lateonenite

Cheers shily, I was asking a general question about the Rhogam dose rather than this patient - I have the creepy feeling because it's been a long time since I looked at our guidelines in Australia. I had assumed though (bad thing in a blood banker) that anti-D was given at the same or similar dosages everywhere. Do you mean that in China that prophylaxis is only given in certain cases and tailored to each patient? Thanks,

But seriously, can I ask a dumb question? Why is the Rhogam dose so high? We give 250iu first trimester, 625iu at 28 weeks, then another 625iu post partum if bub is Rh positive. We did have a 600iu dose in there somewhere for quite a while, but it was discontinued because bubs were showing signs of HDN from the prophylaxis. I think. I type this out and have a creepy feeling that I've misread something somewhere.

Is that another way of asking if they're crap Malcolm? *snicker snort*

Except, lol, when they want reassurance that the transfusion will be or has been "safe" and don't necessarily want to be the only responsible party. Admittedly that's usually toddler doctors (as opposed to baby-doctor-interns). It's equal parts amusing and frustrating in the middle of the night, because they don't want to wake up either the hematologist or haem reg.

We have an automatic test added to anyone with a positive antibody screen or history of a positive antibody screen that comes up on their side as "Crossmatch delay" and we answer it with a comment. We also notify the treating clinician if the patient has an antibody. If the phenotype is difficult, or there are multiple antibodies, we will order two units at least from Red Cross (but we also look at the Hb incase we need more). We have high enough stocks most of the time for straightforward things like Rh or Kell we can find units in our own fridge. The only time we will crossmatch without an order (which we soon rectify by either explaining to the doctor, or getting our hematologist involved to speak to said doctor) is if the patient has an auto and compatibility is impossible; then we get our hematologist to liaise with the clinical team - all incompatible units must be approved by our docs first.

We do all Rh neg and O positive mums and prems; but if the likelihood is an ABO, we don't elute if we have mum's history (meaning we have performed her antenatal screens and they're clear). I don't think it matters whether they act on the workup from our end of it (because presumably if they don't, the jaundice, if any, is mild); a lot of docs use the group and Coombs as exclusion of other things. Hmm, will ask resident brain box, however.

This makes me wish I could thank you twice. Or even thrice.

Thanks everyone!

That doesn't sound right. I've moved to a different health service using a different build - you should be able to have whatever you want. Then again, we only screen in one phase; if we use another phase (depending on the patient's requirements), we don't put that in Cerner. Maybe that's the difference. I'm not following why you have a different number of keystrokes for positive or negative. Can you tell me what the DTA's are? (You might be guessing I've worked on an implementation - you'd be right. I don't like it or hate it, but then I came from an old, old, OLD computer system prior. Most of the work was on the bench. That's right, gasp, immediate spin crossmatching. In 2009. )

I'll check them out, thanks. I just checked our library - we have five copies of the AABB manual - snicker - including two each of the tenth (1990) and eleventh (1993) editions. They'd be old enough to vote and get drunk by now. Love it.

Hi Malcolm, We're a staff of 12, a central lab servicing four satellite labs (meaning we are their reference for antibodies). The general level of staff knowledge is quite high, but we also train our own staff and those working in the satellite labs (satellites are usually multiple-disciplinary). I'd say on the basis of that, we need either a bit of both (general and reference) or one of each. I think we have at least 30 - 100 specimens per day, plus a lot of antenatal work, we'd crossmatch at least 20-40 units per day all up. Cheers, Fran

Hi, can anyone recommend a good reference text for blood banking? We have the usual lab collection of old ones, but I wondered if there was anything new out there. Cheers, Late.

Sorry, I haven't been checking the forums often enough. The only thing I'd bring up with anyone using emergency dispense, is once you assign the units to a patient (correct inventory, etc.), the time and date of dispense is set to when the emergency dispense happened, not when the units were actually given to the patient. Did you find this?

We had a lady who had an AIHA (and eight alloantibodies). Her Hb would drop fairly regularly, to the tune of about every three months she would reappear in the hospital. At 2 a.m, usually. She wasn't feeling very well, so she would sit up and watch her stories, in case her hospital stay this time went on for too long. Every three months meant that she would arrive in ED just after the new rotation started, so these poor fresh-faced baby docs would be faced with an antibody list as long as the metaphorical arm (she was very helpful about that with them, bringing in her Ab cards) and ring the lab in a panic.

"Hi, it's Frances from...where the hell am I?" "I don't know...you called me." It's always nice for them to turn the tables isn't it? (Usual is "I need product for my patient?" "Which patient?" "err, umm, hang on, I'll just get their details.")