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gagpinks

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  1. Like
    gagpinks got a reaction from dragonlady97213 in Anti-Inb   
    After all these preparation patient delivered at home. Baby and Mum didn't need any blood.
  2. Like
    gagpinks got a reaction from exlimey in Anti-Inb   
    After all these preparation patient delivered at home. Baby and Mum didn't need any blood.
  3. Like
    gagpinks got a reaction from TreeMoss in specimen labels   
    In uk we follow strictly zero tolerance policy therfore no pre printed label allowed.   There are chances where patient could be misidentified and labelled wrongly. 
    Recently we had near miss incident.  Patient came to A&E and G/S was performed and Group was O pos. Then Patient transfer to ward and clever nurse decided to take two sample same time  eventhough two sample policy (2 sample at 2 different time and by 2 different phlebotomy ). She decided to send one sample and thought will send  second sample after one hour. Lab performed group and this time it was Bpos. So lab asked for second sample and nurse send same sample(taken same timewith first sample ) for second time. So second sample again B pos. As per our protocols we two sample has same group we can accept the group. Luckily patient was sure about his group and question about it. Fourth sample taken and found to be O Pos. Case was investigated by TP and found there was WBIT from ward nurse.  
    SO no matter what policy, system or rule we bring mistakes are still happening. It's really depends on person who takes blood. They need to be visulant.
     
  4. Like
    gagpinks got a reaction from MaryPDX in 4 hours to transfuse   
    Hi Cliff 
    We count 4 hours from the time it's out of controlled temperature. If you pack your unit in controlled transport box than time start from it opened the box.
    It's worth looking JPAC guidelines 
     
  5. Like
    gagpinks got a reaction from exlimey in Anti-Inb   
    Lady is at low risk bleeding at delivery so plan is to transfuse ABO and D and Rh compatible in case of emergency with methylprednisolone or if she is stable but need blood than frozen unit can be obtained. 
  6. Like
    gagpinks got a reaction from Malcolm Needs in Anti-Inb   
    Lady is at low risk bleeding at delivery so plan is to transfuse ABO and D and Rh compatible in case of emergency with methylprednisolone or if she is stable but need blood than frozen unit can be obtained. 
  7. Like
    gagpinks reacted to Malcolm Needs in Blood Bank Saline for Prewarm Testin   
    I would thoroughly agree with exlimey, including his citation of Scott's point - DON'T DO IT!
  8. Like
    gagpinks reacted to SMILLER in Blood Bank Saline for Prewarm Testin   
    If there were only a few bacteria or yeast in there I am pretty sure that they would flourish in a 37 C environment.  If I was a red cell I would npt want to be mixed with that!
    Scott
  9. Like
    gagpinks reacted to Malcolm Needs in SCARF cells   
    I'm sure you are right about exaggeration.  This is something that genuinely worries me about Health and Safety (amongst other things).  If they keep making all sorts of claims where things are DANGEROUS, the old thing about "crying wolf" will occur when something that is REALLY DANGEROUS gets ignored, because people get apathetic about H&S because of exaggeration.
  10. Like
    gagpinks reacted to exlimey in SCARF cells   
    Well said. The world is so "dangerous" these days, it's a wonder we're still around.
  11. Like
    gagpinks reacted to Malcolm Needs in AntiD +Anti G   
    Strictly speaking, the BSH Guidelines state that there is no need to irradiate small volume transfusions for neonates, BUT, given that the baby has already had an exchange transfusion (which will have been irradiated) and is probably a little premature, irradiation will do no harm, and may do some good.
    I may be speaking out of turn with the Guidelines, but, in this situation, I think "belt and braces" may be best.
  12. Like
    gagpinks reacted to Malcolm Needs in Warm auto antibody crossmatch / testing frequency   
    In NHSBT Red Cell Reference Laboratories in the UK, we used to cross-match with neat and adsorbed plasma too, but I could never see the sense of cross-matching with the neat plasma, when we knew before we started that the cross-match would be incompatible due to the warm auto-antibody.  It seemed to me to be a complete and utter waste of expensive reagents and even more expensive time.  We no longer perform a cross-match with the neat plasma (one of my few victories!).
    We would adsorb an absolute maximum of eight cycles, and if these multiple cycles did not result in success, we would telephone our own Consultant Clinician and discuss the matter.  Almost every time, this would result in them advising us to give ABO, Rh and K matched blood, following an immediate spin cross-match (and, of course, negative for any antigen against which the patient had already produced a clinically significant antibody, such as an anti-Fya), and our own Consultant Clinician would contact the patient's physician at the hospital and tell them what we were doing and why.  Following such an instance, we would discuss with our own Consultant Clinician how we would approach subsequent samples (including how many cycles of adsorption we would try before "giving up"), so that we did not waste precious time and reagents in the future.  Unless there was evidence of the need for more frequent transfusions (suggesting the formation of a possible new antibody specificity), we would often go seven days between adsorptions, however, we would certainly NOT gauge this on the strength of the DAT, as variations in the strength of the DAT are no guide whatsoever as to whether a new antibody is present or not.
  13. Like
    gagpinks reacted to NAN47 in False Positive KB test   
    We in our blood bank have sent away kleihauer positive samples for flow cytometry testing which has come back as negative as the technique looks for 'RhD Antigens' on the foetal red cells, in which case it is likely that the foetal cells are D negative and a negative flow result is returned. 
  14. Like
    gagpinks reacted to Yanxia in antigen typing during pregnancy   
    and from my daily work, i find we can tell from the proportion of cells, if transfused is less, then on  the mix field result, the large part is the patient's own cells
  15. Like
    gagpinks reacted to Malcolm Needs in childbearing age   
    Which, of course, gives her an extra day to get pregnant if it is a leap year!!!!!!!!!!    (but I do agree)!
  16. Like
    gagpinks reacted to Maureen in I'm coming back to Providence!   
    We’re excited ~~ the 69th ASCLS-CNE Annual Convention’s speaker program is now available on the web ~ the site is open for online registration  
    Providence is a great city to visit in the spring – and this is an excellent opportunity for networking and learning.
    Feel free to share this link  www.ascls-cne.org/annual-convention  to view the program and register!
  17. Like
    gagpinks reacted to Malcolm Needs in Warm free auto antibody with weak auto control   
    Thank you for the further information catm.  It has strengthened my feeling that what you have here is actually a "cold" autoantibody of wide thermal amplitude, despite the fact that the DAT appears to be positive with an anti-IgG, rather than anti-C3d.  Although most "cold-reacting" autoantibodies tend to be IgM, it must not be forgotten that some are IgG (as are some cold-reacting alloantibodies, such as ABO antibodies, anti-M, etc, and the classic DL autoantibody, anti-P), however, this could also point to a mixed "cold" and "warm" autoimmune haemolytic anaemia.  In addition, it could well be that the lady has no free complement in her system, because of consumption.
    The ABO and Rh results in CAT are classic for cold agglutinin.
    Again, the reactions at room temperature, performed on neat, unadsorbed plasma are classic, as is the macrocytic anaemia and the very high antibody titre.
    May I suggest that, if you can, you treat the patient's plasma with dithiothritol, to see what happens, particularly in CAT?
    Could I also suggest that the plasma is tested at strict 30oC?
    Your comment, "We use NHSBT Adsorption cells..." suggests to me that you are not a Reference Laboratory (I am quite prepared to be slapped down if I am wrong!) and, if I am correct, I would strongly suggest that a sample is sent to a Reference Laboratory.
    Lastly, may I ask that you keep us informed about this patient?
  18. Like
    gagpinks reacted to Malcolm Needs in Positive DAT   
    The nearest I have seen to this is:
    Sachs UJH, Roder L, Santoso S, Bein G.  Does a negative direct antiglobulin test exclude warm autoimmune haemolytic anaemia?  A prospective study of 504 cases.  British Journal of Haematology 2006; 132: 651-661 (DOI: 10.1111/j.1365-2141.2005.05955.x).  Don't be fooled by the title of the paper, as the paper does go into this, but only briefly.
    In such cases, we used to gauge to see if the intervals between transfusion episodes were getting shorter, suggesting that a "new" antibody may be present, but this also depended on the doctors looking after the patient remaining the same (brand new doctors out of medical school tend to be a bit more enthusiastic about ordering transfusions, until they are tamed!).
