RichU

Our irradiated red cells have an updated expiry of 14 days max and are not irradiated if older than 2 weeks. Non-Hodgkins lymphoma does not require irradiated products.

We have a policy where we do not perform a cross-match on the first sample of a patient. This sample gets a full group card (forward and reverse group) and a confirm ABD card. The next sample, and any future samples, only have a confirmation (forward group). These 2 samples must be bled at least 10 minutes apart so that there is less chance that the incorrect patient is bled twice. Our blood donors get the full group card and a donor ABD card (Dvi+) on first donation. Further donations just get the donor ABD card

Thanks for your speedy reply Malcolm. To clarify - If a R1wR1 cell is positive by IAT in the screen/panel but negative against (the same) enzyme treated cells, can I exclude Anti-D, anti-C, anti-e and anti-Cw? Regards, Rich

Hi all, I am happy to use a negative enzyme result to exclude Rh antibodies. However, I have a nagging doubt about being able to do this with anti-Cw but can't find any reference to this. Have I made this up or can anyone point me to where I can find this in black and white. Cheers, Rich

Serious Hazards Of Transfusion (SHOT) have haemolytic transfusion reactions in separate reporting categories. All of the following can be 'Serious Adverse Reactions'; HTR Acute HTR Delayed HTR Hyperhaemolysis FAHR See SHOT definitions if you want more info. SHOT Definitions - Serious Hazards of Transfusion

@Malcolm Needs, I have done as you suggested and await a reply. Rich

Why are haemolytic reactions excluded from definition of ATR? SHOT in UK only defines Febrile, Allergic and Hypotensive Cheers

Hi Saeeed, I'm just curious to know where the auto control is. I would expect it to be in well 12 of the IAT panel card. Also, where are the enzyme panel results? Also, also, the group card seems to have a different number to the IAT cards - 476258 and 470258?

Hi and thanks for your replies. Sorry for not updating - i've been off work. Our enzyme method is papainised cells tested using BioRad NaCl cards. A follow-up sample reacted exactly the same for us but the reference lab report a unspecified antibody by IAT and enzyme IAT, don't say they cannot exclude anti-D or anti-E and require no further samples this pregnancy. Rich

Hi all, We have a 28/40 pregnant patient, group O neg with an antibody that fits exactly with anti-D on our IAT panel but is negative in enzyme. Previous sample reported by our reference lab as having non-specified antibody. Anti-D (and anti-E) could not be fully excluded. No record of prophylaxis. Any ideas? Cheers, Rich

I just answered this question. My Score PASS  

If the patient has had a recent transfusion, elution studies might show if the antibody coating the cells in the patient's sample has a specificity. Red cells with the corresponding antigen should be avoided unless you have previously typed the patient and can say whether it's allo or auto.

I just answered this question. My Score FAIL  

Ah ok. Makes sense. Cheers

How do you know a positive screen isn't caused by an alloantibody underlying the prophylactic anti-D unless you do an ABID?

Jsbneg raised the elephant in the room!

The same phenomenon is seen if you use a spun sample for DATs. The cells at the top can be negative and the ones from the bottom positive if recently transfused.

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.