Blood group test each time you go into hospital.

[JohnRoss]

Can anybody explain the following. Every 5 years I have a colonoscopy and before this I see an anaesthetist as the French do this under a general anaesthetic. The gastroenterologist orders a battery of blood tests including a blood group test which I take to show the anaesthetist. I book an appointment for today at the local blood testing lab and they ask if I have a blood group card which I show only to be told that it is out of date despite being done at the same place 5 years ago.

So today I go to the blood testing lab with the prescription and am called into a side room and the lady sucks out several vials of blood, no problem and quite painless. "Go and wait in reception" she says after she has finished and I do. After a few minutes another nice young lady calls me into another room and sucks out some more blood so a hole in each arm now. I ask "Why can all the blood not be taken out at the same time, why two needles and two holes?" I get an look that one would give a small child that asks a silly question " Because it is the law Monsieur"

Now I am all for safety etc but as I have now collected three of these blood group cards for various reasons over the last 9 years and I assume your blood group does not change so why bother. It makes sense if the blood group is unknown or unproven of course. Also why two different needles and extraction separated by less than 5 minutes, why not take all at the same time. There is a slight risk of infection every time you shove a needle into someone, makes no sense to me. The extra time and needles must cost and I thought they were short of money. There must be a logical explanation, are they looking for aliens, dopplegangers, changelings?..................JR

[NormanH]

or AIDS?

[Théière]

[quote user="NormanH"]or AIDS?
[/quote]

How kind.

As many French physicians have discovered so many things over the years I guess it is a system and that's that. I would be more concerned with the general anathestic every five years. I don't know of anyone in the UK having a general anasthetic for a colonoscopy.

[Swissie]

Agreed Théière, it also struck me as being very strange bordering on dangerous. Is there a specific reason for this JR?

There was a huge problem some years ago with blood contamination (due to inapporiate testing of blood donations) and it cost France millions- and the health of many patients, mainly heamophiliacs. So all processes linked to blood have been greatly tightened up - even so, it does seem excessive. Why not ask the doctor when you get a chance, and report back. Bonne chance.

[JohnRoss]

Well having had them both in the UK and here I know which I would rather have. They are doing a gastroscopy at the same time. I don't think that it is deep anaesthesia and you are only out for a short time. No it is this extraordinary obsession with testing the blood group that I don't understand, makes no sense for your safety or for their costs....................JR

[Théière]

Without too much detail [+o(] what was the difference between the two countries techniques?

Again raising the question of safety and cost, an anathestic is both far riskier and more costly than a syringe and a needle site.

[Swissie]

No idea when you had the procedure done last in the UK, but as in France, technology and practice have improved greatly over past few years. Much better to have valium, or similar than full anesthesia- surely.

[JohnRoss]

I don't think it is that dangerous and by law you have to see an anaesthetist within a short time of any procedure needing anaesthesia just to make sure that you are up to it. Like many Crohn's sufferers I need regular internal inspections to make sure that things liked stalked polyps have not developed which if left alone could eventually become cancerous. I have also had part of the colon removed, covesical fistula and stenosis, here and the treatment was brilliant. They don't usually use anaesthetic here for a simple proctoscopy but to see further up a colonoscopy is needed. The first time in the UK they shoved 30 odd feet of fibre optic up me wotsit and that was only with heavy sedation. Other colonoscopies I have had in the UK were not a barrel of laughs what with violent colon spasms etc so it is much better to be asleep and not involved in the process as it were. If any one reading this is going to have one here in France please don't worry, I try not to, as they are very good at it in my opinion.........................JR  

[Théière]

Compared to giving a syringe of blood it is.

30 feet! the human colon is only around 1.5 m, (6ft), were they in the same room as you [:)]

Obviously a different procedure (small intestine)

[Russethouse]

I had a colonoscopy with just Valium 'sedation' I can't say it was pleasurable but it was not uncomfortable, no spasms,  and it had the advantage that I could see the screen which was re assuring.

[Sprogster]

The main reason that most colonoscopies are done under sedation, is that it reduces the risk of perforating the colon, in that having the patient sufficiently conscious to complain of discomfort, helps the doctor judge how much pressure to use. Also of course there is the added risk of a general anaesthetic and the further costs involved in a GA procedure.

[JohnRoss]

So nobody knows the answer then. You have to just hope that the doc knows what he is doing and that it is in the best interests of the patient I reckon......................JR

[Swissie]

Don't reckon - ask again and tell us. A Forum is not always the best place to ask specialist questions. Again, very likely to be linked to the famous French blood scandal of recent years.

If your French is up to it, Google  affaire du sang contaminé France.

[NormanH]

1)And if the colon is perforated, and you then need surgery, isn't it better that you are already under anaesthetic ?

2) I am sure that my reply about AIDS, generally ignored or ridiculed is the answer to the question about the frequency of blood tests.

Your blood group may be the same from year to year, bit your HIV status certainly isn't.

The blood test checks both, but without the implied insult of asking you to have a AIDS test before surgery..

[Théière]

1) The ratio of perforated colons to non perforated colons would not justify either the expense or risk associated with anathestic.

2) why would the patient have AIDS in one arm and not in the other, regular blood tests are required to look for tumour markers. JohnRoss specifically asked why two test (one in each arm) were carried out several minutes apart.

[Frenchie]

When you have to have an op, in order to make your new card, they need two samples because they are analysed in two different labs, in order to avoid mistakes, which of course would be lethal. 

That explains the two different samples taken.

[Clair]

This might help re blood group testing:

 

[quote]VALIDITE DE LA CARTE DE GROUPE SANGUIN

L’Etablissement Français du sang (EFS) est particulièrement vigilant sur la cohérence des informations figurant sur les cartes de groupe : L’identification du patient doit être complète et toute omission (ex : nom de jeune fille) ou imprécision (prénom incomplet) nécessite une nouvelle réalisation des deux déterminations du groupage sanguin. 

La carte n’est considérée comme définitive qu’après une deuxième détermination effectuée au sein du même laboratoire à partir d’un nouveau prélèvement réalisé à distance du précédent, ou par un deuxième préleveur.

La carte ne doit comporter aucune mention manuscrite ou gommettes autocollantes pour le groupe ABO : les anciennes cartes, portant des notifications manuscrites ou des gommettes ou sur lesquelles le phénotype rhésus n’était pas réalisé, sont donc à jeter. [/quote]

VALIDITY OF BLOOD GROUP CARD

The

French Blood Establishment (EFS) is particularly vigilant about the

consistency of information on card of group type: The patient

identification must be comprehensive and any omission (eg name maiden) or

inaccuracy (name incomplete) requires a new analysis of the two

determinations blood grouping.

The card is considered final after a

second determination is made within the same laboratory from a

new sample taken separately from above, or by a second technician.

The card must

not contain any handwriting or adhesive stickers to the ABO group: the old cards

bearing handwritten notices or stickers or on which the phenotype rhesus monkeys

was not realized, are to be disposed of.

[Frenchie]

Well, as for anesthesia, I'd rather have it !! As it seems it is just uncomfortable for some people, but for others it can be really painful, so much that they have to stop the procedure and anesthetize the patient.

Principe de précaution, once again.

Sometimes, I'm glad I'm French !! [:-))]

Claire, I had a minor op last year, and they said to me in hospital , that  they send one sample to a different lab , ( or maybe in some cases they analyse them in the same lab, but have it done by different technicians.)

No AIDS test done, unless one of the doctors/nurses is incidentally  in direct contact with your blood  .

[Swissie]

It's like saying all women should have ceasarians just in case, or that any tooth extraction should be done under GA.  Anaesthesia should be avoided whenever possible - for health reasons. But also as the use of theatre, extra nurses, several doctors, etc. It is hugely expensive, and in most cases totally unnecessary.  I would certainly refuse a GA. The OP's case sounds more complicated and therefore may well be a good exception.

