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Malcolm Needs

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  1. Like
    Malcolm Needs got a reaction from bmsjbatt in Tech gone for 4 months, returning   
    I wouldn't let ANYONE work in my lab without a full competency check.
     
    I would also not expect anyone to allow me to work in their lab without me having to undergo a FULL competency check.
     
    Every lab is different.
  2. Like
    Malcolm Needs reacted to bloodbankninja in Explanation for positive DAT and Elution results?   
    I'm not the one who decided he had hemolytic anemia from the IVIG.  That was the pathologist.
    He looked at the patient's other results like the haptoglobin and decided that the patient had some hemolysis. 
  3. Like
    Malcolm Needs reacted to Cliff in Printable thread option   
    Thank you, they are gone now.
  4. Like
    Malcolm Needs reacted to bmarotto in Non ABO, Non Antibody Mediated Hemolytic Transfusion Reaction   
    We had a patient many years ago who had repeated intravascular hemolysis during or after most transfusions.  No antibody was detected by us or our Red Cross reference lab.  I phenotyped the patient and each transfused unit and suspected anti-C.  Samples were sent to George Garratty's lab and they detected anti-C reactive using manual polybrene testing.  
  5. Like
    Malcolm Needs got a reaction from Yanxia in Non ABO, Non Antibody Mediated Hemolytic Transfusion Reaction   
    Even under such circumstances, the DAT could be negative Yanxia.  I once saw a fatal ABO transfusion reaction where the DAT was completely negative, because all the transfused blood had been haemolysed.  Although the reaction was fatal, only a small amount had been transfused.
  6. Like
    Malcolm Needs reacted to R1R2 in Explanation for positive DAT and Elution results?   
    That's why they pay me the big bucks!  NOT!!! 
  7. Like
    Malcolm Needs got a reaction from Yanxia in Explanation for positive DAT and Elution results?   
    Ah, then I think there is your answer.
     
    IVIG is a sort of soup, with all sorts of antibodies in it, including anti-A, anti-B and anti-AB.  In one case in the UK, at one stage, when these antibodies could be present in quite high titres, this was the cause of prolonged red cell apalasia in an ABO mismatched stem cell recipient.  Within the UK, these "allowable" titres have now been reduced, but the antibodies are still there in small amounts.
     
    Elution can be a very sensitive technique (adsorption and elution is used, for example to tell the difference between someone who genuinely lacks a high incidence antigen, such as Lan, and those that express the antigen extremely weakly; too weakly to detect by normal serological techniques) and so any anti-A, anti-B and/or anti-A,B in the IVIG is likely to sensitise your patient's red cells and you would be able to elute them back off.
     
    In a way, it is the same as the prophylactic anti-D immunoglobulin that is given antenatally that can sensitise a D+ baby's red cells, but is too weak to cause HDFN.
     
    I would be extremely hesitant to "diagnose" a haemolytic anaemia from your evidence bloodbankninja.  At best, from your evidence, you have a case of a serological transfusion reaction, unless the child requires a transfusion, and, even then, the requirement for a transfusion may be coincidental, due to the underlying pathology.
     
    Good call R1R2.
  8. Like
    Malcolm Needs reacted to Sandy L in Non ABO, Non Antibody Mediated Hemolytic Transfusion Reaction   
    Oh sorry, I was suggesting Laurie contact him.
  9. Like
    Malcolm Needs reacted to R1R2 in Explanation for positive DAT and Elution results?   
    Has this patient received IVIG or something similar?
  10. Like
    Malcolm Needs reacted to LAURIE in Non ABO, Non Antibody Mediated Hemolytic Transfusion Reaction   
    *She is not a small stature women: 179 lbs 5"2"
    * No particular rationale for giving washed cells
    * I would say all units given from a cold environment except when blood warmer used; reference lab ruled out over thermal range of 4-37C
    * All samples are EDTA...next visit I shall request both EDTA and clotted sample for evaluation
    She seems to tolerate single unit transfusions best, but why? nothing particularly significant with medication history...just want a reason!!
  11. Like
    Malcolm Needs reacted to John C. Staley in Donor Units Issued In Plastic Bags - Regulatory Requirement?   
    On a slight tangent, I have never seen a blood bag that could be broken by simply dropping it.  At one facility we bagged them in paper sacks.  The administration thought that friends and family of patients might be disturbed at the sight of units of blood being carried through the hospital! 
     
