Malcolm Needs

Sounds like the General had an excellent army! More power to your elbow Eoin. :D

Whoops! Spelling again! That should be "memento" and not "momento". I think George deserves better than being remembered for only a moment!

Jodi, I've only ever seen these being demonstrated by company reps, and have never used one in anger myself, but I think most of them are a waste of money (which is one of the reasons I've never used one in anger). They are fine if you are using the panel supplied by the people selling you the software and if the antibody is either a simple monospecific or a simple combination, but anything other than that and forget it. SOme allow you to input other panels, but you have to make absolutely certain that you put in each and every antigen correctly (otherwise you end up with rubbish; as in rubbish in, rubbish out) and you then still have the problem that they will only identify a simple monospecific or a simple combination. You will find that, eventually, it is far quicker to teach you staff to read antibody panel sheets than it is to rely on computers. It also gives them an advantage over those who only rely on computers when, and if, they go for a job elsewhere; this skill is transferable. Others, of course, may disagree violently with me! It wouldn't be the first time!!!!!!!!!!!!!!! :)

Over this side of the pond, we require three identifiers. We require a full name (forename and surname, both correctly spelled), a full date of birth (age or year of birth is not sufficient) and hospital number or Accident and Emergency number or Major Incident number oraddress or National Health Service number. You be amazed, given all that choice, how many samples are sent in with the third identifier entirely missing and/or the first two incorrect (particularly as all of our samples at the Reference Laboratory pass through the hands of the Hospital Blood Bank before they are sent to us). The NHS number is, of course, not available in countries other than the UK, I fully acknowledge that, but I do still wonder at the fact that only two identifiers are required. That having been said, I agree with Cliff's comment about how the numbers are assigned.

I know exactly how you feel Brenda. We had an MHRA inspector that was the male mirror image of your female FDA inspector.

Thank you for that really helpful post Rashmi! Actually, you are not too far off the truth! I've been bequeathed some of George Bird's original seed collection, but there is no way I'd use those. They are strictly kept as a momento of the great man. We are getting some lectins looked at by NHSBT Reagents at the moment, but there doesn't seem to be any validated kits about. We are having to use out-of-date kits with strict adherence to controls. We've got a few T-activated cells, Cad+ cells etc frozen down, but they won't last forever, and the dreaded MHRA have invited themselves in on the week beginning 03.08.09; Oh joy! :mad:

The people who make the lectin kits for T activation, etc, used by the NHSBT in the UK have stopped producing it. This has left us with something of a problem (to say the least). Can anyone please help by suggesting where else we can source such kits????? :confused::confused:

When are you on a night next?............I'm sure we will have a DAT pos baby or seven that need eluates performing mega urgently. Malcolm is not really that old, just VERY MUCH older than me!

What you say is true about warm autos being potentially dangerous, but hyperhaemolysis is more so. Hyperhaemolysis can strike whether or not there is a warm auto present and whether or not there is an alloantibody present. It is best to avoid transfusion at all if there is a history of, or worse, an on-going episode of hyperhaemolysis, as it is very often fatal. If transfusion is essential to preserve life, try high-dose IVIG and methylprednisolone.

I'm sure it will say something on the product insert.

This is not going to be a tremendously helpful post (nothing new there then with my posts), but really it is up to you. You have to decide for what you are going to use the new technique (be it gel for tube, or tube for gel), and then perform parallel tests with each until you are happy that the new technique is at least as good, if not better, than the old technique (but you have to decide how many comparisons you need to do to be happy about this and record this and the results you obtain). Sorry. :redface:

I agree with all of the above, there are others that can/should be used too. Not in any particular order these include: complaints/compliments from your users (fully knowing that individuals tend to complain much more readily than give compliments). Number of hours spent/receiving training and education (both internal and external). Number of Health and Safety incidents (including near misses). Number of internal staff grievances. Number of open non-compliances with your licencing people (FDA or whoever). NOT the number of non-compliances (we all get those), but the number that are still open after a reasonable time. Number of outstanding annual appraisals. Variance on budget (over or under spend). Number of days sickness taken by staff (short term, rather than long term). Costs per activity. Many of these will "measure" staff satisfaction within your department, which is as important, if not more so, than the satisfaction of staff outside your department, because, from their point of view you will not get 10/10 in a top box survey, otherwise they think you have no room for improvement. Good Lord, I've just re-read this lot, and there is a lot of work involved. Try a few to begin with and work your way up!

