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Malcolm Needs

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Malcolm Needs last won the day on February 11

Malcolm Needs had the most liked content!

About Malcolm Needs

  • Rank
    Seasoned poster
  • Birthday 12/14/1954

Profile Information

  • Gender
  • Interests
    Rugby Union, Cricket, cooking, wine, port, reading, crosswords, lecturing, more wine and more port!
  • Biography
    Pretty boring really, but not that pretty!
  • Location
    Croydon, Surrey, England
  • Occupation
    I have taken a brand new role in the NHSBT and am now involved very much more on the education and training side of red cell immunohaematology. My title is still Reference Service Manager, but with Training after it (Reference Service Manager - Training). I am very excited about this change, as I have a passion for training and education.
    Reference Service Manager with the NHSBT.
    Chartered Scientist.
    Member of the British Blood Transfusion Society, having twice served on their National Council.
    Fellow of the Institute of Biomedical Science. Member of their Special Advisory Panel for Transfusion Science and Chief Examiner for Transfusion Science for the Institute.
    Author of the chapter "Human erythrocyte antigens or blood groups" in Fundamentals of Biomedical Science, Transfusion and Transplantation Science, edited by Robin Knight, for the IBMS. 1st edition, Oxford University Press 2013 (ISBN 978-0-19-953328-2, pages 19-44.
    Just been appointed to the BCSH Blood Transfusion Task Force (writing Guidelines).
    Member of ISBT and AABB.
    I am now retired from the Blood Service, but still do the other things!
    Got bored with being retired, and so am doing locum work in Blood Transfusion at St. Richard's Hospital in Chichester, West Sussex (and thoroughly enjoying myself!).

Recent Profile Visitors

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  1. Can leuko-reduce prevent GVHD

    Sadly Neil, since that paper, and after many years with no TA-GvHD reported to SHOT, there has been just such a case in the last couple of years.
  2. Can leuko-reduce prevent GVHD

    Irradiation does not "kill" T lymphocytes per se, which are the cells that cause TA-GvHD, but what it does is disrupt the DNA within the nucleus, and this disruption prevents them from cloning. As a result, they are unable to "reproduce" (for want of a better way of putting it) and so, instead of being able to form a clone within the recipient, will be removed from the circulation by natural apoptosis. Prior to this apoptosis, once they have been irradiated, the T lymphocytes are relatively benign.
  3. A2B pacient transfusion policy

    As long as the anti-A1 remains "cold reacting" only, and the thermal amplitude does not widen, the clinical significance remains as "not clinically significant", and, personally, I would happily transfuse blood by electronic issue. Even if the thermal amplitude does widen, unless the anti-A1 actually reacts at strictly 37oC, it will remain as "not clinically significant", but I would, nevertheless, perform a serological cross-match - "just as belt and braces".
  4. CAP TRM. 40670

    They obviously do! Patty, PLEASE do not think I was getting at you. As you will guess from John's post above, this is (just) one of my pet hates. It was nothing personal!
  5. CAP TRM. 40670

    If you have sorted out what is causing the unusual reaction pattern, then it is no longer a discrepancy. However, I would still not perform an electronic cross-match, AS THERE IS NO SUCH THING (a computer does not, and never has, performed a cross-match). I would, however, perform ELECTRONIC ISSUE.
  6. Florida Shooting.

    My thoughts are with you all tonight, particularly those amongst our community who are having to deal with this. So sad.
  7. Look at who wrote the lecture, and you will see why Scott! The key word in the title is "Correct"!!!!!!!!!!!!!!
  8. DAR/Cdes question

    I should warn you that I am no molecular biologist - all I know is what I have adsorbed from reading and from some of my friends and colleagues who are accomplished molecular biologists - but I am absolutely certain that both the mutated RHD and RHCE genes contribute to the weak expression of the C antigen, as you seem to suggest.
  9. DAR/Cdes question

    I am a little confused by your question, in as much as, in one place you say that the patient has the Partial D Type DAR, but in another you say that the patient has the Dw antigen, sometimes known by its trivial name Weil, or more properly as Rh23, which is a low prevalence antigen associated with Partial DV Type 4. I think you mean that your patient has the DAR D Type, and that the D antigen is typing weakly. Am I correct in thinking this? I hope so, otherwise it doesn't make sense (at least, to me). Turning to the CdeS type, there are several (at least 8) of these in terms of genetic background. All have one thing in common, and that is a Leucine to Valine substitution at position 245 of the mature position, due to a point mutation in exon 5 of the RHCcEe gene. Five of these also have the Tryptophan to Cysteine substitution at position 16, resulting in the expression of (normally) the C antigen, due to a point mutation in exon 1. However, 74% of C-, c+ Black Americans with normal expression of c have Cysteine at position 16. The thing is though, that any C antigen that is expressed is weakened, and some anti-C reagents do not react with it. On the other hand, because there are at least 4 amino acid residues that are involved in the expression of the C and/or c antigen (at positions 16, 60, 68 and 120), it is more than possible (in fact, probable) where mutations are present, that the c antigen is expressed at a normal strength, whilst the C antigen is also expressed in the weakened form. Indeed, the C antigen itself is a Partial C antigen, and such an individual can produce a form of anti-C, rather in the same way that an individual with a Partial D can produce a form of anti-D. So, to cut a long story short, this is why the individual will express the c and e antigens in the cis position, even though they also express the C and e antigens (in a manner of speaking) in the cis position, and why the ce (compound) antigen can also be expressed.
  10. DAR/Cdes question

    Big rugby day here in the UK - and will be again tomorrow, but, after that, I will TRY to answer your question, but it is not an easy question to answer!
  11. Most warm auto-antibodies have a specificity within the Rh Blood Group System, although some others, more rarely, have a specificity outside of this system, such as auto-anti-Wrb. Most of the auto-antibodies from within the Rh Blood Group System mimic anti-e, anti-E, anti-C, anti-c or a combination (or even a compound antibody, such as anti-Ce or anti-Rh7), but, in reality, they are actually weak forms of anti-Rh17 and/or anti-Rh18, although strong examples are not unknown). As they are usually mimicking antibodies, they can usually be adsorbed out with red cells that do not actually express the actual antigen on their surface (for example, an apparent anti-e can be adsorbed out using R2R2 red cells). PLEASE DO NOT try to identify them yourself, as the actual specificity is not significant, but will take an awful lot of time and you will require some VERY rare red cells, such as Rhnull, D--/D-- and the like, and these should be reserved for when they are required to identify the specificity of rare allo-antibodies, such as anti-Hr, anti-HrB or anti-Rh29, where a true specificity may well be vital to identify. In contrast, most "cold" auto-antibodies are true specificities. For more information, you would find it hard to beat reading, Petz LD and Garratty G. Immune Hemolytic Anemias, 2nd edition, Churchill-Livingstone, 2004, although I would advise you to be selective, as it is a very detailed book!
  12. Okie

    Why not Scott? It was standard practice back in the day, and we didn't kill too many people, even then!
  13. Okie

    Unfortunately, I no longer work for NHSBT and so I no longer have access to the SOP.
  14. Okie

    Only when using standard laboratory saline to suspend the red cells, and yes, we have an SOP for this (as for ALL techniques we use). If we are using LISS, however, it is vital that a 1 to 1 ratio of serum/plasma to red cells is used, to prevent either false positive or false negative reactions, as anything else would change the overall ionic strength of the reactants in the test.
  15. Case study mentor

    Never say never - bet you get an Rhnull next week!!!!!!!!!!!!!!!!!!!!!!!!