Malcolm Needs

Hi Andy, Yes, that is what I meant in my post. By the way, welcome to the site; you will be a great asset. :D:D:D:D

This is all to do with the relative rarity of group O D Negative blood (roughly about 7.2% of the White population, and rarer in other populations). The D antigen is the most immunogenic of all the red cell antigens (apart from ABO), which means that a person who is D Negative is highly likely to produce an anti-D if transfused with D+ blood. Anti-D, in itself, is not dangerous, just because it is in the circulation. However, the antibody will cross the placenta and with destroy foetal red cells if they express the D antigen. Therefore, we try to avoid giving D+ blood to any female of "child-beariong potential" (horrible phrase), just in case they are D Negative. Actually, in the UK, we would not consider giving group O D+ blood to a female in an emergency who is less than 60-years-old (and the same applies to K+), unless there was no other choice (i.e. the hospital had run out of group O D- blood, the lady was in danger of exsanguination, and no group O D- blood could be transported to the hospital in time to save her). I hope this is of help. :)

Hi Esther, My own thoughts are that one would only use maternal blood for transfusion of a baby in extremis, when no other suitable blood is available. The danger of GvHD is a very real and present danger that can only be mitigated by irradiation of that blood. If your antibodies are anti-Cw, anti-K and anti-Lea, the chances are that the problem antibody of the three is the anti-K, but Cw-, K-, Le(a-) blood from unrelated donors would be readily available, and I would choose this blood ahead of maternal blood every time. Whilst your own red cells would be compatible (assuming that you are the same, or have a compatible ABO blood group as your baby, which is not necessarily the case) your blood would also have to be washed free of the "offending" antibodies in the plasma, prior to irradiation, and the more manipulation of the unit, however careful one can be, the more chance that there is of bacterial contamination. The answers to your two questions, in my opinion are, therefore: 1. It is important to avoid giving your baby maternal blood, unless there is no alternative, and 2. I think that you would be wise to accept the advice of the Blood Bank that is not interested.

My ER person that didn't know their own Blood Bank could cross-match blood. jasonviau's ER person that didn't know that O Neg was not 0 Neg. Who do they let into ER these days???????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! HELP!!!!!!!!!!!!!!!!!!!!!!!!!! :eek::eek::eek::eek::eek:

Yes Linda, I see where you are coming from, but a colleague of mine has just had a horrible case where a D- lady with bleeding varicies made anti-D. She had an anti-D, but they did not do her other Rh antigens. She then went on to make an anti-c because she turned out to be an r'r', so it may also be worthwhile doing the other antigens in the case of someone who has made anti-D! In the case of a 70-year-old male undergoing a one-off surgical procedure, such as a THR with an anti-E, who was R1R1, I wouldn't worry if he made an anti-c too! :eek:

I am from the UK, and so do not know the rules and regulations of which you speak, but at least some of the problem lies with your parent company for you not being able to access their computer (especially in this day and age). :eek:

Yes, I would agree with you, but I would take into account sex, age and clinical condition.

It's part of an Iron Age village reconstruction in Dorset (with an Iron Age family in front - I am now going to hide from my wife and son until the anger has blown over - 2 decades should do)!!!!!!!!!!!!!!!!!!!!! :tongue::tongue::tongue::tongue::tongue:

I'm afriad you are correct. We get a certain flt fee for being on call in the first place (we are based at home), and then we get paid if we have to come in to work. This is more complicated than it sounds. If you get called in, and you finish the work in 5 minutes, you still get paid an hour (of course, this never happens). If you get called in and you work for four hours, you get paid the first hour, and then every quarter of an hour after that. I can't remember how much it is, but one os not going to retire to the Bahamas on it! It is much less than a plumber gets for being called out to a burst pipe! Believe it or not, the hospitals actually pay no more for having an investigation performed during on-call hours than they do for sending it in during core hours! :eek:

I agree with you Steve (as I always tend to) about the huge vacuum in London, but it is not for the want of trying on the part of some people. Mike Gorge, of the University of Westminster (for whom I have huge respect), and others have tried very hard to get such a course off the ground, but to do so, there has to be sufficient interest shown by potential students and their employers. From what Mike tells me, it is the latter problem that is the stumbling block (although, that having been said, even the former is a problem). If there were to be a concerted effort by all parties, and I mean concerted, there is a very good chance that such a course be run, but at the moment, most of the efforts are disparate. :confuse:

I've been in since 6.30 this morning. It is now 10.10 at night, and I haven't nearly finished the auto-antibody case. I've just been called by Medway Maritime about a patient on the table with a pan-reacting antibody reacting by IAT only (not auto). I suspect that will take about 2 hours to get here and then I've got to investigate it (another 2 hours?). At the moment, I can't even switch on a television, let alone teleport!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :eek::eek: Oh, and I've run out of milk for my coffee (I should probably have it black anyway).

