Malcolm Needs

Thanks for the sympathy (I need it), but I don't feel so much humbled as totally crushed. What an idiot I am!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :surrender:surrender

I must admit, I got the wrong end of the stick to start with. I thought that you were talking about a name like, for example, O'Connor, but it still makes no difference in our Laboratory. If the name is James Robert, or Robert James, as long as ALL details (Date of Birth and Hospital Number) agree on both sample and request form, we are duty bound to accept it. We do, however, encourage our hospitals to put the surname in capital letters (James ROBERT, where the surname is Robert, and Robert JAMES, where the surname is James). This encouragement has fallen completely on deaf ears, I might add! The problem is, the first time the sample comes in, you don't know. It is only with the submission of subsequent samples that we may find out which is which (or when the patient themselves complains because we have their names switched on an antibody record card issued to them. The other problem is that of names that are unfamiliar to the English. We recently had a sample on a Sri Lankan patient submitted to us. The forename and the surname were both other 15 characters long, and even my laboratory assistant, who is himself Sri Lankan, could not tell which was which. In a way, therefore, the answer is "a lemon", in as much as the comma should count, but in most cases it cannot, as we know no better on the first submission of a sample. :disbelief:disbelief

Ah, but, if we are all inbred, are we really normal? All those homozygous recessive genes!!!!!!!!!!!!!!!!!!!! :sarcasm::sarcasm:

I thoroughly agree - and spinning the card a second time is NOT doing something about it! :eek:

We would not consider a missing comma a mislabel, even in the case of both names being considered as a first name.

We do the separation of the plasma/serum from the red cells for each sample separately, but there is no way that we could work on the actual samples from start to finish separately. We have about 25-30 samples a day, many of which require complex serology, adsorptions (either auto or allo), titrations or quantitation, cross-matching and many of these take more than 5 hours to complete. With a total bench staff of 9, plus vital help from Assistants and Clerks, we just could not cope working on one sample at a time. If only we could, life would be so much easier (and safer for the patients).

I agree with Tim about the use of microscopes. Peter Issitt, somewhere in the 3rd Edition of Applied Blood Group Serology (I'm not sure which page now; I read it cover to cover for my Fellowship examination, but that was many years ago) said that microscopes should be banned from Blood Transfusion Laboratories. Whilst I may not agree with him in every case, I do agree with him in principle.

This could also be entitled, "Don't ignore the blindingly obvious." As many of you will have noticed, I enjoy posting on this site. Some of you have been extremely kind about some of this postings. BEWARE! I think you should be told just how dangerous it may be to believe anything I say. I have just spent several hours working on a sample from one of our hospitals. It was from a lady who is pregnant, known to have an auto-antibody reacting with papain-treated red cells, is group A, R1r, K- and who is pregnant. Indeed, tomorrow she is due to have an LSCS delivery. The hospital sent it in for me to have a look at because there is now an antibody by IAT, reacting with all screening cells and panel cells. I did the usual work-up of ABO and D typing, a DiaMed gel enzyme and an IAT panel and a DAT. She was still group A, D+ (so I got something correct!), DAT negative, 5+ pan-agglutinin with papain-treated red cells, but a mixed-field type reaction with all the panel cells by IAT (auto negative). What antibodies give a characteristic mixed-field reaction thought I; ah, Lutheran?! So I spent Lord knows how long picking out a whole load of Lu(a-b-) and Lu(a+b-) red cell samples to test against her plasma by DiaMed gel IAT. All but a couple were incompatible! "What has this (missing adjective) lady made now?" I thought. I could see no pattern, and then it struck me. Those red cells that were compatible were all group A, and those incompatible all group O. I repeated the panel by pre-warmed, warm-washed LISS tube IAT at 37oC, using a monospecific anti-IgG reagent. All the panel cells were compatible. So I have spent hours working out the blindingly obvious; the lady has an auto-anti-HI!!!!!!!!!!!!!!!!!!!!!!!!!!! Argh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :imslow::imslow::imslow::imslow::imslow:

Like David and NedB, we used to make them up assiduouisly, and then someone asked "Why?" (classic question, of course). We no longer do so. The only time they were ever of any real use was when, back in the day, I used to have to produce AHG, and they were used for standardisation (which, considering there was absolutely no standardisation of the C3d-coated red cells, was a bit of a joke in itself)! Good luck in Blood Banking; it's a fascinating subject that many of us have learned quickly to love.

Hi PattiJoNye, I have attached a short monogram on the subject that I wrote for one of the hospitals served by my Reference Laboratory 2 or 3 years ago, who wanted to know almost exactly what you want to know yourself. I very much doubt if your Consultant will be swayed by the monogram itself, by I do cite 4 references that may be of use (particularly the Transfusion Editorial by George Garratty). I hope this proves to be of, at least a little, use to you. Best wishes, Malcolm Three cell screen versus two cell screen.doc

That is an excuse; not a reason. We Use DTT and Chloroquine and use gel with no problem whatsoever. :mad:

