Malcolm Needs

I'm sorry; I know I'm a pain, but I am a little worried about the word "shaking" (although I do know what you mean). There are so many people nowadays who are very "anti-tube" that I would prefer the term "gentle resuspension by a slight rolling motion of the tubes". There; that's got that off my over-pedantic chest!!!!!!!!!!!!!! :redface::redface:

Two, maybe three years ago, the NHS in the UK went through something called Agenda for Change. This, supposedly, was to make pay equal throughout the NHS for equal work and responsibility. There are nine grades (although there are "sub-grades" to Grade 8). If you are a Grade 1 you pay to work (virtually - the pay is so bad). If you are a Grade 9, you are paid very well. Most Biomedical Scientists are between Grade 4 and Grade 8. I'm an 8b myself, with Grade 8C and Grade 9 above me - but no positions - even my boss, who is charge of RCI throughout the NHSBT is only a Grade 8C, so you can imagine how many positions there are in blood transfusion throughout the country who are Grade 8 (particularly for pure transfusionists, who do not also do haematology). The Grade is not based on the person, but based on the person's Job Description. Guess what? Most people's Job Description was changed to make them into a lower grade, and this was particularly so in certain parts of the country. I know of one person in charge of blood transfusion over five hospitals who was "offerred" a Grade 7 Job Description. Equal pay? Don't make me laugh. There are many very bitter Biomedical Scientists over here (although I fully admit I did quite well out of it myself). :mad::mad::mad::mad::mad:

We have to ABO group potential renal donors and recipients for a Renal Unit in the South of England (why we, as a Reference Laboratory perform these ABO groups, instead of their own Hospital Blood Bank is a mystery, but that is another story). One of the coordinators always writes on the donor request form "Potential Living Kidney Donor". I have often wondered how they revive these people to assess whether they are willing to donate this organ, if they are even willing so to do after being dead. I have pointed out on many occasions that "Living Potential Kidney Donor" might be a little more appropriate, but have been banging my head against a brick wall. :rolleyes:

In this case, I would have thought daily QC would be quite adequate.

No. The Testing Department does use an anti-D that detects Partial DVI, but they use something called Totem that is capable of detecting a wide range of other Partial D types, many of which would not be detected by "conventional" anti-D reagents. The Testing Departments do not, by the way, use DaiMed technology for their ABO and D typing. They use microtitre plates (I think). Any "strange" reactions they get with their anti-D reagents automatically means they hand the donor samples over to us in RCI for complete elucidation (although we cannot claim to always get the answer; we sometimes have to send samples off to the International Blood Group Reference Laboratory for molecular work-ups).

I agree; the donor is much more likely to be an Am, an Aend or something like that (much weaker than an A3 or true Ax). AS for how the donor was originally found to be a subgroup of A, they may be using the same reagents by the same technology as you now Jason, but was this so when they first detected the A antigen on the donor's red cells? In any case, in such a situation, a Testing Department worth their salt should pass over any suspected ABO descrepancy (even if it turns out not to be so) to their own Reference Laboratory so that it can be checked with extra reagents, extra techniques (adsorption and elution, as suggested), different temperatures of incubation, and may even test saliva for the presence of A substance (although it is exceedingly rare so to do in this day and age).

I don't know for certain of course, but I think you could be laying yourself open to trouble if anything went wrong and you had not performed a validation. Even if you think it is paying lip-service, better that than paying massive dollars in compensation if you cannot provide evidence of work done to prove that they work, prior to introduction.

The Red Cell Imunohaematology arm of the NHSBT in England uses DiaMed technology extensively (although not exclusively) and we are extremely impressed with it, for similar reasons to those given by David (although, of course, all of our staff are spacialists, rather than generalists). That having been said, we do also use other technologies. We will fall back on tube techniques on a fairly regular basis (about once or twice a day) when we are dealing with a case of AIHA, particularly if the autoantibody is "cold-reacting".

I'm certain this article would be far more up-to-date than the one I suggested. :D

Will do. We do see the weakening of the A antigen on a fairly regular basis still. There was one Consultant Haematologist at a London Teaching Hospital who, unfortunately, had AML himself. The Laboratory could tell whether he was in remission or in relapse by the strength of the A antigen on his red cells.

The following reference may be of help (or, of course, may not!): Bryan CF, Winklhofer FT, Murillo D, Ross G, Nelson PW, Shield III CF, Warady BA. Improving access to kidney transplantation without decreasing graft survival: long-term outcomes of blood group A2/A2B deceased donor kidneys in B recipients. Transplantation 2005; 80: 75-80.

Whilst I can quite see that birds would enough the sweetness of the Spotted ****, I must warn you not to feed them in the vicinity of any preditors, such as cats. Although sweet, it can be quite heavy, and the poor little mites may not be able to take off in an emergency! :D

There is a theory going around that it may be a clone of red cells that are D Positive that would normally be supressed, but that in certain disease states, this clone can grow and take over the D Negative clones. This theory has been put forward by some extremely emminent workers in the field (although I will not name them here, until more work has been done to prove/disprove their theory).

Well you have, but there is also the difference in the anticoagulant, the preservative, the controlled storage of the unit, compared to that of the sample (often, initially, kept at sub-optimal temperatures for some time after drawing) etc, etc, so the two are not comparable anyway.

Yes Terri; I couldn't agree with you more. The other thing is that, hospitals that only discover multiple antibodies (or a single antibody directed against a high frequency antigen) are the ones that send in a sample to the Reference Laboratory a few hours before the planned surgery (often an inadequate sample) and then moan if we don't get compatible blood back to them within minutes of the receipt of the sample! :angered:

Thanks for that Cliff. It's just that I've had some very kind posts directed at me lately, and I wanted to thank those responsible. Of course, I could always just post back saying thanks, but that's too simple for a pedant like me!!!!!!!! :thanks:

Thank you so much. Although I thoroughly enjoyed my holiday (particularly being able to spend quality time with my wife and son [in fact, being able to spend any real time with my wife and son]), I'm glad to be back. Do you know what has happened to the "Thanks" button??????????

NOT from where I'm sitting!!!!!!!!!!!!!!!!!!!!! :D:D

Right, now (I think) I understand and, from what you say, I cannot see that you are doing anything wrong.

Ah, yes Brenda, but I am not talking about individuals with a partial D (they are very obviously well-known to have the potential to produce alloanti-D); what I am talking about are very rare individuals that have been determined to be Weak D Type 1 and Weak D Type 2 by molecular methods, but that have, nevertheless produced a weak alloanti-D. Received knowledge suggests that such individuals just should not be able to do this (a bit like the fact that bumblebees should not be able to fly, but nobody has told the bumblebees this)!! It is a b****y nuisance actually, because you have to tell the white lie to certain (junior) audiences (that Weak D individuals cannot produce alloanti-D) and tell the truth to certain other (more senior) audiences. The trick is knowing to which audience you are talking - and I seem to get it wrong more often than not!!!!!!! :redface::redface:

I may have got the wrong end of the stick here Brenda, but, from my point of view, it doesn't matter what the cell button looks like, nor, to a certain extent, whether or not the red cells are fully suspended, but whether the washer actually works. To do this, once a week we will set up as many tubes as we have places in our washers, that contain a known weak anti-D (not a strong anti-D that we have diluted, as this will have different reaction constants) and R1r red cells. These are incubated at 37oC, as normal, and then washed in the washers being tested. At the end of the washing, we add AHG, centrifuge gentle, and record not only the results as positive or negative, but also the strength of the positive results, and record these as normal. In addition, once every 6 months, or when we have a new batch, we would also test the strength of the AHG by adding a dilution of human plasma to the washed red cells, to ensure that the AHG we then add is inhibited. I'm still not sure that I have answered your point, or, come to that, have now grasped the correct end of the stick (my body is back in Surrey, but I'm afraid that my mind mind may still be in Cornwall)!!! :confused:

Totally and utterly agree.

It depends on how long before delivery the maternal sample was drawn. As long as it is still in date for cross-match, the pre-delivery sample is quite adequate. From the transfusion point-of-view, even if there had been a foeto-maternal haemorrhage at partum, the mother would still not have made any new antibodies that quickly.

I am no expert in this, but I understand it is something to do with the static electricity that you get with plastic tubes that you do not get with glass tubes. As I say, I am no expert, and so this could be apocryphal.

We test all our washers, using a known weak anti-D and D+ red cells weekly. This is probably over-kill, because, as someone else said above, if the check cells work, the washer is working (but we have to follow the national SOP).