Malcolm Needs

Yes, when we issue blood as "suitable for", we always warn that the blood should be transfused slowly and that observation of the patient during the transfusion is of paramount importance (not that it isn't anyway, but you know what I mean). :):)

Sorry to be a pain, but could you explain this a bit more please? Do you mean post-Rhogam, or just drop the screen full-stop? :confused:

Is the blood used for an IUT not irradiated to prevent this (and TA-GvHD) happening??????????? :eek::eek:

Yes, I agree with you Kate that everyone reports to someone else, and from a Managerial point if view, I think that this is right. What worries me, and I think a lot of others working in Blood Transfusion Laboratories in many hospitals in the UK, including some very big teaching hospitals, is that the person running the Blood Bank is not only managerially subordinate to the person running Haematology, but is also often subordinate to them on a technical level. As I said in an earlier post, herein lies the problem, because some of these people, with very little knowledge of blood transfusion (and that often learned many, many years previously) do tend to interfere and throw their weight around in the Blood Transfusion Laboratory itself, when the person in charge of this Laboratory knows a great deal more about the subject, and is usually very much more up to date with their knowledge. :(:(

Well, actually, we do too at the Reference Laboratory. It's on the grounds that we never believe anyone else's results but our own, and if the patient has been recently transfused and we get a mixed-field reaction with anti-D, we will report it as "D??". :redface::redface:

I agree, but in this case it did not take a lot of thinking to know that the procedure invented by the Medical Director made no sense whatsoever!!!!!!!!!!!!!!!! :eek::eek:

If we are cross-matching for a patient with a low-frequency antigen or a patient with WAIHA or CHAD, where we actually find the cross-match compatible, we will call the cross-match "compatible". If we are cross-matching for a patient with WAIHA or CHAD, where the cross-match itself is either incompatible, or we are cross-matching with adsorbed plasma, or we are cross-matching for a patient with an antibody against a high-frequency antigen, such as anti-Kna, where we know that there are no clinically-significant atypical alloantibodies present, we will use the term "blood suitable for...Joe Doe...". There was an excellent editorial by Lawrie Petz a few years ago on this subject, which is still very valid and worth a read. Petz L. "Least incompatible" units for transfusion in autoimmune hemolytic anemia: should we eliminate this meaningless term? A commentary for clinicians and transfusion medicine professionals. Transfusion 2003; 24: 1503-1507. :):)

1. At least one, if not more (it's national). 2. Once a day (in the early hours, between about 01.00hrs and 02.00hrs - which is a real pain in the b*m if you are trying to issue a cross-match, because at thet time of the morning, it's got to be urgent, otherwise we wouldn't be doing it, usually involves a bleeding liver transplant with 5 antibodies minimum, and, because we then have to issue by hand-written compatibility labels, usually involves a Sri Lankan name - but hey, it's got to be done some time, and that is the time when the computer is least used)!!!!!!!!!!!!!! 3. I'm not sure, but I think none (I think, which is always dangerous, that the server writes to a tape/CD-ROM, or whatever the IT bods use, all the time). :):)

Excellent points Carol. :):)

Only if the case is on computer already. If the patient is new, or was wrongly grouped before, or the present or previous sample was taken from the wrong patient, or the unit were incorrectly grouped, then NO!

In turn, I see from where you are coming Steve, but I would argue that Agenda for Change should have sorted out these discrepancies, but recognise that this has, in no way, happened. :(

I absolutely, utterly and completely agree with both you and L106 concerning these sentiments. There is NO logic to this whatsoever. :mad::mad::mad::mad::mad:

You could try telling the physician that any blood issued to the patient is issued as uncross-matched if they do not provide a second sample, and that they are, therefore responsible if there is any reaction, and follow this up in writing so that you are legally covered. You may well have to have the backing of your Medical Director, but if he/she is worth his/her salt, you should get this without question. My experience is that the very thought that the physician may actually be held responsible for their actions in relation to a blood transfusion, particularly one involving uncross-matched blood, works wonders!!!!! :confused::confused:

