Malcolm Needs

Hi LaraT23, Are you absolutely certain there is nothing in the plasma? The reason I ask is that, very often, if the cell expresses a low incidence antigen (known or unknown to the producer) you will get quite a few apparently spurious positive results. Antibodies directed against low incidence antigens are quite common amongst the general population, more often than not as a "soup" of many specificities. We had an Lu:14 cell on one of our panels not too long ago (we knew about this one) and detected 2 anti-Lu:14's in 2 weeks. I had never detected one before, and have not since. If the Ortho screen cell and cell #2 are expressing low incidence antigens (not necessarily the same low incidence antigen, by the way) this may explain the problem. On the other hand, of course, it may not!

Is that the one that goes: 1. Use a team approach. 2. Describe the problem. 3. Implement and verify interim containment actions 4. Define and verify root causes. 5. Verify the corrective action(s). 6. Implement permanent corrective actions. 7. Prevent problem recurrence. 8. Congratulate the team. ??????? No, never heard of it! Yes, we do use a version of this, but I always get stuck at 7. I can never bring myself to go on to 8!!!!!!!!!!!!!! :rolleyes:

I didn't know ***** was a swear word in the USA????!!!!!!!!!! :redface::redface:

I couldn't agree more with you LIMPER55. There are Health and Safety Regulations for good reasons, and Health and Safety Regulations for the sake of regulations (and these latter regulations bring the former into disrepute). :mad:

Oh, I know what it means, it's just that the first question drives all the others out of my mind!

I already regard you as an absolute asset Brenda. WELCOME!

I must admit that I have had trouble with the "5 whys" technique - not least trying to think of 5 questions beginning "why?". I can usually get one question in my mind that drives out all the others, namely, "Why did we ***** up?". :confused::confused:

"Unvelievable". I love it! As it intimated, I am a great fan of gel, but, in the right hands, I am a great fan of pre-warmed, warm-washed, tube IAT, using either a broad-spectrum HAG or a monospecific anti-IgG. I had the huge honour (and luck) of being trained in red cell serology by both Dr. Carolyn Giles, when she was in charge of the Red Cell Reference Department of the WHO International Blood Group Reference Laboratory (when Joyce Poole was a Senior Medical Laboratory Technician in her Department) and, of course course, by Joyce Poole herself (who is now Head of this Department). Both taught me how to perform these tests, and, in Carolyn's case, not that she ever did swear, she swore by the technique. In Joyce's case, I know that she still uses the test in her Department on a regular basis. I honestly don't think that this technique is intrinsically insensitive; I think that it is the way people are taught how to perform the technique, and in particular, how they are taught to read the results that is wrong (that and trying to perform a test that is, essentially, unfamiliar to them through lack of practice. I have seen people bash the living daylights out of the tubes are gently spinning them to make the red cell button after addition of the AHG; so much so that they could make a strong anti-D negative! THey are not taught the gentle "tip and roll" required for this technique, with the emphasis onnthe word "gentle". I further think that they are so used to the robustness of the CAT that they do not realise just how gentle the resuspension has to be, and just how weak a positive reaction can be, and still be clinically significant. Without doubt though, it is a technique that needs practice, practice, practice, and performing it once in a blue moon is NOT sufficient to maintain competence. We use it in the Reference Laboratory that I manage quite a lot, but I make sure that my staff/colleagues are well and truely competent in the technique before I let them loose anywhere near a patient's sample. I do agree wholeheartedly with you though about the fact that, what goes on out there is scary! AS the saying goes: "Be afraid, be very afraid!". :eek::eek:

A good point, well made Brenda. We see quite a few of these too. It is probably because, although it is always quoted that there are about 14, 000 Kidd antigen sites per red cell, this is, of course, an average. Some cell samples will have more (the ones that you see reacting) and some less (the ones that you don't see reacting). I totally agree with you that anti-Jka is not an antibody that you want to miss. You only need to look at the antibodies that have caused most clinically significant delayed haemolytic transfusion reactions in any haemovigilance schemes around the world, and anti-Jka always seems to come out on top. We now always run a panel of enzyme-treated red cells by IAT, as well as our normal untreated panel by IAT, and we find that this is much more sensitive than running just the normal IAT panel with an enzyme panel (i.e. we didn't used to take the enzyme panel on to IAT). We get some cracking reactions like that. The problem comes, however, in two ways. Firstly, if the anti-Jka is not detected in the screen (which, in the UK, you only need to do by IAT). Secondly, if there is an "enzyme-auto" pan-reacting antibody present too, as, of course, this masks the anti-Jka (mind you, you soon pick it up by IAT after the transfusion - especially in the eluate!). I think this is the one drawback with using plasma, rather than serum. You do not have the complement system around to help you detect complement binding antibodies. We had a fatal case of anti-Vel in the UK only about 5 years ago, where the anti-Vel could only be detected in serum; but too late I'm afraid. That having been said, I wouldn't want to go back to clotted samples (except for certain specific tests) and I wouldn't want to go away from gel; I think it is a fantastic system too. Like you, I can't recall having seen a case of anti-Jkb reacting in a similar way, but, also as you say, they are considerably more rare in any case. :)

I'm extremely sorry Brenda. I think waht happened was that we were posting almost together, and you just won! As a result, your post appeared just above mine, and NO, it most certainly was NOT aimed at your post.

