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YorkshireExile

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Everything posted by YorkshireExile

  1. We have the same "problems" as ElinF. We use gel and don`t do weak D testing on our prenatal patients, but if my gel reaction shows 1-3+ positivity I`m obliged to report it as RhD positive. I then put a result comment in stating that the patient is actually a weak RhD positive. If there is a discrepancy with the historical group being Rh Negative, I then have to explain that as well. Unfortunately with my wonderful(!) Cerner Millenium computer system I cannot actually report the group initially as Weak D positive, so I have to put the comment. If these patients required blood I would try to give them Rh Negative blood to be on the safe side.
  2. Here in the good old middle east (Abu Dhabi to be precise) I have no choice but to treat leucoreduced units as CMV negative. Our local blood supplier does not test any of the units it supplies for CMV. My hospital is a maternity hospital with a specialist 50 bed NICU unit. All difficult maternity cases and premature babies are referred here. So I have to end up giving ELBW babies (<750g) leucoreduced blood with an unknown CMV status. We do about 50 top-ups per month, and in four years here I have only been told of 2 or 3 neonates that got a CMV infection. Of course the doctors suspect it has come from the blood units transfused but I believe the mother can also be the cause if she is CMV positive and is supplying infected milk through breastfeeding (please correct me if I`m wrong!) So if we say we have done 2400 top-ups over 4 years and only had 2 or 3 CMV infected babies during that time, can we say that leucoreduced blood has been shown to be as good as CMV negative blood - or is 2 or 3 infections still 2 or 3 too many?
  3. Thanks for the reply Malcolm. So is the RCOG statement of March 2011 "Women who have a weak expression of the RhD blood group do not form anti-D and therefore do not require prophylaxis" correct or incorrect? In a routine hospital lab situation I would never know if my weak reactions were due to a weak D or a partial D. All I can report is the phrase they are familiar with i.e Weak D. So should I be advising my doctors to give these patients an anti-D injection during their pregnancy? Or should I just settle for an easy life and agree with the RCOG and our current policy
  4. Our hospital policy is not to give an anti-D injection to our antenatal patients who have a weak D antigen. This is based on the RCOG guidelines of March 2011 which specifically state "Patients with a weak D antigen DO NOT develop anti-D". Is this correct? I`m sure I`ve read literature in the past where these patients can, albeit rarely, develop anti-D. We do not specifically test our antenatal patients for the weak D antigen, but the fact that we use the Diamed (Biorad) gel ABO/Rh+Reverse group cards means we can see clearly when there is a +2 agglutination or less with the D antigen, so we feel obliged to report the group as Weak D positive. Does anyone routinely give an anti-D injection to these weak D patients?
  5. Is there anything wrong with actually using a sample from the baby (if there is enough plasma) rather than needing a sample from the mother?
  6. We do antigen typings with Diamed (now Biorad ) gel cards. We also do panels and XMs with gel cards. I only use tubes for the Immediate Spin XM. I haven`t used tubes for grouping, or pre-warm antibody screening or AHG crossmatch or antibody ID for a number of years now. I don`t really care about scruffy and weak reactions due to RT antibodies unless they are strong enough to affect my AHG crossmatch. Then I would simply send Malcolm my samples at the IBGRL for him to identify using all the wonderful tube methods. - Thanks Malcolm and team!
  7. There are definitely gel cards available for anti-K. We use Diamed ones everyday. For S and Fya we do exactly as you describe and have no problems.
  8. Hi Malcolm, Unfortunately here in Abu Dhabi it can be very difficult sometimes to get group specific platelets. Sometimes the only group I can get is AB. It`s better than giving no platelets at all for my sick neonates. Well done in remembering the titre value of 1:32. Are you sure you`re not the person who has just won all that money on the euro lottery?;)
  9. Thanks Malcolm, I`ll remind you if necessary! Enjoy your half days leave - why not make it a full day?
  10. I wonder the same thing as BankerGirl. Why are AB platelets not made in the UK? Are AB donors specifically reserved for FFP and/or Cryo? Bankergirl - can I ask you my original question? Do you have a specific reference that says it is okay to give AB platelets to a non-group AB neonate? Malcolm, you mentioned platelets are tested to make sure no ABO high titre antibodies are present. What is the definition of "high" in this case? What would the titre level have to be before it would be considered unsafe to transfuse? Are there different cut-off levels if the platelet is going to an adult as compared to a neonate?
  11. Malcolm, I recently read your article in the BBTS journal concerning correct terminology, so I know I`ll have to tread very carefully here. I suppose I should have termed the platelets "Group AB Platelet concentrates". Is that correct, or am I missing something else?
  12. Thanks Emad, But I`m looking for a specific reference for a table that includes AB as one of the group choices to give. The choice of AB is not in the BCSH guidelines table.