I can assure you that Steve is one of the good ones! I know that money isn't everything (although, of course, it helps!), but what really annoys me as much as the non-blood banker bosses who override (or try to) those of us who know a bit about it, but the fact that they also, very often, get paid considerably more than the most senior person in the blood bank, because they "have to look after blood bank too". In many hospitals in the UK, the person in charge of blood bank reaches a "glass ceiling" in terms of pay, because they will never be able to reach the level of the most senior member of staff in haematology, chemical pathology, microbiology, histology, etc, etc. :angered::eek::boo::angered: (JUST) ONE OF MY PET MOANS!!!!!!!!!!!!!!!!

We bought our 10-year-old son Harry a DVD called "Addams Family Values" for Christmas (amongst the rest of what was on sale in Croydon - my wife Dee did the shopping!!!!!!!). In this, their daughter Wednesday smiles at one point. She scared everyone by doing this. I really cannot think what brought this scene to mind!!!!!!!!!!!!!!!!!!!! :confuse::confuse:

To follow up my own post (sorry), I will give an example. During my career, I have had the misfortune to have dealt with at least five major incidents. These included three bombs, when the IRA were operating in London, and two train crashes. On the fourth occasion, despite the fact that I was nominally in charge of the Blood Bank, the person in charge of Haematology (who was my line manager, and who knew basic blood transfusion, but who had never dealt with a major incident in his life) happened to be around, and "took charge". I cannot give too many details, otherwise personal identities would be revealed, but suffice it to say, the result was near chaos, and the victims survived "despite", rather than "because of". This sounds very egocentric on my behalf (for which I apologise), but it was, nevertheless, true. :mad::mad::mad::mad:

Eh? Can I have that in writing?????????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

Yes, except now, to get above the basic grade, you need a Master's (unless you are as old as me - this came in after I got to Chief).

I have been in that position, and believe me, not only does it feel like an insult, IT IS AN INSULT! :angered::angered:

Sorry, I mean 19S, not 15S. I'm a twit. :redface::redface:

I totally agree with you that this, on the face of it anyway, is a ridiculous practice. I absolutely agree that, the more difficult you make it for the pregnant lady, the more likely it is that she will not bother to come for the shot of anti-D immunoglobulin. One question I have is, what if there is a foeto-maternal bleed 24 hours after the type and screen? The lady could well be sensitised in this time, if there has been a "silent" bleed prior to this and the bleed at 24 hours stimulates a secondary responce (but you sure as hell won't pick it up). Secondly, what if there is a large, but "silent" bleed after the 28 week anti-D is given? How does your BB Medical Director expect you to then tell the difference between immune and prophylactic anti-D? He/she might argue, "Yes, but how often is that likely to happen?" (either scenario). I would ask, how many times have you detected anti-D in a pregnant mother after the 72 hours, without there being an overt sensitising event? :eek::mad::mad::eek:

I somehow doubt it! It is an ultra-centrifuge that spins at VERY high rpm and which was used to discover that IgM was 15S and IgG 7S (the S being the Svedberg). It takes about a week to stop when it is at full speed. :D:D

I think this is unlikely, unless, of course, you are using a Svedberg centrifuge. :D

I usually agree with what you say Lara, but over this one, I'm afraid that I must go with the post from mhc. :redface:

I think what Bill is getting at (correct me if I am wrong Bill) is that, in the UK, the Blood Transfusion Laboratories in the Hospitals are very often run by a "senior" Biomedical Scientist (who may well be an expert in Blood Transfusion matters), but who has to report to a "chief" Biomedical Scientist in Haematology (who may well be an expert in Haematological matters, but who may well be "pretty average" in their knowledge of Blood Transfusion). In other words, the real expert in Blood Transfusion is responsible to, and subordinate to a Biomedical Scientist in Haematology, who may not have an in depth knowledge of Blood Transfusion. Is that correct Bill? :confused::confused: