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.
