Jsbneg

A research team led by NHS Blood and Transplant scientists based in Bristol, at NHSBT’s International Blood Group Reference Laboratory (IBGRL), and supported by colleagues at the University of Bristol, has discovered a new blood group, MAL. 🙌 🩸

They identified the genetic background of the previously known but mysterious AnWj blood group antigen, thus allowing identification and treatment of rare patients lacking this blood group.

Louise Tilley, Senior Research Scientist, IBGRL Red Cell Reference at NHS Blood and Transplant, said: “The genetic background of AnWj has been a mystery for more than 50 years, and one which I personally have been trying to resolve for almost 20 years of my career. It represents a huge achievement, and the culmination of a long team effort, to finally establish this new blood group system and be able to offer the best care to rare, but important, patients."

hashtag#NHSBT hashtag#GiveBlood hashtag#SaveLive hashtag#NHSCareers Activate to view larger image,

Sounds like total rubbish from both a clinical and scientific viewpoint. Another instance how the administrative/legal model of reality is undermining civilization :).

I couldn't agree more with you YorkshireExile.  At a stretch, and I mean, at a stretch, it MAY be relevant to such tests as quantification and titrations, where you are giving a result involving a measured number, ascertained with red cells that may express different numbers of antigens, which may themselves involve protein or carbohydrate substitutions, but that is all.
How on Earth your inspector thought that this was remotely relevant to blood grouping, with all the positive and negative controls used to ensure the antisera are working properly, and the temperature mapping of everything these days, like you, I cannot see the point.  Either he or she was trying to justify their position as an inspector, and/or was going well over the top.
I would be amongst the first to say, very loudly, that Quality in the world of Blood Transfusion was pretty low at one point, but now, there are times when Quality issues actually interfere with the laboratory doing its job, for no good reason, and this seems to me to be one.
END OF RANT.

I would definitely refer this patient's sample to a reference lab for JK sequencing. As my friend Malcolm mentioned above, variants of JK antigens are not uncommon. The most common variant I've seen is caused by c.130G>C, which causes weakened expression of the Jka antigen. Interestingly, some patients with this variant would make anti-Jka, but I don't think we know much about the clinical significance of this antibody.

I would definitely refer this patient's sample to a reference lab for JK sequencing. As my friend Malcolm mentioned above, variants of JK antigens are not uncommon. The most common variant I've seen is caused by c.130G>C, which causes weakened expression of the Jka antigen. Interestingly, some patients with this variant would make anti-Jka, but I don't think we know much about the clinical significance of this antibody.

I would definitely refer this patient's sample to a reference lab for JK sequencing. As my friend Malcolm mentioned above, variants of JK antigens are not uncommon. The most common variant I've seen is caused by c.130G>C, which causes weakened expression of the Jka antigen. Interestingly, some patients with this variant would make anti-Jka, but I don't think we know much about the clinical significance of this antibody.

I would most strongly advise you to send a sample, possibly even multiple samples throughout the pregnancy, to a Reference Laboratory.

As the patient is pregnant, there is the possibility that the Jk(a) antigen you are detecting is actually being expressed on the red cells of the foetus, and you are detecting it as a result of a foeto-maternal haemorrhage.  However, the Jk(a) antigen is not necessarily straight forward, as there are weakened forms of the antigen (and the Jk(b) antigen come to that) where there are amino acid substitutions remote from the site usually associated with the Jk(a) and Jk(b) antigens (280 of the mature protein).
In addition though, you have, obviously, to consider the health of the unborn baby who, even if the antibody does turn out to be a maternal auto-anti-Jka, may cause haemolytic disease of the foetus and newborn, albeit this will usually be be very mild.
I attach a PowerPoint which may, or may not help you in your decision to send a sample to your local Reference Laboratory (also tell them the ethnicity of the patient).
 
Interesting case - please keep us informed.
In Depth Lecture on The Kidd Blood Group System.pptx

Wow , thanks everyone!!! Such great advice! I am so grateful for all the tips. They are all really helpful!!!

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

My motto was "when in doubt, shake it out".  Seemed to work for me.

I've been a BB'er for 35 years (at the same hospital)  my very first manager (who was a good,  seasoned BB'er) used to tell us........., "if you have to hunt for it - it's not there".
As you become more adept at reading tube reactions - your eyes will not fail you!  Trust your gut.
As for your technique - it all sounds good!  Practice with a few techniques to find the one that works best for you
I "tilt and giggle", button up, The tilt helps with seeing Mixed Field - which we tend to see a lot here - It also helps with seeing "how" cells are falling off the button - are they chipping off or are they "swirling" off.....or is there a little of both?  (For some reason I always think of the "tail" of an old RPR test .....which probably dates me, LOL!)

It sounds to me like you are doing everything that you should do, without either over-shaking the tube, or over-reading the contents.

I am extremely glad that you are not using a microscope, as, if you did, you would almost certainly see the odd couple of red cells "kissing each other", even if they have been incubated in isotonic saline.

The other thing is (and I speak with some 43 years of working in blood group serology) if the reactions in the tube are THAT weak, the chances of any atypical alloantibody that you might miss being clinically significant are absolutely minute.

If you are still worried, however, get a more experienced worker to read your tests as well, until you feel confident.  That is how I learned when I started.
I wish you the best of luck in your future career.

Hi, I am a new bloodbanker and forgive me in advance for asking this question. My question is….I am afraid when reading tube agglutination I will miss a weak reaction and call it negative. I think it’s my technique. When I am reading a tube reaction after centrifuging ….I hold the tube so that the button is facing upwards and then I gently swirl while watching the button to see how it falls off. I look for any granules. Is this right ? Are there any tips on how not to over shake a tube and miss the weak agglutination . Thanks for reading my question. 

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

Yes, nationally in the UK, via BSH Guidelines.

Below is our policy for switching Rh negative patients to Rh positive red cells for non-emergent cases. We would document that decision and any pathologist instructions in the patient's profile. 
For emergency release/MTP we follow policy and do not notify the provider unless it is a patient under 19 years or a female of child bearing potential. 

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

Our Red Cross just informed us that it will discontinue providing CPDA-1 rbc.  We primarily used it to provide volume reduced red cells to pediatric patients under 3 years of age.  We will volume reduce AS-1 or AS-3 by centrifugation or washing (Terumo 2991) instead.  Probably unnecessary for most patients, but this is a long standing practice here, and it doesn't seem worthwhile trying to adjust pediatric practice in this regard.  Most patients do not need the additional volume provided by the anticoagulant-preservative in AS-1, etc., and avoiding unnecessary volume is a reasonable goal in many patients. 
There is no inherent virtue to CPDA-1 vs. AS-1 and similar solutions, and rbc preservation is slightly better in AS-1/AS-3 by in vitro metrics.  There is absolutely no factual basis for using CPD-A1 in preference to AS-1, etc. in pediatrics.  Purely expert opinion and probably unduly conservative.
 
I've attached a nice presentation by Dr. Saifee at the University of Washington, who createdAdditive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx it to educate her colleagues about using AS-1 instead of CPDA-1.
Additive solution AS-1 in Children Univ. Washington presentation Dec 2021.pptx
Pediatric RBC White Paper - November 2021.pdf

Attached is the validation plan for the last freezer we bought in 2020 but it was not a Helmer.  Also, if you ask Helmer (it might even be on their website) you can get their temperature mapping they already completed.  Normally it's included on the technical data sheet.  We validate the temp holds for 24 hours empty then 24 hours full of normal stock.  However, we are staffed 24/7 and we use Isensix continuous temperature monitoring (which pages me and the other lab leaders if the temp is out longer than 5 minutes, again at 15 minutes and a third one at 20 minutes) so if it alarms staff know to move the stock back to our second freezer.
Validation Plan NEW Plasma Freezer 05.22.2020.doc Freezer Temperature Mapping.pdf Helmer Refrigerator and Platelet Incubator Temperature Mapping.pdf