Auntie-D

My two pennies worth... I did measurement of uncertainty on KB - 47%. Shocking sensitivity... We changed our policy that any foetal cells required follow up by flowm while we were addressing the issue.
We solved it by requiring all staff to take part in each EQA session and following up any discrepancy of >10%. We also introduced scoring for our controls and required all staff to do a count before moving onto the patient ones. Any discrepancies in the control scoring or EQA resulted in retraining.
What actually happened was that because staff were required to do an actual count, rather than an eyeball, for every kleihauer, they organically became more proficient. We also were able to identify the staff member who was counting lymphocytes as foetal cells...
For anyone who is interested - there is a modified KB that I have developed (sadly I never published before leaving the labs) that has a counter stain for the white cells - makes the foetal cells ping

Not for anyone Rh neg - the instance is only 1% of the population. My uncle isn't allowed to work in China as he has a high-risk job and is O-Neg
 
Edit - The ranking of ABO blood groups phenotypic distribution in China is O > A > B > AB. The proportions of A, B, O and AB type in China population are 28.72%, 28.17%, 34.20%, and 8.91%, respectively.

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

Hey - not all of us are like that. I operate a 'good enough' system, but one which means people aren't guessing and messing

Hey - not all of us are like that. I operate a 'good enough' system, but one which means people aren't guessing and messing

It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT).

Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct.  In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups.  They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.

I'm back but I am no longer in the lab. I'm a quality manager now full time. I've just moved to occupational health but have done a stint working with stem cells and ATMPs which was fun (JAICE is on another level). Current employer is thinking of starting up a lab and offering POCT/phlebotomy in mobile units - guess who's going to be project managing the whole lab startup? I took the job to get away from the lab lol

Quality knobhead here - details are required on reports, not SOPs. ISO 15189 states that docuements need to have:
a)        All documents are identified to include:
—     a title;
—     a unique identifier on each page;
—     the date of the current edition and/or edition number;
—     page number to total number of pages (e.g. "Page 1 of 5," "Page 2 of 5,");
—     authority for issue.
Information for users (ie lab handbook)
The laboratory shall have information available for patients and users of the laboratory services. The information shall include as appropriate:
                  a)    the location of the laboratory;
b)        types of clinical services offered by the laboratory including examinations referred to other laboratories;
c)         opening hours of the laboratory;
d)        the examinations offered by the laboratory including, as appropriate, information concerning samples required, primary sample volumes, special precautions, turnaround time, (which may also be provided in general categories or for groups of examinations), biological reference intervals, and clinical decision values;
e)        instructions for completion of the request form;
f)          instruction for preparation of the patient;
g)        instructions for patient-collected samples;
h)        instructions for transportation of samples, including any special handling needs;
i)          any requirements for patient consent (e.g. consent to disclose clinical information and family history to relevant healthcare professionals, where referral is needed);
j)     the laboratory’s criteria for accepting and rejecting samples;
k)  a list of factors known to significantly affect the performance of the examination or the interpretation   of the results;
I)     availability of clinical advice on ordering of examinations and on interpretation of examination results;
m)      the laboratory’s policy on protection of personal information;
n)        the laboratory’s complaint procedure.
o) The laboratory shall have information available for patients and users that includes an explanation of the clinical procedure to be performed to enable informed consent. Importance of provision of patient and family information, where relevant (e.g. for interpreting genetic examination results), shall be explained to the patient and user.
Reports however need to include:
a)         a clear, unambiguous identification of the examination including, where appropriate, the examination procedure;
b)        the identification of the laboratory that issued the report;
c)         identification of all examinations that have been performed by a referral laboratory;
d)        patient identification and patient location on each page;
e)        name or other unique identifier of the requester and the requester’s contact details;
f)          date of primary sample collection (and time, when available and relevant to patient care);
g)        type of primary sample;
h)        measurement procedure, where appropriate;
i)          examination results reported in SI units, units traceable to SI units, or other applicable units;
j)           biological reference intervals, clinical decision values, or diagrams/nomograms supporting clinical decision values, where applicable;
k)         interpretation of results, where appropriate;
l)           other comments such as cautionary or explanatory notes (e.g. quality or  adequacy  of  the  primary sample which may have compromised the result, results/interpretations from referral laboratories, use of developmental procedure);
m)      identification of examinations undertaken as part of a research or development programme and for which no specific claims on measurement performance are available;
n)        identification of the person(s) reviewing the results and authorizing the release of the report (if not contained in the report, readily available when needed);
o)         date of the report, and time of release (if not contained in the report, readily available when needed);
p)        page number to total number of pages (e.g. “Page 1 of 5", "Page 2 of 5”, etc.).
These are the basic ISO requirements - Other standards may require further info ie JACIE/CLIA

Less is more - don't overcomplicate things

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...

I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

Less is more - don't overcomplicate things

I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I think they're probably thinking down the TACO route - which is highly unlikely in an MHP situation. If TACO happens when the MHP is triggered, then it likely wasn't an MHP...

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

There was a study done here by ORBCoN in Ontario, Canada.  It showed that most (I think it was 99%) babies were delivered from people under the age of 46.  So yes, not all.  But most.
Best of luck on your journey to conceive.  I had mine at 40.  So I'm always tired, but love her to bits.

LIMS validation checklist -
- that it won't let you issue ABO incompatible units
- that it alerts you if you are issuing ABOD discrepant units
- your antibody flags alterts
- that it won't let you electronic issue if the patient has antibodies (it would issue as uncrossmatched not EI)
- that it won't let you issue expired units
- that it wont let you issue on one sample
-  that it wont let you issue on an expired sample
Much of this may already be in place but will need revalidating specifically to the electronic issue process. If any of these fail, or are not possible on your system them you shouldn't electronically issue.