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Auntie-D

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Posts posted by Auntie-D

    DIC and death!

    in General Information

    Posted

    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

    DIC and death!

    in General Information

    Posted · Edited by donellda
    per poster request

    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?

    Does anyone else get their red cell reagents from Blood Centres rather than commercial suppliers?

    in Equipment

    Posted

    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...

    Whole blood in pediatric cardiovascular surgery

    in Transfusion Services

    Posted

    I worked in a pediatric hospital where we provided whole blood for cardiovascular surgery. I seem to remember that my boss would express the plasma of whole blood units that were not used and make them packed cells. I am currently working in a larger pediatric hospital with a very active cardiovascular surgery program but whole blood units are not used.

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

    Pipette Verification

    in Equipment

    Posted

    True, but how often do you calibrate your balance?????????!!!!!!!!!!!!!!!!!!!!!!!!!

    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...

    issuing RhIg to be injected off site

    in Transfusion Services

    Posted

    We have a midwife who practices in our area. For her Rh negative patients, she would like to bring samples from baby and mom for post part workup. She would then like to take the RhoGAM to the patient's home for injection. We currently give RhIg to outpatients if they come in with a doctor's order. The RhIg injection seems to be covered under the midwife's license.

    Is there any reason we can't do this?

    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...

    Pipette Verification

    in Equipment

    Posted

    Thanks for your replies. I guess we will stick to quarterly like it has in the Technical manual but I do think it's a bit much. That's just my opinion.:o

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

    Transfusion Reaction Cultures

    in Transfusion Services

    Posted

    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

    Not the same 5 day thaw plasma discussion

    in Transfusion Services

    Posted

    what??!!! NOO!! show him/her an article with comparative studies. Send it by email and copy the Blood Bank director.

    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...

    Mode-to-mode QC practice

    in General Information

    Posted

    We get around this by alternating which analyser we use as the one for 'urgents' and only QC the open side for each analyser every other day. We have a magnetic 'urgent' tag that gets swapped over as soon as the new day's controls are validated. It's just making sure people only use the analyser marked URGENT for urgents. We do the same with retics too - only one analyser runs retics each day.

    Gel vs. Solid phase

    in Transfusion Services

    Posted

    Is it still true that with solid phase you have no way of identifying mixed field populations. I've not used it since I was in training but it wasn't well thought of at the time as mixed fields didn't show up. There's a SHOT report where an ONeg patient was given APos in error and transferred to another hospital after having a massive transfusion reaction. The new blood bank typed him as APos and he was given further APos units and died.

    Or has technology progressed since then :)

    Positive DAT on neonatal sample.

    in Transfusion Services

    Posted

    Thanks Auntie and Malcolm

    Some times we do not have mother's sample so we just use neonate's sample. Units compatible-with baby sample by AHG. Yesterday I had a similar case, so posted it here.

    We would not crossmatch a baby without a maternal sample - it is deemed a minimum requirement to antibody screen the mother and crossmatch against the maternal plasma. This is the case for neonates until 4 months (though above about 8 weeks we crossmatch against both).

    As well as allowing a better idea of what antibodies the mother has, it also means that huge amounts of blood don't have to be drawn from a teeny baby - just a spit to do the group...

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