Malcolm Needs

Hi Shirley H, I do believe I know you, do I not! I would be heavy on the risks if I were you, with particular reference to who would be in deep trouble (the CEO) if the recommendations are ignored! :D:D:D

Hey, a lot of people already think I've got a big head. If you carry on like this, it will explode!!!!!!!!!!!!!!! :redface::redface: It's just that when I started out in Blood Transfusion, I had some fantastic mentors (such as Dr. Ken Goldsmith, Dr. Elizabeth [Jan] Ikin, Dr. Carolyn Giles, Joyce Poole, Ted Wheeler, to name but a few) and I feel that I owe it to them to try to help others.

I know exactly what you mean Rashmi, but in circumstances where CEO's do get a "talking to", particularly where extra finance for the Blood Transfusion Department is required, the MHRA are quite capable of taking things much further (and higher), and have recently done just that in one of their inspections. In the particulr case of which I am thinking (not public knowledge yet, so I can't name names) the BBM was given extra budget, extra powers and was promoted a KSF Grade (so it can work to our advantage). :D:D

Well, I do know of one Chief Executive who was asked by the MHRA how he was going to run his hospital without a Blood Transfusion Department (some "veiled" threat), so, as the MHRA are going to inspect against this, I would advise Chief Executives to take it very seriously! :eek::eek:

In the UK, the UK Transfusion Laboratory Collaborative, backed by the Institute of Biomedical Science (IBMS), Serious Hazards of Transfusion (SHOT), the Royal College of Pathologists (RCPath), the British Blood Transfusion Society (BBTS) and the Chief Medical Officer's National Blood Transfusion Committee (CMO's NBT) and equivalents in Scotland, Wales and Northern Ireland, has now published the "Recommended minimum standards for hospital transfusion laboratories" in various journals (two of which are Transfusion Science 2009; 19: 156-158 and The Biomedical Scientist 2009; 53: 744-745). The implimentation of these recommendations will be monitored, as appropriate, through current Medicines and Healthcare products Regulatory Agency (MHRA; where applicable to BSQR 2005) inspections. The impact of these recommendations on transfusion laboratory errors will be monitored by SHOT reporting via the MHRA Serious Adverse Blood Reactions and Events (SABRE) reporting system. This thing has teeth, and I suspect they will use them. I am wondering how people are getting on with implimenting these recommendations, and how much support they are receiving "from above"? :confused::confused:

Ditto in the NHSBT (and the rest of the NHS, as far as I am aware).

In such a case, we would always order a new sample. If this showed that a mistake had been made, we would immediately tell our Consultant, who would tell the patient's Consultant, and would contact our Quality Department to initiate a Root Cause Analysis. It may be no fault of the phlebotomy staff (doctor, nurse, phlebotomist); it may be someone who is using somebody else's identity (in which case, the police may become involved).

We do all sorts of tests on samples to identify the specificity of the antibody(ies) with no reference to a Consultant. This includes instigating such things as a DL test or tests for mixed cold and warm AIHA. However, if our findings suggest an unusual combination of antibodies, a combination that would give us problems supplying blood (say an anti-U+Jka), an antibody against a high incidence antigen, we would take our results to the Consultant for him or her to report to the hospital. The same applies if we find a DL positive or a mixed cold and warm AIHA, as these require medical input for correct treatment. We would also consult with a Consultant if we think that other tests, performed by other Departments, such as HLA or platelet antibodies in the case of multiple stillbirths, could be the answer, but again, the need medical input. In this way, we are very lucky, because we are "given our head", but have excellent Consultants to back us up (and to suggest other tests that we may have overlooked). :):)

My goodness Yanxia, I certainly wouldn't worry about your English! I should be ashamed of the fact that I can speak no other language than English (and often people tell me that I am not much good at speaking that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!). :D

As a Reference Laboratory, we have access to plentiful supplies of R1Rz, and so would always rule out/in an anti-E accompanying an anti-c, but in 99.99% of cases (or more), clinically, it makes absoultely no difference whatsoever! If you are going to transfuse a patient who has anti-c, you would normally go for R1R1 anyway (I am accepting the fact that I am ignoring rare Rh patient types for now) and, in the case of a pregnant lady, the level of anti-c is usually far more important than the level of anti-E (and, if the level of anti-E is that high, and considered more important than the level of anti-c, the reactions will be noticably stronger with c+E+ red cells than with c+E- red cells). I do, therefore, see where you are coming from and agree. :)

Well, it is true that I am from a Reference Laboratory, but that having been said, the BCSH Guidelines in the UK strongly advise that an enzyme panel is run as well as an IAT panel, and so most Hospital Blood Banks will also run an enzyme panel. I do agree with you that, in the case of a warm auto (and many times in the case of a "cold" auto) the enzyme panel adds nothing. Yes, we run our enzyme panel in gels, but, unless there is an auto present, this panel is often extremely useful. :)

It is the word "punative" that worries me. This is exactly what these inspections should NOT be, but they seem to be like this on a regular basis in the UK too. Then, instead of you learning and improving the service as soon as possible, you spend a whole lot of time explaining things to your own Quality Department. :rage::rage:

I honestly can't remember if I've put this attachment on before. If I have, I apologise. If I haven't, it may, or may not, be of interest. You judge! :) Review of the current progress in developing universal red cell products and their potential to.doc

A very great pleasure.

What was her antibody(ies)? I know that we are not supposed to make moral judgments, but it seems to me that, if she had already lost 9 babies, anyet still had such disregard for the child she was carrying in her 11th pregnancy, the FDA should have looked at her and taken away her license!!!!!!!!!!!! :eek::eek:

We use an enzyme panel automatically, together with an IAT panel. Does this mean that you do not necessarily do the same? :confused::confused:

Yes, in extremis I would agree with this.

Hi David, I'm not saying you are wrong about the women of child-bearing age (I wouldn't dare!), but in my attachment I do make an arguement as to why I think this should be done. IT DOES NOT MEAN THAT YOU HAVE TO ACCEPT MY ARGUEMENT, I HASTEN TO ADD!

I must say, except in the circumstances I alluded to in my earlier posts, it does sound somewhat over the top to me too!!!

The case being that the patient was male, I honestly do not know why the supervisor was so worried, unless the patient was, or was likely to become transfusion dependent (in which case, I would also be wary of them making an anti-c; they had already shown themselves to be a responder by making anti-E+K).

Do I take it that the patient was a female of child-bearing potential (hateful phrase)? If so, I can quite see your supervisor's concern. In terms of "common" antigens, the c antigen is the second most immunogenic, behind the D antigen. If a person who is c- is transfused with c+ blood, there is a very high likelihood that they will produce an anti-c. Anti-c is amongst the three most common causes of clinically significant haemolytic disease of the newborn/foetus. Therefore, if the patient is c-, you would not want them to be stimulated to produce anti-c, and you would give c- blood. This only pertains if, for example, the patient is an R1R1, rather than, say, an R1r, and is female. I attach an essay I did a few years ago concerning this and other occasions when you might give phenotyped blood. It may be of use, or it may not, but it is there if you want to read it. Phenotyped Red Cell Transfusions.doc References.doc

Thanks shily. A higher percentage than I thought, but I see that you are still not "swimming" in the stuff!

Congratulations!!!!!!!!!!!

Oh yes. I am not saying that this kind of emergency cannot happen. All I'm saying is that, these days, they should be exceptionally rare.

I must admit that I was/am curious to know why, in these days of vastly improved antenatal care, with MCA Doppler/ultrasound commonly available and planned delivery, any lady with an at risk pregnancy is not sent to a Specialist Fetal medicine Unit for pre-natal care and, if necessary, delivery; certainly in the USA? Except in cases of severe ABO HDN in the first pregnancy (very rare) or HDNF due to an antibody that was not detected during the pregnancy (either because it was directed against a low incidence antigen, or because the lady did not attend antenatal appointments), such emergencies in a "local" hospital (sorry for the derogatory term - I've been racking my brain for the correct term and have failed miserably) should be exceedingly rare, and it follows that the need for such emergency blood should be equally rare. As I say, I'm more curious than anything else. :confuse::confuse: