Malcolm Needs

I see what you mean!

love it!!!!!!!!!!!!!!! :d:d:d:d

"but some of us have been privileged to have had a very good one that has nurtured and developed us over the years." You know, it's very nice of you to say this Rashmi, but I really can't recall you ever having worked for me! ;)

Hi Janice, The obvious answer is a national database, but there are two drawbacks to that which immediately spring to mind. The first is cost. We are finding this to be almost prohibitive in the UK. When you consider the size of the UK compared with the USA, the cost would have to multiplied a huge number of times. The second sounds a bit insulting, but it is not meant so to be. If you do get a national database, but may be worthwhile restricting who can post on it. Not every facility will have the ability to correctly identify antibody specificities. It may be that there is a level of skill problem, but it is more likely that there is a lack of sufficient reagent red cells and/or typing reagents (unless, of course, the antibody is pretty basic, like an anti-Jka). It would be much better if complex mixtures of antibodies or rare antibodies are posted only after their specificity has been corroborated by a third party, like a Reference Laboratory, but not necessarily a Reference Laboratory (we are not the be all and end all in these matters). Other than that, I really do not have an answer.

A few extra spring to mind (although it could be argued that they apply to life, not just to immunohaematology). Never cover up a mistake. Always be ready to admit that you could be/are wrong. Always be open to other people's suggestions, however junior to you they may be. Never be afriad to say "I don't know", however senior you may be. I, and others, may come up with more, but I think the rules that you have put down are splendid. I would, perhaps just add two more that are pure immunohaematology, and these are; Unsterstand the principles of your tests. GET THE BLOOD GROUP RIGHT although I think you may have mentioned this latter golden rule! Good luck with your course.

Thanks Tim. After today I am on holiday for a couple of weeks, so I will not be able to do any of this work until I return, and then I would like to get a decent number of samples tested before I say anything, but I will certainly keep you informed of how I am getting on. Once again, thank for the idea, which I intend to plagerise unmercifully!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Aren't semantics wonderful; they make everything so clear! As I implied in my thread on Nomenclature in the Education Section, if everyone used the correct terminology, there would not be these arguements; but first we all have to agree what is correct!!!!!!!!!! :cries:

Of course, this solution may be seen as a little extreme, but aren't guns legal in the USA........................ :plotting:

Tee-hee! You and me both Mary! Love the quote.

I agree with you on the second point Mary, but not the first. We often identify an anti-Cw, either on its own or in conjunction with other atypical alloantibodies, so the presence of an anti-Cw is realistic. What is very much a moot point is whether or not anti-Cw is clinically significant in terms of haemolytic transfusion reactions. I have never seen a convincing case. As far as I am aware, there is only one paper in the literature that implicates anti-Cw in haemolytic idsease of the foetus (as opposed to haemolytic disease of the newborn) and this case was never sent to a Reference Laboratory for independent verification, but was diagnosed at the hospital (And no, I am not decrying hospital laboratories. All I am saying is that independent verification is always worthwhile from a scientific point of view). Kollamparambil TG, Jani BR, Aldouri M, Soe A, Ducker DA. Anti-Cw alloimmunization presenting as hydrops fetalis. Acta Paediatrica 2007; 94; 499-501.

We would also do the latter on the first occasion we seem them, but not after that unless they suddenly require more frequent transfusions. If we cannot detect a "new" atypical alloantibody in the plasma after differential alloadsorption, we will go on to perform differential alloadsorption on the eluate ( and a complete pain it is to do so too)!!

In the UK, the Guidelines say that, as a start (if the patient actually needs FFP in the first place) they should be given 12-15mL/kg body weight. This is about the ONLY blood component that the doctors regularly under-prescribe! I've got an idea, but don't quote me on this, the this figure of 12-15mL/kg body weight is set to go up. It won't make any difference; they will still order 2 units of FFP for both Tom Thumb and Goliath!!!!!!! :rolleyes:

If I can find the actual reference amongst the detrius on my desk here at home, I'll post it.

I would agree that a "mini-panel" would be sufficient, rather than a full panel, although we always run one positive.

In the UK, a patient is not eligible for electronic issue if a clinically significant atypical alloantibody has every been detected in their plasma, so this would not be an issue (unless, of course, the patient switches hospitals, forgets to produce their antibody card and the antibody is no longer detectable, and then they are a candidate for an anamnestic response). However, am I correct in thinking that you are referring to an antibody directed against a low incidence antigen here John, where the antigen is almost certainly not going to be expressed on the screening red cells? If so, that is a slightly different situation, because you are much less likely to come across, for example, a unit that is both K+ and Wr(a+) (although, of course, it can happen) than one which is K+ and Jk(a+) (to use Donna's example). Even then though, there was a paper/editorial written some years ago now by George Garratty entitled something along the lines of "Do we need to worry about low incidence antigens" (I don't think that is by any means the correct title, but it was something like that) in which he showed amthematically that there was very little chance of a unit of blood expressing a low incidence antigen being given to a patient by electronic issue, who had an antibody directed against this same antigen, and it being strong enough to cause anything more than a minor delayed haemolytic transfusion reaction, resulting in a little jaundice and a requirement for re-transfusion as the red cells are removed from the circulation. If I can find the actual reference amongst the detrius on my desk here at home, I'll post it.

Bit of advice to the originator of this thread: if you have issues with your superiors you should address them, then getting nowhere, request a meeting with this person's superior or with an employee relations person in HR. Don't air them in a public forum. You can tactfully get the advice of your peers on this forum without bashing your superiors.

Hi Tim, No, I had not even thought of trying your idea. I think it is a quite excellent suggestion, and I will certainly try it out. Thank you. :D:D

We use a month as the cut-off point in the NBS, but I think that this time frame is quite emperical.

Ture, there are not so many samples, but they are all complicated, otherwise the hospitals shouldn't have sent them to us in the first place, so what we lose in numbers, we gain in difficulty, and some of them are urgent, such as the trauma victim I worked on on Saturday with a positive DAT, whilst working on another patient with symptomatic anaemia and a positive DAT. SHould I have chosen which one to work on first? We risk assess each time we do the work, and always have.

Do not worry for one pico-second. I've only learned how to spell my name properly myself in the last two years! :D

I would not argue for a single second about the idea of having one sample open at a time. That is quite a different matter.

Yes Rashmi, I know what you mean and know what you are talking about - and it is still utterly preposterous and impracticable. When you are performing differential adsorptions on a sample, you have to perform three full panels at the end of the process - that's a minimum of 30 indirect antiglobulin tests. Sometimes these have to be hand washed to keep them warm. Even if you stagger these, and I have NO idea how you could do this, you could STILL only get through one patient's sample a working day. This is not the kind of serology you can load on to a grouping machine and walk away. It is intensive, hands on. I repeat, patients would die of old age, or worse, die from lack of blood, or, worst of all, be given blood as an emergency without testing, because we wouldn't be able to perform the proper testing in time. Mind you, I could always leave your hospital's samples until we've finished all the others, if that is what you want!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :rolleyes::rolleyes:

One thing that I have not understood throughout this thread is, in the case of antibodies/antigens that show dosage, and I know that the number of antigens for a particular specificity varies with the human source of the red cells, if the antibody/antigen reaction is showing dosage, surely it doesn't matter how many examples of red cells expressing "heterozygosity" are used, they are still going to have negative reactions. Surely, cells expressing "homozygosity" is the way to go, if they are available? :confused:

Many of the samples my staff work on have extremely strong auto-antibodies. They require an initial antibody investigation, multiple differential alloadsorptions, followed by three more panels (one for each adsorption cell) and sometimes extra cells if the panels are inconclusive, and then, often a cross-match. This lot, on average, takes about five hours. We average about 25 samples a day (not all of them are that complicated to work on) with, at best, 5 staff at the bench. On average, each of them has two of these complicated samples a day. If they worked on one sample at a time, I calculate that many of the patients would die of old age before we could get the results out. Yes, you do have to be VERY careful about identification, etc, but one at a time. Utterly preposterous and totally impractical! :mad::mad::mad:

Hey, that's MalcoLm, but, sadly, you are absolutley right about my spelling prowess!!!!!!!!!!!!!!!!!!!!!!!!!!! :redface::redface: