Fluffy agglutinates

So, do you see yourself as a 'listed building' or 'site of special scientific interest'?

I've been following this thread with interest & I do find the conduct of the staff member concerned very alarming! They are showing blatant disregard for patient safety. I know mistakes can happen to anyone but most are preventable and as for falsifying results - that cannot be justified ever. Over here in the UK in order to perform this sort of work you need to be a HPC registered biomedical scientist (Health Professions Council). Once you are registered you become 'public property' & have professional standards & responsibilities to uphold. They have a complaints system which anyone can access & use. See link for examples http://www.hpc-uk.org/complaints/hearings/ . The HPC has the power to suspend/ reinstate/ strike-off or restrict your scope of practice. You wouldn't be able to work in the profession again if struck-off. Any employer can also check the registration status of any employee at any time (it will tell you if they are under investigation/ suspended/ struck-off etc). We are registered for 2 years at a time during which we are expected to undertake 'Continuous Professional Development'. At the end of each 2 year time-frame ~5-10% of registrants will be called upon randomly to prove they have done this. Re-registration is mainly taken on 'good faith' given the audit outcome. Each registrant signs a binding document stating they have upheld the expected standards & CPD (& will continue to do so) in order to re-register. We pay for it too! I think it is a very good scheme & certainly makes you more responsible for your own actions! This system allows any concern over individual staff conduct to be raised & investigated independently by the HPC. For your person in question I wouldn't hesistate to report them over if working over here. Is there nothing similar in the US? I know some other posters have asked if the lab is AABB accredited - do they have any power?

Thanks all for your replies. I think it's quite good to be able to use 2 measures (in an educational way) but may cause problems in patient notes where a measure may be assumed (if the recorder happens to omit the F or C). (I still use pounds & ounces when baking instead of grams but this is mainly due to learning to bake using my Mum's old cookbooks!)

A very silly question but I'm curious... being from the UK (& a certain age) I've grown up with temps measured in 'oC' such as 'crossmatch compatible by IAT at 37oC'. Now whenever I've been to the US on my holidays I see temp displays (everywhere!) given in F. So what do you use in the lab? Daft I know but humour me please!

I don't know if they did any tests at 37 but I would think it unlikely as the original reference lab couldn't detect the anti-B at room temp or 4oC.

We're not allowed to use the dropper! We use a pipette to give a precise amount e.g. 50ul for a 'drop' I think it's just as likely to be the user as the dropper - it depends on angles, amount of 'squeeze'! etc.

If I may I think you are a little confused over what is actually happening at this stage of life... Any IgG molecule will be transported by the placenta regardless of its specificity. This is what conveys protection in the first few months of life (i.e. the baby has the mother's immunity for a time). Maternal IgG in the fetus does not cause production of IgG in the neonate. All Ig levels in newborns are low with the exception of IgG (but this is maternally derived). The acquired IgG specificities will depend on what the mother has produced. After 18 months the IgG level will only be ~60% of an expected adult level. I would advise trying an immunology book for further details (e.g. Roitt's Essential Immunology). Hope this helps a bit!

Ok folks an update for you... IBGRL results are in: patient is a Bh, genetic background BO1 Antibodies: Strong anti-A, weak anti-B, but has not produced anti-H Patient is of Cantonese ethnicity. Baby due in about 4 weeks. No 28 week sample was sent in - so developing antibodies have not been checked of late. What blood would you like on standby at delivery for Mum?!

Still waiting for the report to come back!

It's a very interesting case! Seems very unusual to only react in that way to red cells. May be you should get this written up? Thanks for sharing it.

Blimey a telling off from the Master! Ok perhaps I was being a little simplistic in my response (it's difficult in a forum!). If I got anything less than a 4+ reaction with my anti-D then I would perform a partial D typing panel to find out what it truly was - A thing that seems to be missing in the case that started this thread. There seems to be no interest in finding that out. And I DO think that it is very irresponsible to give out anti-D to people who don't need it. It is a human sourced product that potentially contains allsorts of contaminants! Secondly we do not have an endless supply of this stuff to waste...

Ah yes, I have read about those but you must agree they are infinitely rare & it would be a waste of resource to change guidelines on the strength of them. The stance I am taking is from our UK guidelines & I still think it is daft to give prophylaxis when the Mum is a weak D! Where do you draw the line at what is weak? 3+/ 2+/ 1+ etc? In this case I would be much more interested in confirming the patient D type (i.e. checking for partial D) before 'liberally applying' anti-D proph. As for those hospitals of yours testing for DVI in babies they are being very naughty!

Hi, definitely not a stupid question. In theory I suppose it could happen. The anti-B used was very avid though!

Crikey, that is sad! What about when the weak D patient complains about getting an unnecessary injection of human-sourced product?! I wouldn't like to have to work that way. Guess we're lucky over here...

I realise this is an old post but I have to ask: Why would you give prophylactic anti-D to a woman who is D positive? This is completely against our guidelines here in the UK. Is it different in the US? People with weak D cannot make allo anti-D. D+ is D+ whether weak or not. Someone who is a partial D is highly unlikely to react 'weakly' with anti-D; they are either strongly pos or completely neg. The only D variant of concern, with respect to anti-D stimulation, is DVI & that shouldn't be picked up as positive in any patient testing (as the anti-D you use should not react with DVI).

Well in that case I wish you a speedy recovery & best wishes!

I certainly will. Enjoy your time off!

Hi Malcolm, indeed this is an interesting case! I wanted to post it here to see what people thought of it. I think for more details you should speak to a certain Mr E at the Liverpool reference lab... He was very excited too (they had a B el at the same time which was great for comparison & also very unusual!) I had thought about the Lewis type also but with the patient being pregnant they didn't do this (I think I would have anyway though). The sample is indeed on it's way (last night) to IBGRL & no I don't know the answer yet!

Ok here goes... Patient referred as 'Group O, no anti-B' (first thought is - well that's not a group O then!) Pregnant. Ethnicity possibly Chinese descent. Not ill (this is an antenatal sample). Antibody Screen Negative. Forward group - O Reverse Group - B (i.e. has anti-A but no anti-. Anti-A is 4+ reaction. Patient red cells are negative with anti-A,B (commercial) & anti-H Patient plasma is negative with O cells (4oC/ 22oC/ 37oC) Adsorption/ Elution with anti-B is 'negative' - patient is not a B el Secretion Test - 'no inhibition' The closest match I can make with these results is a B hm BUT you would expect the anti-B & A,B to react weakly or, if not, be able to get a positive using the adsorption/ elution method. Any thoughts anyone? I'm puzzilified!

Just out of interest was the pre-transfusion sample a 'true' pre sample? - by that I mean you say the patient has received a lot of products lately, had they had red cells in the weeks leading up to the reaction? I personally would be screening this patient every 72hrs for developing antibodies. However, it is very unusual to have this sort of immediate reaction when dealing with red cell antibodies other than ABO (I presume that was definitely ruled out!). You could consider a Kidd antibody. Try an enzyme IAT panel & see if anything pops up. You could also put the eluate up by enzyme IAT too. It would be interesting to see what happens next - please keep us posted. p.s.I would expect that an autoantibody will be appearing in your screen soon...

This is what we use in the UK... http://www.transfusionguidelines.org.uk/Index.aspx?Publication=RB&Section=25&pageid=646

This is a very interesting question! Can I ask if you are going to be using an automated system? If so you will find the answer out during validation! I would think the analysers will recognise a card which has been incubated but not used yet & reject it for you if it falls out of spec. It should also be set up to use cards in order of loading (avoiding the situation in the first place). DiaMed analysers allow a 37oC incubation maximum of 30 minutes per test, then it throws them away for you. If you are using these cards manually then the storage temp should be adhered too i.e. like Malcolm said 18-25oC is your range. If you've used a part card then you've gone outside the recommendations (and yes we do this all the time!). Thank you for bringing this up! I wonder that I've never considered it before now. I shall have to ask my local friendly reference lab...

Hi all, I was wondering what you all think of the qualifications needing to be mainly 'IBMS' accredited especially with Modernising Scientific Careers pulling the plug on the IBMS existence? A few things trouble me... 1. the Edinburgh MSc is not IBMS approved but does contain the most comprehensive transfusion & transplantation elements in comparison to most of the others on offer. 2. I'm not entirely sure if the Bristol MSc is IBMS approved (on the IBMS list it has 'MSc Haematology' & MSc 'Biomedical science' but doesn't mention a specific transfusion one) 3. I've been told this will not affect NHSBT staff only hospital staff. This seems very odd to me - the experts in transfusion science do not need the same qualifications!? And we too have MHRA inspections... 4. for those with 'equivalent qualifications/ experience' how do they go about proving it? There was nothing in the guidelines to help with that. How will hospitals be able to fund these qualifications & provide suitable training? As a scientific trainer in the NHSBT I'd be very interested to know what we could do for you guys out there! We do run very good courses at the moment (wellI would say that wouldn't I?!) but we'd love to know what's missing/ needs improving... Any thoughts?

I was always taught, and firmly believe, that the safest way to screen donors is by questionnaire. This is then backed up by the lab tests. When faced with writing down answers people are far less likely to lie about their behaviour. Conversely the result would be 'if you don't ask I won't tell' or 'I didn't think that was relevant'. It is important to remember that the vast majority of the general public know very little 'science' & struggle to understand why we impose such rigorous checks on our donors. In my view until we have tests that remove the 'window period' of potential infection we must continue with the donor health-check as we have always done.

Still works for me!