Auntie-D

The reference lab called it a 'non-specific' cold. Looked pretty specific to me with decent reaction strength and even showing dosage... ** hum - they're the experts I suppose...

Not as costly as a transfusion reaction with a new antibody... That being said our samples in the UK are valid for 7 days unless the patient has been transfused within the last month.

There are talks about giving only ONeg until a second sample has been received thus eliminating ABOD problems. In the case above it wouldn't work but I think it could be a good idea - if only we had enough ONeg

A baby will only have maternal antibodies at birth so an antibody screen (and reverse group) are not necessary. The group should be done on cord blood and any crossmatches should be done against the mother's plasma/serum for newborns.

Not sure about how it is in the US but in the UK the second group can be just a forward group. I did work in one lab that allowed EI on 2 groups done on the same sample - needless to say they lost accreditation at their first inspection

If you have a look at some recent posts you will see there are a few of us 'newbies' to management here - I've been doing the job now for 2 and a half years and I never expected it to be hard - but definitely rewarding. One tip - don't try and change thing straight away, it won't gain you any plus points. Make lists and creep the changes in! Also if it doesn't break CAP standards don't worry about it - you will have plenty to deal with without worrying about the smaller details And ask people what they would like changing - you could make people happy Welcome and enjoy the support from this site!

Ha ha after all I said in my post earlier, we get one in the lab and I still err on the side of caution until it is confirmed lol

There is dosage so I am almost certain that there are two antibodies there. One if definitely anti-M - the only one that fits with the picture. The other could be either S or Lea. How strong would you consider strong? I'm wanting to err on the safe side - we are 120 miles away from the next nearest hospital which is at least 3 hours by road. Is a 4+ reaction strong enough to be considered strong?

Here's one for you. 70yo M with upper GI bleed, no previous transfusion history in 11 years. Negative antibody screen in 2000. Firstly - we are a small, remote and rural lab and do not offer antibody identification as part of our service. All IDs are sent away to our 'hub' lab. I've just tested the current sample and it's given a 1+ reaction in cell 3 in out 3 cell screen. The sample will be sent away but I thought I would do a little further investigation to put my own mind at rest as to the clinical significance - after all the patient is bleeding and there may be a requirement for blood. Possible antibodies at this point are S and Lea. My first step, as the reaction was so weak was to respin the sample and repeat the 3 cell screen. I also put up our 2 cell rr screen just to increase the possibility of eliminating something. As the reaction was very weak I also ran the same at room temperature. The results of the 2 cell screen was a positive reaction in the first cell, not eliminating anything. But Imagine my surprise when the RT mini-panel showed a reaction in both cells 2 and 3. There was dosage, with cell 3 reacting as 4+ and cell 2 reacting as 3+. The first cell of the rr screen was also reacting 4+. This gives the possibility now of E, c, M, S, K, Lea, Fyb and Jkb I'm steered towards two antibodies with one being IgG and the other IgM. Of the possibilites I am elimiating E, c, K, Fyb and Jkb due to them being IgG. This leaves S or Lea (from the original screen) plus M. I am thinking that S is more likely than Lea. So what do you think? Please bear in mind that I am not trying to identify the antibody to put it in our records, more for interest. I am going to recommend and empirical crossmatch at 37 and RT IAT and instruct the use of a blood warmer. Hopefully what is negative at 37 will also be negative at RT... I'm also going to suggest that the patient be transferred.

Challenging of alarms is important though to ensure the procedure works. It would be unfortunate to find this after the event. In fact, how would one know if it weren't being challenged?

You can use what Diamed/Biorad call 'D blend' to cover all (most) D-types. But separate to this there should always be two groups done on a patient from seperate alequots for ABO and D. ABO is covered - you can either use whole blood (forward), spin (reverse) or packed cells (forward) spin (reverse). You also need two Ds from separate aliquots too. As well as identifying as many D subgroups as possible, it also reduces patient mixups - if you use two separate alequots from separate spins you are likely to pick up a discrepancy between the forward/reverse or two Ds. Use just the one spin and there is a risk of sampling the wrong patient twice and increasing the risk of issuing a false group. The weak D thing is a separate issue. The second monoclonal D is a 'failsafe' on the grouping if done manually. Not sure where we actually stand with automation. Everywhere I have worked doesn't do two Ds if the analyser is used.

