RichU

NHSBT routinely perform IAT and enzyme IAT using BioRad LISS/Coombs cards. (Anti-IgG + C3d). I found this helps identification with some weak antibodies or where there is a mixture and one is enzyme sensitive. At my current hospital we still perform enzyme panels on NaCl cards. There are less reactions with antibodies we don't wish to detect. Of course you can't use enzyme techniques alone when identifying antibodies so it's a choice between; improved identification and detecting more insignificant antibodies (enz IAT) or Detection of fewer bothersome antibodies but harder to ID some cases (enzyme). Maybe use IAT and enzyme routinely and employ enzyme IAT to help solve tricky/weak examples? You would have to do some kind of testing/documentation/risk assessment etc. if you're not following manufacturer's package insert I assume.

BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn states 'Anomalous or indeterminate cord Rh D groups should be treated as D positive until confirmatory testing is completed.' For neonate transfusions see Malcolm's answer.

I used this case study as part of my Higher Specialist Diploma in Blood Transfusion. The IBMS have asked if I would like to give my PowerPoint presentation ('What the f?') at the 2023 Congress. Thank you to all the contributors - I will certainly big up PathLabTalk if I do get to do it. Rich

Is this in case the sample tube was not actually from the donor who gave the unit? If that is possible I would have greater concerns regarding the validity of the grouping and antibody screen!

I guess low titre anti-A and anti-B. We don't have any whole blood. The usual major haemorrhage pack provided is 4 red cells and 4 FFP for transfusion in 1:1 ratio. During the TT motorcycle road racing we keep a box of 2 O neg red cells and 2 group A FFP for immediate use. This hopefully gives us time to test a sample and issue group specific if further units are required.

When I worked for NHSBT RCI we kept the cells used for XM in Cellstab (containing preservative) for about a week. All our serology was performed manually so we had already taken an aliquot of cells which had been washed in saline before making suspensions. (Usually in Dil2 or BioVue's equivalent)

We use DiaMed tech. Manual work is read using the Banjo card reader. Reagents are all scanned into the IH.com software to give a full audit trail - user, batch numbers, expiry. Unless the QC has been performed (identical to the analyser) and read the results have a QC watermark across them.

We regularly used to run RT or even cold gel panels (LISS cells on Saline cards) to id M, P1, Le etc. If suspected A2 patient with anti-A1, use A2 cells in the reverse grouping card. We would test the grouping cells for the identified antibody. WARNING! These may require a degree of skill as may have to perform manual testing.

Just an observation.... When I worked in a reference lab in the UK we tested the patient's cells against AB serum in parallel when performing IAT typing. This was part of the testing protocol and there was no DAT required. I would only think about doing a DAT if this negative control was positive. Is there a charge for running a monoclonal control with monoclonal typing reagents?

We use NHSBT 10 cell panel in Cellstab as our secondary. They also do enzyme treated version. (and 3% NISS version). We have to attach our own barcodes to use them on the IH500 and you might have to talk to BioRad to ask if they can install software to let you use the cells. Scottish NBS also produce a panel I believe.

Don't whoever makes your gelcards produce reagent cells too? When I worked for NHSBT we used BioVue cells on BioVue cards and BioRad cells on BioRad cards.

No products/components since 2016 (see my previous post) TO OUR KNOWLEDGE. Being a small island nation, patients quite often get treatment in the UK which we don't know about and vice versa - very helpful. So he may have had D pos platelets. I think it unlikely he had D pos red cells for a planned procedure. We did XM 4 units (O neg) in 2016 but none were required. Thanks all

Thanks for your input. Patient came in this time for Laparotomy. The only other product we have issued is Beriplex (prothrombin complex to reverse Warfarin) in 2016 when he had an AAA. (Antibody screen neg) Cheers

Hi Guys, Has anyone seen the following scenario before and , if so, how common is it? 2002 male O neg patient transfused 4 units of Oneg and 6 O pos. 2012 and 2014 antibody screen negative. Now using the same methodology (DiaMed IAT), we have a strong anti-D. No D positive units transfused since 2002. Why is anti-D now apparent 20 years after the transfusion of D pos cells but not 10 years ago? Cheers, RichU

I think it depends on individual circumstances. I would not keep K- units as a requirement for these patients once therapy has ended and no antibodies are detected. I would always give c-, E- units to an R1R1 patient with anti-c whether or not anti-E had been detected. @Malcolm - as I've said before, there are always caveats with serology! (even that statement)