lateonenite

I used to enucleate for the eye bank (deceased donors, obviously) and used to hate doing those collections - not just for the collections themselves but the sometimes gungy blood you'd get out of them with fat globules in them.....now we group for cadavers here and I'm always reminded of those days.....

My favourite as a brain-clearer (but applies equally well to the lifts in our building): "I say we take off and nuke the site from orbit - it's the only way to be sure." My boss is fond of "There's no crying in blood bank" and I'm in convulsions over "Poor planning on your part does not constitute an emergency on mine."

Our protocol is the same as everyone else, and in the end it's up to us as to what we will give out according to what we have currently on the patient (ie, if we have a current sample grouped then always group specific rather than our O's). According to protocol we are supposed to get haematologists approval to switch a patient from Neg to Pos, but what really happens is that we'll notify them that it's happening (because we eithr don't have the stock or it's an older patient). Approval we only need for females less than child-bearing age or transfusion dependant patients in a trauma/bleeding situation. Of course, we have had a doctor say to one of our seniors: D: Well can't we have the O Negs? S: No, as I explained, the patient has antibodies, (a little-c in this case), we need to give you O Pos D: Well, everyone knows O Neg is the safest to give in trauma, don't you know that? He still grits his teeth at that today, and it was some years ago now....baby doctors are so speshul.

"If the ABO/Rh types match, this does not mean that the samples were collected from the person indicated on the label." So we are bothering because? Good Lord. We request a recollection; doubt as to the specimen viability (e.g. contaminated) or identity is an automatic "No result" (i.e. we cancel the test or put in a code that answers the test with mislabelled, etc). We might, and rarely, but might leave the results in after speaking to the person responsible for the collection and attach some kind of comment - but really, not. In Australia, an authorised person is only ever a doctor; some of our nurse practitioners (equivalent a physician's assistant, I think) may be able to order a selected panel, but it must be co-signed by a medico within 14 days of the request. It has to do with the ability to bill the government for Medicare (not the same as the US version). Jump in here please, Malcolm, if I have this wrong, but I think our Medicare is similar to the NHS in a number of respects.

At another hospital, we had a Dr Death and a Dr Killen.

We have a manager in our area who keeps all of the unlabelled samples his lab receives in a bucket in the fridge. When the doctor or nurse rings up and says they're coming down to label it, he replies with "Sure, come down" and when they appear he duly hands them the bucket and tells them to pick out the specimen they want to label. Always with a smile.

There once was a little rural hospital who would be the first port of call for trauma patients before they were transported to a larger (usually metropolitan) hospital for further treatment. The ED staff would ask for blood products to travel with the patient. They would duly send crossmatched or uncrossmatched blood (depending on how much time they'd had), but, not having a water bath for thawing FFP, would send the frozen blocks with the patient. So far as I know, no-one ever complained. (And yes, I really wish I was kidding.)

I had a doctor query an automated diff result. Dr: Can you tell me the automated diff result for ****? Me: Let me just look that up....no I'm sorry, I can't, the automated diff is unreliable as the total white cell count is <0.1(x10^9). Dr: Well, umm what does that mean? Me: let me just have a look at the previous, well on the last FBC there was "1 neutrophil seen" on the film - there just simply aren't enough cells to get an accurate result from the analyser. Dr: Does that mean I have to put more in the tube?

Me! I'm right! (Shades of Monty Python - "I'm Brian and so is my wife!")

Hiya, Are we counting differently? If I say Monday midnight, I mean the midnight following Monday <day>, even though it is technically counted as 0000, the beginning of Tuesday. Convention. Maybe it's a down under thing. When I read you reply, at first I calculated Mon (0) 24 + Tue (1) 48 + Wed (2) 72 + Thu (3) 96; this makes sense from the other posts, but not for an Australian blood bank. We use "3 days" as convenient shorthand - by guideline it is 72 hours (ANZSBT 2.1.7), but we mean inclusive of day of collection; again, sample collected 0800 Mon expires by lab protocol at midnight Wednesday, but we can extend to Thursday 8am - but no longer than that. Some laboratories religiously adhere to the 72 hour guideline, but that has a lot to do with the limitations of their LIS - our old one had no idea about specimen expiry, others, like the local LabLink and one of the PathNet BBT builds, expires the sample promptly so that there is no possibility of a lab-induced adverse transfusion outcome. Cheers, Fran

"3 days" is inclusive of day of collection, so a specimen from Monday 8am expires Wednesday midnight, but we can extend to Thursday 8am. Sorry, wasn't clear!

This is incredible. We have no post-graduate accreditation or exams (although I'd like them) in Australia - it all relies on refresher training by each individual laboratory and the QAP from the Royal College of Pathologists Australasia - and not everyone gets to it, believe me (especially not in a 24/7 lab with a dedicated, multiskilled night staff). Before anybody asks, blood bank is one of the better departments for skill assessment - we have to handle a QAP-like situation. When I say multiskilled, I mean we are required to work in either blood bank, haematology or chemistry with some specimen reception work (depending on the shift).

