Auntie-D

Quite recently this has been introduced (previously you had to scan the barcodes on the bag for the donor number, product, group and expiry). It is known as EDN - electronic distribution note. The box containing the blood has a tag with a barcode - you click a cog on the computer desktop and all units allocated your hospital download to an 'invisible' file. You then going into the hospital LIMS and barcode the tag in. This then imports all the units in the system. Some LIMS have it set up just to set the group but others to include the full Rh phenotype (genotype?), K type, any other antibodies that the units are antigen negative for, whether the unit is irradiated, methylene blue treated, and also CMV status. It is a FAB system and virtually fool proof (I think) ETA - hopefully I won't have offended Malcolm with my terminology this time. I'm hungry so not thinking on complete form...

Again - please don't do this. Forward and reverse groups should be off two separate aliquots to reduce the risk of lab generated WBIT (if the wrong patient is accidentally selected there will be a descrepancy between the forward and reverse groups if there is an ABO incompatibility). There are two 'correct' approaches (IMO and also has been policy in all the labs I have worked) 1 - Do your forward group on whole blood with half the amount of dilutent (not ideal for patients with a low haematocrit but useful in emergency situations - though I have never seen a weak forward group due to prozone effect), then spin the sample and do the reverse group. 2 - spin the sample and set up your reverse group, then spin the sample again and set up your forward group. The 'waiting' time whilst the sample is respinning is a mini incubation period and will lessen the chance of you getting really weak back groups. The chances are you aren't going to kill a patient due to ABO incompatibility (assuming they have a historic group), but what you could do is delay the provision of blood by crossmatching the wrong group and having to start again. But then you can't guarantee an AGH crossmatch to pick up ABO incompatibility...

Malcolm - this is why I love this site! True sharing of knowledge

We just give A Pos HT neg platelets to everyone (unless specifically ordered) *shock horror*

We approach it a different way - the compatability sheets accompanying the units have, in big bold writing "These units have been issued uncrossmatched and the physician prescribing the blood takes all responsibility for any possible adverse reactions.". The forms have to be signed when the blood is transfused for traceability. We have considered extending the concessionary release form to cover the flying squad but in all honesty - who are we to delay the provision of blood in an emergency situation? That's a clinical decision... If the clinician deems that the patient is bleeding too much to wait for a full crossmatch (or EI) then my view is 'just give them the blood'. The physician is prescribing the units and taking responsibility. What we do however do is fully audit all Massive Haemorrhage initiations and use of flying squad - any that are deemed 'inappropriate' use result in a one to one training session on the implications. In the past two years we have only had one and that was in 'death week' and due to a panicking medic thinking better safe than sorry. ETA - this is in the UK

My mum recons she has been told she needs vein to vein transfusions - never did get to the bottom of that one... (She's just bog standard O Neg with no antibodies)

It has always baffled me as to why they don't...

Yep I sure am! OP - Anti-D can go away (rare but it happens). We have a patient who is male and has a recently developed anti-D that is no longer expressed. It is more likely that the scenarios to have happened that others have mentioned.

So if the baby was only 4 weeks gestation, then the foetal cells must have been maternal - has HPLC been done to see if she has HPFH?

Such an utter tragedy! But seeing the queues of people waiting to donate blood filled me with hope for humanity.

Just for future reference - it is considered good practice to do the forward and reverse groups off different 'spins'. We have an SOP that we use whole blood for the forward group (and half the diluent), then spin and use the spun plasma for the reverse group. If there was a discrepancy on the forward group then the sample is now spun and ready to go for a second check. I find, doing it this way also saves that crucial 5 minutes as you don't have to wait for the sample to spin to get a provisional group.

Turns out we don't have a subscription to that or any other journal - guess what I now have to do? Yep that will be to put a business case in...

Malcolm you are right - the same reason you are more likely to get a positive DCT on the analyser because it takes the cells from the bottom. All our analyser weak pos ones are repeated manually and are usually negative. Here's a zebra for you? Could the baby sample that was tested have been from the wrong baby, and the baby was in fact rh neg? The rh neg foetal cells would persist...

We panel monthly unless the patient has recently been transfused or is pregnant - then we repeat the panel.

With the national shortage (absence) of 250iu and 500iu units of anti-D, is anyone collecting data of the number of babies with iatrogenic HDN due to overdose of prophylaxis? Could this happen? Could for example, a 13 week old foetus be exanguinated by the mother being given Rhopylac? We have been giving Rhophylac 1500iu for all gestation and some women have multiple doses. I daren't ask in the lab in case someone laughs at me. I have been distinctly uneasy in issuing myultiple lots of Rhophylac for ladies under 20 weeks

I've worked in a lab where the porters were allowed to collect blood (lab's own porters) as long as they were fully competency assessed. In our current lab our Lab Assistants do some running.

Our protocol only states that platelets need a fresh line.

We have an excel programme developed by our blood bank manager. It caluclates the dosage based on INR and weight and gives the correct amount of PCC to give. You then print the sheet and attach it to the paperwork.

Malcolm - get off my case you know what I meant... Do you say 'arrrgh aitch' when you say it out loud?

Is this a new acronym?

It's the moving averages on the advia and does all basic parameters - usually it is set to compare the last 30 results. Any deviation from the mean is flagged - great fun when you put a rack of oncology samples on Ours is set for RBC MCV MCH MCHC WBC cor - the correction between the perox and baso cell counts Hb cor - the correction between the measured and the calculated Hb MHC cor - the correction between the MCH and CHCM The cut off is a values of below 0.95 or above 1.05 (5%) but people seem to accept anything between 0.8 and 1.2 *sighs* Not sure why there is no platelet moving average though... Neut x/y is the average point of your perox scatter plot - it gives you an idea of the shape of the scatter without having to look at the plot.

But it is either positive or negative reactivity-wise, it is only degree of reaction that cause an issue. If a patient is clearly Rh negative in gel then I can't see the need in the expenditure - a 2+ reaction, yes, but a clear-cut 0?

Scotland also guarantee their units - they also Kell-type, but don't give a full Rhesus phenotype, unlike the UK. I do LOVE that you get ABODK and Rh phenotypying now - it's the best thing since electronic issue!

*Sighs* yes I typo'd - smack my legs and send me to the corner with the naughty hat

I'd be less concerned about the numbers transfused - at the end of the day that is a clinical decision and who are we to disagree with their medical judgement. I am more concerned with the timings - routine topups ordered and transfused out of hours, 'urgent' crossmatches ordered out of hours but not used, routine topups ordered out of hours etc. We also operate the policy of 'don't give two without review' - we electronically issue so this isn't an issue for us timewise. Our hospital transfuses to clinical need - for example a patient today was transfused only one unit, enough to alleviate his symptoms, with a Hb of 43. Previously the hospital would have ordered (and transfused) at least 4 units - on appearance not numerically excessive as it would still only, in theory, have raised to Hb to 80, but in this case it it would have exceeded clinical need. I think the laboratory assessing need is wrong - we are not dealing with the patient at that moment in time. We can educate them as to what is appropriate use, but at the end of the day they are the ones responsible for the patient.