No, no eric 1980, they have price explosions!!!!!!!!!!!!!! Sorry - awful pun!

Couldn't agree more Anna.

Whoops! Yes I would. That will teach me to read the thread/post properly!!!!!!! :redface::redface:

Neither have I, and this is something that has worried me from the start of this thread.

TimOz, I agreed with everything you said until you got to the bit when you said, "Yet we seem happy to stagger into a lab at 2:00AM, knock over a few groups, crossmatch 12 units of blood for 3 patients and the most recent QC was a thermometer in the waterbath 19 hours before." I disagree strongly with the use of the word "happy". Although it is mitigated by the fact that I am being paid for on-call (albeit about an eigth of what I would get if I were a plumber on-call), I have never been happy about being called out at this time; you just ask my wife!!!!!!!!!! "tolerate" maybe; "happy" NO! Seriously though, you make some excellent points.

That is fantastic news feliciat. Thank you very much indeed. :D:D

Hi webersl, It means "Necessity compels". It comes from, "He must needs go that the Devil drives.", a quote from Shakespeare's "All's Well that Ends Well", I, iii. The French say, "Il faut marcher quand le diable est aux trousses." The Italians say, "Bisogna andare, quando il diavolo e nella coda." Just in case anyone thinks that this poster sounds intelligent, everything underneath the sentence, "it means "Necessity compels" comes from "Brewer's Dictionary of Phrase and Fable". I have enough trouble speaking (and most certainly spelling) my native English, let alone French or Italian!!!!!!!!!!!!!!!!!! :redface:

The first school of thought is correct in as much as, if the patient is haemolysing their own red cells to such an extent that it is becoming a life or death situation, you would transfuse e- red cells. BUT, the auto-antibody is much more likely to be a high frequency Rh antibody that happens to react more strongly with e+ red cells than e- red cells. e-, E+ red cells will still adsorb this antibody and will be sensitised in vivo by the antibody and will be destroyed by the RES, but at a slower rate than e- red cells. In addition, however, transfusion of any red cells can exacerbate the auto-antibody and strengthen the auto-antibody (at the same time making the specificity broaden) and, of course, the patient may also make a genuine allo-anti-E. This, to a certain extent, also answers the second school of thought (but also r"r" blood, if the patient happens to be, for example, a rr female of child-bearing potential, is as rare as hen's teeth). I hope all my blather helps!

Mollison's Blood Transfusion in Clinical Medicine, 11th edition, editors Harvey G Klein and David J Anstee, Blackwell Publishing, Chapter 3, pages 85 and 86.

Hi eric1980. For the rationale behind my post above, read my post in the thread ALL OTHER TOPICS, AUTOANTIBODY CROSSMATCH ADVICE. I'm not trying to push what I think. This quotes the AABB Manual. Read it (it will only take two minutes at most) and then sleep soundly! :)

Actually Tim, I wouldn't disagree with what you have said at all, except that the people in my lab have been performing titrations on pregnant women day in, day out now for many years. As a result, they are extremely experienced in the methodology, and have shown the predictive correlation between titre by CAT and outcome of pregnancy.......BUT I agree entirely with you that performing these tests by CAT in inexperienced hands is simply asking for trouble.

Thanks for the clarification concerning the age of the centrifuge TimOZ, and, once again, I apologise for getting the wrong end of the stick with regards to your connections. :redface::redface:

TimOz is completely correct in saying that such controls are highly important. I think that a lot of people, especially Quality people who have not worked in a Blood Bank, put too much reliance on a mechanical QC, leading to a false sense of security. That having been said, why replace the centrifuge? Why not just send the thing away and get it repaired? I hate to be cynical, but have you not got some connections with a company (DiaMed) that sells these centrifuges TimOz? I may well be wrong (I often am), in which case I apologise profusely in advance. :confused::confused:

Most of your OB MDs wouldn't have a clue how to do a Type and Screen. Surely what you mean is that they like to order a Type and Screen? When I was working in a hospital environment, we often had Clinicians telephone us and say that they would like to cross-match 2 units of blood for a patient. The standard answer was to invite them up to Pathology and tell them that we were quite willing to let them cross-match the 2 units, or would they prefer it if we did the cross-match for them. In the end, it usually worked, and they treated the people in the laboratory who could actually perform the cross-match with an awful lot more respect. I know that I am being pedantic here, but I do think it is important that we are respected for our skills by our colleagues, and should not run ourselves down by allowing disrespect, even if it is only unintentional (on both sides).