We wouldn't dream of recommending that Lu(a-) blood be given over this siode of the pond. It does not cause haemolytic transfusion reactions, and, for various reasons (such as the fact that the Lutheran antigens are not well developed at birth, the antibodies are often IgM and, even if they are IgG, are probably adsorbed onto the apical side of the placenta) do not cause haemolytic disease of the newborn. We would always recommend blood compatible by the indirect antiglobulin technique. We very rarely recommend that Kp(a-) blood be given. The instances of haemolytic transfusion reactions caused by anti-Kpa have always involved an antibody with a fairly meaty titre, and so a unit that is found to be compatible by the indirect antiglobulin technique are unlikely to cause a clinically significant reaction, although, of course, they may boost the antibody.

Oh boy was that ever true. Mind you, I know quite a few people who had some pretty good exchanges with John Case (not least my old boss Carolyn Giles)! !

It rather depends on what you want to do; the full Monty or the minimum. I would always include a weak anti-Fya, for reasons given above. I know exactly what you mean about the Law of Supply and Demand. Over this side of the pond we are lucky in that the NHSBT Reagents Department actually produces these weak antibodies for us and, being an NHSBT Reference Laboratory, we are supplied them free and gratis. It is not the same for the hospitals. While you've got the chance, I would use patients' samples if I were you. Over here, anyone who has been transfused cannot give blood (at least, for therapeutic use, because of vCJD), so we have to rely on antibodies stimulated by pregnancy, but I don't think the same applies in the USA (does it?). If not, you might be able to get some weak antibodies from your blood supplier, if they take off the plasma from whole units.

Quite right that the doctor shouldn't have a say in it. Most obstetricians/neonatologists wouldn't know when an eluate is required (mind you, why should they? It's not their speciality.).

Have a care adiescast. I don't mind being called an old timer, but Rashmi can be vicious, believe me!

The answer is, logically, that you should be required so to do. Otherwise there is a danger that clinically significant antibodies will be missed. I am not, by the way, disputing that you are not required so to do. You just should be!

No Dar, I think you've got the wrong end of the stick about what I was saying. You could miss an anti-Fya (for example) because your Fy(a) antigens on your panel have deteriorated. It is important to know that your panel's labile (ish) antigens have not deteriorated to such an extent that you miss a clinically significant antibody. It is not that the antibody is labile (although, of course, some are, such as anti-Jka).

Fair comment.

I think that they are being optimistic or wildly over-confident about their product.

Dar, I agree wholeheartedly with you. What on Earth is the point of testing for the antigens that weaken during storage before you've stored them? I think she's lost the plot and needs retraining before she comments on others' shortcomings (an incredibly common problem amongst inspectors throughout the world it would seem).

If they are group O, I would agree, but even these are sometimes given to other groups (such as when HLA-matched platelets are required) so you would still have to be careful, and the donors should, at the very least, be flagged. The other problem is that donors with high titres have usually been "boosted" by some form of sensitisation, very often an ABO incompatible pregnancy. These individuals are obviously "responders" and so they may have other antibodies (HLA, granulocyte and/or platelet specific antibodies), and so they may also be "dangerous" donors from the point of view of TRALI.

I couldn't agree more with you John. If they are going to insist on other antigens being tested, they should at least choose those that are known to be labile upon storage (or maybe not labile, but at least are known to weaken during storage) like the Duffy antigens. It is utter nonsense.

Hi Rashmi, Don't quote me on this, because I'm not absolutely sure, but the BPL has just been inspected by both the FDA and the MHRA (which must have been fun for them) and I think that you may now be able to get IVIG from them. Best to ask them I suppose.