  19. Like
    gagpinks reacted to Malcolm Needs in Anti-Inb   
    Hi Gagpinks,
    As long as the Reference Laboratory know that the lady is pregnant, have had a sample to ensure that she hasn't produced any other "surprise presents" (in the form of an additional antibody specificity or specificities (always fun when the patient already has an antibody for which it is nigh on impossible to find compatible blood) and know her EDD, that should be enough.  It is now up to the likes of the NHSBT RCI Consultant, with special reference to Dr Rekha Anand, who does such a fantastic job, to find either frozen units or, in the case of Rekha, "tame" donors to cover the labour.  Otherwise, it is down to the equally fantastic Dr Therese Callaghan to import said units from elsewhere in the world.  All of this will go on in the background, and I would suggest that the hospital, let alone the patient, will not know it is happening.
    If it was the lady of whom I was thinking, the reason blood was not supplied was because 1) she didn't need blood and 2) because she went to a hospital who had no idea about her antibody specificity (thank goodness).  The two units at the NFBB were never defrosted.
    How many weeks is she pregnant now?  Don't be surprised if the titre of the antibody falls during the pregnancy, as the baby's Inb antigen will be expressed on the apical surface of the placenta, and so will adsorb out some of the maternal antibody anyway.
    Keep us informed, if you don't mind.  This should be an interesting case for virtually everyone on this site - it is VERY rare (worth putting in an HSD portfolio, for example!).
  20. Like
    gagpinks reacted to Malcolm Needs in Anti-Inb   
    She almost certainly does.  If, however, it is the same woman as I dealt with in her previous pregnancy, good luck!  The lady I am thinking of was something of a "wanderer", who was booked with about five different hospitals covered by NHSBT-Tooting Centre, and finally gave birth in another hospital completely, in the NHSBT-Colindale Centre catchment area!  It made for a fun life for us, as there were only two units of In(b-) blood in the national frozen blood bank at the time, and I would be simply amazed if there are any more than two now!
    I would let the NHSBT know pretty quickly about this woman, if you have not already so done!!!!!!!!!!!!!
  21. Like
    gagpinks reacted to StevenB in Positive DAT   
    Interesting topic.  In just a few posts, it is easy to see there is a variety of ways labs approach the "how often are elutions performed" question and under what circumstances.  I too agree with Malcolm; in the presence of AIHA and a positive DAT, most likely you will get off a panagglutinin every time you perform an elution.  Once this occurs, there is no point in performing additional elutions on a routine basis.
    In the patient though who has a positive DAT and is transfused on a regular basis, and has a negative eluate (yes, this does occur) the elution question is a bit different.  Technically, any transfusion can result in the production of an alloantibody that may or may not present itself in a hemolytic fashion.  It is possible to have a "delayed serologic transfusion reaction" that shows no signs or symptoms of a hemolytic process. In this scenario, the idea of not doing an elution on a regular basis because it has never revealed anything in the past, may result in missing a newly formed, clinically significant antibody that is only detectable in the eluate.  Not performing an eluate in this scenario is not without risk and should not ever become "policy" without proper overview of the clinical situation.
  22. Like
    gagpinks reacted to Malcolm Needs in Warm free auto antibody with weak auto control   
    I am afraid that I am not totally convinced that what you have here is a "warm" auto-antibody.  I just wonder if, what you have is either a "cold" auto-antibody of wide thermal amplitude or, possibly, but seen less commonly, a case of a mixed "warm" and "cold" auto-antibody, however, having said that, I am not certain, from what you have written, whether or not the direct tube testing at room temperature was performed on allo-adsorbed plasma or "neat" unadsorbed plasma.  Please would you clarify this?  Please would you also try to tell us the patient's underlying pathology?
    I would not worry too much about the patient's autologous red cells give slightly weaker reactions than those seen with panel cells or screening cells.  The autologous red cells will have been "bathed" in the high titre antibody in vivo, whereas the other red cells are, if you like, "meeting the antibody for the first time"!  It is likely, therefore, that there is a certain amount of "antigen blocking" going on with the autologous red cells.
  23. Like
    gagpinks reacted to Townsend in Positive DAT   
    We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
    Stephanie
    Elution Flowsheet COMPAT SER FS4.doc
  24. Like
    gagpinks reacted to Malcolm Needs in Positive DAT   
    I don't want to get you into trouble, but I would suggest that you gently persuade your manager to either read (and take notice of) BSH Guidelines or (or better still, and) contact an NHSBT Consultant to get advice/contact one of the writing group of the Guidelines (medically qualified, if necessary) to save him/her and his/her staff a lot of totally unnecessary work and expense (particularly as his/her budget is provided by British tax payers, of which I am one)!!!!!!!!!!!!!!!!!   
