Malcolm Needs

Hi Stephen, I've managed to contact Clare. As they stand, the Guidelines do indicate that the blood should be re-cross-matched every 24 hours, but this is recognised as being unachievable in almost every case. I understand that the Guidelines are under review at this very moment, with a view to being published later in 2010, and this particular problem is one of the things that is being addressed. It is likely that, with evidence gathered from all around Europe (and, indeed, other parts of the world) that the overall time will be extended to a 72 hour window, to bring us in line with most of the rest of Europe (although this is yet to be set in stone, as it were). The 72 hour window will allow you to cross-match on a fresh sample, and keep the cross-matched blood for 72 hours, or to cross-match on a sample taken the previous day, and keep the cross-matched blood for 48 hours, or to cross-match using a two day old sample, and keep the cross-matched blood for 24 hours. When, and if, this is agree and incorporated into the Guidelines, this will make life very much easier I think, particularly over weekends. Please understand though, that this is not yet agreed, nor is it in the current Guidelines. I hope this is, at least, of some help. :):)

Hi Lindz82, Not only could sepsis cause the extra reactivity, but in my opinion (and it is only an opinion) the sepsis has caused the extra reactions in this case. This was why I asked about the underlying pathology with regard to the amputations. Pathological bacteria, as opposed to the normal gut flora (in their normal place within the body), chuck out all kinds of junk (most of which is pretty nasty to the human body) and this junk gets into the blood stream and causes all sorts of problems for the serologist (to put it scientifically)!!! :o:o

Excellent post Rashmi. I thoroughly agree!!!!!!!!!!!!!!!!!!! :D:D:D:D

Never presume; always make certain!

It didn't raise my eyebrows; it gave me a complete face-lift! I think that, so far, you have been lucky. We've just dealt with a patient who, having made an anti-E+M+Fya+Jkb, and that's all for many years (almost ten in fact), suddenly produced a rip-roaring anti-Fy3 in three days. Sent an Hb of 7g/dL before transfusion down to 3.g/dL after transfusion! :eek:

Fair comment John. I was assuming that the urine was pink/red and that one couldn't tell whether it was haematuria or haemoglobinuria.

True, but antibody profiles change too. You may identify an anti-Fya (for example) in the present sample, that was not identified in the previous sample, and you wouldn't give Fy(a+) blood on the grounds that the physician did not order K-, Fy(a-) blood. If the situation changes the other way (the patient does not, after all need CMV- blood, for example) then, fair enough, the physician should let you know, and you can take this requirement off your computer records (assuming, of course, that the computer programme will let you!). I must admit that Kate Murphy's post has made me think long and hard, and I may be changing my opinion (some may say this is a unique situation, I might add)! :confused:

Yes, but I can see where jayjay is coming from. It would only be a very rough template, and not necessarily one that could be used in a cogent argument to be used against some very hard-nosed people (the Hospital Board). They will require purely objective arguments and will regard such a template as extremely subjective. I can also see where you are coming from, but you would almost certainly have to identify another hospital (or hospitals) within the UK, who have the same catchment area, patient mix, etc, etc, and who satisfies the inspectors, before you could use such a template, and that ain't gonna be easy. I think that you are going to have to find another way involving local arguments. This is almost certainly what you don't want to hear. Sorry. :redface:

I think that the document is excellent (personal opinion), but, perhaps, in this one area it could have been more explicit? :confused:

Hmm, thinking about it, it is difficult to argue with what you say.

In a way, it sort of is there (page 723) "Free hemoglobin in the urine is indicative of intravascular hemolysis. Hematuria, or intact red cells in urine, and myoglobinuria both have other causes." It is tacit, I fully admit, but the only way you are going to tell the difference is by centrifuging the urine (but it could be a lot clearer)! :rolleyes:

You should, otherwise haematuria can be mistaken for haemoglobinuria.

I think that people may be talking at cross-purposes here. I think the bands that you are talking about pluto, are the bands in the new document from the Chief Scientist. I think the bands you are talking about Rashmi, are the Agenda for Change bands. Am I correct?

This is an excellent question. You are quite correct about the Guidelines. I will give Clare Milkins (one of the authors) a quick telephone call (if she is in) and ask her.

What you say concerning Friday is true, but only true if you get compensatory leave prior to doing an on-call duty. This is not true of all Laboratories. I should think that, if you have an arrangement whereby a senior Biomedical Scientist from another hospital can field telephoned problems at night, the same would apply to the core hours??? I don't know; I just wonder. Of course, the Blood Bank staff can always ask the most senior person in Haematology, because they always seem to know more about blood transfusion than the actual individual in charge of the Blood Bank Laboratory in the UK; or so it would seem!!!!!!!!!!!!!!!!! :sarcasm::sarcasm:

I have to say there are probably quite a few Blood bank managers in the UK who do not attend meetings or participate in any form of networking or discussions, this is not a good example to set staff.

A very hearty welcome to you froggymork. I think that you will find this web site fascinating and very educational. I've learned huge amounts from my fellow posters since I joined. :D

Well said!

Also, what was the pathology behind the amputations? It could well be bacterial metabolites that are causing the serological problems.

Much as I hate to agree with Rashmi over this one (not because I hate to agree with Rashmi per se, but because I don't want to have to perform the temperature mapping). The move can completely ruin an incubator, fridge, freezer, water-bath, etc (but it is a pain to have to do it)!!!!!! :bored::bored:

I'm not sure, but I believe what is being discussed in this thread is a rise in temperature and other minor symptoms. I am worried, though, that there are some places where the report of a suspected transfusion reaction takes so long to get to the Blood Bank. In the case of a more acute transfusion reaction, the symptoms of a red cell antibody reaction can mimic the symptoms of the transfusion of a bacterially infected unit of blood or blood component. If the unit or the blood component is bacterially infected, your Blood Supplier needs to know as soon as possible, because other components made from the same unit may be out there at another hospital (or even in the same hospital) and these need to be quarantined with immediate effect. I'm not entirely sure how well the ward staff understand this, and the need for any suspected transfusion reaction to be reported to the Hospital Blood Bank, and then on to the Blood Supplier as a matter of urgency, and we need to get this information across in words of one syllable. :eek::eek:

I agree - rouleaux is not, after all, cause by a red cell antibody.

It's an absolute pleasure. I often think that we are guilty of not fully explaining things to the patients.

Good for you! That is a great attitude.

Yes and no! Certainly in the UK, any blood that is given to a newborn baby is group O (but it has been tested to make sure that the ABO isoantibodies are NOT strong) and this probably applies in the USA as well. The reason for this is that the blood is usually required fairly urgently after the birth, and so there is not much time to "organise" an ABO identical donor (we have to have some on the shelf ready to go at all times). Group O blood can be given to almost everybody in the world, apart from incredibly rare people who have the Oh type (and I do mean incredibly rare). The other thing is that, until the baby is born, we have little to no idea of the baby's ABO group, and under such circumstances, group O is the safest by far. Although there is no doubt that group B individuals are rarer than either group O or group A (but commoner than group AB) there are plenty of group B people in the population who are Cw-, Le(a-) and K-.