  13. Does anyone have a specific reference for a table referring to the choice of platelet group to give a neonate if the patients own group is not available? I am specifically wanting group AB platelets to be included in that table. The only reference table I can find is the BCSH amended guidelines (2006) for neonatal transfusions. In that table, group AB platelets are not specifically mentioned as it is assumed they will be in short supply. They are only mentioned in a note below the table. I have a very pedantic neonatal consultant who wants written reference proof in a table that AB platelets are one of the choices to give to a non-group AB neonate. Thanks.
  14. Thanks Malcolm and Lara for the replies. I now understand what PANTS means, but I`m no clearer on understanding the concept! Are you saying that blood destined for paediatric patients should have a more sensitive antibody screen done on the donor plasma? That instead of just using cells in LISS for the antibody screen (we use a Diamed 3 cell screen) we should also use a 3 cell enzyme-treated cells screen (In effect a 6 cell screen)? Plus we also have to dilute the donor plasma 1 in 4? Why? Is this standard practice in the UK or anywhere else in the world? What is the rationale behind this?
  15. I have a friend who is helping design the the Blood Bank part of a computer system. She has been told to include the rule that all blood for neonates and children under one year old should be PANTS negative. We both have no idea what PANTS stands for. Can anyone help?
  16. Many thanks Gregor. This will be an immense help in my work.
  17. Having read the blog I thinK I understand what the changes are all about, so I voted for option one.
  18. Liz, Our process is this: We get a fresh unit of whole blood collected in CPDA-1 anticoagulant straight from our small donation center. We then centrifuge the unit so it is hard-packed. It is then stored like this. When it is required for a neonate top-up we then remove most of the plasma to make the packed cell with a HCT between 70 and 80%. We then take the required volume necessary from the packed cells and reserve the rest of the unit for that particular neonate (if the birth weight is < 1Kg). All our top-ups are leucoreduced, sickle cell negative and G6PD normal. They are not irradiated -at present. I actually want to change this process and use units collected in additive solution (in my case SAG-M). The packed cells would be made as normal for a RBC unit and then when a top-up is required an aliquot would simply be taken from the unit. There would be no more centrifugation involved. Fresh blood would be used initially and then the unit reserved for the neonate throughout the shelf-life of the unit. For various reasons this would make my life a lot easier in my Blood Bank. I have discussed this with my neonatologists and they seem okay with this. I told them that the HCT of the units would be only 60-70% if I did this method, but they would adjust their volume requirements accordingly. My concern was the extra mannitol and potassium I would be giving with these units. But every bit of literature I have read (British, American, BCSH, AABB) concerning neonatal top-ups with SAG-M units says this is not a problem. The amounts involved in top-up transfusions are too small to be a cause for concern. So is my current method acceptable? Is my proposed use of SAG-M units acceptable? Are they both okay? Thanks to everyone for the interest in this topic!
  19. At the beginning of the year, at the instigation of our neonatologists, we started reserving specific units for neonates to reduce donor exposure. This was limited to all neonates with a birth weight of less than 1000g as they were the ones expected to have most transfusions. Exceptions could be made if necessary. All the literature I have read states that the minimal doses of K+ in the top-up units are of no consequence. Do people use blood in additive solution for neonatal top-ups, or blood collected in CPDA-1 or CPD? Also, do people give specifically CMV negative blood, or is leucodepleted blood considered equivalent to CMV Neg? Is it okay to give CMV Pos, leucodepleted blood to Extreme Low Birth Weight neonates?
  20. Thanks for all the interesting replies. For this particular case our O Neg inventory is extremely depleted and we would have to give O pos if required. It would be interesting in one way to see what would happen if we actually did transfuse - would anti-D develop or not? But my practical mind outweighs my scientific mind and I hope the patient doesn`t actually need any more transfusions. I have actually followed Johns advice and spoken to the doctors this morning concerning this topic (thanks John). I`ll have to wait and see what happens now.
  21. Thanks for the replys. Our transfusion - happy doctors have not decided to transfuse yet so everything is okay at the moment. They will probably decide to transfuse in the middle of the night and I will have to be woken up to explain to them why its okay to still give O Pos blood.
  22. A couple of days ago we had a patient in OT who had a major obstetric haemorrhage and required 12 units of blood. Unfortunately she was O negative and because of the shortage of O negative blood, 8 of these units were O positive. She eventually had a hysterectomy and seemed to recover okay. I have just checked her Hgb this morning and it has dropped to 7.3, so it is very likely that the doctors may request blood again. So the question is: Is it okay to keep transfusing with O Positive blood if the antibody screen remains negative? O neg blood is in very short supply here so it would be a problem. Of course, if anti-D does develop then I have no choice but to give O neg, but until then...........
  23. As far as I know, for routine top-ups it is okay to use blood which has been collected with an additive solution (be it AS-1, SAG-M or Adsol). Multiply transfused - no problem whatsoever. Very premature - no problem except for ones with known renal problems.
  24. I agree. We have recently been upgraded to the new CM version and this return temperature thing suddenly appears. Any temperature is acceptable as far as CM is concerned. Just one of many little CM problems we have. At the moment I can`t even dispose of a unit of whole blood if I wanted to!
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