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gagpinks

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  1. Like
    gagpinks got a reaction from Cliff in New, but not new   
    Yes I agree!! This is how I found about this website and I just loved it
  2. Like
    gagpinks got a reaction from Malcolm Needs in Guidelines for HEV neg blood   
    Thanks Malcolm 
    Enjoy your holiday! !! 
  3. Like
    gagpinks reacted to tbostock in On call phone calls   
    I'm on call 24/7.  I tell them to consult the policy first.  If you try and can't find it anywhere in a policy, ask your coworkers to show you where to find the answer.  If nobody else on your shift can point you to it, THEN you call me.  Do not guess!
    I get a lot more text messages than I do phone calls.  Usually they already know the answer, they are just wanting me to confirm their answer.  We have quite a few generalists on my eve and night shifts that are not very experienced with difficult BB issues, so I have no problem with them calling me.  I would much rather that than a patient gets hurt.  I feel like it's part of my job as BB Manager to support them and have them feel confident in asking for help when they need it.
    I think the key to "weaning" them from calling too much is giving them really great policies (written very simply so anyone can follow them, even if they have not done the test for a while) and some good flowsheets (which I am still working on) for antibody workups, RhIg workups, etc.
  4. Like
    gagpinks reacted to Malcolm Needs in Weird type   
    There is a way of confirming it by genoty[ing, but it would cost the Earth for very little return.
    I would like to know how old is the patient and what is the underlying pathology?
    You have to remember that the the A, B and H antigens, in common with other carbohydrate-based red cell antigens, are not direct gene products, simply because only proteins can be direct gene products, whilst sugars cannot.  In the case of an AB individual, at least two different transferase enzymes are responsible for conferring either the N acetyl-D-galactoseamine residue, in the A antigen, or the D-galactose residue, in the case of the B antigen.  These two enzymes are in direct competition with one another as to which one "wins the race" to convert the H backbone to either A or B; sometimes the "A transferase" wins, and sometimes the "B transferase" wins.  In this case, it could be that the A-transferase is winning "hands down", and that the B-transferase is "whimping out a bit"!  Sorry, that last bit wasn't written exactly scientifically, but I hope you understand what I mean!
  5. Like
    gagpinks reacted to Malcolm Needs in NIBSC   
    Rant totally justified Anna - and gagpinks, I should have suggested to you well before now to challenge your UKAS Inspector to show where (anywhere) NIBCS reagents are mentioned in ISO15189.  I presume that you are aware that the weak anti-D reagent produced by NHSBT has a specific concentration of anti-D (although I am at home at the moment, and cannot, for the life of me, remember what is this concentration, but I know that it is very low, as it was lowered a few years back, to reflect the fact that everyone was getting "too good" at detecting the the slightly higher concentration of anti-D, as a result of using more sensitive techniques, such as column agglutination technology, and, not to be forgotten, a general increase in the ability of Biomedical Scientists to actually detect antibodies!).
    As I said above, we do NOT routinely use NIBSC reagents in RCI in NHSBT, except for quantification, where we are looking at a concentration of antibody, and all of our eight RCI laboratories have just been inspected by UKAS.  We did not get an NC for this.  I would suggest that your particular UKAS inspector was, shall we say, a little over-enthusiastic!  Were they actually a Blood Transfusion person themselves (either now or retired)?
  6. Like
    gagpinks reacted to Malcolm Needs in Reverse Typing   
    Yes, of course, which is why you MUST use enzyme-treated group O red cells (screening cells - not just one example of group O red cells) as a negative control.  If you do, and the group O red cells give a reaction, you still don't know the ABO group, until you have sorted out the specificity, and then used reverse grouping cells - and group O - cells negative for the cognate antigen.  If you don't use a negative control - you should be sacked!!!!!!!!!!
     
    Nothing personal!
  7. Like
    gagpinks reacted to Barb Thompson in O neg with Ant-c?   
    The patient is rr.  Reference reported it as "unidentified antibody with anti-c specificity".
