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Malcolm Needs

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Malcolm Needs last won the day on August 17

Malcolm Needs had the most liked content!

About Malcolm Needs

  • Rank
    Seasoned poster
  • 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
    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!).

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  1. But Dad and baby could both be incompatible with mum major side. E.g. Mum could be group A and Dad and baby group B, or have I read this wrong (it wouldn't be the first time)?
  2. The highest percentage of DAT Positive Cord Bloods are as a result of sub-clinical ABO HDFN (say, a group S mother and a group B baby). The next highest in terms of percentage is now D Positive babies of mothers who have been given anti-D immunoglobulin during the pregnancy (most certainly in the UK). Although the DAT is often positive, it is always a sub-clinical condition. Probably the next in line in terms of positive DAT is idiopathic positive DAT in the baby, probably due to non-specific uptake of proteins on to the red cell membrane. Unless the mother has a known atypical alloantibody in her circulation, it is highly unlikely that a positive DAT will result in clinically=significant HDFN (unless the father has passed on a gene to the baby, resulting in the baby expressing a low prevalence antigen on its red cells, and the mother having the cognate antibody in her circulation - but this is REALLY rare). In most cases, do nothing, unless you have time and money to waste. Wait until the paediatrician/obstetrician decides there are clinical reasons to start worrying, rather than just a positive DAT. The baby needs to be treated, NOT the test result.
  3. A fairly short, but very interesting interview with Neil Blumberg in the July 2019 edition of AABB News, as he his one of three new inducts into the National Blood Foundation's Hall of Fame. Congratulations Sir and, from what I know and have read, thoroughly well deserved.
  4. Okay Scott, but can either the clinician, or you, tell me what constitutes a "significant increase"? Surely, the absolute titre is much more significant than an increase? I am not for one moment decrying an increase, that is certainly important, but we also need to know at what titre the anti-S becomes clinically significant in pregnancy. In the original report involving fatal HDFN (Levine P, Ferraro LR, Koch E. Hemolytic disease of the newborn due to anti-S: a case report with a review of 12 anti-S sera cited in the literature. Blood 1952; 7: 1030-1037) the authors state that the titre was between 64 and 128, BUT, it is very important to remember that this was only seven or so years since the IAT was first described, when the sensitivity of the test was, shall we say, primitive, usually involving tile techniques and an AHG made in sheep, goats, rabbits, etc. The evidence is, therefore, not 100% reliable. I would have thought that, in this day and age, it would be much more reliable to monitor any pregnancy by such techniques as ultrasound/MCA Doppler, than by the antibody titre, when we do not know what titre is clinically significant in the first place.
  5. Two reasons. The first is that severe HDFN caused by anti-S is very, very rare, but it does happen. The second, and much more importantly, is that a titre is a snap shot that tells the obstetrician ABSOLUTELY NOTHING in isolation. Supposing the titre is, for example, 512, the pregnancy can be monitored (as it can be anyway, whatever the titre) and there can be clinical intervention, if required. On the other hand, supposing the titre is 2, what does that mean prior to conception? Again, the answer is ABSOLUTELY NOTHING. The baby may not inherit the GYPB*S gene from the father, so the antibody will not increase in titre, or the baby may inherit the GYPB*S gene, but that doesn't mean the titre will automatically rise during the pregnancy, although, of course it can. It sounds to me that the clinicians are fishing, but without either a rod or a net (they haven't got a clue)! I know that the UK Guidelines do not apply in the US, but it might be worthwhile suggesting that they at least read "British Committee for Standards in Haematology (BCSH): White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S. Guidelines for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine 2016; 26: 246-263 (doi: 10:1111/tme.12299) and/or Royal College of Obstetricians and Gynaecologists (RCOG). The management of women with red cell antibodies during pregnancy. Green-top Guidelines No.65; May 2014. https://www.rcog.org.uk/globalassets/documents/guidelines/rbc_gtg65.pdf.
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