Auntie-D

The Anti-D pos and neg is the control you need to do for every batch to control the methodology. This is in addition to a single daily QC for all reagents and cards in use. For the first batch of the day we set up a weak control, either D or K (we alternate each day) and challenge all grouping and screening cells and reagents. Just treat your whole blood control like a patient and it simplifies the whole thing

So it WAS Falcip. ? Everyone took the Mick out of me for calling a dual pathology! I never did get round to looking at the results...

How can a method be *too* sensitive. If they've got anti-c, surely you're best picking it up than ignoring it? I'd rather have a 3+ reaction than a 1+ reaction...

In the UK the primary mode is gel. I'm finding it a bit weird following this thread - I've been qualified 12 years and have never used anything other than gel for primary identification. The only problem I have found it that Ortho doesn't seem to pick up anti-Cw (but who cares ). Diamed (BioRad) seems much more sensitive all around. We can send IDs away to our reference lab (who use Ortho) and what we scored as a 2/3 will come back as 0.5! There have been 4 occasions in 2 years that we have identified an antibody with Diamed and Ortho hasn't picked it up. And we only do about 30 groups a week!

Ditto! It's hard getting the 'old timers' to stop doing films though

Someone's been plagiarising Dr Wiki and Professor Google...

I'd be interested in any reply to this. We still use HS D-dimers - huge numbers = DIC, <250 and Wells' Score less than 2 neg for dvt, >500 for PE

Oweee Rh-fan - red and big ack! Jeez... Yes I know it's either/or was just double checking... hit , instead of / Everyone else - thanks for the help Malcolm - I know it's only ever reported as extremely mild but this guy has that much wrong with him that he could probably do without a transfusion reaction on top of it all - no matter how mild He's a 'frequent flier' and we like to do our best for him He's a nice chap

Usually corrects itself if you do the group warm (not the antibody screen of course).

The answer to that is 'none'. It is the RBC contamination that is affected by it. It's a bit like asking 'how long is a piece of string?'

We have a patient that is on repeat transfusion and has had phenotyped (just CDEK) for over 20 years without developing an antibody. He has just been on holiday and has had his top-up in a well known teaching hospital who, despite being provided with full clinical information, EIed the patient unphenotyped blood! The patient has now come back home with an anti-f! We are a remote and rural lab and do not hold huge stocks of blood so now have to manage this patient. For routine top-ups he is now going to have to have two visits - a pre-sample t be sent away and then com in again for his transfusion. Logistically, this is going to create so much more work and also impact the patient's lifestyle as multiple appointments will cause problems at work My question is though, if he is to go into crisis at any point (bearing in mind that the nearest blood centre is 3 hours away), am I right in thinking the c-, e- blood will be negative for the f-antigen and thus suitable?

In our trust we do not restrict D- patients to D- platelets. There is very little evidence that there are enough red cells contaminating platelets to illicit and immune response. Platelets contain no Rh antigens so cannot illicit an immune response by themselves. This is a paper her covering one hospital's study. http://www.ncbi.nlm.nih.gov/pubmed/19856725 If you have any concerns and wish to be on the 'safe side', 500iu of will cover up to 4mls of blood - it is highly unlikely that the platelets are going to be contaminated with any more than this. And don't worry, giving D+ platelets wouldn't make the woman sterile... Edit - the sample applies to cryo and FFP.

I don't understand the question... Punctuation may help :tongue:

I disagree. If you purchase a cucumber and it goes past expiry before you eat it, you still have to pay for it. You can't just return it and say 'I didn't use this so I want a refund'. Why should transfused products be any different. The only exception I can see to this is if you have thawed units and they have been used on someone else. If someone has requested a thawing and the units have been wasted - they should pay.

The first thing I did was ask everything what bugs them and how can I help - I found there were lots of ideas bobbing around that my predecessor had vetoed. Really good ideas! Involving people with the decisions and shaping their lab how they actually wanted it really helped me settle in. It was just little things like doing a workflow analysis to help the day flow more easily - samples moving round the lab in a circuit rather than back-and-forth. I also took the pressure off a bit - my predecessor was a stickler for turn-around-times and insisted every sample be processed as and when it arrived in the lab. I suggested that 3 batches a day was enough - 10am for the ward round things meant that the first hour was free for getting organised, then 2pm and 4pm. Anything non-urgent arriving after 4pm now waits until the next day. I've also said that preops need only be done once a day so if the 10 o'clock samples are all pre-ops for 3 weeks away then the 10am batch doesn't go on and waits until the next batch. This also frees up time for people to take time to do Continued Professional Development and the like. Changing the workload like this hasn't made it any more difficult at 10, 2 and 4 but it has made it a lot easier between times. Of course there's always the odd urgent crozzie to contend with but my staff are much happier knowing that they don't have to break their backs. Oh and I've also introduced a radio!!

That is the truth!!!

Nah I'm one of those multidisciplinary freaks!

We have a standard comment of 'not applicable after transfusion'. You are right - the results would not be reliable. We do serum folate now so have eliminated that little problem

D-dimers are raised in pregnancy anyway so this has no significance unless you are querying DIC (but it's too low to point to that anyway).

Hospital policy is to use the wristbands in the case of an unconcious patient and verbal confimation for a concious patient. A delta check would pick up a failure in procedure. And if a delta check was ignored and a patient was transfused the wrong blood the legal people would be pulling their hair out. Delta checks are our final check to verify the validity of a sample. I've just this minute used the delta check and identified a drip arm sample on a patient with a Na of 118 - all the other results were low too compared with the previous sample. I've just validated the repeat sample and all the parameters are now normal. Reporting borderline calcium, sodium and the like could have resulted a patient being treated in an adverse manner. I LOVE the delta check

Ah makes sense for off site shipping

Just covering all bases Our medics are notoriously bad for not providing relevant information. Sample today ?LRTI but failed to mention that they were on chemotherapy which would have gone a long way to explaining the Hb of 70, neutrophil count of 0.5 and platelet count of 28. It would have also saved us a phonecall - the GP was completely unconcerned as those were the results they were expecting...

If the unit is to be transfused this is complete overkill. In the UK if the unit is going to be transfused to that patient then it can be out of temperature for 4 hours - it just cannot be put back in the fridge. A lot of hospitals have not taken this up yet as it is harder to track the time out of the fridge for 4 hours than 30 minutes. But we need to make things easier for them in an emergency, not harder. To validate the box ever time it is used makes more paperwork for them and more for yourself too. Once every 6 months, with the temeperature actually challenged is sufficient. We do a 6 monthly check winter check where we leave the box in a bike locker with a data logger in - this is challenging extremes of low temperature. We do this as our blood is transported by van and it takes about 6 hours to reach us. We also do a high temperature validation in the summer where we leave the box on our hot windowsill. In both cases we also use a data logger to record the ambient temperature to ensure there was indeed a challenge. IMO it's no use challenging the boxes to room temperature - they need to be challenged for the worst case scenario.

Bacterial?

Nursing staff do clerical check at their end (and sign the transfusion reaction form to say it has been done) and we do for anything we 'touch'. In both cases it is done by someone who wasn't involved in any of the process to reduce the risk of a 'cover up'.