I'm looking for an adventure and possibly looking for a job in Sao Paulo, Mexico. Does anyone know where the best place is to start looking?

To be honest - I'd rather not be in a position where I prove something is a problem. The practice you descibe would not be permitted in the UK without full validation on each donor and timeframe first - evidence based medicine as you describe. Just because it is done that way in the US doesn't mean that the rest of the world is wrong - check out data on opportunistic baloon ablation of narrowed renal arteries in patients with both CHD and CKD. The US has led the way with doing this and many have followed suit. There has recently been a multi-centre, worldwide study showing that the practice increases morbidity and mortality. Until I see evidence of the stability of antigen sites on sagm donor cells I will continue to use panel cells treated for optimal antigen stability. I do not wish to risk the prozone effect.

Our microbiology department do it

Thought I'd see if there is any difference between haem only, chem only, combined blood sciences and multidisciplinary. We're multidisciplinary...

So we have just got the Grubbyment figures in and it seems we are working twice as hard as our 'hub' hospital. As a 'spoke' we are processing just short of 180,000 samples per staff member, per year. Our 'hub is processing just over 90,000 per staff member, per year. I was AMAZED! And we work out 20p per test cheaper... So how are we against everyone else? Are we massively overworked? Is it about average? Edit - It autocorrected the poll question - that isn't my poor spelling! It did it twice too... Spelling police - please don't get me

So we have just got the Grubbyment figures in and it seems we are working twice as hard as our 'hub' hospital. As a 'spoke' we are processing just short of 180,000 samples per staff member, per year. Our 'hub is processing just over 90,000 per staff member, per year. I was AMAZED! And we work out 20p per test cheaper... So how are we against everyone else? Are we massively overworked? Is it about average?

Fully agree with this - if you lose your job who is going to keep an eye on them? You have done your bit - you have reported it. It will all come out in the wash eventually

Bew member and so far both started threads are promoting products - I suspect this is actually a spambot advertiser...

This is an entirely unsatisfactory practice - units for crossmatch are treated for optimal oxygen carrying capacity, screening/antibody cells for optimal antigen life. A unit of blood may not have sufficient reactive antigen sites to allow reaction in vitro to occur. They are perfectly capable of illiciting an immune response though.

Ahh get you. I'm reluctant to have two on the go and repeat things so I just use the eKSF one for both. You can still store the documents just not link them

You tried the e-ksf one?

So, for example, take a patient with anti-D. Patient has lived in the area since their first cord blood sample at birth so full transfusion history. Patient comes back for a transfusion for a.n. reason and the 3 cell screen is strongly exhibiting a reaction in the first two cells of your 3 cell screen. How do we know that the patient hasn't had a transfusion elsewhere and developed anti C and E? Even patients with a full history sometimes get transfused elsewhere - hence our patient with an anti-f

Ta for putting the ref Yiams - was busy busy at work earlier... There's another article somewhere based on a multi centre massive trauma study that recommends a 1:1 PRC:FFP

Don't think of it in terms of red cells given, think of it in terms of red cells lost. They are not going to be returning their Hb to 'normal' they will be aiming for 10 or so once the bleeding has stopped. 6 units might not sound like a lot but if they transfuse 6, it's more than likely that the patient has lost more than 10. If someone has lost their whole volume of red cells, they are going to have also lost their whole volume of clotting factors. 6 units doesn't sound like much but for me that would be all of my blood! tients in terms of volume replacement than colloids. Fluid replacement by colloids, to maintain BP, has been show to reduce the clotting factors and seriously increase the time bleeding. By relacing fluids with FFP and cryo we are replacing the clotting factors, as well as the fluid loss. educed. There is no evidence that giving platelets for someone with a platelet count over 50 shows any benefit. Barabarakym - our Cryo is 5 donor pooled.