geekay

Sir, It looks like a situation like the one when we use the CODE SPECTRA for stem cell apheresis ? If my memory is right, we do use "very little amounts" of heparin while doing the procedure with COBE , in order to reduce the incidence of "citrate toxicity" ...But in these situations we add heparin to the saline line ......and not to the patient or citrate line ... Maybe the poor the company person could not explain properly ... with regards and wishes.. engeekay2003

Hi everybody, I agree to the fact that in this instance, Blood Bank had done their best as per protocol and was not to be blamed ! But my way of thinking was different ! With so many senior and experienced people around , I had expected somebody to come out with a solution which can prevent such instances for the future , because I believe in the saying "an ideal Blood Bank personnel anticipates the problem and prevents it , rather than waiting for the problem to occur".... By seeing the replies, am I to believe that we are stuck here without any solutions ? in emergency situations, "issue the blood and hope for the best"..is it ? wishes to all, engeekay2003

Thanks sir... very informative... we do a complete identification procedure though ! I am sure , it will definitely come handy to many ! best wishes ...

Hi aakupaku, we use manual technique only. and the test tube showed 4+ positivity in the reaction with anti-D antiserum. and the antibody identification in manual tube technique, showed anti D antibody. with wishes and thanks friend, engeekay2003

Hi there, In doubtful cases, giving Rhogam is safer than the complications arising out of "not giving it " ! It has been stated so in some standards manuals also ( I think Mollison ?) best wishes..!

no grading... only the word "mf" is used. best wishes..

we perform the complete cross match as per protocol. best wishes.

I would appreciate inputs from the members in the following scenario please ! Blood sample of a pregnant lady walking into the hospital for the first time is received in the Blood Bank and the test for anti D typing shows 4+ reaction. But was not compatible with D positive blood. Later on , antibody identification reveals anti D antibodies. (For transfusion, "D negative" blood is given as "D positive" blood was incompatible.) In my career for the first time, I am coming across such a situation . How do we explain such a scenario of anti D antibodies in a "D positive " patient ? :eyepoppin I have my explanation, but I would appreciate inputs from the members also please ! in anticipation, and with wishes to all, engeekay2003 :disbelief:disbelief:disbelief

Hi all, I fully agree with Dr Susannah.... This definitely suggests that "rouleaux formation" does give "false positivity " in the gel technique... I had many similar experiences with Diamed few years back... Though I had brought up the topic some time back in this column, it went unnoticed anyway.... This querry, when it was raised to the "Diamed company" few years back, nobody from the company could give any explanations in this regard. This is a warning signal for all who blindly follow the "gel techniques" ! best wishes....

Hello sir, In the place where I work, we follow the rule " play it safe ". so with a smiling face, defer such donors... am keen to know the inputs from the other members too ! with wishes... engeekay2003

Hi everybody... Does G6PD a cause for deferral in Blood Donation ? I find different leading Blood Banks following different protocols ~! If the donor is perfectly healthy in all other apsects, and is not on any medications, and his Haemoglobin is excellent, does G6PD alone a reason for deferral ? Maybe the other senior experienced collegues here may have their share of inputs ! Does AABB has any specificity on this ? in anticipation, engeekay2003 :confused:

Hi everybody... A perfectly young healthy Blood Donor walking into a Blood Bank is found to have a small area of hypopigmentation (2cm approx diameterA) on the forearm ...he is not on any medication....the hypopigmented patches does not seem to be infective. or does not look like any chronic disease as he had taken opinion from various leding dermatologists. On this cosmetic ground alone, are we justified in rejecting this donor ? I find lots of senior well experienced collegaues in this site.... I am keen to get the inputs from them on this please ! I am interested to know, what they will do in such a situation in their organisation ? what is the reason they will give to the donor, in case of rejecting him ? Does AABB has any specific clause for "an uncomplicated skin lesion " of this sort ? in anticiaption, engeekay2003 :confused:

Hi there ! I am also attached to a saudi hospital . Where I am working , the protocol followed is : -Do the FP first for doing the grouping / typing alongwith haemoglobin concentration ! -Do the "test for sickling" alongwith the "grouping confirmation from the segments", in the laboratory ! That means, the technologist who is doing the ABO confirmation will be responsible for the "sickle test" -And for serology etc etc, pilot tubes are available... This gives me a chance to clarify with "you " something... why is it that some saudi hospital blood banks are still , rejecting blood donors who are positive for "sickle test" and "G6PD" ? Is there any specific regulation in SAUDI or is it just a matter of "over cautiousness " ? Sorry that I am asking a counter question for a question asked ...... :confused: :) best wishes ...

