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I have an idea of what I think it might be, but I would hesitate to say without a bit more information concerning the condition and underlying pathology of the patient. How old is the patient? Have they recently had something like an atypical pneumonia? I think, without knowing the answer to the above questions, that the specificity of the antibody MAY be between "anti-O" and "anti-Q". I would suggest performing an indirect DL-test. I may well be wrong, OF COURSE, but the attached may help. Paroxysmal Cold Haemoglobinuria (PCH).pptx

I was joking about the specificity being between "anti-O" and "anti-Q", in that anti-P, the specificity almost always involved in a case of PCH is a "cold-reacting" IgG anti-P that "fixes" complement (and P is between "O" and "Q" in the Western alphabet). A pretty poor attempt at a joke, I fully admit! While I am not saying definitely that it is a case of PCH, the fact that the patient has a suspected AIHA, that the auto-antibody appears to be "cold-reacting", that it is IgG and that it also involves activated complement, strongly suggests that this may be the line to go down as an investigation. We didn't perform a DL test routinely by any manner of means (despite being a London based Red Cell Immunohaematology Laboratory). It was always discussed between our own Consultant (or, at night, weekends or Bank Holidays) by the on-call Consultant, but all of the staff knew how to perform the test, even if they were a lone worker. We always used to dread being asked to perform such a test as a lone worker, as it took so long to do!

Man you got me good, started searching for anti-O and anti-Q and thought that I missed something big It's cool, no hard feelings! Anti-P sounds much more familiar. That's why we don't do DL test ourselves, we don't have time for it.

@Malcolm Needs......YAY! it always makes me feel a little "smarter" when my thoughts are consistent with your answers!!! PCH was my first thought!

First, blood given pre-hospital is quite routine these days. Both ambulances and helicopters are carrying Low Titer O Positive whole blood that they transfuse on scene in response to traumas and hemorrhagic shock. In South Texas, the ambulances and helicopters receive their blood directly from our blood supplier. Who will be stocking your helicopter? Will it be your facility? If so, you have a lot of work to do. If your supplier, you have nothing to fear. Second, when a unit is given pre-hospital, our EMS techs give the empty blood bag and a record of transfusion to the receiving nurse in the Emergency room, who then sends them to the blood bank (theoretically, practically we seldom get them right away). Our emergency room physician orders a type and screen upon arrival. Only if an antibody is detected (or we have a history of a clinically significant antibody) will we perform any crossmatching with the unit. I would suggest you google the topic Low Titer Whole Blood. It will help you answer your question.

Our LIS is set up to allow an EXM for PAT specimen outdates of 14 days if the patient qualifies for EXM.

When you use extended sample expiration, how does this affect electronic crossmatch? The sample collection date would cause our LIS to reject the EXM rule. Do you just perform IS serological crossmatches?

We do 21 days.

For those interested, this is what we have settled on for now unless it comes out that other locations are tracking something else useful: -Post-wash total Hbg >15 (Hct>45) to indicate good wash quality -effluent line clear or not -Also found post-wash heparin concentration of >0.5IU/mL as indicator of poor wash quality, but not sure if this is feasible to test anti-Xa levels... this one is to be continued.

Transfusion Medicine in our institution includes the Blood Bank/Transfusion Service, Donor Service and Stem Cell Processing Laboratory. Outside each facility we have the relevant signage. Some places it includes Therapeutic Apheresis, which in our institution is both physically separate (so is our Donor Room) and located in the Dept. of Medicine (Cancer Center). As long as the facilities are well defined, I'm not sure the overall name matters much, except on stationery, which no one uses much anyway :).

I would consider switching to Immuco ECHO Lumena before going to Grifols. You could also look at Bio-Rad's IH system for gel alternatives. That said, I prefer Ortho for gel and Immucor for solid phase.

I'm sorry, but I find this appalling. Fancy worrying you like that. I know that I said only 5 people per 1, 000 are Co(a-), but in 2014 (the last year to which I have access, as I am retired) NHSBT had 38 such units frozen down in the National Frozen Blood Bank, and well over 100 "walking donors", who we could call upon at any time, to provide "fresh, liquid" blood. If you compare the number of people living in the UK (and the size of the UK come to that) to the number of people living in the USA (and the size of the USA, where many of the individual states on their own are larger than the UK), you can see that the USA would also have had numerous compatible units frozen down, and would also have had many, many "walking donors". It is totally unacceptable that the medical staff should have frightened you like that, with comments that are patently untrue.

