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April 2024 Challenge

The golden rules of Immunohaematology.....

TimOz
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TimOz Enthusiast

TimOz

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Hi Everyone,

I am off to a less than well developed South West Asian country in 2 weeks time and have been reviewing and writing my teaching materials. I like to open with a set of "Golden Rules of Immunohaematology" for the education and amusement of the students (and my amusement too if I am honest). I would like to publish them here for your erudite comment or addition.

Am I wrong?

Is there anything I have missed?

The Golden Rules of Immunohaematlogy

1.a. 90% of Immunohaematology is simple and understandable with a few basic Immunology principles.

b. 8% is complex and esoteric – you need information, journals, advice and textbooks.

c. 2% makes no sense and never will.

d. 40% of what we think we now know is wrong and will be proven incorrect.

  • Nomenclature is hopeless – you have to learn it.
  • For every rule – there is an exception.
  • You must understand your tests.
  • The most dangerous thing in any lab are the humans.
  • Get the blood group right.
  • Get the sample right - right patient, right tube, right label.
  • Do antibody screens well with the best methods and screening cells.
  • Get the blood group right.
  • Crossmatch well.
  • Get the blood group right.
  • Put the blood in the right patient.
  • Get the blood group right.

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Malcolm Needs Grand Master

Malcolm Needs ☆

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A few extra spring to mind (although it could be argued that they apply to life, not just to immunohaematology).

  • Never cover up a mistake.
  • Always be ready to admit that you could be/are wrong.
  • Always be open to other people's suggestions, however junior to you they may be.
  • Never be afriad to say "I don't know", however senior you may be.

I, and others, may come up with more, but I think the rules that you have put down are splendid.

I would, perhaps just add two more that are pure immunohaematology, and these are;

  • Unsterstand the principles of your tests.
  • GET THE BLOOD GROUP RIGHT

although I think you may have mentioned this latter golden rule!

Good luck with your course.

:)

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RR1 Mentor

RR1

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and the murphy's law of blood bank - the chance that the new patient you are working on will have an antibody is directly proportional to how fast they need the blood!

Absolutely spot on !

I've also applied Murphy's Law to the overall, everyday blood bank functions :

" if something can go wrong, given the chance, it will".

However these thought processes now have to be documented and called Risk Assessments.

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TimOz Enthusiast

TimOz

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Thank you for the kind words and the input. Here is the updated, reordered and slightly reworded version (my apologies if I have corrupted anyones input with my rewording)

The Golden Rules of Immunohaematology

1. Get the blood group right!

2.a. 90% of Immunohaematology is simple and understandable with a few basic Immunology principles.

b. 8% is complex and esoteric – you need information, journals, advice and textbooks.

c. 2% makes no sense and never will.

d. 40% of what we think we now know is wrong and will eventually be proven incorrect.

3. The most dangerous thing in any lab are the humans.

4. There is no such thing as an unlabeled tube in Blood Bank.

5. Never cover up a mistake.

6. Always be ready to admit that you could be/are wrong.

7. Be open to ideas and never be afraid to say "I don't know".

8. For every rule – there is an exception.

9. Immunohaematology is not black and white... get used to the gray.

10. The nomenclature is hopeless – you have to learn it.

11. You must understand the principles of your tests.

12. The chance of finding an antibody is directly proportional to how fast the blood is needed.

13. Get the sample right - right patient, right tube, right label.

14. Do antibody screens well with the best methods and screening cells.

15. Crossmatch well.

16. Put the blood in the right patient.

17. Get the blood group right!

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  • 2 weeks later...
TimOz Enthusiast

TimOz

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Hi Madhu,

I have been to Sri Lanka many times. There have been a few issues while I have been there including a very sad suicide bombing very close to where I was. Hopefully the fighting has stopped. Such a beautiful country and kind and generous people. I would have said that they don't often beat us a cricket but after our shameful performance losing the Ashes I am not so sure anymore.

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madhu Rookie

madhu

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Hi! Tim,

True...a beautiful country and very nice people.I have been there only once but do have a few friends there.

Hopefully things will be better from now on...for them as well every one else.

As for cricket...u win some u lose some. sri Lanka is quite a good team themselves and unfortunately, Oz has been in the news lately for all d wrong things.

Again, I hope they will change for the better.

Oh, by the way, I did copy your golden rules and made a colourful poster of it...blue, pink, yellow..grey....:)

Even though I no longer work in a blood bank, I intend to pin a copy of it on my desk pin board and will pass it on to all blood bankers who would like to have it.:)

Wish u luck.

madhu

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  • 4 weeks later...
Grippy Apprentice

Grippy

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"The most dangerous thing in any lab are the humans."

I can't agree with this. I don't like how it's written or the implication. The most valuable thing in a lab is the human. That's what I think. The equipment is worthless without us. I know what you are trying to say but it needs to be said differently. If we think of ourselves as the most dangerous that's not productive or positive and a positive attitude is essential.

Otherwise I like your post

Edited by Grippy
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TimOz Enthusiast

TimOz

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Hi Grippy,

Thanks for the post. Unfortunately, all available data shows that errors causing patient morbibity or mortality are almost always caused by human error. Ever heard of a bottle of anti-A failing and causing a death?

When I am teaching transfusion safety, I use the slightly humourous acronym CBL effect (Carbon Based Lifeforms).

The intention of the statement is to make sure all Immunohaematology staff remember that they have to be very attentive and careful. It is worded harshly and I make no apology for that. It needs to be. I have to disagree with the first half of your last sentence. I feel that lab staff need to be very well aware and reminded often that they can and do make errors. They need a positive attitude, good management and well designed testing systems and environments to ensure errors are prevented or detected and corrected. We are dangerous and we have to think that way.

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Malcolm Needs Grand Master

Malcolm Needs ☆

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Hi Grippy,

Thanks for the post. Unfortunately, all available data shows that errors causing patient morbibity or mortality are almost always caused by human error. Ever heard of a bottle of anti-A failing and causing a death?

When I am teaching transfusion safety, I use the slightly humourous acronym CBL effect (Carbon Based Lifeforms).

The intention of the statement is to make sure all Immunohaematology staff remember that they have to be very attentive and careful. It is worded harshly and I make no apology for that. It needs to be. I have to disagree with the first half of your last sentence. I feel that lab staff need to be very well aware and reminded often that they can and do make errors. They need a positive attitude, good management and well designed testing systems and environments to ensure errors are prevented or detected and corrected. We are dangerous and we have to think that way.

Once again, I find myself in total agreement with you Tim, and if you want to see an example of why I agree with you, have a look at my post (#149) on the thread "Just for fun".

:redface::redface::redface:

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