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Malcolm Needs

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Malcolm Needs last won the day on June 8

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About Malcolm Needs

  • Birthday 12/14/1954

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  • 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
    Sourton, Devon, England
  • Occupation
    Prior to retirement, I had taken a brand-new role in the NHSBT and was involved very much more on the education and training side of red cell immunohaematology. My title was Reference Service Manager, but with Training after it (Reference Service Manager - Training). I was very excited about this change, as I have a passion for training and education.
    Reference Service Manager with the NHSBT.
    Ex-Chartered Scientist.
    Fellow of the British Blood Transfusion Society, having twice served on their National Council.
    Ex-Fellow of the Institute of Biomedical Science. Ex-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.
    Was a member of the BSH 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!
  • Real Name
    Malcolm Needs FBBTS

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  1. Believe me when I say that you are lucky!
  2. We would write something very similar in such cases, but would always mention the specificity of the antibody that is no longer detectable, in an effort to avoid anamnestic responses.
  3. I meant that they would NOT report it as "Negative", or "No Antibodies", but WOULD report occasionally as "All Clinically-significant Allo-antibodies have been Ruled Out using etc.", or words to that effect.
  4. In the UK, it is STANDARD practice in all laboratories that I know to use either the phrase "No Antibodies Detected", or, more frequently, "No Atypical Antibodies Detected", as the latter also includes such things as the iso-antibodies of the ABO and H Blood Group Systems. Indeed, some go further still and use "No Atypical Allo-antibodies Detected", as this covers such findings as an auto-anti-H, auto-anti-I and auto-HI, as well as the ABO and H iso-antibodies. These phrases do not mean that there are no atypical allo-antibodies detected. It would be an incredibly rare set of screening cells and antibody identification panel cells that would both express, for example, the HJK antigen, or any other genuine low prevalence antigen. In some cases, where an atypical allo-antibody IS detected, but it is known to be clinically-insignificant (such as anti-Kna), we may use the phrase "No Clinically-Significant Atypical Allo-antibodies were Detected" (or words to that effect). One thing is for certain, and that is that a UK Reference Laboratory (and most hospital laboratories) worth their salt would report out as "Negative", or "No Antibodies", although, even using the phrases I've quoted above, occasionally the phrase, "All Clinically-significant Allo-antibodies have been Ruled Out using etc.", or words to that effect. MIND YOU - you have to remember that I am RENOWNED for being a pedant - but I learned it from a few good sources; Peter Issitt, Carolyn Giles and Joyce Poole (to name but three).
  5. I THINK there are figures in the earlier "Mollison's (but I am relying on a notoriously bad memory). Personally, only a few (in 43 years), but there are figures annually in the UK SHOT Reports (Severe Hazards of Transfusion).
  6. Why do they want to know the titre of IgG anti-A or anti-B? It has been known for decades that the titre makes no prediction of the severity of ABO HDFN? The only real predictor is that the foetus/newborn will suffer at the same gestational period, or earlier, than the previous pregnancy, and to the same extent, or worse, than in the previous pregnancy. The problem comes with the first pregnancy, but, as titre is not predictive, surely it would be sufficient for the doctors to know whether or not IgG ABO antibodies are present in the maternal circulation in the first place? I realise the IgG ABO titre is very relevant in solid organ transplants and stem cell transplants, or have I missed something?
  7. I would be wary of relying on enzyme-treated red cells, as a negative reaction could be due to the cognate antigen being denatured by the particular enzyme used.
  8. The trouble is that, if the antibody happened to be an anti-Jka or, worse, an anti-Vel, the resulting rise in titre, following an anamnestic response, could be fatal on rare occasions.
  9. Extended cross-match, UNLESS, the history of which other hospitals the patient has been treated is known. Of course, in the UK we have a national database of patient's antibodies, which makes life an awful lot easier, even if the data is just a "snap shop".
  10. The trouble was that, in those days the anti-D immunoglobulin was known as "anti-D for Mum's Bums" in the UK, as the shot was given in the gluteal muscle. But, there was an awful lot of fat in that muscle, so the anti-D had a habit of "staying there", rather than being adsorbed into the blood stream. This meant that, even when the dose of anti-D immunoglobulin was calculated from the Kleihauer-Bekte test, the actual dose reaching the circulation was far lower than the calculated dose, and women used to produce allo-anti-D as a result. Nowadays (at least in the UK) the shot is given in the lateral deltoid muscle, where there is a good deal less fat, and so the shot is adsorbed into the circulation much easier, and so there are fewer cases of maternal allo-anti-D. I realise that this is a very vague explanation, and that there are many other causes of anti-D immunoglobulin being less than effective (such as giving it to the father, or even to the ambulance staff (SHOULD be unbelievable, but is actually true), but it does show just how complicated such a simple thing as this can be.
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