Colin Barber

Deny, keep up the good work, if he is genuinely an intelligent man I am sure you can find him some well founded, peer reviewed, scientific literature to counter the internet quackery he has been reading. The thing with the success of anti-D prophylaxis is there are, thank goodness, not the damaged babies or women unable to have live children to readily inform the lay public of the benefits. By almost eradicating HDN/HDF due to allo anti-D, we have taken it off the radar so there just aren't the friends and relatives around anymore to drive home how serious this can be. Anyway as I said good luck and I do hope they see sense. Colin

In the UK the British Committee for Standards in Haematology (BCSH) offer the guidance on the attached Choice of groups for children.doc

I started this thread as a seasonal piece of whimsy, but as Liz pointed out, there is a very serious side to this if patients are now refusing anti-D on the basis of this miss-informed nonsense. No doubt the husband is as we speak : 1. Changing their diet and eliminating all sugar, white flour, caffeine, sodas, processed foods, and alcohol. 2. Using a lower bowel tonic and occasional colonics to keep the bowel clear. 3. Use of herbs to cleanse the blood such as: A. Periwinkle B. Red Raspberry Leaf Tea C. A tea made from red clover blossoms, chaparral, licorice root,poke root, peach bark, Oregon grape root, stillingia, cascara sagrada,sarsparilla, prickly ash bark, burdock root, and buckthorn bark. D. A few capsules of: goldenseal root, blessed thistle, cayenne, cramp bark, false unicorn root, ginger, red raspberry leaves, squaw vine and uva ursi. And a few capsules of: black cohosh, sarsparilla, ginseng, licorice, false unicorn, holy thistle and squaw vine. 4. Also, included in the diet blood builders, such as grape juice, molasses, beets, and others Anti-D, apart from very rare anaphylactic reactions and a problem with the Irish anti-D about 15 years ago, has one the safest product histories. The benefits of anti-D prophylaxis are huge, how many cases of HDN/HDF do we see these days compared to the days before its introduction. Deny I hope you can make this couple see reason.

No fear not your words did not hurt at all, I was just worried that you may have thought my post was a serious post. It was mean't to be light hearted. But as Liz pointed out there is a serious concern that pregnant women could read this web site and take it all as scientific fact.

Dear QCDan, I have a few questions and a suggestion for another line of thought: 1) Is the ARC part of your Transfusion service ? were their findings like yours no aparent red cell antibodies in the pre & post transfusion samples. 2) If the ARC is part of your donor blood collection service ? do they have any cells from donor testing with which they can reapeat the crossmatch on any units given and perhaps to a DAT on the unit that was incompatible (was that with pre & post transfusion plasma). 3) Did the post transfusion Hb level fall below the pre transfusion level. Point 3 leads to my alternative line of thought - If the post transfusion Hb fell below the pre transfusion Hb then is this a case of transfusion induced hyperhaemolysis. Whilst this is normally seen in Sickle Cell or Thalassaemic patients it has been described in non-haemoglobinopathy patients as well. I have seen several cases of transfusion induced hyperhaemolysis in our sickle patients, but I did have a haemophilia patient who I am convinced also had transfusion induced hyperhaemolysis - his serology was negative and his Hb crashed following transfusions with all other symptons of an acute haemolytic episode. He has not required any red cell transfusion recently so I have not had a chance to explore this theory with him further. Good luck with your MDS patient. Colin P.S. I should have read all the posts on this before I posted my thoughts - I see Malcolm has also mentioned Hyperhaemolysis as well.

Liz on a more serious note there in lays the danger of the world wide web.

Don't worry I don't as Malcolm spotted it was a festive season jape.

Well of course it's tongue in cheek - just thought we could all enjoy some of the fringe ideas knocking round the interweb. I don't think the NHSBT are going to ask us to change our patient's diets next time the O Neg goes below 3 days stock. Well I hope not anyway !!!!

http://www.vaccinetruth.org/rhogam.htm According to this web site you can change your RhD status from Negative to Positive by changing your diet. Clearly as transfusionists we having being worrying about how to meet the demand for O RhD Negative blood and here is the answer??????.

@Malcolm, how many of your staff have worked out with the Royal Wedding Bank Holiday, for 3 days A/L they are off from 22/04/2011 (22 April) until 03/05/2011 (3 May). Sadly I was not as quick on up take on this as some of our more switched on staff and only realised when it was too late as we had reached limit on staff leave for the magic 3 days.

