Auntie-D

I'd go for the Sysmex - used it in the past and it's great for reprucibility between analysers and also 'down time' due to maintenence. Whatever you do stay away from Sieman's Advia 2120i. The analysers have horrendous down time. It takes about 4 months for the laser to 'bed in' so in the meantime there are 'issues'. Also it works on peroxidase staining and as about 1% of the population are peroxidase resistant you end up making films and doing a manual diff on LOTS! Another problem is that is has a closed system rather than tubing so if you get an unclearable blockage you have to replace a whole unit rather than just a little tubing... EXPENSIVE! Also the peroxidase bath has very tiny holes (think way smaller than a shear valve) that you cannot clear if there is a blockage - new bath EXPENSIVE! Oh and did I mention that we signed up for a managed service contract and it turns out that reagents aren't included, nor are parts. Oh and they doubled the reagent prices immediately after the contracts were signed (even before the analysers were installed).

Are you making the Leishmans up from powder? If so, how long are you leaving it to 'ripen'? It needs a minimum of 6 weeks in a dark cupboard for optimal staining. As Khalidm3 stated - it also needs to be a saturated solution - this will mean it will need filtering before use. Another thing to look at is how the slides are prepared - slow drying time can make stain uptake poor, as can heavily bloodstained preps.

Give them all the references you can find about FFP/cryo being better for the patient than colloids. Once we educated them about this (and told them that we are more than happy to issue lots of the product - as we have lots of it) they started following our MHP to the letter. Patients really do seem to recover more quickly, and less red cells seem needed when you treat volume loss with FFP rtaher than colloids. It's just easier to stick a bag off colloids up though than request, and sign for a bag of FFP...

Malcolm - agreed fully! The reason I prefer tiles is that it's so much easier to see even the smallest agglutination on them. I did my HNC project (way back lol) on weak-D idnetification between tube, tile and gel. Turned out that tile is almost as sensisitive as gel, and both are hugely more sensitive than tube. I feel it is operator sensitivity that is the key - how many, when using tube, do a microscopic examination of any negatives for micro-agglutination? Tile is sooooo much easier to see tiny agglitinations.

We now do. Scenario - patient with a massive haemorrhage - stock running low - more blood ordered for patient *and* stock and flying squad replacements. Doc intercepts the delivery driver and takes ALL the blood! And then high tails it out of the hospital to the airport to helicopter the patient away. With a lab staff member giving chase to retrieve the A+ blood that really wouldn't be suitable for the O+ patient... Our forms now include instructions that the products are only ever to go to the laboratory!

Macolm - I much prefer tiles for rapid groups, rather than tubes but all of my staff are reluctant...

It's sodium hydroxide - foetal cells being more resistant, don't lyse. Foetal cells red, maternal cells green/brown. Used to determine if the cord blood is actually foetal when the maternal and baby group are the same. A dummy question from me here - you say 'fixed by washing more' so do you wash all your foetal cells? I've never worked anywhere that does wash foetal cells (unless there is a problem), but then I've never worked anywhere that uses clotted samples either...

I can see how it would work if the clot hasn't fully formed. But what happens if the clot has fully formed and all you have left is serum? That's my point. All well and good if you catch the sample before it has clotted fully but what if the clot is complete? Surely it's just easier to use EDTA?

I'm not young enough to never have done a tile group But if you are using clotted blood I assume you are doing a reverse group using the serum? Baby ABOD are notoriously weak in some cases - could this result is a 'changed' group in the future? Also how do you confirm that the cord blood is indeed foetal? If the sample is clotted you can't do a NaOH test... I just can't get my head round how this can be safe Edit - crossposted with Ann.. I'm still not convinced by this... At very least it is a faff

Just a completely dumb question here but if the sample is clotted how do you group the babies? Edit - we get EDTA only

The pre-validated ones are well worth the money. A lot of labs validate their own using data loggers but this is a pointless exercise as it is very difficult to actually challenge the temperatures. We validate ours by exposing to extremes of temperature in summer and winter but this is actually quite difficult to do. One thing to remember is the boxes should be revalidated annually also

If the result is 'negative' we issue a report stating that the bleed was less than 4 mls - 500iu *should* cover a bleed of up to 4ml.

Oh but it does... As Malcolm so eloquently demonstrated

The simple answer is because gel is a-more sensitive and b-easier to read. My bet is that if you redo your panel in tube and examine the cells microscopically there will be agglutination...

If someone initiates the MHP we automatically issue them with 6 units group specific (they should in theory have had 4 flying squad to be going on with until we get a group), 4 FFP and 2 cryo. As soon as someone initiates the massive haemorrhage protocol we order 4 platelets as we are 3 hours away from our nearest blood centre. We ensure that they have a designated 'runner' - usually one of the junior docs as they are able to communicate better the potential need for more products (other places have used porters as runners but this can create confusion IME). We keep issuing 6,4,2 (and 2 platelets) until they tell us to stop. After the first 10 units (if given within a 24 hour period) we issue uncrossmatched and don't retrospectievly crossmatch - with such a fluid loss... One thing our wards have found invaluable, with us being such a small centre, is a 4 monthly 'dummy run'. We do it every 4 months due to the doctor's rotation - they seem to find it quite helpful for their training in how to cope in a crisis We recently had a RTA - biker vs car - and the patient had a ruptured spleen and liver. We used 31 red cells, 16 FFP, 8 cryo and 4 platelets and the patient survived! It was eeirily calm taking the blood to theatre. Noone got confused, noone flapped, everyone knew their roles, the medical team knew that we were going to keep the blood coming, you would have barely known it was a crisis!

Our repeat depends on the time since tha last transfusion or pregnancy/gestation.

I used to be able to access the arcade through my arcade stats in my profile - this seems to have disappeared Any ideas anyone?

There were two 'phenomena' seen. on was dual populations the the groups of chemo patients, the other was a persistent missed weak antibody - never clinically significant ones, just anti-Cw.

A tip from a trainer It's better practice to refer to SOPs when you get stuck rather then your own notes. It's easy to get things 'back to front' when writing them down the first time you see it). If you follow the SOP you are doing it the way it is meant to be done. If you follow your own notes and you make a mistake you could be disciplined for not following the SOP. Example - someone I trained took down the dilutions incorrectly for neonatal grouping and effectivly wasn't doing a DAT at all for about 3 months. Luckily I did a review after 3 months to check how he was doing and picked this up. Unfortunately it meant that a lot of babies had to be recalled and bled uneccessarily The chap was convinced he was doing it correctly as he was folowing his notes - unfortunately his notes were wrong... But enough of the alarm stories! You'll love your job 99% of the time it's a dull as dishwater but that 1% of the time is buzzing!

This does work But be careful as if you don't use a locking needle you can end up creating a sperm laden missile as the pressure can shoot the needle off the syringe (been there )

I've found this with analyser v/s manual technique too - the Diamed Gelstation samples from the bottom whereas people tend to sample nearer the top or middle.

Have you checked the tube under the microscope to see if there is agglutination but you just can't see it?

Griffols does an 8 well card that does 2 Ds and also Kell

Could the complement have come from Wharton's Jelly from the cord? Was a repeat done on a heel ***** sample? Edit - OH come on!! That is a geniume word and not swearing. Heel stab - is that any better?

It is specific for the UK but the infomation is pretty general. I'm sure you could register outside of the UK...