruments.  Alas, when Auntie D had her 3 instruments in 1989 there were really no approved instruments in the U.S suitable for Transfusion Services, just a few "Mega" sized instruments for batch typing mass quantities of samples in a donor center.  We purchased ProVues soon after they were 1st licensed, maybe around 2004, and at that time I believe perhaps the only other instrument was the ABS 1000.  Fortunately since then quite a few good instruments have been licensed in the U.S so things are looking up!

We would do an extended Gel XM as long as the current screen is positive.  It's required by the LIS.  The computer system disqualifies them for electronic XM in this instance.  If the screen becomes negative in the future, they would qualify for electronic XM as the antibody is classified as not clinically significant

Another reason for the slow adoption of automation in the U.S. has to do with the slow process for FDA approval of automated instruments.  Alas, when Auntie D had her 3 instruments in 1989 there were really no approved instruments in the U.S suitable for Transfusion Services, just a few "Mega" sized instruments for batch typing mass quantities of samples in a donor center.  We purchased ProVues soon after they were 1st licensed, maybe around 2004, and at that time I believe perhaps the only other instrument was the ABS 1000.  Fortunately since then quite a few good instruments have been licensed in the U.S so things are looking up!

Have a care one and all!
 
When I started, we used small precipitin tubes for grouping, performed antiglobulin tests on tiles or in capillary tubes, then went on to the tube antiglobulin technique, then the microplate and eventually on to column agglutination techniques.  When I started, there were no monoclonal antibodies and we made our own AHG in sheep!  There were no computers, and so everything was written down on paper, rather like Bob Cratchett when working for Scrooge in Dickens' A Christmas Carol!
 
Bah, humbug!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
 
I will now go and lie down, before I fall asleep over my dinner from old age!!!!!!!!!!
 
       

Thankfully my physician daughter seems to have been absent the day in med school when they give the workshop on arrogance and intractability.

And you said, Sure, pull up a chair!

funny how that stuff occurs. I got written up once for not providing blood culture reports 1/2hr after the specimen was collected . . . The Medical Director provided some direction to the intern. (I reported "no growth upon plating")

The kind of people who tried to "write up" Scott and David should have their crayons taken away until they can learn to play nicely!...or, to put it another way, they should have their ability to try to ruin others' professional lives taken away until they actually have a clue about what they are talking - which, in the case of most such people, is a life sentence!
 
       

For what it's worth I was told by an AABB assessor that there is not any experimental data that shows the blood turns poisonous after 4 hours, but that it it was just a "sounds reasonable" thing, that you should be able to get a unit into a patient in 4 hours and that there's an increasing chance of bad things happening to the blood as time drags on after that.
 
I would guess the CAP citation is the one about staff being knowlegable (i.e. following) about procedures. If your P&P says everyone should be wearing red clown noses, you'd better be doing it when they come.

Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required.  All of these responses display in the patient's Medical Record.  For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing.  Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required.  All of these responses display in the patient's Medical Record.  For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing.  Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

I believe TOCO is an anagram for COOT, where TACO is an anagram for INDIGESTION.
 
Scott

I would agree that for patients this is overkill.  If they are SO weak that they don't come up in gel (and I can only talk for the Biorad cards but they can usually detect down to about 600 D-sites per cell - and the anti-D that you are using, Yorkshire exile, will go down even further) then I would not want to transfuse D+ anyway. What would you actually do with the result?? For cord bloods, well - is a cord blood with so few D sites likely to immunise a Dneg mum?  Donors is another question altogether.  I can well see that soon donors will be fully genotyped and then D will just be another antigen amongst many.  Currently though, there are papers that showed that a number of Del donors was being missed each year.  I also believe that Switzerland, who has been routinely typing their donors for about 2 years, have also found a couple.  Very interesting, academically, but it has pushed up the price of a unit of blood quite a bit and there's no actual evidence that they have actually immunised anyone, as far as I know.  I just get a bit upset sometimes when we in the developed world go to extraordinary lengths to maybe reduce the already negligible risk down further when many countries in the developing world don't have the resources to do more than an ABD slide - if they have the blood in the first place.

Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required.  All of these responses display in the patient's Medical Record.  For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing.  Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

Or the wrong armband is put on the patient in the first place. If the patient is not IDed by asking them their name and birthdate, or if a nurse who knows that patient doesn't ID them when they can't ID themselves, you can still get WBIT.
 
We do use the mobile devices and have had some mislabeled specimens - thankfully not blood bank. The phleb IDed the patient verbally, scanned the patient's armband and printed the labels at bedside for the tests to be drawn - so far so good and following policy. She then failed to get a sample from the patient and left to draw the next patient. What she did not do was tear off and discard the labels she'd printed after IDing the previous patient, so the next patient's samples got labeled with those. She managed to do it twice in one week. She's now working in another department of our facility - not because of the labeling errors, but because she felt that phleb was not a good fit for her (Ya think?!!). After that a 'final check' policy was put in place. Before the phleb leaves the bedside, the tube labels are supposed to be compared to the patient's armband. Still not foolproof if the step is ignored or done casually.
 
Could we still have a labeling error - absolutely! The whole house of cards is totally dependent upon everyone following policy. If one person decides one of those steps is silly or they 'don't have time', then the cards come tumbling down and we have WBIT. The Swiss cheese principle also applies. Do I think the mobile devices are an improvement? Yes, they are. We definitely have fewer issues, but we police the heck out of the process. Someone follows every phleb to the floor twice a month and watches their process for drawing blood bank samples. Keeps them from developing their own shortcuts or inadvertently changing the process. Doesn't mean that someone won't freelance when we're not watching them. Bottom line...you cannot blindly trust that device alone.
 