BTW in the UK new research has recently highlighted that sigmoidoscopy, which examines only the lower part of the rectum, where 2/3rd of cancers occur, could reduce mortality by an incredible 43%. this procedure can be done by specialised nurses in outpatient clinic and takes 5 mins. All small polyps are removed during the procedure if present. Patients with larger polyps (over 1 cm) would then be referred for colonoscopy. Interesting.

[Théière]

When do they start the stop watch, 5 minutes, I think you'd want them to take a little more time and care. The waiting time obviously wasn't included or the evacuation time. Poor 1/3 who have cancerous polyps further round as they will be overlooked. If you are going the the discomfort of the proceedure may as well have the full colonscopy.

Good Idea that two blood test, especially as some of the staff in the NHS are not wonderfully gifted, some are though [:)]

[JohnRoss]

Crohn's is characterised by areas of inflamed intestine so that might make colonoscopies more painful. I suspect the 30 foot job is done where the gastroenterologist wants to identify the area of the gut affected, often the small bowel though in some cases the colon as in my case. This site suggests that some countries will use general anaesthesia whilst others will not. http://www.info-radiologie.ch/exploration-colon.php 

Normally this examination is performed under deep analgesia or anesthesia (complete). The choice depends on local customs and regulations of the country in which the optical colonoscopy is carried out..

As far as the blood tests go I noticed that the vials filled by the second nice young lady where two in number and that would make sense for blood grouping by two different labs. The first lot were for various tests like ESR, liver function, kidney function etc etc. Still does not explain why the samples could not be taken at the same time and why the blood group has to be retested every few years but there you go.........................JR 

[5-element]

[quote user="Swissie"]  I would certainly refuse a GA. The OP's case sounds more complicated and therefore may well be a good exception.


[/quote]

Sigmoidoscopy = possible to have just LA

Colonoscopy = GA

If it is not known in advance whether the procedure will  involve only the sigmoid colon, there is usually no choice between LA and GA.

Someone I know who had no anaesthetic at all for a sigmoidoscopy that went further, was terribly uncomfortable and in a lot of pain, and would never do this again.

If there is any investigation that involves (or might involve) the whole colon, there is no question that it has to be a GA. Especially if there is any suspicion of pancolitis or Crohns.The GA in that case can be very short-lasting (about 20-30mins). I had a colonoscopy with general anaesthesia, and the anaesthetic was the least traumatic part of the procedure!

 

[Théière]

[quote user="5-element"]

Someone I know who had no anaesthetic at all for a sigmoidoscopy that went further, was terribly uncomfortable and in a lot of pain, and would never do this again.

If there is any investigation that involves (or might involve) the whole colon, there is no question that it has to be a GA. Especially if there is any suspicion of pancolitis or Crohns.The GA in that case can be very short-lasting (about 20-30mins). I had a colonoscopy with general anaesthesia, and the anaesthetic was the least traumatic part of the procedure!

[/quote]

Someone I know who had no anathesthic at all for a sigmoidoscopy that went further was uncomfortable but not a lot of pain.

Someone I know also had a whole colon investigation (colonoscopy) with only a mild sedative, again uncomfortable but not a lot of pain.

[5-element]

I guess it might depend on the state of their colon. If there is inflammation or ulceration, it can be more than just uncomfortable.

In any case, I am happy to have the gastro-enterologist make the decision. So is my husband, who has various colonoscopies both in the UK and in France, due to severe ulcerative pancolitis (sometimes suspected Crohns). Once, in the UK, while under light sedation, the consultant proceeded to give him detailed instructions and advice. Unfortunately, afterwards my husband did not remember a thing, not even that the consultant had spoken to him! 

I am not sure that gastros here  leave the decision to the patient about what kind of anaesthesia they wish to have.

 

[minnie]

On the subject of General or Local, my oh had a colonoscopy last year and asked if he could have an LA instead of the GA. He was told by the consultant that only an anaethetist is allowed to give any anaesthetic in France. If they book the anaethetist for the procedure and have to pay him the full amount then they might as well go with a General anaesthetic. Anaesthetists are, apparently, not happy with giving Locals.

Of course, this may all be eye-wash!