pstruik

'Use common sense, and don't lick anything in the lab' - now that's my kind of policy!

As an aside, my daily e-mail bought up in the list of topics WEIRD TYPE (Malcolm Needs) which, only slightly tongue-in-cheek, I found myself in complete agreement with

Of course, if this was in the US the OP would be Other Side of the Pondering ... I'll get my coat

Malcolm proving that men can indeed multitask - especially as he was probably being a transfusion guru, watching rugby and enjoying a fine wine all at the same time

Whilst there is general agreement that Malcolm is, indeed, awesome, those of us lucky enough to know him try not to tell him too often in case it goes to his head

To completely mangle an already strained analogy and to offer support to Malcolm - two heinous crimes - zebras and unicorns are always likely to be detected less frequently by people who don't look for them. Our routine testing is always going to be less exhaustive than that done by specialist laboratories on referred samples in cases of special interest which is why they find wonderfully interesting things and get to, say, jet around the world telling people about them ... Jealous ? Moi ? (No. The inestimable Mr Needs very much deserves his reputation)

Not at all helpful to your particular problem I am afraid but in preparation for introducing our RAADP programme we stopped routinely performing DATs on cord samples from babies born to mothers without antibodies about 6 months before we started. I awaited the outpourings of grief and woe, the wailings and the gnashings of teeth from our midwives and paediatricians. And it never came. In fact when I asked at my transfusion training sessions up to a year later it was almost universally believed that we performed a group and DAT on every cord sample. Which gives a clue as to how much notice was taken of our lovingly crafted reports. Good luck with finding a solution to your problem.

Having had the pleasure of Malcolm's knowledge and company for many years at a variety of venues I would suggest your planned taking him out for a pint scores fully in quality but is lacking somewhat in quantity. You are, however, guaranteed a good time.

John is so right about not adding complexity. In our laboratory's MHRA inspection the poor man tasked with rating our efforts at quality having spent a lifetime in the business kept returning to his mantra - keep it simple. His experience allowed him to cut through our layers of complications to find the necessary instructions so having an outside and knowledgeable being to cast their eyes over your end product is also helpful.

We used to do as Magnum and although I never claimed everything was at 37C - as Malcolm in his tedious way is quite correct to point out it almost certainly wasn't - it was all what we scientists describe as 'warm' and allowed suitably crossmatched blood to be provided for such patients with a minimum of fuss, tantrums, tears, doubt, worry or referral to a 'proper' Transfusion laboratory with experts and waterbaths and tubes like what Malcolm has

From a UK perspective I had never realised how much time and effort is saved by having a single NHS supplier (Thankyou NHSBT) who guarantee supplies of products to hospitals however large or small at a standard price meaning I never shared your joys of shopping around or discussions with CFOs * My deepest sympathies to you all for having to cope with this as well as all your other Transfusion duties * One did suggest that, our hospital being in the South East of England we could perhaps obtain blood more cheaply from France ... luckily my loyal staff prevented me from entering into debate (There was language !) and no more was ever heard on the subject.

Although the manufacturers may well have factored in the 6 months life of the solution when calculating the 'do not use after' date for the powder - I, although neither a manufacturer nor au fait with the regulations concerning such things, would have done. You have asked an excellent question and I, despite my point above, would, whenever there was any doubt, always choose the safer option.

There is a certain delicious irony in a - very sensible - question about the non-use of arrows asking people to point you in the right direction ...

Shortly before retiring my discussions with our Obstetric Consultants in our busy Maternity Department showed that whilst we agreed performing regular quantitations on maternal anti-D and anti-c antibodies was worthwhile I did manage to *almost* persuade them that titring other antibodies was of virtually no assistance in management of the pregnancy compared to MCA Doppler/ultrasound. We parted without a conclusion being reached. Since I left the number of titrations has remained fairly constant but my garden is far better tended.

You are right, of course, that the physicians aren't that interested in the details. In my lab we used to report everything with an emboldened interpretation/conclusion section at the end which was especially useful when eg we found patients who had an unexpectedly positive DAT which only came to light when testing pre- and post-transfusion samples whilst investigating a suspected reaction. You are raising that most central question which we don't ask often enough - what is the purpose of this report ?