Malcolm Needs

We have tranexamic acid, DDAVP, O, D Negative blood and group A thawed FFP on board our helicopters in the UK (well, not ALL our helicopters of course, but all of the "ambulance helicopters).

Welcome Nick Pavicevic.

Welcome UTECH.

Most certainly Mabel. Hugely important.

Welcome Rural Hospital - an unusual name!

Welcome Jesper.

Yes, I'm sorry, I didn't realise that the hospital literally only had six units.

Welcome Ben Todd.

Welcome JannaHemo.

It doesn't matter Mabel. There is a continuum from A2 to the weakest possible A type - but they are still group A (it is a moot point as to whether the really, really weak group A individuals should be given group O blood - see the Blood Group Antigen FactsBook), but who really cares what label they are given? They are a weak sub-group of A. I admit that it matters to people like Martin Olsson (for whom, I should say, I have enormous respect), but they are people who are looking at things at the molecular level, rather than the serological level.

Sorry, but that is almost certainly not a possibility anywhere, otherwise we would have all done it years ago. As I said above, if you give everyone group O red cells, because they can all have those (except Oh individuals, oh, and individuals with other antibodies than anti-A and anti-B), you will run out of the group O units you require for group O patients.

A long time ago now, I was working in a very large London teaching hospital, when we received a patient who was a group B police officer (this was about the time when the IRA were active in London, but this case, as far as is known, ha nothing whatsoever to do with them). He had received multiple stab wounds. We soon went through our stock of group B, and eventually got through out stock of group O. Although we had ordered more stock to be delivered by "Blues and twos", at this stage we had a choice. We either transfused him with group A, or we let him die. The doctors in charge decided to give him group A. He survived, and when the emergency order of stocks has arrived, we switched back to group B, and then group O. Yes, his renal function was shot to pieces for a while, but, to be honest, that was probably the least of his worries at the time. I'm not saying that this would work every time, because it won't, but you can treat a haemolytic transfusion reaction, even an acute haemolytic transfusion reaction; death is difficult to treat. As Prof Brian McClelland MB ChB ND Linden FRCP(E) FRCPath (former Director of the Scottish National Blood Transfusion Service) once wrote in Thomas D, Thompson J, Ridler B. A Manual for Blood Conservation. 1st edition. 2005. tfm Publishing Ltd, "Transfusion has risks, but bleeding to death is fatal."! To my own shame, I once did a book review of this for the BBTS, and misquoted the title as, "A Manual for Blood Conversation."! The embarrassment!

I would say that she is a subgroup of A, but would quite definitely transfuse her (if necessary - you may not have to) with group A blood (straightforward group A, not subtyped group A). She will not suddenly produce an anti-A and, even if she produces an anti-A1, so what? It is sufficiently rare for an anti-A1 to be clinically significant in terms of a transfusion reaction, that such circumstances are still reported and published (since 1911, when it was first reported that there was an A2, as well as an A1), but, in all that time, there has NEVER been a report of anti-A1 causing haemolytic disease of the foetus and newborn. Giving her group A will not harm her in any way. Giving her group O will possibly deprive a person who is genuinely group O, blood, which will no longer be available.

That is because, although such individuals (DIV and DV) can make allo-anti-D, they are far less likely to so do. If you look at the exons involved in the DIV and DV mutations, compared with those of the DVI mutations, this becomes much clearer (see attached). DIV DV DVI Mutations.pptx

Welcome Ana Pryz.