Abdulhameed Al-Attas

Yes, as Galvania has stated,Normally, acid in the stomach is strong enough to break down and destroy immunoglobulin antibodies. However, the baby's stomach acid does not break down the antibodies in the mother's breast milk. This is because the mother's mammary (breast) glands package immunoglobulins with a protective substance. This allows the immunoglobulin to reach the infant's intestine, where it is absorbed into the bloodstream. Once the immunoglobulins enter the bloodstream, they move throughout the body, searching for any foreign substances that may harm the body.

Welcome Riaz!!

Welcome Maribel !!!

We also use Biorad,But I think that you can use freshly drawn Citrate,EDTA or CPD-A anticoaglant, Samples drawn into plain tubes may also be used.

Yes, Anti-C3d is NOT necessary because Anti- C3d monospecific coombs reagent would react with red cells sensitized with components of human complement involved and cause agglutination of the red blood cells,so they are ONLY useful for identification of complement fixing antibodies.

Yes, I agree with Shily, Because IgG anti-D cannot directly agglutinate red cells suspended in saline, the manufacturer adds a high concentration of albumin. The albumin (being a dipolar molecule) increases the dielectric constant and decreases the zeta potential, allowing the red cells to come closer. Once this occurs, the IgG anti-D that has attached to D-positive red cells can form cross-bridges and agglutinate the red cells. Rh Control This control must be done in parallel with all Rh(D) typing tests. The Rh control is an autocontrol that reveals whether or not the patient's red cells are agglutinating in the absence of the D antigen, i.e., are clumping whether they are D-positive or D-negative. The control consists of testing the patient's cells with an Rh control medium (supplied by the manufacturer) that contains everything that is present in the anti-D typing sera except the anti-D. The Rh control is essential because red cells that are presensitized with antibody in vivo (i.e., have a positive DAT), can be caused to agglutinate in a high protein medium, even if they are D-negative. When the high protein in the anti-D brings the cells close together, any antibody already on the cells can form cross-bridges and cause a false positive. If the Rh control is positive, the D typing result is invalid. The Rh(D) type must then be determined using a low protein anti-D serum, e.g., saline anti-D, chemically modified anti-D, or monoclonal/polyclonal anti-D.

Agreed; go with your own trauma policy.

This is a critical titre and hydrops fetalis is considered to be likely,In general, critical titers of anti-D are 16 or 32. Titers for anti-K are generally lower, a titer of 8 being typical. Titers are generally performed every 4 to 6 weeks. Once the titer reaches the predetermined critical level, additional testing such as ultrasound, amniocentesis, or cordocentesis are generally indicated to determine the severity of the disease.

At one time, anti-D was the most common antibody implicated in severe HDFN. Due to the routine administration of Rh immune globulin (RhIG) to Rh negative mothers, the incidence of anti-D HDFN has decreased substantially. The antibody has not been eliminated, however, and it is still implicated in HDFN and can be associated with severe disease,but Anti-K will be the most common from now on. The development of alloantibody such as anti-K to fetal RBC exposure may be less if the fetal cells are ABO incompatible with the mother. This is proposed to be due to the shortened life span of ABO incompatible fetal red cells in maternal circulation.Anti-K is frequently associated with a severe form of HDFN due to the ability of the antibody to suppress fetal erythropoiesis in addition to causing hemolysis. Some antigens are well developed on fetal cells (e.g., Kell), some are slightly weaker (e.g., ABO), and some are poorly developed or not present at all on fetal cells (e.g., Lewis).

I agree with John, unless you want to switch back to group specific after 10 units of group O, in that case ,you need a new sample and a full X-match including Antihuman globulin phase. If it is incompatible then NO switching, continue transfusing group O.

Correction! I mean to a D Negative Neonate,sorry for that.

Yes,that is a very good reason NOT to transfuse a D+ PRBCs or Platelets to a neonate. I agree with that Mabel Adams.

I agree,ABO compatibility is the only requirement.

We crosmatch 2 antigen negative units but not release until ordered.

Hi Brenda Hutson, Sorry,I was only replaying to KKidd(but failed to quote)who mentioned that Their Emergency Form has 3 sections:Uncrossmatched Blood,Change of Rh type and Testing diffculties. My point was that the ordering Physician can only sign for Emergency Blood Release Form for Uncrossmatched Blood Only. and that change Rh and others are for Blood Bank Director. Hope I made myself clear. .

Our Emergency Blood Release Form is for Uncrossmatched Blood Only. It has a statement by the requesting Physician that reads:This patient with MRN Balaa,Balaa, needs immediate Red cell Transfusion,he/She is so critically ill that the delay usually associated with crossmatch will endanger His/Her life. Consequently,I hereby request and accept responsibility for adminstering Red Cells to this patient without complete crossmatch. New Emergency Release Form that contains number of units requested is the requirement each time. But things like Bacterial Testing,Irradiation,Donor Screening Serology,NATor switching Rh are the responsibility of our Blood Bank Director and NOT the requesting Physician.

Gel testing offers many advantages over traditional methods: • Improved sensitivity and specificity • No-wash antiglobulin procedure • Standardized procedures • Improved turnaround time • Enhanced regulatory compliance And also uses small sample size.

Malcolm,you are always my teacher in this forum,if it is not Anti-Hrb or Anti-Hrs,please tell us what are you suspecting ?

You can ONLY expect to see AHG phase,NO RT and NO 37 Degree Centigrate reactions.

Yes,we accept verbal orders in Emergency situations on the grounds that the delay usually associated with the pre-transfusion tests will endanger the patient's life,but a pre-transfusion sample must be provided for prompt performance of ABO/Rh and the crossmatch of the units released.Any furthe orderes release ABO/Rh specific through IS. There must also be a signed statement by the requesting Doctor,accepting the responsbility for administering red cells to this patient without a complete pre-transfusion tests.

Congratulations

Could you please give us your reasons for using O Rh Negative for all your Neonatal Transfusions and Why one unit is being used for all Neonates? Thanks in advance.

Our standard practice for neonatesTransfusion is to dedicate a fresh group O Rh specific,leukodepleted and centrifuged top-ups. Irradiation is only for Pre-Terms and We do not wash RBC for neonatal transfusion.

Nice to have you back Lisa.

For Neonatal Routine Transfusions( Not Exchange),we obtain initial specimen from the neonate,perform forward ABO and D typing,perform the Ab. screen using either the neonatal or maternal specimen. If Ab.screen is positive:Identify any Antibodies present and select a fresh group O, D-compatible packed RBC unit lacking the corresponding antigens,Crosmatch the blood using the maternal or neonatal serum/plasma and donor cells, include the Antiglobulin phase.Only dispense compatible unit(s) ie. without agglutination or hemolysis. But if Ab.screen is Negative,we do NO X-maching,just dedicate group O Rh compatible,Fresh (>10 days)packed RBCs and aliquot the requested amount using the sterile connecting devce(Terumo Sterile Tubing Welder),include 5-10 mls forthe dead space of the tubing.NOTE- if the Antibody screen is neghative and Group O, D compatible cells are used, further compatibility testing and ABO/Rh grouping are NOT necessary during the neonatal period.