    I have, however seen one explode,  I was packing a unit of whole blood in one of the old spring loaded presses.  As I was slowly rasing the lever I was distracted and the lever slipped out of my hand at the beginning of the process.  The plate that, normally, gently squeezes the blood bag slammed into the unit with such force it ruptured the top seam and blood covered the walls as well as myself.  We had most of it cleaned up when a new house keeper arrived.  She took one look at the blood dripping from the ceiling and running down the walls, turned into the closest bath room, threw up repeatedly and then left.  No one ever saw her again. 
  12. Like
    Malcolm Needs reacted to Liz0316 in Working up patients with a Warm Auto Antibody   
    If your patient has not been recently (or ever) transfused an auto adsorption can be done. I like to get a baseline adsorption even if the patient has never been transfused. I want to see  negative cells somewhere. So, if your screens, panels and elutions are all positive, and you suspect an auto antibody, I would perform one (or send to reference depending on time of day!) Once established that the patient has no allo antibodies and then is transfused, I look at reactions for the next time they come in. Has it only been a few days? are all reactions even and the same strength? It's always best to get diff adsorptions within 3 months of transfusion, but I also realize that may not always be possible. Sometimes your crossmatches will give you the answer. I have found that a XM using 4 drops of plasma and no enhancement (inc 30 -60 min) will depict a compatible XM. Remember your auto antibodies are far more fragile than the allos. An allo antibody will react (at some strength) especially if incubated at 60 min. However, back to patient safety...do the auto adsorption first, then get diff adsorptions done on a weekly basis. That's what we do - unless it's an extreme emergency of course.
  13. Like
    Malcolm Needs got a reaction from Likewine99 in Using complement coombs control cells with polyspecific antisera.   
    The thing is that most people now use EDTA samples for testing these days, and so the need for anti-C3 in the AHG is obsolete, as EDTA is antagonistic to the complement pathway, as it chelates Ca++, Mg++ and Mn++, all of which are required as cofactors in this pathway, and so Michele is absolutely correct to question the need for the use of polyspecific AHG in the first place.
    The only time you really require a polyspecific AHG containing anti-C3 is when you are performing a DAT, but then you should go on to test with monospecific AHG reagents, if the DAT is positive.......
    ......and your P.S. is very apposite Michele!
  14. Like
    Malcolm Needs reacted to Cliff in A Couple Of Queries.   
    Most of the Library is back.  I still need to move more documents.  As I mentioned it's a very slow and tedious process.
  15. Like
    Malcolm Needs reacted to tbostock in Accepting RH type results on OB patients from other facilities   
    We get a Type and Screen on all OB patients; this was an organization wide decision as we had a couple patients bleed out during delivery. We decided delivery is high risk enough to require it for all. We do not look at prenatal results at all. They are upstairs on the paper chart; we only hear about them if they don't match ours. We have it in our policy that transfusion, RhIg admin, etc are ONLY to be based on results obtained at THIS hospital. And yes, we do monitor cord blood orders down here. They were constantly missing them, or refusing to order them for Rh Pos moms with clinically significant antibodies, etc. So now we have them send down ALL cord samples, Cord Blood Evaluation test is ordered for every baby in their Newborn Order Set. Then we evaluate it in the BB and cancel the ones that do NOT need to be performed based on mom's blood type and antibody status. Yeah, it's complicated, but we just couldn't get OB to understand/cooperate.
  16. Like
    Malcolm Needs reacted to galvania in Resolving Abo Discrepancy In Mts Gel   
    Wow - lots of points here to answer.
    Firstly Malcolm - I was not aware of the study you made.  I automatically said LISS because I was thinking about the LISS solution that goes with the cards you are using, and whose chemical parameters are fine-tuned to work with the buffers in the cards.  Ordinary saline can leave 'trails' in the gel sometimes because of incompatibility of the Osmolarity of the solution (Please don't ask me to go into any more detail than that anyone, that's about as far as my chemistry goes).
    Secondly - antibodies like M and N in gel as compared to tube.  Well, I'm not actually aware of any study that has actually compared the rate of positives for these antibodies in tube as opposed to gel, but I know they are picked up, provided the cells have the required antigen and, as Malcolm said, can cause unexpected positive reactions in the reverse group.
    Thirdly, the air-gap.  Aafrin is quite correct in what he (she?) says.  I would like to add a couple of things, though.  Firstly the air gap is important in that it allows the cells and the plasma to mix correctly in the reaction chamber, avoiding the situation where half of the red cells have never come into contact with the plasma before they hit the gel.  For an antibody that is of any reasonable strength, you probably won't see any difference in the reaction strength.  However VERY occasionally, when you have a very weak antibody, you can see a difference, and that could be a difference between a weak + reaction and a negative.  In some tests, like a one-step enzyme test (which I wouldn't recommend because it's so insensitive anyway) the difference will be bigger, because half of the cells won't even have come into contact with the enzyme.  The second thing is that the air-gap is much less important when you are pipetting with an Instrument (rather than pipetting manually with a pipette).  This is because the way the pipetting is carried out by the instruments is not quite the same. The plasma is pipetted with more force, so the mixing is more efficient.  This diminishes the need for the air gap.  I hope that answers everyone.
  17. Like
    Malcolm Needs reacted to ChrisH in online group study for SBB exam   
    Why don't you post to this message board your questions or thoughts as you read each chapter. I am sure we all you help you. It may also benefit those that are taking the exam at a later date.
  18. Like
    Malcolm Needs reacted to galvania in Resolving Abo Discrepancy In Mts Gel   
    Dear all, it is not that unusual to get weak or neg results in the reverse group in gel.  there are a number of things that you can do to force the reaction.
    1.  Incubate at room temperature for 10-15 minutes before centrifuging.  If that does not work ->
    2.  Put everything in the fridge for 30-60 minutes before pipetting (that means cards, cells and plasma).  Then pipette the cold red cells followed by the cold plasma into the cold card and put it back into the fridge for 15 - 60 mins before centrifuging.  There are three things that are really important here if you do this.  Firstly you absolutely must use at least 1 group O cell as well to rule out the possibility that any positive reactions you are seeing are due to cold antibodies. Secondly, when you pipette your cells into the reaction chamber, you absolutely must have an air gap between the top of the supernatant and the cells before pipetting the plasma on the top.  Otherwise, you may well get a 'double population' due to some cells starting to descend down the gel before the centrifugation process starts and before they've had a chance to react with these weak antibodies.  This is important due to the extended incubation.  Thirdly you absolutely must include controls.
    3.  If that does not work, you can do the same thing, but use 100ul of plasma instead of 50ul.
    4.  If that does not work, take an aliquot of your reagent red cells (including the all-important O cells, spin them down and remove the supernatant.  Replace with your normal LISS solution.  Repeat the test with these cells.  All the provisos for point 2 would also count for this option.
    5.  If that does not work, you have no choice but to revert to tubes; but in my experience, the normal 'weak' iso-aggs due to old age or illness will be induced to stick one or two red cells together like this.
  19. Like
    Malcolm Needs reacted to Eoin in alternatives to transfusion   
    This is supposed to be discussed by clinician when getting consent. How often does it happen? Probably rarely.
    We are considering separate consent fr transfusion - one of the best I have seen is -
    http://www.urmc.rochester.edu/urmcmedia/hh/services-centers/blood-transfusion-center/Documents/Consent-for-Blood-Transfusions-419BT.pdf
     
