Auntie-D

Get some cheap address labels and affix to the tubes so the ends are attached to each other rather than round the bottle. Dead easy write on then We can't change the rules and accept computer generated labels just because it's easier...

Might sound like a really daft idea but one way is to get the patient to go for a short jog beforehand. Believe me it works. Only if the patient is fit and well of course...

Another thought... Could the positive reaction have been due to Wharton's jelly?

As 85% of the Caucasian population is K neg it isn't at all a big ask. Randomly selecting a bag from the fridge would only have a 15% chance of it being K+ which is why incidence is low. Yes incidence is low but the consequence for the 15% of those 15% who have a K+ baby is severe. And you really should credit you staff more intelligence. I find your statements about generalists quite insulting!

I've seen K, C and c that haven't shown up at 28 weeks but were present at delivery. Fortunately everywhere I have worked so far tests mothers at delivery, if they weren't tested it wouldn't have been known until the next pregnancy or during a requirement for blood. Better to be prepared IMO, especially since some antibodies can have the titre fall to ur detectable levels over time. Catch them while you can

Why are you antibody screening newborns out of curiosity? A cord sample for a group and a maternal sample for antibody screen is recommended, but only if the baby is for transfusion. There is no need to antibody screen a newborn as you are effectively just testing the mother... As for why the baby shows it but the mother doesn't? The Placenta actively transports antibodies across resulting in a (usually) higher titre in the baby than the mother. Maybe the mother does have the antibody but in too low a titre to be detected.

Malcolm you really are the font of all knowledge!

Agreed with others about circulatory overload but another way to look at it is that a person with a Hb of 4, transfused numerically, could get 6 units of blood. That is 6 donor exposures. Imagine if that person developed and antibody to an antigen in every pack and ended up, with say, 6 different antibodies. What happens if that patient then needs blood due to an actual clinical need? There was an african descent chap who had had a few top up transfusions (reason never investigated) who developed 3 antibodies. He was admitted into hospital with moderate GI bleeding and a rapidly falling haemaglobin and 6 units were requested. I cross matched 6 and all came up strongly positive. I set up a panel and empirically cross matched the whole of our blood fridge resulting in only one suitable unit! Samples were sent to our reference centre who had no suitable units, they forwarded the samples on out of the area and two more were found suitable. The surgeons were reluctant to transfuse incompatible blood and gave just the one unit that morning. The two other units arrived late afternoon and the patient was taken to theatre. At the lowest point his Hb was 4.2 and after the surgery and 3 units it was 5.4. He was put on iron and erythropoietin and had no further transfusions. He left hospital 3 weeks later with a haemaglobin of 8. He now does autologous frozen donations This happened when I was Still very new to the job and I have, fortunately, not seen a similar case since!

Think of it in volumes gained. If 500ml is drawn that would only give you 190 ml or less in a pack so I'd say no. Better to send the patient away to their docs to organise getting their Hb up so they can donate a decent sized pack next time Also why is their hct less than 38? Should that be investigated?

Here's a question for all... Chronic anaemia in a walking well patient - why transfuse? Their bodies have adapted... If there is no medical reason a Hb can be returned to 'normal' in about 3 months with iron infusions and/or folate/b12. Our lady with the Hb of 2.4 wasn't transfused and recovered perfectly well with just iron infusions and folate supplements. How can donor exposure be justified, based on numbers alone, if the patient is clinically well?

We had a vegan with a walk-in haemaglobin of 2.4, the lowest I have seen, with recovery, in massive blood loss is 2.8. TBOstock - that is an amazing story! Edit - I forgot to add that this lady wasn't transfused either. She was given iron infusions and folate and within 3 months her hb was 12.5! Yes she was symptomatic, but her body had adapted so transfusion was deemed unnecessary

One thing to remember with gel packs is that they need at least 24 hours to cool fully, so any used packs must be quarantined (we do for 48h) to allow them to become cold enough. We found that if they are just cooled for 6 hours they do not keep their temperature. Or boxes are validated for 12 hours with 2 packs below, one to each side and one above, for up to 6 units. For every unit less than 6 a cool pack needs to be added to eliminate the dead space.

EI is only permissable for a completely closed computer system with no manual entry. As soon as anything need to be entered manually EI is no longer appropriate.

Really happy with them for customer service, price and quality!

It is not advised as pressure and centrifugation during transport can lyse cells.

Here's a thought? Was the tube examined under a microscope? If not, it cannot be guaranteed that there is not microagglutination that cannot be easily seen by naked eye...

Malcolm - you do like to accentuate your posts don't you? *I did give you thanks for that post though*

*face plants* Edit - my favourite is : "Positive antibody screen? Well we'll just give them flying squad - that's suitable for everyone. Right?' Edit 2 - it wasn't a top up for IDA was is?????

Better safe than sorry

I don't look at it as the likelihood - I look at it as the consequence. Are you possibly going to give someone a DHTR? I don't think I could live with myself issuing a negative result over a more sensitive, positive result...

Grief! 7 days? Our cells have a 28 day expiry on and show no loss of reactivity during that time. We used to use Diamed to the same effect but now use a donor-centre's own cells as they are much cheaper.

Our albumin has an expiry of 9 months if kept at root temperature. We date the bottles from when they were removed from the fridge and will discard if the 9 months is past. We are actually now considering disposing of them as there is always the possibility that the room temperature has reached over 25oC. I'm looking for evidence of degredation when not temperature controlled and will make my decision based on this...

It could probably be easily solved by keeping the reagents in the fridge more. We keep ours (though not ortho) in the fridge unless they are actually being opened for use. They go back in the fridge immediately after - not after the antibody screen is finished... Edit - the expiry quoted is based on the reagents being kept in the fridge. If they are out during the day then you will expect degredation.

We have a 3 phase approach 1) Group specific - where there isn't time for a full crossmatch but not critical enough to warrant 'flying squad' - 10-15 minutes. We do a rapid tube group and an immediate spin crossmatch to rule out ABO incompatibilty. An retrospective full G&S and crossmatch is done. 2) Emergency crossmatch - where fully crossmatched blood is acceptable insufficient but there is insufficient time to wait for phenotyped blood and a new panel (usually for people with known antibodies). Blood is issued empirically crossmatched within 45 minutes (manual). I believe the TAT for an analyser crossmatch is more in the region of an hour. 3) Fully crossmatched - sufficient time to wait for a panel and phenotyped blood - TAT is 6 hours minimum. We are at least 2 hours away from our nearest centre so this usually only happens for electives. In my last lab where the testing was done 'in house' the TAT was 2 hours. HTH