Fluffy agglutinates

I have just come across this 'documentary' via a google alert. http://firstnoharm.wordpress.com/film/ I haven't seen it but it looks like a major piece of ill-informed propaganda by 'doctors' & 'experts' - all with one view-point it would appear! Has anyone actually seen this? I would be interested to know what you think and what the potential impact could be given that this film's message is for patients to refuse transfusion at all costs. There is a review here http://movies.nytimes.com/2012/09/28/movies/primum-non-nocere-first-do-no-harm-by-james-reynolds.html?partner=rss&emc=rss&_r=0 The reviewer does say that a counter argument would have been beneficial but still ends with 'Still, “Primum” makes its point clear: If ever in a position to choose, a patient should just say no to transfusions'! Robina

most definitely worth it then - A belated Happy Birthday to you!

I'm glad you got your punctuation correct! So your weakness is out then - get Malcom drunk & the next day he's mellow! Hope the festivities were of equal standing to the hang-over.

Hi Malcolm, I'm going to stick my head above the parapet & come from an alternative angle or 2... This paper http://journals.lww.com/pedresearch/Fulltext/1997/03000/Alternative_Pathway_Activation_of_the_Complement.5.aspx discusses complement protein levels in preterm & full-term babies. They argue that despite full-term babies having C1, C2,C4, C3 levels at 50% of maternal levels, their mechanisms for complement activation appear to be intact. So is it possible this is the baby's true response to the anti-Jka afterall? Or, as the antibody appears so weak, might the baby have an infection that is confusing the serological picture?? What do you think? *withdraws head to avoid shooting!* Thank you for posting such an interesting case! Robina

Ooo, how exciting! Mum didn't make any antibodies did she? Will the baby receive a card of any sort? Just thinking a few years down the line they will potentially just receive 'D-' or worse still if it's a boy may be even 'D+'...

Hi Blut It's definitely a NEQAs reply you need - they should have quite accurate figures of just who is still doing enzyme screening in the UK. When I'm teaching I always ask the audience if anyone still does an enzyme screen routinely - I haven't had a yes in 6 years! So that may be some indication at least. As for picking up otherwise undetected Kidd antibodies, I personally would only be truly confident if it was an 'ENZ with AHG phase' screen in use. I'm pretty sure no one is doing this... Robina

Hi Malcolm, We often get disgruntled people asking why they need to learn Rh nomenclature, haplotypes, genotype & phenotype etc. They think they should just be able to ask for 'antigen negative' & have it delivered. They take ages to connect 'what I want' with 'what actually exists'! It also makes me very sad indeed that some transfusion staff don't want to learn. It is very difficult not to swear sometimes!

Hi Rashmi, Part of my job is teaching on the NBS courses so I can give you an idea of the people we get & why... Last week we ran our Practical Intro to Transfusion Science (5 days theory & prac). Quite a few were multi-disciplinary. It seems that some managers are happy to send staff on this course & then expect them to be competent (& ready for solo-working!). One person had been told to do the advanced course but he insisted himself that he needed to start with the basics. In my opinion, based on recent attendees, is that transfusion training in the workplace is random, intermittent, lacking in underpinning knowledge, not followed up, not given enough time, & leaves the BMS feeling either (as you mention) that there's 'nothing' to it or completely terrified of transfusion. Everytime I talk about BCSH guidelines it's quite clear that they are not being used in the lab as source material for training - not one of the 9 attendees had heard of them! And yet they carry out pre-transfusion testing... We always encourage the attendees to go back to work 'armed' with questions about why their policies are set the why they are. A couple of new 'policies' I heard about this week at one hospital: If anti-Kpa cannot be excluded they are told to select K- units as these 'won't be Kp(a+)' - their blood bank manager has decided this! If anti-Cw cannot be excluded they are told to give C- units (regardless of patient Rh phenotype). My real worry is that transfusion knowledge is disappearing at an alarming rate & no one appears to be too bothered. Is time & money so tight that we can no longer teach our staff the basics? The one thing that does give me hope is the majority of attendees at the end of the week realise how much they don't know & go away wanting to learn more. Also, this goes for all BMSs not just the multi type. What do you think can be done to help improve this situation? Robina

:threaten:What can I say but we're harder up North! Our patients can take it...

NBS policy now says that any unit found to be DAT+ is Ok to transfuse - don't think they can return them anymore!

I received these beautiful posters today - thank you so much! They are great pieces of work (some may say art!). Have you considered submitting them to a conference at all - perhaps BBTS in Glasgow UK in Sept 2011?

No problem Malcolm, thank you for battling the dust & trying! I wonder if our library might have a copy hidden in the depths somewhere...

that's because she'd have to vacuum around you! For practice at successful file removal I suggest Jenga practice... http://www.mountainphotographer.com/wp-content/uploads/2008/06/drunken-jenga2.jpg I like to think of it as a 'piling system', so long as you know it's in there that's all that matters:p

Bit of a fire hazard are you?! Don't worry I won't hold my breath - just if you get a chance. I had a lovely day thank you. Delicious pub lunch in the countryside!

Malcolm that is very interesting - I've never heard that that was the reason for the term Du. I have heard many people say that it was short for 'undecided' - I shall correct them! If you find the article I would love to read it.

I don't think it's way off at all. It's a very valid point. It also bugs me that commercial companies are continuing to create unnecessary extra ways of performing standard tests just to eke out a few pennies more from a crippled healthcare system. Consider that Third world blood banks don't even have consistent power supplies to run their centrifuges! Sorry - bit of a rant there! (and now I'm definitely off-topic...better be on my way:sprint:)

Fair enough but you do have 72 hrs to administer the treatment, plenty of time to get results back from the hospital or for the patient to get the bus to the hospital. In my opinion if the patient won't consider/ accept correct treatment then it is their responsibility to accept the consequences. I wouldn't want to rely on a different test just because they can't be bothered to hang around. Of course this is easier for me to say as we have free healthcare!

Even in these areas you speak of surely it would still make more sense to do ABO/Rh (& ideally an antibody screen) together? It doesn't take long! Out of interest what sort of situation might require anti-D prophylaxis without blood bank support? As Liz says it is not required 'stat' so why rush an important decision? To me this is a commercial company trying to promote an unnecesary product with the added downside of fracturing tests that go perfectly together for a very good reason.

I'm with Liz on this one - not sure I see how it would be useful with respect to the other testing already in place. In the UK the woman's RhD status is known from around 12 weeks into the pregnancy. As RhD isn't the only result required for complete antenatal monitoring why would you do this as POCT? (i.e. you still need to know the ABO group & antibody screen result so this is where RhD typing fits - if it ain't broke don't fix it...)

Well I guess she's got the right idea then!

Perhaps as a D pos you can offer to trial the reverse theory & see if you can become D neg. You would obviously need plenty of excess alcohol, sugar & other tasty refined foods. I think New Year's Eve would be an ideal starting date for this experiment? (Disclaimer: As a D pos person who has followed the proposed 'D pos to D neg' diet religiously for many years I don't think it works. However, I may be an anomaly so it's worth a try...)

Careful now. You don't want people thinking you're going soft!

Cheers Malcolm, peace at last (for a few days at least!).

Ok Malcolm are you going to put me out of my misery? I have spent the last few weeks with Mr Egg tying up the interweb with various search strings/ terms & conundrums! Please, please tell him the answer!

Absolutely delighted for you! Blooming well done :cool: As Malcolm said you did the hard stuff & it's shown. Hope you're inspired to keep on in transfusion! Fluffy:)