  8. Like
    gagpinks reacted to David Saikin in Honoring f ag in WAIHA   
    Just a question regarding ce (f) ag when dealing with warm autos.  If the patient phenotypes as R1R2 is it prudent to provide c neg rbcs or just go with Rh ag specific?  I have always gone with ag specific but I find the reference lab used by my current assignment recommends "c" neg.  Looking for opinions please.
    Thanks in advance.
  9. Like
    gagpinks got a reaction from Malcolm Needs in RE: new BCSH guideline on the use of anti-D for the prevention of HDN   
    This is what I exactly understood. If antibody screen is positive at 28 weeks  and also if lady has sensitizing event prior to 28 weeks we always send sample to measure titre regardless of the strength of reaction. 
  10. Like
    gagpinks reacted to NAN47 in RE: new BCSH guideline on the use of anti-D for the prevention of HDN   
    Thanks Malcolm, I completely agree that assumptions should never be made on such things and I will be sure to raise this issue, so basically what is being said is that if a positive antibody screen is detected at the 28 week screen for anti-D that this should be sent for quantification even if the patient has recently received Anti-D Ig for a sensitising event earlier in the pregnancy?
    Thanks for your thoughts
  11. Like
    gagpinks reacted to Malcolm Needs in RE: new BCSH guideline on the use of anti-D for the prevention of HDN   
    Assumptions should NEVER be made on the strength of the reaction of the lady's plasma with D Positive red cells.
    I have seen too many cases (and one is too many) where the lady's anti-D is really high in terms of IU/mL, but the strength of the reaction is actually quite weak, simply because the D antigens on the red cells are swamped by the amount of anti-D and the D antigens are blocked.
    These Guidelines are designed to take into account such rare examples for the sake of the mother, father and baby/foetus, rather than to take into account the feelings of the Biomedical Scientist who may think that they can make such decisions on a misguided idea that they are experienced enough and will never make such a mistake.
  12. Like
    gagpinks reacted to NAN47 in RE: new BCSH guideline on the use of anti-D for the prevention of HDN   
    Hi all,
    I have been reading over these new guidelines and am interested in people's thoughts on the following paragraph
    There have been several cases in the UK where immune anti-D has been mistakenly assumed to be prophylactic without a validated method of measuring the strength of serological reaction or taking into account an accurate history (2010 SHOT Annual Report). It is important therefore that regardless of any prior administration of anti-D Ig, any anti-D detected at 28 weeks should be quantified and the results made available in the woman’s hand-held and hospital records.
    At present we do not send patients sample away for quantitation if they have been recently given anti-D and presume that it is prophylactic anti-D that we are detecting, is this a common practice in other hospital blood banks?
    Thanks
  13. Like
    gagpinks reacted to mollyredone in More Issues around Uncrossmatched Products   
    Goodchild,
    That is our issue also.  They call many more MTP than turn out to be.  One of our last ones had all the units returned to us...out of temperature of course.  Throw away four O Neg PRBCs and 2 liquid plasma.  Another MTP on a fellow with a 1.9 hemoglobin...they used 1 PRBC and one FFP.  Or they will call an MTP, get the first pack and then want 4 more FFP-is this the massive protocol or ordering a la carte?  Sorry to grumble.
  14. Like
    gagpinks reacted to Malcolm Needs in More Issues around Uncrossmatched Products   
    I can understand your reasoning Brenda, and can quite see your point, but I think that the fact that your units of blood will have been "on the shelf" for a while, the chances of there being sufficient viable T lymphocytes in them, and for these to remain in the patient's circulation long enough to cause TA-GvHD is unlikely - not impossible, but unlikely.
  15. Like
    gagpinks reacted to Brenda K Hutson in More Issues around Uncrossmatched Products   
    Thank you Malcolm; that does help.  So it brings up that gray area I am struggling with.....in an emergency.  It is true that Massive Protocol is always an emergent situation, but my struggle has to do with the fact that if you have the time to switch from uncrossmatched to crossmatched (still Massive       Protocol), is the assumption then that you also have time to meet special requirements (we do not use electronic crossmatch yet....so there is a little time involved)?  I am leaning towards writing in my SOP that "if time allows," we will Irradiate units for patients on crossmatched MTP who require Irradiated; but that if time does not allow, to obtain a variance from the Medical Director.  I will run that by the Head of Oncology and Trauma Docs to make sure they are ok with that. 
