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Malcolm letting off steam!


Malcolm Needs

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We have recently had a sample sent to us on a 98-year-old patient, to see if she is a Weak or Partial D!

We have now had one on a 37-year-old lady, asking for the same tests, which may seem reasonable, until I tell you that this patient is just about to undergo a Total Abdominal Hysterectomy!

Don't these people think before they send such samples to the Reference Laboratory???????????!!!!!!!!!!!!!!!!!!!

Just me ranting!!!!!!!!!!!!!!

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Actually I believe the phrase; "Preaching to the choir." is appropriate here. Even here in the small rural clinic where I currently ply my trade, I have to constantly suppress urges towards mayham!!! The most common thought I seem to have is "WHAT ARE YOU THINKING!" and as you can see, this is thought very loud.

:explosion

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I once had a smaller lab send segs from two units that "looked compatible" with their patient that had anti-Jka. They wanted me to antigen type the segs for Jka. Only problem with that was...the patient's current antibody screen was negative!!! :faq:

What were they thinking!! LOL!!

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I once had a smaller lab send segs from two units that "looked compatible" with their patient that had anti-Jka. They wanted me to antigen type the segs for Jka. Only problem with that was...the patient's current antibody screen was negative!!! :faq:

What were they thinking!! LOL!!

Ah, sorry to disappoint you bbanker2, but I can, actually see from where they were coming.

Anti-Jka is notorious for "disappearing", both in vitro and in vivo, but coming back to bite you on the b*m, causing severe delayed haemolytic transfusion reactions due to an anamnestic response.

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Rant on Malcom, I understand completely. And btw, I agree w/you on the Jka typing.

And bbanker2 just remember, better safe than sorry, esp with Jka. Twice in my career I've seen Mr. Jka cause "adverse outcomes" for the recipients.

Folks in smaller hospitals encounter "odd" stuff so infrequently they were erring on the side of caution. Been there done that, it's scary.

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Maybe they have a historic anti- Jka that didn't show on this sample.

Yes I understand Malcolm. I had difficlty finding a (one) compatible unit for a patient with multiple allos, so I called to ask them to delay the surgery, the sureon said its ok I dont really need the 5 units that I requested just send me three... WHAT!!!??!!!! Did he not understand me??!!! so I guess they really do not get weak / partial D stuff either.

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Ah, sorry to disappoint you bbanker2, but I can, actually see from where they were coming.

Anti-Jka is notorious for "disappearing", both in vitro and in vivo, but coming back to bite you on the b*m, causing severe delayed haemolytic transfusion reactions due to an anamnestic response.

Malcolm -

Maybe your rant colored your perspective! I feel a little foolish correcting the "great one" but I think bbanker2 was shaking his head about someone thinking that performing a compatibility test with a sample that wasn't demonstrating the antibody, actually had any importance in selecting the units for transfusion. He knew you needed to select antigen negative units for the reason you stated, and using the patient's current sample wasn't going to help anyone select appropriate units. They sent him the "two units" to confirm they had selected the right ones and he was left not only having to find units for them to transfusion, he needed to explain to the facility that they had gone down the wrong path - of course, without offending! I never liked telling someone they were so far off the mark when it was so obvious that they had missed the point completely.

Just my thought - :salute: Jeanne

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I once had a smaller lab send segs from two units that "looked compatible" with their patient that had anti-Jka. They wanted me to antigen type the segs for Jka. Only problem with that was...the patient's current antibody screen was negative!!! :faq:

What were they thinking!! LOL!!

Jeanne, he was asked to type for Jka.

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I once had a tech wake me up in the middle of the night to ask if he needed K neg units for a patient whose screen was currently negative but had a previously identified anti-K . By the time he finished asking the question he had figured out the answer. Too bad he had to wake me up to do it. :) I guess he just didn't think long enough.

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Jeanne, he was asked to type for Jka.

Liz,

Think about it. The facility sent segments from units that looked compatible with antibody negative serum. Of course they looked compatible!

They asked bbanker2 to type these specific segments for Jka, as if the compatibility somehow made them more likely to be Jk(a-). If bbanker 2 tested those specific units, he would have no better chance than testing random units. Jeanne's right.

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Malcolm -

Maybe your rant colored your perspective! I feel a little foolish correcting the "great one" Jeanne

You are far from foolish Jeanne. I agree (see my post above), but PLEASE don't call me the "great one", or anything else like it. EVERY individual is capable of making mistakes (and does). Anyone who claims that they have never made a mistake (or will never make a mistake) is a disaster waiting to happen. What's the saying? There, but for the Grace of God, go I.

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Can I now rant!!??!! Patient comes into hospial - 58 yo male with a scalded foot. UEs and FBC done and Hb turns out to be 46. UEs normal so not a diluted sample but repeated anyway just in case. Hb still in mid 40s. Patient asymptomatic. Ferritin <1, folate pretty low too. Consultant decides to start the patient on iron, folate and erythropoetin and to send the patient home the next morning as he is non-symptomatic. I nearly cried halleluja!!!!

Next day, new consultant. Sees the Hb and freaks. Orders 3 units and transfused them that morning. Retests hb and decides to transfuse a further 2 that afternoon. Lab advised the risk of circulatory overlad but was told 'I'm the consultant'. We are still waiting to see if the chap is OK...

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TACO on the close horizon?????????!!!!!!!!!!!!!!!!!!

Yeah that is my thought...

I have a disciplinary today for doing a ferritin on a sample where is wasn't asked for - patient had a previously raised ferritin of 2k prior to his last transfusion. The consultant haematologist asked for a repeat ferritin and transferrin to be done to see if the patient had iron overload due to repepated transfusion. XM request came in without a request for Hb or ferritin/transferrin - so I did one. Ferritin rasied further (transferrin is a sendaway for us) and Hb was 97. I informed the clinician and caused a right uproar. Apparantly that is bad enough to warrant a formal disciplinary. Wish me luck - it's at 2pm today :(

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Should've been more specific I guess.... They thought the units were Jka negative just because they "looked" compatible with a patient whose antibody was no longer detectable. I just directed them to order antigen negative units from their blood supplier.

Edited by bbanker2
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PLEASE don't call me the "great one", or anything else like it.

Oh Malcolm, I'm afraid my "tongue in cheek" humor didn't come across well. I hate to say it but we've both been around long enough to know that "there, but for the grace of God, go I". I've certainly had my share of moments when half way through a question or comment I realize I'm sawing off the limb I'm sitting on! ;) Jeanne

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But, Malcolm, we were curious if the 98 yr old was a partial D. It would be fun to find one. We must satisfy our curiosity sometimes to keep up our interest. :D

(No, I have not moved to England; just joking about why I might have wanted to send him that test.)

LOL! No, the patient was a very straightforward Weak D!

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I'm back from the wilds of Africa and find that I missed BBT! I agree with Mabel, it may not always be necessary or practical or the best use of resources to see which subgroup of A or type of partial D a patient is, particularly when there are easy work-arounds, but it sure is fascinating and fun. It's why we're not working in chemistry!

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