pstruik
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Everything posted by pstruik
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'Use common sense, and don't lick anything in the lab' - now that's my kind of policy!
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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
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Of course, if this was in the US the OP would be Other Side of the Pondering ... I'll get my coat
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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
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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
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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)
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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.
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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.
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Engineering controls/barriers to prevent errors
pstruik replied to kirkaw's topic in Transfusion Services
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
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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.
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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.
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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 ...
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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.
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Reporting transfusion reaction investigation results
pstruik replied to knelson's topic in Transfusion Services
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 ? -
My experience with my tame haematology consultants (all too many, over the years) bears out Mabel and her singular oncologist - they found the strength of the DAT very helpful in monitoring treatment although whether our numerical report provided a 'comfort blanket' or actually aided them in following a rigorously tested, peer-reviewed, scientifically validated process is not for me to say. Other than that I tend to agree that reporting the strength of the reaction adds nothing of clinical value - EXCEPT - (bee in bonnet alert) - except for a mixed field reaction. Mixed pictures always tell a story. In my humble opinion the story is invariably worth careful unravelling and the interpretation carefully reporting.
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Truly Cliff, you are an awesome megastar We do not deserve you ...
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Many years ago on a day when I was in the middle of completing our MHRA return with no assistance from anyone and feeling very stressed I wandered from my office into the lab to discover about 10 such things in 30 seconds. I - very unprofessionally - had a rant which was soto voce but in a somewhat menacing tone and continued through the silence for what seemed like a very long time and ended with me shrugging my shoulders and - even more unprofessionally - walking out and going home. I am in no way proud of my behaviour nor commend such a course of action to anyone. And I did apologise profusely the next morning. BUT standards showed an instant, long-lasting and dramatic improvement. I suppose the answer is to use media like this to vent your frustrations and then finding an appropriate way to communicate that to your staff. Good luck.
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Disappearing A1 antigen?
pstruik replied to Mabel Adams's topic in Immunohematology Reference Laboratories
... and it will always be the last one you pick ... (because of the general contrariness of the universe and also that you stop looking once you've found it} -
I found it to be a good site and Malcolm disagreeing with only one of the answers confirms it
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I seem to remember reading a study years ago (probably before many of you were born ...) which showed that a Pre-operative Autologous Donation programme should be stopped as the increased risks from the extra driving involved in donating the units more than outweighed any reduction in possible harm from a post-operative transfusion. For many years this was my favourite transfusion fact.
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Fetal Maternal Hemorrhage screening methods
pstruik replied to Nancy L.'s topic in Transfusion Services
As a lab serving a busy maternity unit we would routinely perform a Kleihauer test on all mothers, regardless of blood group, who suffered an IUD or gave birth to an unexpectedly anaemic child as the result was of great assistance to the Coroner or Paediatricians. Although not peer reviewed, unofficial and entirely anecdotal we used to find that foetal cells which had been in the maternal circulation for any length of time would appear crenated in the Kleihauer and seeing many such cells was strongly suggestive that the bleed had been chronic rather than acute. I found it very annoying that so much useful information could be gained from this test as I always loathed the Kleihauer with a vengeance. -
As Lab Manger, if we were adequately staffed and I wasn't needed in the lab I would often deliver uncrossmatched blood to the ward/theatre as I was then able to talk to them and find out more details of the situation and how the patient was, which made it easier for us to be pro-active, and gave me an opportunity to provide advice on what products may be needed, in what quantities and in which order. This was well received by medical staff but it was always made clear that this was an extra and not something we could offer routinely, and certainly not on a 24/7 basis.
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I believe, from (my unreliable) memory, that it was the tendency for incomplete engagement of both parties when dual checking that led to the suggestion that doing it independently would mean each individual would check more effectively. Certainly from personal experience it is very easy to allow one's mind to wander when doing 'routine' checks, even when another mind of that same mind knows how vital it is. Let's face it, human beings aren't that good at checking details - which is why automated systems are ever more popular, As for independent checks, like much within medicine I don't think a great deal of research has been done to objectively find which method, if either, is better. Is there a psychologist in the house ?
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DAT on every hematology work up!?!
pstruik replied to janet's topic in Immunohematology Reference Laboratories
I agree that doing a DAT on every patient is almost certainly wrong but never underestimate the power of a DAT - for Haematologists move in mysterious ways ! I used to tend the needs of 4 Consultant Haematologists who all used completely different (and secret) criteria for selecting which patients required a DAT. The only thing they had in common was their immense gratitude when, based on other serological findings, we performed a DAT which gave an unexpectedly positive result - they appeared to find this extremely useful in their diagnosis and treatment - even though they never explained exactly how. It seems a relatively cheap and easy way of keeping an important and fairly benign alien species happy.