We use 3 days (expiry is at midnight), but we use our discretion in some cases and extend to 72 hours. With bleeders we will often extend if the 72 hour expiry is in >12 hours time (e.g. it's 4 am and the specimen officially expired 4 hours ago, it really expires at 8pm tonight, and the patient is going off again)

We use 72 hours in Australia.

Yes and yes and no to retic separation. I don't think I was clear about that one specific scenario anyway. Running away now!

For a single antibody, we would run a primary 11 cell panel, and the CSL's are good at separating out Rh antibodies particularly, not so terrific as things get more complicated. The 16 cell panel we use when the patient has multiple antibodies, otherwise it's generally used for selective panelling, after the primary panel. We can't say something has disappeared if we haven't proved it - especially if our screening cells don't necessarily demonstrate the disappearance because the "new" antibody can be positive in at least one cell that crosses with the "old" antibody. I will say what we now do is only report an anything new and the other information is available in the LIS, but our testing practice has not changed. And, I'm Australian: The ANZSBT guidelines 2.2.2.1: "Red cells should be selected which are negative for the relevant antigen where the antibody is clinically significant [Table 1]. Antigen typing should be confirmed by the laboratory performing the pretransfusion testing." Table 1 lists by clinical significance, obviously. Using the patient's serum is not an accepted method of confirmation of antigen-negative status. You can quibble on the use of should up there, but GLP dictates that "should" in this instance means "must" - everyone makes mistakes, even the ARCBS.

Holy Ag's Batman! *faints dead away* In trauma on night shift, we will go crossmatch compatible if we can't ID, and leave it for the mythical "someone else"...but the work up still happens later.

I'll confess I've never been trained to selectively panel from the positive antibody screen. We run a primary panel (usually 11 cells (CSL) or 16 cells (Immucor) with known multiples), then select cells to knock out knowns, prove likely ones (definite neg for known, or dosage with known, pos for suspected). In our previous system also, we would report history of anti-X and then anti-Y detected in this sample, so we would have to demonstrate the disappearance of a known antibody if that was the case. I'll add to that we never use the patient's sera to verify antigen negative status, every unit we receive must be pheotyped to confirm antigens by guidelines, regardless of the information provided by ARCBS.

We only ever use autologous whole bloods, everything else is component therapy.

The other advantage of on-site, user performed validation is you can spot any problems in your build - things that will be unusable in practice and can (hopefully!) be changed prior to implementation to reflect the expected use. It also helps in developing organisation-specific training materials. We opted for our own, not using the vendor's since they were effectively useless for our purposes "Select hospital <Never heard of one like that before>" (sure...and then everyone is confused and discombobulated when it comes to the real thing) and it certainly gave our end-users a degree of comfort knowing that the training materials were prepared specifically for them. We changed to computer crossmatching from immediate spin, so that comfort zone was helpful.

Sorry, I wasn't clear - the strengths I was referring to was not a case of attempting to identify an antibody, more to monitor a transfusion dependant patient who had received (heterozygous) antigen positive cells as nothing else was available; if the patient required blood and the panel cells were stronger on those antigens then we would have to insist on antigen negative (if possible). The patient I'm referencing above had a non-specific auto 4+ on original adsorption with varying reaction strengths in panel cells. We had no option to phenotype more than Rh cells as the patient was transfusion dependant (and I mean, at least every month) and had received transfusion elsewhere by the time the antibodies started to come up. Hence the debate with very specific patients like this - why bother panelling when no identity can really be made - even our external reference had to give "cannot rule out....."

We set up nine test patients, one for each blood group plus an unknown. Then we crossmatched (or attempted to) for every blood group and product type; i.e, Patient A Pos was crossmatched against "red cells in adsol" O pos, O neg, A Pos, A neg, B Pos, etc., then "red cells LD" O Pos, O neg, etc. It tested that all of our patient-to-product compatibility rules were working across all of the applications, because we also tested our assignment and issue applications at the same time with the same patients/products. The AABB guidelines have it that this validation has to be performed at every site - luckily the ANZSBT does not have that guideline. It's time consuming, before we did this I had no idea that there were 12 different platelet types offered by the ARCBS (Australian). At least once its done it only needs to be done again whenever there is a product change by Red Cross. Hope that helps.

Do you have an assignment and issue module as well? I'm re-editing this reply because somehow I got completely messed up with my new mac.....see my next entry.

I go with whenever the specimen has expired, because the 72 hour expiry is the minimum time frame for potential new antibodies to form. Particularly at the moment in our lab where we do not baseline phenotype patients until an antibody is formed - for transfusion dependant patients, the phenotype is impossible. There is an argument in our laboratory about patients with multiple antibodies - particularly one with an auto; the theory was that we could not detect any "new" antibody. But I'd have to point out that the antibody panel in those cases has a lot more to do with reaction strength than actual identity. There have been occasions where we've had to transfuse Kidd or Susan heterozygous because we couldn't get E, C, Cw, K, Kpa, Fya, Jka and S neg, so subsequent panels would show increasing reaction strengths. If the patient is an inpatient has had no transfusions since the last specimen, then yes, a week to ten days would do (even if the patient was transfused in the previous three months), but we have had patients that have gone to a private provider, received a transfusion and formed an antibody, come back to our hospital within a week. Unlucky. Fran SEALS