The first thing to say is that almost everyone is that, roughly speaking 98% of all the people within the White populations are Kp(a-), and, as near as makes no difference, 100% of the Black populations are Kp(a-), so this part of your group is not only normal, but very normal indeed. The part of your group that is rare is the fact that you are Co(a-). Only approximately 5 people per 1, 000 are Co(a-), so the chances are that your partner is also Kp(a-), but would be Co(a+). This means that your daughters are very likely to be Kp(a-) and Co(a+b+), getting their Co(a+) from your partner, and their Co(b+) from you. All that having been said, only the genes governing the red cell groups are inherited from their parents. Do I take it, from your chosen name, that you have an anti-Kpa and/or an anti-Coa? If so, do not worry for a single second. Your daughters will not inherit your antibodies, and it is these that cause problems and complications in pregnancy. For your daughters to have complications in pregnancy, they would have to be exposed to Kp(a+) blood, either from a transfusion, or by a previous pregnancy (their previous pregnancy, not yours). As I said above, the chances of their partner being Kp(a+) is only 2%, and even then, it has to be remembered that not everyone who is Kp(a-) and is exposed to the Kp(a) blood group make an anti-Kpa. Even if they do make an anti-Kpa, it is incredibly rare for anti-Kpa to cause any problems in pregnancy. In the case of the Colton blood group (the Co bit), as all of your daughters are likely to be Co(a+b+), and it is not usual by any means for people to make antibodies against a blood group they express, it is even less likely that any pregnancy will be complicated by anti-Coa. I'm not sure how well I have explained all that, but I really don't think that either you, or your daughters, have anything to worry about concerning problems with pregnancy as a result of your blood type.

I'm afraid my answer this time is going to be less helpful, because it very much depends upon the particular technology used by the laboratory, meaning that there is no single answer (and 28 weeks of pregnancy, from this point-of-view, is irrelevant - we would do the same tests at any stage during the pregnancy). The majority of hospital laboratories use a technology known as column agglutination technology, or CAT. With this, the reactants (for example, your plasma and a sample of donor red cells) are pipetted into what is known as a "reaction chamber" at the top of the column, after which the whole thing is incubated at 37oC (body temperature) for about 15 minutes, and the card is then centrifuged at a specific speed for a specific time (there is a bit more to it than that, but I don't want to go into too much detail and confuse the issue). This type of technology is superb for detecting clinically significant antibodies, but can be prone to detect clinically insignificant "cold-reacting" antibodies, that will cause neither a transfusion reaction, nor problems with a pregnancy (haemolytic disease of the foetus and newborn). These are sometimes called "false positives", although, strictly speaking, they are true positives, but not really the type of antibody we want to detect. This is a bit of a nuisance (for us). There are loads of other technologies and techniques, but the Reference Laboratories will have access to almost all of these. In addition, the Reference Laboratories will have access to many more examples of rare red cells and grouping reagents. In a case like yours, I would think that the Reference Laboratory would first work out the actual specificity of your antibody, and then perform tests (probably in good, old-fashioned test tubes) to see whether the antibody reacts at 37oC or at a lower temperature. This will tell them whether or not your antibody will need to be monitored throughout your pregnancy. I would be very surprised, given what you have told us about your case, if the Reference Laboratory would require another sample during your pregnancy, as 28 weeks of pregnancy is thought of as a sort of "cut off" point - BUT, I must reiterate, I am commenting "from afar", for one thing, and, in any case, am not allowed to diagnose or give specific advice to your case.