    My concern here (and it may just be a lack of understanding on my part) is that while I understand the theory behind the decreased risk of antibody      formation say in giving Rh POS to Rh NEG (etc.), I am thinking that the issue with Irradiation is the opposite....that the reason we give Irradiated is        because the patient already has a weakened Immune System and yet Irradiated products are still required to prevent the risk of GVHD.  So in my mind, I would think this would put them at a greater risk of GVHD (giving non-Irradiated to a patient massively bleeding) if we are only considering the Immune System status of the patient (i.e. since the problem in GVHD is the cells you are transfusing attacking the patient.....which I am sure you know), but      perhaps the excessive bleeding, also does not give the transfused cells a chance to mount an immune response against the patient??  That is the part I have never really thought about.
    In getting feedback from some other Hospitals, there are some that do state that once they are on crossmatched massive protocol, they give Irradiated Products (if required) and only get a variance if they cannot keep up with the need.  Obviously, if the choice comes down to a patient bleeding to death vs. giving Irradiated products, we would opt to give non-Irradiated products (at least I have that part clear in my head ).
    Thanks again........
    Brenda Hutson
  16. Like
    gagpinks reacted to Brenda K Hutson in More Issues around Uncrossmatched Products   
    Sorry ahead of time that this e-mail is long....I don't seem to know any other type of e-mail than long.....
    I have worked in large Trauma Centers as well as medium and small sized Hospitals that were not trauma centers but might get the occasional "trauma" patient (currently at 180 bed Hospital moving towards becoming a Level 3).  So I know protocols used in various places and situations, but am struggling with a couple of things here (I think it is difficult to be "between" being a trauma center, and not being a trauma center).  Here are the current issues I could use your feedback on (and what your practices are):
    1.  I am told that in the State of Calif. (which I no longer live in), the Law is that only a Physician, P.A. or N.P. can place electronic orders for emergency protocol products.  I don't know if there is any such law in my state.  But one of the problems we have is that up until yesterday, the Physician taking care of the patient (i.e. in ER or OR) was the one expected to place the electronic order (though a Nurse could call with the verbal order).  This means we end up waiting a long time for the order so we cannot enter testing results and/or print subsequent "uncrossmatched" Transfusion Forms with patient information on them.  So in an ER meeting yesterday, we discussed having another Physician, a P.A. or a Nurse enter Emergent or Massive Protocol on behalf of the Physician.  Do any of you have Nurses placing these orders in the computer?  Both names would then be displayed in our particular system.
    2.  So we have 2 emergency protocols.....Emergent (4 uncrossmatched RBCs) and Massive (4+4+1).  With both protocols, we do not honor any special requirements the patient may have (i.e. Irradiated; CMV-; etc. which I believe is the standard-of-practice).  Emergent Protocol is always/ only uncrossmatched RBCs.  However, we have said Massive Protocol could be Uncrossmatched or Crossmatched (if a patient is bleeding for awhile, we may have completed their testing and as we all know, Physicians prefer crossmatched RBCs.....but they still may need the type/ numbers of products that constitute Massive so they would then be receiving Crossmatched Massive Protocol).  Problem is.....for Crossmatched RBCs, our computer system actually performs a patient history search and forces Irradiated Products when appropriate (and a Physician can add a Health issue to request Irradiated if desired), but it does not perform this search for Emergent or Massive Protocol (automatically defaults to Leukoreduced).  And while we would give Leukoreduced to any patient needing Uncrossmatched Massive Protocol....if we follow our Crossmatched protocol, we should be honoring any special requirements the patient has (i.e. Irradiated).  But 2 problems with that now:
         a.  Would be difficult to keep up with Irradiating Units on a patient on Massive Protocol
         b.  Because our computer system does not do the Irradiation Search for Emergent or Massive Protocol (and cannot differentiate Crossmatched massive from Uncrossmatched massive)...unless a patient already had certain restrictions, we would not know then if this patient should receive Irradiated products (in our Hospital....and these days with the use of Hospitalists.....it is more difficult for them to have the knowledge of what patients should receive Irradiated products; that is why we built our system to search by pre-programmed diagnosis and/or a location of Cancer Center....so cannot depend on a Physician ordering Crossmtached     Massive Protocol to necessarily tell us that this patient should have Irradiated products.  Just wondering, do you guys only give Uncrossmatched Massive Protocol....or are there others that also offer Crossmatched Massive Protocol?  And if you give Crossmatched, do you honor special blood requirements?
