Steven Jeff

I have had the pleasure of knowing Malcolm for more than 20 years initially through the South Thames TADG and he has always been consistent on the use of correct nomenclature at all the meetings and lectures I have heard him speak at, and rightly so. And Cliff it was great going back to Malcolm's original post on this topic.

We never accept anybody else's results either. All investigations are repeated and we act on those.

Guess who educated me about Anti-M and the slightly acidic gel!!!! Steve

Unfortunately Mabel, the BCSH guideines in the UK say that antigen (M) negative blood should be given to patients with an anti-M reacting at 37°C. Steve

In my experience we often detect and identify Ant-M be the Gel technique automated or manual. However, my understanding is that the only way to determine the thermal reactivity range of the anti-M is by repeating the tests in tubes at 4°C, RT and 37°C. If the anti-M does not react at 37°C (in tubes) then cross-match compatible blood can be issued. If the anti-M reacts at 37°C then M antigen negative blood should be cross-matched and issued. Pre-warming cells, sera, gel cassette, reagents etc. does not work well, if at all with anti-M. The anti-M binds to the M antigen on the cells too strongly to disassociate during the incubation stage of the gel cassette. I have also been lead to believe that the gels are slightly acidic which increases the strength of the reaction between anti-M and M antigen. In practice we refer all new anti-M samples to our local RCI laboratory for confirmation of the thermal range of the antibody. Regards Steve :)

I know from experience that Malcolm and his team are very supportive of Hospital based transfusion staff. Hospital based staff are always on the front line and often have to cope with haematology as well as blood transfusion issues and prioritising what is important at the time is the challenge. Steve

1.5oC seems more sensible to me Eoin, 1oC seems too small a rise. There would be too many transfusion reaction referrals for a 1oC rise in my opinion. Steve

It looks far too small for a filarial worm and there are no inclusion bodies. Is this the only one in the film, if so query whether this is an artefact of some form Steve :)

To be honest Liz I do not know how they prepare the platelets, although I do seem to recall that a pool of five was better than six individual packs. Steve

In the UK platelets are provided from the National Blood Transfusion Service as platelet pools from 5 donors or the equivalent by apheresis of a single donor. At the hospital where I work all platelet requests are run by the consultant haematologist for approval or otherwise. The exception being major trauma. Steve :)

We only use a Diamed (Biorad) IgG card at hospital that has a large maternity workload. All our samples are collected into EDTA anticoagulant which negates the use of a card with anti-c3d. Steve

I agree with Auntie-D and your seniors on this, the slide hasn't properly dried prior to fixation. Bone marrow aspirates should be left to dry for at least an hour, the same with thick films for malarial parasites. The conclusion is reached through experience, the longer the drying the better. Steve

I entirely agree with the point you have made. We can discuss the merits (or otherwise) of testing two samples or one sample twice etc. The focus must be on the whole process from sample collection to transfusion (wrist to wrist) including the use of printed barcoded PID labels on the samples provided they are generated at the bedside. The less human/manual manipulation the better. We can dream!!!!!Steve :)

Mabel, my understanding of the UK guidelines is that electronic issue (EI) is acceptable in the UK on manual typing, however it is strongly discouraged. It is unlikely that any laboratory in the UK would undertake EI without at least one group and screen being processed through an automated analyser with the results being transferred directly to the blood bank computer system following authorisation on the analyser. Steve :)

As Auntie-D has said it became unacceptable in the UK some years ago to stick extra labels on the blood bag because of the risk of the glue leaching into the blood through the bag. We could order labels with acceptable glue, but most opt to use a label tag that can be attached to the blood product bag. Platelet bags if I remember correctly are designed to allow a bit of breathing through the bag and extra labels inhibit this process. Steve :)

Malcolm is entirely correct, I will do my best for the benefit of the patient, but would not hesitate to let a clinician know that they may be at fault. Fortunately I believe that in the UK we are well respected in Blood transfusion and accepted that we are expert in our field, we expect compliance with our standards (as required by the MHRA) in order to provide a safe blood transfusion service. Steve :)

We record our stocks on a daily basis,usually in the morning. Later in the afternoon we place our orders for blood components to be delivered by routine delivery the following day. We have what we call our minimum and maximun stock levels and we aim to keep them at those levels. In summary we have daily routine deliveries with the exception of Saturdays. We also have the option of extra ad-hoc deliveries (cost extra) should stocks get too low or we have special requests. Finally, we have the option of emergency 'Blue light' deliveries which are to be used in an emergency only, and the requesting clinician has to give their approval/authorisation before we make these requests. We do not have a wastage problem. I wouldn't call it guesswork, more experienced judgement on what is a reasonable stock level. Steve :)

Submitted in duplicate for some reason!!!!!!!

I am with Joanbalone on this, it is not my job to babysit the surgical or medical departments, they have a responsibility to the patients in their care. They have their own checks to make prior to any surgical procedure which includes checking on blood component availability. Steve

I think that is what makes the computer generated label acceptable in the UK. The label must be printed at the bedside using a hand held label printer connected to a bar code reader. The patients wrist band has PID information in the form of a bar code which is scanned into the hand held printer. The labels printed and attached to the samples Steve :):)

It was only last week that I sent a sample from the hospital I work in, to Malcolm’s RCI laboratory on a lady who is 16 weeks pregnant with an anti-K. Malcolm’s laboratory has reported back an anti-K titre of 16000 with a request for repeat samples at 20 weeks, samples from the partner and advice to refer the lady to a specialist fetal/maternal unit. If I remember correctly (telephone report so far) the samples will be sent to the International Blood Group Reference laboratory in Bristol I suspect we will have little to do with the further management of this patient, because I am sure she will be referred and rightly so. Steve :)

I had a patient with a Hb of 2.4 in the early hours a couple of years ago, post myomectomy the previous day. The lady survived following a hysterectomy with platelet, FFP and red cell support. Blood and platelets arrived by blue light courtesy of Malcolms blood centre. Like others have said survival is often dependent on acute or chronic loss, age of patient, fitness of patient etc. In my case acute loss but patient was young. Steve :)

That is an example of inconsistency of the inspection process. At a meeting of the South Thames Technical Advisory Group in Blood Transfusion Science in January this year, electronic issue was a hot topic on the agenda. There were hospitals that require two samples to be tested with a minimum of 30 minutes between collection of the samples and those who test the same sample twice. Both these groups of hospitals were accredited. One of the arguments that developed was that the focus should be on robust phlebotomy procedures that ensure that the correct sample is taken the first time, and personally that is my view, after all it is possible that two samples can be taken at the same time and labelled with different times. Or even worse two samples could be collected from different patients and labelled as the same, which is the correct one? Robust phlebotomy is the key, not how many samples we test. Steve :)

Microbiology, they are the experts Steve

Thats fine Malcolm, I have to say I was somewhat confused when I read your response and very grateful to Liz and her response pointing out the contradiction. I was still trying to work out what was wrong - my brain cells being much slower!!! Steve