Thanks ELondon. Could I just say again, even if the Reference Laboratory does detect an antibody (or more than one, come to that), it is not a particularly abnormal thing in pregnancy, but it does not mean for one minute that the pregnancy will be affected; Mother Nature has seen to that. There is another Blood Group System named Lewis. The antigens within this system are soluble in the plasma part of your blood, and are adsorbed onto the red cells from the plasma (they are not intrinsic to the red cell membrane). During pregnancy, the concentration of plasma lipoproteins (fatty proteins in the plasma) can increase enormously (about four-fold). These plasma lipoproteins "mop up" the soluble Lewis antigens, and a pregnant woman, who would normally be, for example, Le(a-b+), can become Le(a-b-), and may even, temporarily, produce antibodies against the Lewis antigens (an individual hardly ever produces antibodies against an antigen that they express - but strange things happen in pregnancy!). In addition, ALL babies are born as Le(a-b-), so any Lewis antigens Mum produces will NOT affect the baby! There are many, many other antibody specificities that will not affect the pregnancy at all. Now, I should say two things. Firstly, I cannot say, from a distance, what is the antibody in your plasma (that can only be done by the laboratories at the Hospital and the Reference Laboratory, but it does not sound at all serious). Secondly, i am what is called a Biomedical Scientist, not a doctor, and so I am, by Law, not allowed to diagnose (as far as I know, neither is the midwife), and this is why I am so glad that you are going to see an Obstetrician, who, I hope, will be able to reassure you even more. Mean while, sleep easier, and enjoy your pregnancy!

PLEASE do not worry. Your midwife is COMPLETELY wrong, and really should not comment about something she patently does NOT understand, and about which she has a pitiful amount of knowledge. She should never have answered your questions with her lack of knowledge, but should have left it to your Obstetrician. I note that you are a fellow "Brit"! Within the British population, the percentage of people who have the R1R1 type (which is a type within the Rh Blood Group System) is 16%. Also within the British population, the K- type (which is part of the Kell Blood Group System) is 91%. What that means is that 91% of 16% of the British population is R1R1, K-, or, give or take, a few decimal points, 15% of the British population (about an eighth of the British population). On Friday, 19th October 2018, the British population was measured as 66,690,116! Let's call that 16.5 million in round numbers. This means that, give or take, 9, 975, 000 in Britain are R1R1, K-. Now, admittedly, your midwife will only be looking after women, but, even then, that means 4, 987, 500 women will have the same Rh type and K type as you! How your midwife has only come across your "rare" type four other times in her career, is beyond belief (and I genuinely mean BEYOND belief), unless, as I say, her knowledge of blood groups and blood group serology is incredibly poor, and I repeat, she should NEVER have worried you like this. Just in case you think that I do not know what I am talking about, I have worked in the field of blood transfusion/blood group serology for 43 years, have been an internationally invited lecturer and am the Chief Examiner in Transfusion Science for the Institute of Biomedical Science in the UK, and am a co-author of the British Society of Haematology's Guidelines for Blood Grouping and Antibody Testing in Pregnancy. I don't write that to "blow my own trumpet", as it were, but to try to reassure you that I actually do know what I am talking about. I should warn you that "consulting Dr Google" is equally as useless as listening to your midwife. You should really relax. YES, it is possible for you to produce red cell antibodies during your first pregnancy, but it is INCREDIBLY RARE. It is even more rare for such an antibody to cause any problems in a first pregnancy. I notice that the report from the Blood Bank was that they detected WEAK reactions with 26 of 30 panel cells, but they could not identify a specificity. They have requested three further samples of blood to send to the Reference Laboratory. Again, to give you some comfort, I hope, I ran a Reference Laboratory in London for 16 years before I retired in 2016, and we saw, quite literally hundreds of cases like yours. For a red cell antibody to cause any problems within you pregnancy, it would have to have a titre of 32 or above (this means that it would still be detectable when it has been diluted THIRTY TWO times). I can assure you that the mere fact that the Blood Bank reports weak reactions means that there is ZERO chance that the titre will be 32 or above. If a Hospital Blood Bank, however big or famous the hospital may be, cannot identify an antibody, it is almost universal practice that samples will be sent to a Reference Laboratory for further testing - AGAIN, DO NOT WORRY ABOUT THIS. There are many, many red cell antibodies that are clinically insignificant, both in terms of transfusion reactions and haemolytic disease of the foetus and newborn (which is what your midwife has left you worried about). I KNOW it is difficult, but PLEASE do not worry. PLEASE take no notice whatsoever of your midwife on this matter (I am sure she is an excellent midwife, but she is patently no expert in the field of blood groups), but DO talk to your Obstetrician, who, I hope, will have talked to your hospital's Haematology Consultant, who, in turn, will have spoken to the Consultant in Charge of the Reference Laboratory, and I am sure that they will echo my opinion that there is NOTHING to worry about. Oh, and lastly, I am R1R1, K- myself!!!!!!!!!!!!!