Auntie-D

We're tied to Fischer

We do one on admission as the final part of the antenatal screening. If the patient is Rh D Neg then we hold back on it until the patient has delevered(or the maternity team start to flap) and just process a post-natal sample ready for prophylaxis +/-Kleihauer. It's surprising the number of antibody screens that are negative at 28 weeks but positive at delivery... Nice to be prepared for the next pregnancy, or emergency admission

What's an OB?

Have asked the mods to anonymise further - can't edit my own thread...

Pre-calibrated digital thermometers is what we use. And I have found it's cheaper to replace them than to send them off for calibration when it is due...

Thanks Malcolm. I'm just stunned that they are pulling the 'We didn't ask for the test and the results so the results were misinterpreted'. Never mind the fact that the patient was in severe sepsis so they should have asked for the test themselves anyway...But after discussion about DIC for them to interpret the results as PE just astound me. When is a PE D-dimer result ever as high as 28k? ** hum... Even without them thrombolysing him, I don't think he'd have made it - he was a very poorly chap Edit - I wasn't swearing... darned American sites

Firstly, hello!! I'm new here and normally lurk around the Transfusion Forum but I have a multidisciplinary question... Scenario... 62 YO male, clinical data - sepsis, 4 day H/O SOB. Tests requested @ 22:30 - U&E, LFT, FBC, Troponin I, Glucose. Results - Glucose 1.2, U&Es pretty much shot, Trop I 0.14, FBC Slightly raised neutrophils, normal platelets. The patient has arrested twice at this point but seems to have stabilised. Tests requested @ 01:30 - U&Es LFT, Amylase, FBC, glucose, Coag Screen. Results - Clucose 8.8, U&Es still shot, amylase borderline raised, FBC shows platelets of 89 fallen from 452 (sample not clotted), PT 17 seconds, APTT 45 seconds and fibrinogen was at the very low end of normal. My first thought was DIC and did a D-dimer immediately which came out at 28,000. I took the printed reports to A&E and discussed with the available medic the possibility of DIC and possible requirements for blood products. I hung around the laboratory for half an hour until I received a call telling me it was OK to go home (non-residential on-call). I questioned the lack of a request for products and they just said 'it's not needed'. Upon coming into work this morning I discovered that the patient had died and to to it off they had thrombolysed him! There is now some debate as to whether it is going to be a simple post mortem or whether there will be further inquiry. The medic is claiming that the interpretation of the D-dimer result was that the patient was having a massive PE, despite me discussing with them DIC. The consultant is claiming that the D-dimer result was not requested and confused medical staff and confounded the error. I know with the presentation the patient had little chance of survival and that I acted in good faith, I'm just a little concerned of legal action. What do you think?

And there was me thinking Liverpool were special!

Do you sell outside of your trust? I should imagine it's a nice little money spinner...

Question in the title... Does anyone else get their red cells from a supplier that is non-commercial? A couple of years ago I priced the cost of reagents and made savings in the region of thousands by switching from our commercial supplier (Diamed) to a Blood Centre that produced their own cells. We now get screening cells, panel cells, reverse grouping cells, controls and QA material from an NHS Blood Centre in England. I feel this works doubley well (is that even a word?) as it reduced our cost dramatically but is also an income for the cash-strapped NHS...

In the UK this would not be allowed. It would take away our unique traceability and also indrodces the risk of bacterial contamination.

I think Rh-Fan meant that an auto at 4oC isn't likely to be significant but one at 15-16oC could be. If we got an auto and it disappeared at 16oC then we wouldn't recommend a blood warmer, if it stayed we would.

Malcom - I'm the money saving queen!

Sounds like she isn't up to date in her CPD - found a lot with 'lifers' who are now in charge. IME all will come out in the wash as soon as the lab undergoes and inpection...

According to the manufacturer's instructions - twice per year. Cheaper to get one balance done twice a year than all the pipettes 4 times a year...

Welcome! I am new to this forum too.

We also transfuse the minimum number of units possible with the largest volume units to minimise donor exposure.

This is what we do for patients who have opted to go home very soon after the birth. The midwife visits anyway so her giving the RhIg in the comfort of the patient's home doesn't seem to incovenience them. It is always issued on a named patient basis with the same patient ID checks as when giving blood. Fully competency for the midwives should be assessed - I've heard of one 'old school' midwife who gave the anti-D to the dad!! Fortunately during her long career (which was ended by this incident) no births resulted in future HNFN - she insisted it was the only time she had given it to the dad but she also didn't know why she shouldn't be giving it to the dad. So who knows...

If you can verify the volumes with a balance there is no need to calibrate quarterly

We've never had a problem here with insufficient volume. Usually between the tag lines and what is left in the giving set there is enough. But where I worked previously they didn't insist on either the giving set or any fluids that had been injected during the transfusion and that did cause problems. I have seen people doing the 'one arm centrifuge' though and shaking all the blood to the end of the bag by swinging it about lol

We check dispensing volumes with a weigh balance weekly and calibrate whether it needs it or not every 6 months.

It's not as bad as it sounds - we're a remote and rural lab and probably only thaw 2 units a month, if that. Our stock tends to go out of date rather than getting wasted through non-use post thaw. Saying that though we did use 16 units of FFP and 8 units of Cryo the other day in a RTI - cyclist v/s car Cyclist survived - 31 units of blood used also! Thank god he was group A and antibody free...

Just bought more shares in coffee My only shares are in coffee and cocoa Never seem to go down in price

Tagging along with this one as our dinosaur consultant haematologist is still having us working with 4 hour expiry!!!!

You've lost me there... Never heard that one before. Off to consult Professor Google and Dr Wiki.