    Thanks in advance for your help.....
    Brenda Hutson, MT(ASCP)SBB
  17. Like
    gagpinks reacted to Malcolm Needs in More Issues around Uncrossmatched Products   
    I can't say, because I have not worked in a hospital for 16 years now, BUT, when I did, I was involved with three IRA bombs in London (Chelsea Barracks, Hyde Park Corner and Harrods) and two rail crashes (Paddington and Selhurst), amongst other things, and, in every case, without fail, the number of victims was over-estimated, and the amount of blood required was grossly over-estimated (by those in A and E) and, as a consequence, the Blood Bank was left with a glut of blood after the event, most of which expired.
  18. Like
    gagpinks reacted to Malcolm Needs in AntiD level   
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  19. Like
    gagpinks reacted to Malcolm Needs in RhD status   
    Yes, Weak D Type 2 can be a real challenge some times!!!!!!!
    You should treat her as D Positive (see Daniels G.  Variants of RhD - current testing and clinical consequences.  British Journal of Haematology 2013; 161 (4): 461-470.  doi: 10.1111/bjh.12275).
  20. Like
    gagpinks reacted to Malcolm Needs in RhD status   
    No - read Geoff's paper.
  21. Like
    gagpinks reacted to Malcolm Needs in AntiD level   
    I believe you work in the UK gagpinks?  If that is so, you should only get such reports when there has ONLY been RADDP, rather than when there has been a dose of anti-D given for a potentially sensitising event - UNLESS AN NHSBT CONSULTANT SAYS OTHERWISE.
    If the anti-D immunoglobulin has been given following a potential sensitising event, it would be a brave (or foolish) Reference Laboratory that issues such a report, until the anti-D in the lady's circulation mimics EXACTLY the scenarios given in the new BCSH Guidelines referenced earlier.
  22. Like
    gagpinks got a reaction from Malcolm Needs in AntiD level   
    Thanks Malcolm.!!  
     
     
     
  23. Like
    gagpinks reacted to Malcolm Needs in AntiD level   
    If the anti-D immunoglobulin was given as a result of a potentially sensitizing event (as opposed to routine antienatal anti-D immunoglobulin prophylaxis), I would think that it is very sensible to monitor the antibody on a regular basis.  The reasoning behind this is that, although you know that the lady has been given anti-D prophylaxis, unless you continue to monitor her, knowing that there has been a potentially sensitizing event, you do not know for certain that the anti-D immunoglobulin has "worked".  It may be that she had already become sensitized to the D antigen, and, if you do not monitor the antibody, it may reach dangerous levels for the fetus before you realise.
    You may like to look up a couple of guidelines that have been issued recently in the UK on the subject.
    The first of these is the Royal College of Obstetrics and Gynaecology Greentop Guideline Number 65 - The management of women with red cell antibodies in pregnancy.
    The other is White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S & British Committee for Standards in Haematology.  Guideline for blood grouping and res cell antibody testing in pregnancy.  This is about to be published in Transfusion Medicine, but has already been published on line (doi: 10.1111/tme.12299).
  24. Like
    gagpinks reacted to Malcolm Needs in Panreactive antibodies on echo, negative dat   
    It is unusual, but it could be that the patient had made an antibody directed against the antibiotics that are used to keep the screening cells and panel cells free from infection, and this antibiotic would not be in either the patient's own circulation (hence the negative auto and DAT) or the units of blood that were cross-matched.  As I say, this is an unusual phenomenon, but by no means unknown.
  25. Like
    gagpinks reacted to John Eggington in Mixed field reaction   
    Gestational age also has an impact, I.e., the more premature a baby is the more likely you are to see this phenomenon
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