Malcolm Needs

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.

I think that you have to look at the requirements for storage of the cards before use. Certainly, with the DiaMed cards we use in the UK, they have to be stored between 18 and 25 degrees C. I wouldn't mind betting that the inspectors will regard pre-incubation of the cards at 37oC as being out of storage temperature range. I know that any inspector in the UK (MHRA or CPA) would have a fit of the vapours if we regulalry did this kind of thing. We received a non-conformance for not having a minimum - maximum thermometer on top of each and every one of our boxes of DiaMed cards stored in our Laboratory. :disbelief:disbelief:disbelief

Sorry, I obviously got hold of the wrong end of the stick. In the situation of which you write, I would flatly refuse to perform any tests whatsoever, and would be inclinded to report the requestor to a higher authority. :mad::mad::mad:

First of all Tonyd, thanks for the link. Secondly though, I think that the MHRA are quite capable of using the recommendations indirectly where they think they should use them (they are pretty smart cookies). The people who could really have looked at this, but who wanted nothing to do with the recommendations, are the CPA. If they could be persuaded to "come on board", I think that we would really be in business. I suspect that they may regret their attitude before long. :frown::confused::frown:

Ah, I think I see what you mean. As far as I know, and, of course, I don't deal with every hospital in the UK, nobody uses more than one set fo screening cells, and does not have access to more than one set of screening cells. As long as you have confidence in your primary screening cells, I can't see the need for the second set.

Who Mary**? lef5501 or me????????????????

Well, I think you are quite correct to have a back-up, but do you need to QC them every morning? If they are consistently working well with the QC, why not just QC them at the same time as you use them? At worst, if they fail the QC, the physician will have to wait for the gel technique.

I'm afriad I don't (not without breaking Copyright Law).

If I may jump in here Rashmi, the answer is that you cc your Risk Assessments to a competent body, such as the MHRA, or the IBMS (who have an excellent legal department) so that, even if you are seen as a "whistle-blower" by your own CEO, you will be legally protected (as long as, of course, what you are writing is reasonable, even if, in the long run, it is proved to be unfounded). You have LEGAL protection, even if your "significant folk" don't like it. Indeed, if you know of a risk, and you do NOT report it, then you could be (almost certainly would be) legally in the wrong yourself. Ignore this bullying. You have powerful friends in the MHRA and the IBMS (and the BBTS come to that, and, possibly, the NHSBT[????????????]). :comfort::comfort: