Jump to content
May 2024 Challenge

Colin Barber

Members - Bounced Email
 View Profile  See their activity

  • Posts

    66

  • Joined

  • Last visited

  • Days Won

    2

  • Country

    United Kingdom

 Content Type 

Posts posted by Colin Barber

    Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?

    in Transfusion Services

    Posted

    I'm sorry, but what is an "FBC sample"?

    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 require a second specimen from a different draw when you have no history for a pre-transfusion candidate?

    in Transfusion Services

    Posted

    We do require a second specimen from a different draw to perform a second ABO/Rh when no type is on record. We will first try to use a specimen from Hematology, if available, to do the retype testing instead of having the patient drawn again. Facility is Missouri Baptist Medical Center.

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

    Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?

    in Transfusion Services

    Posted

    Mabel-

    We require this extra draw to confirm ABO (and by extrapolation, patient identity) only once on their first ever visit with us - people who have no history on file. Any time in the future we deal with them again, either current stay or future admits, we dont require any additional tubes be drawn (besides whatever T&S is required due to specimen outdating I mean). So I think you can argue its a self-limiting blood loss and the return in patient safety far outweighs the cost. We perform the front and back type in tube. Since nearly all of our initial T&S samples are run in gel its also a crosscheck for type discrepancies due to quirks of methodology.

    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.

    Disaster experiences shared?

    in Transfusion Services

    Posted

    Thanks so much. I wanted to share this with our disaster manager but wanted to understand it myself first. I am sure the ppt was created for more local use where everyone would have understood the acronyms. (PS In our hospital a TLA is a Technical Lab Assisstant so we have no shortage of "inside" abbreviations ourselves.)

    Mabel,

    Thanks - sorry I did not acknowledge your response earlier.

    BTW We call TLA's - MLA's (Medical Laboratory Assistant).

    Colin

    Disaster experiences shared?

    in Transfusion Services

    Posted

    Thanks Colin, but I wonder if someone could translate it into American English. :) I don't follow all of the acronyms in the slides. I get the hospital acronyms and can assume the ITU = our ICU but you lost me on the V numbers and the PAS. Likewise HCT, Tabards & PALS. HIC is incident command? What is MIP --major incident protocol?? Bleep system? LAS? Thanks for any help. Sorry if I am being dense.

    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

    Baby with antibodies

    in Case Studies

    Posted

    I have a question: how long of the IgG's lifespan which the infant received from the mother when she/he is in the uterus?

    And the baby can develop his/her own IgG antibodies when it is 3 month old, so I think this antibodies is passive received after birth or the baby's own developed.

    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

    Hemolysis mystery

    in Case Studies

    Posted

    ...well the good news is that our patient was transfused with two units of phenotypically similar blood and had a Hgb increase from 6.8 to 8.8 g/dl without a transfusion reaction:D. The bad news is that we still do not know what exactly caused the hemolysis in the first place. This patient is also receiving HLA matched platelet pheresis transfusions without complications. If we find anything else on this patient I will be sure to update this discussion thread. Thank you very much for all the input and suggestions on this subject. It is a very interesting case and we will be following this one for a while here at the hospital.

    Now lets keep on shaking tubes:).

    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.

    Shelf life of platelets

    in Transfusion Services

    Posted

    Colin,

    Thank you for this reply. I look forward to your next post.:):)

    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

    Shelf life of platelets

    in Transfusion Services

    Posted

    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

    Fetal Bleed Confirmatory Testing by Flow Cytometry

    in Transfusion Services

    Posted

    Thanks Colin -

    This is some good information. Can you provide any clarification as to what you did to initially verify the assay in your lab?

    Thanks and Happy New Year!

    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

    Hemolysis mystery

    in Case Studies

    Posted

    What is hyperhemolysis?

    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

    Change your Rh D status from neg to pos

    in Transfusion Services

    Posted

    I agree 100% with the need for Rh Negative women to be vaccinated with RhIG, but a few years ago some brands of RhIG DID contain mercury in a preservative. The pesky culprit was called Thimerisol, and most health care proffessionals have never heard of it. I have a sensitivity to this mercury compound and was unable to receive tetanus and hepatitis B vaccine until they came out with mercury-free formulations. (Thankfully, I am not Rh negative, so that was not a concern when I was having children.) It may be helpful if you acknowledge this fact and inform the husband that the mercury was removed from RhIG several years ago. The package inserts in both Rhophylac and RhoGam both clearly state that they are preservative free formulations. This way you are not telling him that he is wrong, just that he has read old facts that are no longer valid.

    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

    Hemolysis mystery

    in Case Studies

    Posted · Edited by Colin Barber

    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

    Change your Rh D status from neg to pos

    in Transfusion Services

    Posted · Edited by Colin Barber

    My goodness Colin, when you started this thread, I bet you didn't think that it would develop the way it has.

    This is but one example of what is so great about this site.

    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.

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.