  25. Like
    gagpinks reacted to Malcolm Needs in Anti-H and anti-HI   
    Is it only Bombay phenotype that can produce a true allo anti-H and require I negative blood?
    Yes, it is only a true Oh individual ("Bombay" is the wrong nomenclature.  This misnomer came about because the first few individuals with this phenotype all came from around that area of India, and this is now named Mumbai anyway, but the Oh phenotype has now been detected in many other populations around the world) who can produce a true allo-anti-H, however they do not need I Negative blood, but most certainly do need H Negative blood, and so can only safely be given blood from another Oh individual.
    In Para-Bombay is it only A1, A1B and B that can form a weak reacting anti-H and is it really auto anti-H?
    "Para-Bombay", like "Bombay" is now not used.  The terminology used now is Ah or Bh (you would be lucky to find an individual with the AhBh phenotype as, as far as I know, nobody of this type has been described).   There is some dispute over the genetic background to these individuals.  It is probable that they have a silent FUT1 (or H) gene, but a functioning FUT2 (or SE gene), and so the individuals will produce soluble A or B substance (Type 1), but not the insoluble type of A or B that is intrinsic to the red cell membrane (Type 2).  It is believed, therefore, that the A or B antigens that are found on the red cells of Ah and Bh individuals are actually adsorbed onto the red cell surface from the plasma.  Such individuals would, of course, also secrete a small amount of H substance into the plasma, and this would also be adsorbed onto these red cells.  This complicates matters, with regard to what kind of anti-H is produced.  Certainly, it is usually weak, but is it an auto-anti-H or an allo-anti-H?  The answer is a "bit of a lemon"!  It is probable that such individuals produce an allo-anti-H directed against the Type 2 H antigen, but could also make an auto-anti-H against the Type 1 H antigen.  However,as the Type 1 and Type 2 H molecules are very similar to one another (The Type 1 molecule having a beta-1-3 linkage between the terminal D-galactose and the sub-terminal N-acetylglucosamine, whereas the Type 2 molecule has a beta-1-4 linkage between these two sugar residues - otherwise they are identical), and this may explain the weakness of the anti-H produced.
    All that having been said, some workers think that a weak H antigen, intrinsic to the red cell membrane (Type 2) may be produced in certain circumstances, if the mutation to the FUT1 gene does not produce an absolutely null fucosyltransferase, but produces a fucosyltransferase that can produce the H antigen, but only in very small amounts.  If this were the case, then both the anti-Type 1 H and the anti-Type 2 H would both be auto-antibodies.
    For transfusion they would get 37°C IAT compatible and never A2 or O?
    Transfusion of these individuals is complicated!  If time allows, I would always transfuse cross-match compatible group Oh blood.  If the situation is urgent, then I would give group O blood, even though there is a weak anti-H present, but cover with high dose IVIgG, and keep my fingers, toes, arms, legs and eyes all crossed!
    The same goes for anti-HI.  Is it only "Para-Bombays" that produce this?  Is it really auto-, or can normal A1, A1B and B individuals produce it too?
    Here, I am glad to say (actually, immensely glad to say) we are on safer ground!  Anyone, of any common or uncommon blood type, including group O individuals, can produce an anti-HI, and this is ALWAYS an auto-antibody (on the grounds that an Oh individual, who is also an adult ii individual has never been described - and probably never will be - and this would be the only person who could possibly make an allo-anti-HI!).  There is not an awful lot more to say about that!
    Is there such a thing as auto ant-H and HI in group O individuals?
    Yes, there is such a thing as auto-anti-H in a group O individual, but it is disappearingly rare (as is auto-anti-A in a group A individual and an auto-anti-B in a group B individual).  On the other hand, an auto-anti-HI is not uncommon in group O individuals, although it is rarely clinically significant (only really in cases of CHAD) and, in healthy individuals, you would usually have to perform some "exquisite" serology to prove it was present.
    There, I hope that helps!  Of course, othrs may not agree with what I have written.
     
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