    See what you think. I would also be interested in other replies.
    Cheers
    Eoin
  20. Like
    Malcolm Needs reacted to John C. Staley in alternatives to transfusion   
    Eoin, I like it.  Short, sweet and to the point, as long as I'm (the blood bank) not responsible for explaining it and getting it signed or making sure it gets signed.  This is a clinician responsibility. 
  21. Like
    Malcolm Needs reacted to marvy1 in cold agglutinins and blood/cardioplegia solutions   
    John Moulds wrote a one-page QandA on this topic in the AABB news (Jan 2010). In sum: don't go looking for a cold ab...if it shows up in the ABORh testing for a cardiac case, there may be use in doing a 28 or 32C thermal range test (as well as the regular 37C). 4C testing is pretty much useless as most everyone reacts at that temp.
     
    Malcolm Needs also replied in a similar topic thread back in Feb: 
     
    There has just been a reveiw paper published on the is very subject.

    Jain MD, Cabreeizo-Sanchez R, Karkouti K, Yau T, Pendergrast JM, Cserti-Gazdewich CM. Seek and You Shall Find - But Then What Do You? Cold Agglutinins in Cardiopulmonary Bypass and a Single-Center Experience With Cold Aglutinin Screening Before Cardiac Surgery. Transfusion Medicine Reviews 2013 http://dx.doi.org/10...mrv.2012.12.001.

    Basically, it says that doing such screens before surgery is a waste of money!
  22. Like
    Malcolm Needs reacted to Eoin in Recommend Vendors for QMS Quality Management, templates, doc. control   
    We use Q-Pulse Ver 5.7. I agree with Malcolm. It is great from a manager's perspective. A bit painful to set up, but once up and running your work can be set to flag for the coming week / month or whatever tie you like. I am the administrator in the hospital for it and it can be tweaked to suit you (can set up templates). It takes the backbreak out of ver updating, approval and distribution and only one emergency copy of SOPs need to be kept - the rest is available electronically at all workstations wherever there is a PC. SOP review dates can also be set. It also has Audit, Customer, Training, CAPA, People (staff records), Suppliers, Assets and administration modules on it as well.
    I personally love it. It has stopped my life becoming hell and has saved a number of trees already.
    Cheers
    Eoin
  23. Like
    Malcolm Needs got a reaction from Yanxia in Which is more suitable A neg or B neg RCC's for an AB neg patient?   
    Having spent many happy (???????????) hours titrating ABO antibodies for making human ABO reagents in my youth (long before monoclonal antibodies were even a twinkle in the eyes of Cesar Milstein and Georges Koehler), I can confirm that the anti-A in group B subjects is usually of a higher titre than the anti-B in group A subjects - but you always get the odd individual who's immune system has not read the books!!!!
  24. Like
    Malcolm Needs reacted to Cliff in Disaster experiences shared?   
    Eee gads, I wouldn't wish that on anyone!
    At some point someone will offer me a few million for the site and I'll take it.  They'll make sure it lives on past me.  
  25. Like
    Malcolm Needs reacted to PAWHITTECAR in Disaster experiences shared?   
    Cliff you know that means that you must live forever....
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