Much as I do like the gel technique (we use DiaMed in my laboratory) I think that they are very sensitive at detecting such antibodies as anti-McCa, anti-McCc, anti-Kna, anti-Yka, anti-Csa, anti-Bga, anti-Bgb, anti-Ch, anti-Rg, etc. We are detecting many more of these (and I do mean many) than we used to when we were using tube or liquid-phase microtitre plate techniques. I suspect that manyof the reactions being seen "at the hospital level" (and I do not mean that to sound disparaging) are of this ilk. In most cases, I suspect, hospital-based laboratories will have neither the time, nor the reagents to sort these out (although they would certainly have the expertise). The lack of sufficient reagent red cells may also be true for many Reference Laboratories. In cases where the reactions are 1+ in gel with some panel cells, but weaker (0.5%+ !!) with others, but the auto was quite clearly negative, we will often "diagnose" these as anti-CR1-related, without assigning an actual specificity. On other occasions, if we find nothing by tube IAT, we will put out a report saying that there is nothing there (on the grounds that there are no clinically significant atypical alloantibodies detected). I suspect that this may be part of the problem, but I think that there is more to it than just this explanation. :confuse:

Strangely, I've never worked in an institution that does John!!!!!!!!!! Mind you, if the cord ABO and Rh is identical to Mum's, we would test the cord sample with NaOH, just to be on the safe side (and I know this is not foolproof, particularly if Mum has a high HbF level herself).

I entirely agree with David. Even if you should detect an antibody that was known to be present in a previous pregnancy, the history may be important. For example, we have recently dealt with a first sample in pregnancy in a third pregnancy from a lady with anti-D. The referring hospital was different from that in the previous pregnancy. The first sample this time gave an anti-D level of 3.8IU/mL (in other words, unlikely to cause clinically significant HDNF). However, towards the end of the previous pregnancy, the anti-D had risen to a level of 25IU/mL (very likely to cause clinically significant HDNF). We were able, therefore, to include this fact in the report on the present sample, which would act as a "heads up" for the Obstetrician looking after the new pregnancy that very close monitoring would be in order.

My goodness, that really is scary. You are not supposed to double post, I know, but that story should, in my opinion, also be in the "Just for Fun" Thread, simply because, if you look at the number of hits it has got, it will be seen by the widest audience. I take it the medic still has a job (they always do). :mad:

Yes, you have understood it perfectly, and, like I said in my reply to John, communication is everything. Your case sounds good fun! This is what serologists live for (NOT!!!!!); although you do get a sort of warm feeling afterwards if everything goes well (if you will excuse the phrasing, usually just before you change your underwear after the shock)! :eek:

True, true. I agree that communication is everything.

It makes sense. I happen to completely and utterly disagree with it, but it makes sense. :frown::eek::frown:

Yes, I'm a little worried about this too. As a matter of fact, we have just finished using a panel of cells that included an r"r cell with a weaker than normal E antigen. It was so weak that, in many cases it did not appear to react by IAT with examples of anti-E in pregnant women that other examples of r"r gave 3 to 4+ reactions by IAT (and before you ask why this cell was included - don't - we didn't produce the panel!). It does demonstrate, however, that relying on a single example of a red cell is highly dangerous.

The bit about the Blood Bank knowing nothing about transferred units of blood seems to be a ubiquitous problem John. Sadly, anyone in the UK would recognize the scenario instantly. Now I'm going to be a real pain (nothing new there then). What if the patient was known to have an anti-HrB, came with Rhnull units, and needed an immediate transfusion? Emergency release blood would not be compatible, and it would be known not to be compatible (I am thinking of a genuine case - not being a pain for the sake of being a pain - for once!!!!!!!!!)?

Thank you for that prompt and full explanation. I do wish we still had the "Thanks" button! :)

We no longer have directed donors in the UK, except in exceptional circumstances, such as when only a sibling has blood antigen negative for a clinically significant antigen found in the patient, but we would never bleed the donor of a unit until we know that their red cells are compatible with the recipient. In other words, we would take a sample from the directed donor, ABO and Rh type them and then go on to perform a preliminary cross-match before the unit is taken (and then do another cross-match when the unit may actually be required, e.g. just prior to surgery).

Well put! I have got one question though. If a desperately ill patient has to be moved from one hospital to another hospital (not in the same group), is there ever an occasion in the USA when cross-matched blood would be transported at the same time (such as in an ambulance or in a hospital helicopter/airplane), in case the patient requires transfusion in transit, or has such a rare antibody that only a few units are available (say an anti-HrB) and so would have to be shipped with the patient? (sorry, very long question!). If this does ever happen, how do the various ruling bodies cover this? :confused::confused: Over here, by the way, when such a rare event occurs, we have to have a written medical concession.

You might try fiona.regan@nhsbt.nhs.uk. Fiona is the Consultant within NHS Blood and Transplant in England. Although she may not be absolutely the correct person to contact about this, she would most certainly know who is. If you ask her to forward your email, I am sure she would try to help. She is a lovely lady.

No, it's not you, it's just that we call it RCI (Red Cell Immunohaematology) over here. We use DiaMed gel techniques as a first line of attack (IAT and enzyme IAT), but, if we have no joy with that, we will most certainly fall back on tube techniques, using either a polyspecific AHG or a monospecific anti-IgG reagent (or, on much rarer occasions, a monospecific anti-C3d reagent). If we still have no joy, we will send the sample to another NHSBT-Centre, who use either Ortho BioVue or a solid phase microtitre plate technique. Eventually, we will send samples to the International Blood Group Reference Laboratory. We are extremely lucky in my Laboratory, as we usually have about 60 rare "liquid" red cell samples available for use, together with in excess of 690 frozen rare red cell samples and a vast range of frozen rare antisera, mostly from SCARF, so we are a bit unusual, to say the least.