21 December 2023 (Thursday) - Swearing at the BTLP-TACT

Time for a BTLP-TACT exercise… I had two cases:

 

79396 – A thirty-eight year-old chap in the haematology clinic requiring eight units of blood for an exchange transfusion (do they still happen?) for sickle cell disease

He grouped as A Rh(D) Positive with a weak D. With absolutely no idea what the “less than perfect(!)” software was expecting I called it indeterminate. But this is crap isn’t it (to be blunt). Given a patient in the haematology clinic known to have sickle cell disease requiring exchange transfusion, how likely is it that this dubious D group wouldn’t have been encountered and investigated years ago?

The antibody screen was negative, for which I was grateful.

I selected eight units of A Rh(D) Negative blood knowing full well the software wouldn’t be happy. 

16094 – A thirty-three year-old woman needing four units of blood for surgery.

She too was a pain in the glass (as my grandson would say). An indeterminate ABO group but was Rh (D) Negative, and a positive antibody screen (in cells 1 & 2). I selected panels…

The IAT and enzyme panels were positive in cells 1, 2. 3. and 5 corresponding with anti-D and anti-E but not excluding anti-Cw

I selected four units of O Rh(D) Negative which were also E and Cw negative

 

Needless to say I got the thumbs down. I’m not quite sure why though. Apparently I got the group bits right but selected the wrong blood components. But why I’d done that… It wouldn’t tell me. It has to be said that as a learning tool the blood transfusion simulator leaves a lot to be desired in that it seems to work in a way which is at odds to reality, and when you get it wrong it won’t tell you why.