Malcolm, You have been a busy bee I have just been looking at the library and there is lots of very useful and helpful suff here - well done and thanks. Colin

Malcolm, Thanks, I will look at it and as ever you are mine of useful facts and info. My questions were aimed at providing insight for Fluffy Agglutinates into what people in hospitals might hope to learn from the proposed course. Best and Seansonal wishes, Colin

Dear Fluffy agglutinates I am sure Malcolm's message will contain undoubted pearls of wisdom, however from a hospital TL point of view the things I would expect staff to understand from a course on autoantibodies are, off the top of my head and no particular order: 1) How do you in RCI determine what's there when the antibody/antobodies appear to be pan reacting. 2) Do the autoantibodies shorten the survial of the transfused cells 3) How do you ensure the red cells issued are ok to issue. 4) How do you phenotype the patient when the DAT is positive 5) How often do you need repeat samples 6) Whats the turn round time for getting units - this is what the Dr's will be constantly asking the lab 7) What do you do if the patient is bleeding and blood is required urgently 8) Can the autoantibodies be surpressed 9) What causes auto antibodies to be produced 10) Are they significant in a pregnant patient ? will they affect the baby 11) How do manage a patient who needs weekly transfusions Hope my random thoughts help, and good luck with the course. Colin

Yes the Mac does require " a little getting use to" as you put it, but as you have clearly found out it's worth it. I have never regretted get my Mac and yes it is more user friendly.

You can configure a right click on the touchpad, which I have done on my MacBook Pro. As I said in my last post it's really worth checking the Apple web site it does have a lot of useful stuff on changing from PC to Mac.

Glad to help.

[ATTACH]442[/ATTACH]Until Malcolm is back from leave here is ours. Manual grouping and antibody screening by Diamed New.zip

Malcolm this site would be poorer without your posts and one thing about blood bankers is we all seem to have quite strong views and I am sure we can all verge on the self-opinionated at times, but good thing about a reasoned debate is we can also all still learn something and at times have our views changed by a well formed line of thought. Anyway please keep posting.

Sorry I don't want to sound like I am on Steve Job's payroll or have anything persay against Microsoft, but I feel I must stand up for the Mac corner. I am 53 and if I can change from using PC's (which I still do at work) to a Mac after 25 years of using a PC anyone can. They are not complicated, just different from Windows and I would ALWAYS choose a Mac over a PC. If you go to the Apple web site there are help tutorials for PC users converting to Mac. In the 12 months I have had the MacBook Pro, it has never frozen, failed, required a re-boot and it starts up and shuts down almost instantly. I have a virus checker but it has never pick up a virus, malware or spyware - you try and connect a PC to the net without any sort of protection and its seconds before its infected.

I only discussed this wonderful community for Transfusionists in June of this year and always find something that catches my attention and yes its also very easy to get hooked. But one thing is for sure I will never ever catch up with Malcolm's number of posts.

Liz, Bacterial contaimination of platelets is always a potential problem as they are stored at a controlled 22oC and I do remember a very sad case when I work for the National Blood Service in the UK which resulted in a patient death - this was using standard 5 day expiry pooled platelets. I have to say it's sad if we can't move on though, surely we can learn and adapt our procedures to reduce risk - with transfusion of blood and components from one human to another there is never zero risk. In medicine if we allow historical poor outcomes stop development and inhibit change we will ultimately not benefit our patient's. No one wants to have unsafe or dangerous procedures, products or medicines but I think sometimes the regulatory authorities concentrate on the wrong area's of risk. I so often feel we are put under intense survalence to justify, check, train, record keep in the Lab and then our products go out into the clinical area's and anything can happen and often does which puts patients at more danger. I have contacted colleagues in our National Blood Service to try and get more details of the methods they use for bacterial screening and will share their reply, which sadly does sound like it will help you. Best Wishes, Colin

Yes you can dual boot with Mac's that have intel processors, but you can use Microsoft Office applications in the Mac OS with Microsoft Office for Mac suite.

Liz glad to have been able to help.

Rravkin@aol.com, I am sorry I don't the exact methodology our colleagues in the Blood Service use to test for the presence of bacteria in the packs. They have recently announced that from next year they will roll out bacterial testing of all platelets they issue. If any of the UK NHSBT staff who subscribe to Blood bank talk pick up on this thread they will I am sure be able to answer. The link to changes to platelets is:http://hospital.blood.co.uk/library/pdf/The_Update_Nov_2010.pdf

Liz in the UK NHSBT have a product called extended life platelets which have a 7 day shelf life, these products are usually produced during long bank holidays or when there are acute shortages. They are are screened for bacteria prior to issue. The NHSBT product portfolio is at: http://hospital.blood.co.uk/library/pdf/components/SPN223_version3.pdf