Nurses give meds scanning those armbands, except that sometimes they find it a bit tricky to get the barcode to read. Guess what they do? They put a chart sticker with that barcode on a paper towel, a piece of scrap paper or the back of their hand and scan that. They get reported when anyone from lab spots it, but how often is it not spotted and/or reported? People can always circumnavigate your process.
 
They want to give blood without a second person checking patient ID and using only an armband scan for patient ID. Gives me the shivers just thinking about it! (And since we don't have a blood bank computer system, it's a non-issue right now.) We do use the Final Check blood lock system as an additional part of the safety process and I suspect that we will continue to do so if and when we issue blood that will be matched to the patient by a bar code scan. (And we police the proper use of the lock as well. Strong disciplinary action would be applied to offenders.)
 
Whew! where did all that come from ?  As they say in the arms control business...'Trust, but verify.'

Malcolm proving that men can indeed multitask - especially as he was probably being a transfusion guru, watching rugby and enjoying a fine wine all at the same time

Human anti-He is, indeed, rare, but that is also to do with the fact that the He antigen is, itself, rare (so it is less likely to stimulate an antibody), and, or it appears "naturally", we are unlikely to detect it, as our screening cells are highly unlikely to be He+.  In addition, for want of a better way of putting it, although He is a "single" antigen, there are several genetic backgrounds to the He "antigen".
 
So, let's start from the basics.  Like M is the allelomorph to N, He is the allelomorph to 'N'.
 
What then is 'N'?
 
Well, the N antigen always used to be described as the first five amino acid residues (from the NH2 terminal of the molecule) on the Glycophorin A molecule, viz Leucine, Serine, Threonine, Threonine and Glutamic acid, but now is numbered as numbers 20 to 24 because the first 19 amino acid residues are now not known to be part of the mature molecule.
 
Similarly, the first five amino acid residues (now the 20th to the 24th) on  Glycophorin B molecule are normally also Leucine, Serine, Threonine, Threonine and Glutamic acid, and these make up the 'N' antigen.  Although I have said that there are several genetic backgrounds to the He antigen, essentially it is made up of Tryptophan, Serine, Threonine, Serine and Glycine moeity.
 
So, we have now established that the He antigen is very, very rare (according to the FactsBook, 3% in African Americans, up to 7% in Blacks in Natal, and not found in Caucasians), and so, unless the antigen is particularly immunogenic (which it obviously is not - otherwise anti-He would be more common in Blacks in Natal), then the chances of an individual producing an anti-He, and then being transfused with He+ blood is going to be a good deal rarer - which is why there is no real data concerning haemolytic transfusion reactions.
 
Obviously, if a woman produces anti-He as a result of pregnancy, and she gets pregnant by the same male partner again, then (given the frequency of the antigen) there is usually a 50% chance of the second or subsequent baby being He+, and then, of course, the antibody would have to be IgG1 and/or IgG3, would have to be of a titre of 32 or more (usually) and would have to react at 37oC, which would be even rarer, and this is why we also have no data on HDFN.
 
Sorry if this is a bit rambling, but I am also watching the New Zealand versus Georgia match in the rugby world cup whilst writing this!!!!!!!!!!!!!!!!!  I hope I haven't made too many mistakes.
 
       

Same as Dr. Pepper, we have an order for Transfusion Reaction Investigation that has fields to result the unit DIN and product component type, clerical check, visual hemolysis, DAT, ABO/Rh.  We result those and there is also a pathologist's interpretation.  We also have a worksheet that we retain internal to the blood bank that has details like signs and symptoms of reaction, when and who notified us, etc.

No policy yet, but here's a couple good articles, if you don't have these already.
Jnl Trauma Balancing Risk and Benefit article.pdf
Jnl Trauma Emergency Use of group A plasma.pdf

What about Sidney?  (Grooooan)

The easy ones first eh KatarinaN!!!!!!!!!!!!!!!
 
It was something I remembered from way back (early to mid-1970's), when I first worked at the International Blood Group Reference Laboratory (I went back there again for a short time as a locum).
 
Guinea pig urine is specifically mentioned on page 402 of Race RR, Sanger R.  Blood Groups in Man.  6th edition.  1975.  Blackwell Scientific Publications.
 
I think it came from a paper they cited:  Morton JA, Terry AM.  The Sda blood group antigen.  Biochemical properties of urinary Sda.  Vox Sang  1970; 19: 151-161, but I would have to check that.  I do remember, however, that we used to keep a supply of frozen guinea pig urine for inhibiting anti-Sda, so, presumably, this worked better than other sources of urine.
 
As an aside, do you know that Sda was originally named Sid? It was named this after Sid Smith, who used to be the janitor at the Medical Research Council's Blood Group Unit, when it was in London, as he had the strongest expression of the antigen at the time it was identified.  In those days, antigens and antibodies were usually named after the first two letters of the surname of such a person, but Sm was already being used for the antigen within the Scianna Blood Group System, that is now known as Sc1, so they named it Sid!!!!!!!!!!

In particular, guinea pig urine.  How you get this is another matter (even if you have a guinea pig) because 1) they keep moving and 2) they won't urinate to order!!!!!!!!!!!

Ah yes, it is indeed the O.R.  We don't have the time to sit down and watch a play at the theatre (which is also theatre - same as OR, but with actors instead) - Mind you some of our surgeons are actors!!!!!
 
What an interesting language English is. 
Cheers
Eoin

I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.