eric1980

Hi, all. I was doing an MGG stain on a BMA specimen when I was alerted by the haematologists of unsatisfactory staining. This is a picture taken straight off an eyepiece of the microscope. It appears that for cells along the lymphoid and/or erythroid lineage, there is an artefactual precipitation of stain on the nuclear membrane. Therefore, the haematologists are unable to convince themselves of the identity of the cells in this picture. I didn't read up on staining and so I had to follow the staining procedures strictly. What do you guys think might have happened that led to this? I'll be experimenting if it is due to the slides drying very slowly before I fixed it with methanol. [ATTACH=CONFIG]617[/ATTACH]

Smear cells, basket cells, smudge cells, etc... Where could we find the standard of the identity of these cells? =/

Everytime I log into BBT or, now PLT, I learn something new. My lab is using LH750, and at very high WBC, we do get a "R" flag on all our RBC parameters. We usually do a 1:1 dilution and will get a good result after that. As long as the WBC result is within the linear range. But I am very interested in exactly how other labs correct the RBC parameters. What do you guys mean by subtracting the WBC value from the RBC value? Looks like I have to contact my local Beckman-Coulter representative soon.

The LH750 in my lab reports both sets of parameters anyway. So we report them both. We report abs# for manual differential using the LIS. It's calculated automatically when we key in the %.

We are all scientists here, and by posting in this forum, we should be all out for the science instead of legal and corporate opportunities... Hope the users here know the right thing to do, or not to do. Hi, Malcolm. Used to see you often in BBT. After a couple of years since I stopped posting, you are still around!

My lab's policy is to count and report whatever is still intact. It is apparently not important to report the presence of smudge cells. I disagree with this... So I deviated by using the albumin method to make a blood film, and I do a manual differential count from that. I will grade the number of smudge cells in the original slide and report it as a 1+, 2+, 3+ or 4+.

I wonder what are my chances of convincing my lab to bring in TEGs.

I wouldn't report anything that can be interpreted from FBC. Unless a morphology is ordered, we will have to report hypochromia, microcytosis, etc... even if it can be seen straight from FBC.

My lab uses D-dimer. Stopped using FDP since a decade ago...

We have 2 LH750 and we are trained to do manual retic using brillant cresyl blue... This is just in case we have a flag stating "Abnormal retic pattern" after a rerun.

Some institutions do that. Provided the work culture will not allow a unit of blood to be at room temperature for long periods of time, I guess it's okay.

Rashmi, although I'm now in haematology, 5S(or 6S as we call it in Singapore), covers the entire hospital. Due to our workload, 6S has originally been going as fast as a snail mail. So my lab had to roster a couple of staff off-bench so that we could get the 6S going. So while they can clock work hours, they actually are in the lab solely to do 6S. As the 6S crack troops had an idea beforehand, we started work immediately, and things moved like email. ; ) Now, most of the drawers are neat (Keyword: partition), and benchtops are clutter-free (Keyword: item space allocation), the folders on the shelves looked like they are for sale in bookshops (same colour group or colour code), etc. How long it will last - I have no idea, and I wouldn't bet on it. Although we have assigned one or two staff to maintain it, we (the 6S core group) aren't really sure...

It's been a few months. ; )

Someone told me before, that if we need more and more protocols in order to make things right, it shows that we are not educated in the first place. And to add on to what he said, more protocols will end up with those uneducated relunctant to comply and do more wrong things instead.

You do recognise that you are actually doing an internal check and not eliminating the chance of the ward mislabelling the specimen tube? And that if the re-test is not performed, any ABORH error can be picked up easily at the crossmatch? I believe that sending a second specimen (for patients without history) is more helpful than doing the same test on the same specimen...

If I am in your country, I would apply to work in that BB.

I will take your advice if I'm still working in the blood bank... I learn all I know about BB at work and, more recently, in BBT.com. So if there's anything I'm not taught, I wouldn't know or think about. =( But more importantly, I now realise this possibility and will let my colleagues in BB know about it. Whether they will change their standard operating procedures due to this fact... I dare not bet... I will let them know definitely.

I've read from somewhere that patient who develop anti-E are more likely to develop anti-c as well. So we usually type donor RBC for absence of c antigen. However my lab didn't type the patient for expression of c antigen, though. =/ Now I wonder...

My BB policy is the same as Malcom's.

My lab conducts lunchtime talks every Thursday. Each staff take turns to present, and they can present anything under the sun. Sadly, attendance has always been little as compared to those who are having lunch at that time. And I do not have to mention the number of colleagues who ever use their own time to attend seminars and workshops. In my opinion, supervisors should find out who are those who are willing to sacrifice their own personal time to develop their knowledge, and to give them more responsibility and thus, more chances for promotion/pay-rise (they deserve it!). If there still are those who aren't willing to work a little bit harder, then nothing will make them willingly do it, and we shouldn't try too hard to make them.

I believe the responsibility of order specially processed blood products should fall into the hands of the physician. (They are the highly paid people!) But we BBers should help out by informing the physician about the special needs if we see it in the BBsoftware.

I think the main issue is communication between your parent company and your lab.

For my hospital, the clinical staff got to call the BB to inform us of the reaction, and then we will get some information and then get the nurse to fill up a TR form. The form will state exactly what specimens to send, as well as some of the patient's vital signs that we need to know. And then we wait for them to send everything down.

I am in haematology now, and if I ever encounter a specimen which shows very different parameters in FBC (eg Hb and MCV without transfusion/bleed) as compared with that of hours ago, we will check the patient label on the specimen against the lab-printed barcode label. If it matches, then we will simply add in a comment to warn the physician to interpret this result with caution.

The design is very nice! May I request to put this up in my lab?