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I think this phenomenon is because the B antigens are not well developed on new born baby. BTW, I prefer to use 3+mf to describe it The reason I don't use 4+mf because 4+ agglutination is a kind of solid agglutination, without free cells .maybe I was wrong, just personal opinion.

I totally agree with yan xia about the cause of the mixed-field. A, B and H antigens are not direct gene products (they can't be, as the antigen is a sugar molecule attached to a polysaccharide molecule), whereas the D antigen is a protein, and so is a direct gene product (give or take a few post-translational changes). The gene products of the ABO and H genes are transferase enzymes (alpha-1-3-(or alpha-1-4)N-acetyl-D-galactosyltransferase for the A antigen, alpha-1-3- (or alpha-1-4)N-galactosyltransferase for the B antigen, and L-fucosyltransferase for the H antigen), and these enzymes are not working at their optimum at birth, and so it is not unusual to see mixed-field in the samples of newborns, particularly if they are premature. As the Rh antigens are direct gene products, i.e. proteins, mixed-field reactions are birth are very rare indeed, and usually there for a completely different reason.

The laboratory medical director has the final responsibility for these protocols. Your medical staff should review the policy and discuss it with him/her. We have emphasized that a fever can be the first indication of a hemolytic reactions and the transfusion must be discontinued and a workup performed.

Concur.

We type pregnant women as well. If, there was evidence of a fetal/maternal bleed, we would treat as we would post transfusion (not that it has happened here before!) s

Congratulations on your decision to retire. I highly recommend it.

I'm curious about the "diagnosis". Was the allergist thinking out loud about possibilities? Or has he done some diagnostic testing and issued a report? Could a hyper-reactive immune system respond to some of the effects of storage on RBCs or WBCs? (I'm really going out on a limb here since by knowledge is limited). I've collected donor blood in glass bottles 40+ years ago and more recently for my brother-in-law the veterinarian who needed to transfuse a dog. I don't know if they're still available.

I have had physicians tell me that patients can't have transfusion reactions to autologous blood and that hypotension is not a sign of a transfusion reaction (even though there is a type named that). I've seen them order irradiated blood because they think it is less likely to transmit infections. If the patient has been spiking a temp for another reason and they write off this temp which is actually due to TRALI or a hemolytic reaction and keep giving more of the unit, they have done the patient harm. If you can tell whether there is a reaction going on by playing the odds based on the patient's history and condition then why do we ever do the testing? I've never had to let a heavily bleeding patient wait for a transfusion reaction workup. If their life was in danger from bleeding the medical director would override the usual policy if needed. I'm afraid, in my experience, the pathologists are more knowledgeable than the bedside physicians in may cases.

Also - examine your Joint Commission Standards if your Lab happens to be under Joint Commission accreditation. QSA .05.18.01 - section 2 and 3 state in part: 2. The requirement that suspected transfusion reaction-related adverse events are reported immediately to the laboratory, whether or not the physician responsible for the patient deems it necessary to report the event. 3. Policies and procedures for nursing services related to blood and blood component administration do not conflict with the laboratory's policies and procedures. That is fairly definitive about what they want to see and it differs from CAP. We had to change from " what does the physician want to do" to "we need the Transfusion Reaction Workup" if we hear about it at all. Curious as to what Hospital Joint standards say about the whole thing - I have never seen that set of standards. And most hospitals are accredited by Joint Commission, even if their Labs are not.