One would sincerely hope so. The number of babies affected by ABO HDN is increasing simply because mother and baby are being discharged so quickly after the birth. Of course, the mother is not trained to notice anything odd, and so the babies are being brought back in in extremis, rather than them being treated with phototherapy in the hospital (although, of course, this is hardly the fault of the Blood Banks). :eek::eek:

I am on-call working at the Tooting Blood Centre tonight on a sample with the auto-antibody from Hell. I have just received a telephone call from the Accident and Emergency Department at the Conquest Hospital in Hastings. On the end of the telephone was a Senior House Officer telling me that I would have recieved a Group and Screen on some Joe Doe, and that he would now like me to cross-match. I said I wasn't aware of receiving the sample and how long ago did he send it? 15 minutes came the reply (Hastings is about 65 miles from Tooting by the way). I explained to him in words of one syllable (well, there may have been one two syllable word involved, which may get me fired) that he might like to try telephoning the Hospital Blood Bank. "Oh," he said, "Can they cross-match on site then?" Quite apart from the fact that he should have known this before he was let loose on patients, how does he think the samples are transported? By fighter jet?????????????? :angered::angered:

Indeed, they can be fatal.

No, it's not that difficult, just a bit time consumming. Most of the NHSBT Laboratories are now automated, but my own is still totally manual, and we had no problems. Enjoy the fun!!!!!!!!!!!!!!!!! :D:D:D:D

Most certainly there are. Blindness si also associated with kernicterus, as is opisthotonus. As the deafness is "caused" in the brain, rather than in the ears with kernicterus, there can be multiple disabilities.

It surely must depend upon the size of the Blood Bank. For somewhere like King's College Hospital, I would imagine that you would require an entire WTE for Quality, and the function of the Laboratory Manager is, quite literally, to manage (rather than go out on the bench). For little St. Elsewhere's out in the country, the Laboratory Mmanager could combine the two posts (although I don't think that is a particularly good idea - I think that the posts should be split, so that there is no conflict of interest) and the Laboratory Manager would probably spend quite a lot of time doing benchwork. :confused::confused:

I would tend to agree.

Sorry to confuse you (my fault entirely). No, I would do cross-match compatible for all three. What I meant was that I would not like to try to give the rest of an Le(a+) unit to a patient who had reacted severely to the first part of the transfusion. Seems like it's asking for trouble. Again though (which is why I would give compatible blood) an anti-Lea that reacts like that is disappearingly rare. :)

I voted for cross-match compatible for this, as this is what we do as a general rule. HOWEVER, if the anti-M reacts by LISS tube IAT at strictly 37oC (pre-warmed and warm-washed) we would cross-match M- blood. This is quite unusual. I have heard of 2 cases during my career (starting in 1973) that contained an anti-N that reacted extremely strongly by LISS tube IAT at strict 37oC (again, pre-warmed and warm-washed) that required N- cross-matched blood. One case was one of my own and the other was in Scotland. I have read of anti-Lea causing a haemolytic transfusion reaction, but have never come across one myself (and I gather that such reactions are "self-limiting", in that the Lea substance transfused with the Le(a+) red cells "mops up" the patient's anti-Lea, and the rest of the unit can be transfused quite safely - I wouldn't like to try that myself!!!!!!!!!!!!!!!!!!!!). :eek::eek:

The most interesting thing from our point-of-view was that it was caught up in the postal strike, then delivered to St. George's Hospital, and by the time we received the exercise the red cells were a very deep shade of purple! Aghhhhhhhhhhhhhhh! :angered::angered:

Yes, I suppose they would have to.

I thought so, but I wasn't sure. Thanks Mary**. :)

I probably should not be saying this, as I am a member of the IBMS Special Advisory Committee for Transfusion Science, but I do so agree with you about your first point. I am somewhat surprised that the BBTS representatives on the committee did not kick up more of a fuss. I totally agree with your comments concerning the Edinburgh MSc (especially so, as I lecture on this course!) and, personally, I think that the Bristol MSc is its equal. On the face of it, I would agree with your comments in 3, but when you look closer, some of the recommendations could not possibly be complied with by the Reference part of the Red Cell Immunohaematology Departments of the NHSBT (although this does not apply to most antenatal work and grouping for the armed forces or the British Antarctic Expedition). If, for example, you look at bullet point 2.1, much of our work involves the investigation of auto-antibodies (or rather, what, if anything, is underlying the auto-antibodies). there is no way that full walkaway automation (or any other kind of automation) could be used to perform these investigations. Almost al of the other reference samples contain at least one clinically significant atypical alloantibody, and so the use of electronic issue (bullet point 2.2) is a non-starter for us. I think, though, that many of the general points raised in the Recommendations are already adhered to by the RCI Departments within the NHSBT. Certainly, nobody could work as a Biomedical Scientist during core hours, let alone during non-core hours, unless they were registered with the HPC. Point 4 is well made. Presumably, anyone who is taken on in this fashion would have to show capability and be signed off as such by the most senior member of staff within the Laboratory (and they themselves would have to have qualifications in Blood Transfusion), but I do agree that this should have been made more explicit. As far as I am concerned, funding is a matter for the CEO, and, as I said in an earlier post, they fail to give the correct funding at their own peril. It will only take one disaster to occur, where the CEO is implicated for not funding the requirements listed in the Recommendations, and I think that funding will suddenly be coming out of our ears! :cool::cool:

We keep a sample of the donor's plasma/serum for many years within the NHSBT, just for such a look-back.