Auntie-D

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.

That's easily fixable with a diamond point and a cleverly placed line

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

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...

You will be doing an antibody screen on the mother's serum in a neonate and the DAT is testing for maternal activity against the baby's red cells - HDN or at least sensitisation. The DAT has less to do with transfusion and more the HDN status of the neonate.

Why is EVERYTHING so expensive. Elephant c*ndoms are £250 each!

Thatnks Donna - I did have a look in the library but didn't think to look under education. Off to have a look now. I have made a start on the SOP already and have decided not to make it fully comprehensive - all the unusual ones are to be referred to a senior member of staff and O Neg issued until it's resolved. Thanks again

I am currently writing a new SOP for the investigation of discrepant blood groups - the lab I have taken over doesn't have anything written down. I've noticed that there are many threads on here about discrepant blood groups and I'm wondering if anyone has an SOP for the investigation procedure that they would be happy to share?

In my last lab we had a Diamed Gelstation and it was able to complete everything in 40 minutes from receipt of the sample, allowing us to achieve TAT of 45 minutes which is comparable to a manual crossmatch. You can also pause the analyser mid-run to put an urgent crossmatch on ahead of the current batch. If the TAT is so poor could you not use manual methods in an emergency situation with two groups done on separate aliquots for reassurance? I'm surprised at a TAT of less than 60 minutes - everywhere I have worked has stated less than 45 for an emergency full xm and if analysers couldn't match this they weren't purchased.

All depends on if the patient has already been given products but assuming not: We would ask for a new sample and ABOD but no antibody screen (the screen according to UK regs is valid for 30 days in non-transfused patients). We would us a new wristband number as not doing so has caused havok here... But saying this I had a patient last week (RTA pushbike vs car) who required 31 units of blood, 16 FFP and 8 cryo and the sample we received was only 2ml. We didn't run out. I can't see how a sample would run out before all testing was done... This patient was grouped twice, had an antibody screen and a 10 unit xm and we still had plasma left. If a patient had antibodies I could undertand a samplke running out but it would be good practice to immdiately ask for a repeat anyway?

On whole blood Blood group - 7 days Antibody screen - 7 days DCT - 24 hours Sample are fridged at 2-8oC It used to be that if the patient is preop and has no transfusion before the op a group and screen is done and the plasma frozen at -30 for xm immediately pre or during surgery. The sample was valid for up to 30 days. I removed this as IMO it eliminates the second check that you get from an admission sample. We now get a sample at the preop clinic (up to 30 days before surgery) and immediately on admission. This allows for 2 separate groups with elective surgery reducing error. The 30 day 'rule' for antibody screens is still acceptable though in the UK according to the MHRA and BBT.

Involvement! Allow staff to feel that they are contributing to improving the service. Encourage them to report and do the root-cause between them. Luckily we have willing staff... Unwilling staff who are just coming into work to do their job and then go home tend not to participate If this is your situation you could in for an uphill struggle. A valued member of staff who shows pride in 'their' laboratory will want to report errors. A staff member who feels like a 'lab rat' will not. Reporting rates have more to do with management style than anything else. Edit - a short staffed lab is less likely to report errors due to time constraints. Time contraints precipitate errors, and also precipitate them not getting reported.

We have a form for the use of incompatible blood in an emergency situation (similar to those already given) but should another form be used for 'flying squad'? The whole point of it is that it is suitable to 'grab and go' in an emergency situation and adding another form to the mix is going to delay the blood getting to the patient. I understand when the patient is bleeding incontrollable, has a positive antibody screen and no compatible units are available we need to have release for 'least incompatible' blood. But if the patient is bleeding sufficiently to warrant the use of blood without an antibody screen then more paperwork is counterproductive? We use education rather than regulation with the flying squad. The wards know that all patients with an admission screen can have group specific blood within a similar timeframe to flying squad so our flying squad is used very, very rarely. Group specific requests can be taken over the telephone (provided there is already a sample in the lab) and the compatibility report issued with the blood contains an area that is marked 'uncrossmatched' with an area for the physician to sign to acknowledge this. Our request forms have a box 'Urgent <10 minutes - group specific' and the form is signed by the prescribing medic which reduces the need for an additional form. IMO in an emergency situation we need to make it as easy for them as possible. Introducing more forms can create more delays if they are filled in incorrectly. If the blood is O-K-C-D-E-, and CMV- it should be suitable for someone who is bleeding in a life threatening manner. Exanguination v/s delayed transfusion reaction...

If you have a Diamed card spinner you may be able to get the interchangeable head rather than getting a whole new centrifuge... I'm not sure what the model number is as the one I used was in my training days but one of the ones with the pull off card heads can be interchanged with a tube spinner.

We are a small hospital in a remote and rural area and we get around this problem by only holding AB FFP/cryo in stock (we hold 16 units in total FFP and 8 of cyro). If we run out of AB FFP we switch over to cryo but iif they are receiving enough FFP for us to run out they should be also having cryo anyway.

True, true

There is a regulation in the UK to QC screening cells daily and the MHRA extend this in their inspections to include the QC of all antibody screening reagents, whether 3 cell screen, rr 2 cell screen or panels. Even for countries where it isn't regulatory to QC reagents daily, it is good practice...

Never yet 'unacceptable' but it has allowed us to identify cells that are trending to weakness. All of our cells give a 3+ reactivity and if this falls and the reagents have more than 10 days expiry we replace them rather than waiting for the new batch. So the answer to you question is 'No' but without the action taken for trends the answer could have been different. In 2 and a half years as blood bank manager we have had to replace a batch early (and at no cost) twice, due to weakening of reactivity. The consequence of weak reaction are not something I want to take responsibility for.

IME 9/10 the reason is that the father is not the 'father'. This is why antenatal testing has not been dropped for transfusion or haemaglobinopathies.

We've never had any problems. Babies are classed as Rh neg for transfusion purposes and mums are given prophylaxis. All babies are types and their group amended on receipt of the results.

I'd go with the old blood side - the bili rise wasn't huge so could be due to lysed donor units. What was the patient's pre and post potassium? Another thing - was the patient given irradiated blood? There is an outside chance of GVHD...

We QC all of our reagents every day against a weak-D and Kell control. I would not be happy if any of my staff were using reagents without checking their viability first...