Antenatal monitoring of anti-D and anti-c: could titre scores determined by column agglutination technology replace continuous flow analyser quantification?

OBJECTIVE: To determine if column agglutination technology (CAT) for titration of anti-D and anti-c concentrations produces comparable results to those obtained by continuous flow analyser (CFA). BACKGROUND: Anti-D and anti-c are the two commonest antibodies that contribute to serious haemolytic disease of the foetus and neonate (HDFN). Current practice in the UK is to monitor these antibodies by CFA quantification, which is considered more reproducible and less subjective than manual titration by tube IAT (indirect antiglobulin test). CAT is widely used in transfusion laboratory practice and provides a more objective endpoint than tube technique. MATERIALS AND METHODS: Antenatal samples were (i) quantified using CFA and (ii) titrated using CAT with the reaction strength recorded by a card reader and expressed as a titre score (TS). RESULTS: The TS rose in accordance with levels measured by quantification and was able to distinguish antibody levels above and below the threshold of clinical significance. CONCLUSION: CAT titre scores provided a simple and reproducible method to monitor anti-D and anti-c levels. The method was sensitive to a wide range of antibody levels as determined by quantification. This technique may have the potential to replace CFA quantification by identifying those cases that require closer monitoring for potential HDFN.

When and why is blood crossmatched? A prospective survey of transfusion laboratory practice in two regions in the north of England.

BACKGROUND AND OBJECTIVES: This study was undertaken to provide data relating to the timing of laboratory crossmatch procedures, and the source of requests for out of hours crossmatch, to support interpretation of error reports originating in the transfusion laboratory, received by the Serious Hazards of Transfusion haemovigilance scheme. MATERIALS AND METHODS: Data on the timing, origin and urgency of all crossmatch requests were collected in 34 hospitals in northern England over a 7-day period in 2008. Additional data on clinical urgency were collected on crossmatches that were performed out of hours. RESULTS: Data were obtained on 2423 crossmatches, including 610 (25.2%) performed outside core hours. 30.3% of out of hours crossmatch requests were for transfusions that were set up outside 4 h of completion of the crossmatch. CONCLUSION: 2008 Serious Hazards of Transfusion data showed that 29/39 (74%) of laboratory errors resulting in 'wrong blood' occurred out of hours whilst our audit shows that only 25% of crossmatch requests are made in that time period, suggesting that crossmatching performed outside core hours carries increased risks. The reason for increased risk of error needs further research, but 25 laboratories had only one member of staff working out of hours, often combining blood transfusion, haematology and coagulation work. A total of 25% of out of hours requests were not clinically urgent. Hospitals should develop policies to define indications for out of hours transfusion testing, empower laboratory staff to challenge inappropriate requests and ensure that staffing and expertise is appropriate for the workload at all times.

Where and when is blood transfused? An observational study of the timing and location of red cell transfusions in the north of England.

BACKGROUND AND OBJECTIVES: This study was undertaken to provide denominator data relating to the timing and location of transfusion, to support interpretation of reports of incorrect blood component transfused (IBCT) events to the UK Serious Hazards of Transfusion (SHOT) scheme. MATERIALS AND METHODS: The study was carried out in 29 hospitals in northern England. Data on the timing, location and specialty responsible for transfusion were collected retrospectively (usually the following day) for all red cell units transfused over a 7-day period in September 2005. The timing and location of transfusion of these units was compared with those IBCT reports to SHOT between 1 January and 31 December 2005 in which there was an error in blood collection from the hospital storage site and/or administration to the patient. RESULTS: Data were received on 3123 red cell units, 3118 of which were analysable. Individual hospitals returned data on between 1 and 279 units. The data showed that 888 out of 3118 (28.5%) of units were transfused between 20:00 and 08:00 hours, while 63 out of 169 (37%) of IBCT reports to SHOT where there was an error in blood collection/administration were recorded as occurring during this time period. CONCLUSIONS: Comparison of our data with those from SHOT suggests that transfusions that are given outside core hours are more likely to be associated with clinical errors.

An audit of delays in diagnosis and treatment of lymphoma in district hospitals in the northern region of the United Kingdom.

Prompt diagnosis and treatment of malignant disorders is generally regarded as improving outcomes. There is good evidence for this in the most common solid tumours, bronchus, breast and large bowel. It might be expected that delays in diagnosis of lymphoma could affect the outcome of treatment, as well as causing dissatisfaction among patients and relatives. However it would be difficult to obtain definite evidence for this as a randomised trial of delay is an unethical proposition. The recently introduced National Priorities Guidance (NPG) Cancer Targets require that all new patients with suspected cancer should see a specialist within two weeks of referral by their General Practitioner (GP). There is no good evidence to support this requirement in lymphoma, but we decided to audit delays at different stages of the process of diagnosis and initial treatment of lymphoma as a base line to assess current performance, identify possible shortcomings and set achievable standards amenable to further audit.

Falsely prolonged prothrombin time due to an inhibitor to human thromboplastin.

A patient with nephrotic syndrome of unknown aetiology was found to have a grossly prolonged prothrombin time in the absence of any other coagulation abnormality and with no clinical bleeding problem. Subsequent investigations showed his plasma contained an inhibitor-like substance, directed against human but not animal thromboplastin.