I was so happy to see the response regarding the problems encountered with "Gel technique"......why you know ? All these years, I got the impression that everybody is very very happy with this "gel technique" (EXCEPT ME ) !...... When it was introduced in our country some 10-12 years back, lots of discussions were happening about their "positive aspects". There were presentations about the incidence of "false negatives" in "tube technique". But nobody had thought about the "false positives" in "Gel technique". I am at last happy that , there are at least few more in this world who are getting problems with "gel" like me.......Very much informative this thread was... Thanks to the person who had brought up this topic ! and of course, thanks to the other colleagues too ! best wishes to all !

Hi Mabel Adams, I feel that we do get a better level of "reliabiliy and confidence" in that Donor card , if the card was issued from our organisation ? Because we dont know the standard of testing procedures on the other organisations....... If I had been in your position, I would definitely go for confirmation with a second sample , if the card has been issued from another organisation ! hope you agree ? best wishes...

Hi TSyec, I feel that , majority of the hospitals, Blood Transfusion committee do not have any major role in the clinical settings. They do not have any voice in the clinical side...or majority of the clinicians dont want to be ordered by somebody........agree ? Otherwise, how many surgeons or clinicians have waited for the Hb value of 7 gm% or a platelet value of 10000.cmm , before ordering a Transfusion all these years ? Very few....I am sure.....because like the Blood Banking people, the clinicians also want to play it safe !!!..... "play safer towards the patient's safety" ! play safe towards their own safety ... and of course avoid medical legal problems....! best wishes to you...

Hi there, Ultimately what it matters is the safety of the patient and the safety of the staff employed. Let it be CAP or JCIA , I dont think that any accreditation agency is going to find fault with an institution or an employee, for becoming more duty conscious...and also aiming at the patient's safety ! also, if the patient has come from an institution which is not accredited by CAP or JCIA ? and suppose if the patient has received a Transfusion from another place in between, which he/she has forgotten to mention during admission ? (if I were to be in the position, I will go for repeat grouping....) In Blood banking, lots of things are easy to preach about...! but not easy to practise.....as it involves safety..... Lots of ifs and buts are involved in this issue.... best wishes !

Hi there... Uaually the values for CBC holds good for 24 hours in incapacitated/debilitated patients, if nothing untoward like bleeding etc etc happens. Otherwise, in case the patient is doing well since the preceeding few days, and responding well to the treatment, there is no mistake on the doctor's side, to have referred the earlier report to have a general idea about the condition of the patient / and progress. But whether he should have depended on that value to order for x-match is anybody's guess..... best wishes....

Hi there, while reading your answer on "gel technique", one doubt came to my mind.. How do we say whether the gel technique is not giving "false positivity" or the manual technique is giving "false negativity", in weaker reactions ? I had attended a meeting some years back, wherein a consultant had presented the finding of "false negativity" in manual method...But why cant it be in the other way round ? any references ? any input would be appreciated....

Hi Kathy3171, This is in reference to your reply. I am very curious to know the origin of this "cut-off" value... Any reference for this or was it by "the trial and error method" of the institution ? If you can provide any references, I would be happy... with best wishes...

Hi Barobinson, Hi to you... I feel that your SOP needs to be looked into or re-evaluated....by an expert ? best wishes....

Hi there, FFP, once thawed, can be kept in 4-6 C , (if not immediately used / transfused !) . FFP stored like that in the refrigerator can be used as FFP for 24 hours from the time of thawing. If not used till then as FFP, may be used as stored liquid plasma and can be used as volume expanders or protein supplimentations in renal and hepatic cases. best wishes !

Hi there... Was rather surprised to see the same mistake being repeated by the second technician in the blood grouping and typing.... It is very clear that he had adopted a "short cut" method in the technical procedures.... I believe in the fact that, in Blood Banking dictionary, the word "sorry" or "pardon" does not exist , especially when the mistake has to do with the technical procedures involving steps like "issue and transfusion"....... I remember my senior professors words...."we don't need people with "sixth sense" or "extra intelligence" in Blood Banking ! But we need to have people with "honesty" , "common sense" and "sincerity"....in our field... Hope you agree with me ? (If I had been in your position, I would have taken immediate steps to initialise computerisation in the Blood bank ! After all, "EXPERIENCE IS THE BEST TEACHER " best wishes !

HiGilTphoto, saw your posting today only....sorry for the error which had crept in during my typing. what I really meant was 2 gm%... thanks for crrecting me sir.. best wishes...

Hi there, I fully agree with the opinion that the "gel technique" do give "false positives" , in the testing, may it be grouping, or x-matching, or antibody detection..... In such a scenario, the golden rule is to return to the oldest and the most reliable technique of "manual" technique... best wishes...