Colin Barber

Sorry as Malcolm Needs is often pointing out although we think we have a common language there are differences between US and UK english. FBC is full blood count, I think you may call it a CBC. We could not use our Haematology samples in transfusion as they almost all have printed labels on them from ward or GP ordering systems.

Do you have the same sample labelling requirements for your FBC samples as your Blood Transfusion samples.

What is the time delay you insist on between samples and how do you deal with Trauma or major haemorrhage in a new admitted 1st time patient.

Mabel, Thanks - sorry I did not acknowledge your response earlier. BTW We call TLA's - MLA's (Medical Laboratory Assistant). Colin

Mabel, You are not being dense, TLA's are the bain of our lives - BTW that is 3 letter acronyms. I will translate: V numbers were the hospital numbers in the disaster plan pre-prepared case notes, these had been introduced following a serious train crash in the 1970's - and were never updated, they sat in the cupboard waiting to be used. As they were created before we had computerised hospital information systems we found in the middle of the mayhem everyone's IT systems and the centralised hospital system could not recognise these numbers. For pathology and radiography it meant results were not "on-line" and they had to be hand delivered on paper. PAS = Patient administration system, the hospitals computerised patient's records - often called HIS hospital information systems or EPR electronic patient records. HCT = Hospital Control Team (sometimes called Gold Control in incident plans) HIC = Hospital Information Centre Tabards = a type of apron which labels who each member of the trauma team is - often these are also lead lined as a protection from the mobile x-ray units used in the trauma room PALS = patient advisory and liason service MIP = Major incident plan Bleep system = pagers LAS = London Ambulance Service Hope this helps ans sorry I should really of added a glossary. Colin

The half life of IgG is 23 days, so every 23 days the titre of the passively derived maternal will half. So how long the maternal IgG is detectable will really depend on the titre of the maternal IgG antibodies. I agree with all the posts about re-checking the history. Colin

Thanks to all who posted positive responses to my Powerpoint presentation. Colin

I have a slightly off the wall thought - ? was the patient on antibiotics. I remember spending a lot of time investigative a supposed delayed haemolytic transfusion reaction in one of our sickle cell patients and it turned out to be a drug induced haemolytic episode, but because it followed a transfusion we naturally initially assumed it was the transfusion that caused the haemolysis.

This my presentation from 2006 on our experiences of the London Bombings. Much of this I think is still relevant. Lessons learnt from 07-07-05.ppt

This was the reply from my friend, and its a personal view of his not an official NSHBT view: "Colin The statement is true that there potentially may be some 'misses' but hopefully these will be minimal. This is due to low bacterial numbers at the time of sampling. I agree, a good test at the point of transfusion would be the most appropriate, but as yet there is no such test. This is my personal view not NHSBT's." I have also posted 2 articles from the BBTS on BC of platelets. Colin

Dear All who are following this Thread, Here are 2 articles from the BBTS Journal Transfusion Medicine. BC letter to BBTS Journal.pdf Screening of plts for BC.pdf

rravkin@aol.com, Sorry I am not a Microbiologist, I am a blood group serologist working in a large London Teaching Hospital, so I am not really qualified to explain the reasoning behind the bacteriological testing policy of our NHS Blood and Transplant's new protocol for Platelets. My understanding is that they acknowledge its very difficult to be 100% certain that platelets do not represent a risk of bacterial contamination. However by discarding the 1st 30mls of a donation you reduce the risk of skin contaminents and that the blood cultures incubated for 36 hours before relaese give an extra degree of safety and the continued monitoring of these cultures will alert to a potential danger post release. I will ask my friend who is a Transfusion Microbiologist with our Blood Service if he can answer your specific points. Colin

Liz, NSHBT in the UK have just relaesed this information on Bacterial testing of Platelets. Regards, Colin Information to hospital transfusion teams about bacterial testing of platelets17111.pdf

The validation performed by our colleagues in the Immunophenotyping Lab were: 1) To make a series of dilutions of cord cells in group compatible adult blood, to represent FHM of know volume. 2) To run any of our positive Kelihauers in parallel with the RCI Lab in our National Blood Service - this is where we would send samples normally for confirmation of FMH. 3) To test the NEQAS samples sent to us for FMH. I have also attached a method supplied by our NEQAS lab for making positive samples. Colin preparing FMH samples.doc

Shily, I am sure Malcolm will also post a reply as I know he has investigated cases of Hyperhaemolysis. I my area of London we have a number of Sickle Cell patients who are treated in our hospital. Within that population of Sickle Cell patients we have at least 4 that I know of who are not able to be transfused. The reason for this is whenever they have been transfused once they have become sensitised they have a haemolytic transfusion reaction in which they seem to destroy not only the the transfused cells but also some of there own cells as well. It's very frightening when it happens because as Malcolm says it's potentially fatal. As far as I know there are lots of theories but no one knows the actual mechanism involved in the haemolytic episode, it appears to be an acute onset aggressive haemolytic process triggered by transfusion. Most of the patients have complex serology usually with multiple allo antibodies, the haemolytic reaction occur when phenotyped and crossmatch compatible units are given and post transfusion reaction investigations still show that the units were apparently compatible. I think there is a PhD for who ever works out exactly what is going on in these patients. Colin

Happy new year - well it is for already for my friends and family in Australia - another 9 hours for us in the UK.

Not sure if this will help - this is the SOP for FMH by flow cytometry done for us by our Immunophenotyping lab. We do the traditional Kleihauer in Blood Transfusion and any positives over 2ml of FMH we get confirmed by our colleagues in the flow lab. Colin Investigation of FMH by Flow Cytometry.doc

Liz yes:redface:

BankerGirl, Thanks for the useful post about Mercury in Immunoglobulins - so as you say there was a grain of truth in story. Now we just need Dr Pepper to find some volunters for the colonic irragation, diet changes and herbal tea therapy to see if we can magic up the RhD polypeptide on RhD negative red cells. I would volunteer but I am already RhD positive, but as others have stated the the low sugar diet and colonics would probably do me some good following the usual Christmas over eating. Colin

QCdan, I am not so sure I would dismiss hyperhaemolysis so readily - in your original post describe an agressive haemolytic process which from your description sounds like it was intravascular - back pain, Hb in the the urine, evidence of haemolysis in the post transfusion sample. You also said the second haemolytic reaction was the next day. There may well be an antibody to a low frequency antigen which could explain the incompatiblity found to the unit in the first transfusion reaction you describe, but as other have said this does not explain this patients continued post transfusion haemolytic episodes. In the Sickle patients I have seen with Hyperhaemolysis they usually have allo antibodies and often an auto as well, so red cell antibodies may well be present in your patient. The Haemophilia patient who I think had hyperhaemolysis did have strong multiple HLA antibodies - which does tie in with what Malcolm was saying about Hyperhaemolysis. Your patient is obviously going to need continued transfusion support, so lets hope you do get a definitive answer. Colin

Dr Pepper I await the publication of your proposed research with interest

Here is a recent reference to the problem: http://www.theirishworld.com/article.asp?SubSection_Id=2&Article_Id=15308

Malcolm, yes what started out as what I thought was a bit fun about colonic irrigation, diet and herbs changing Rh status had a serious point and could not agree more about what is great about BBT.

As I remember it, Malcolm will no doubt put me right if I have got this wrong, it was a batch of higher dose I.V. anti-D that was contminated with Hepatitis from an infected donor used to make the batch.