Malcolm Needs

I had the ENORMOUS honour of lecturing on a course with Sue in Cressier in Switzerland in 2015, and I can assure everyone that she is a consummate lecturer, who has the ability to get across the most difficult subjects, and make them fully understandable to even the most junior of staff.

Welcome tirdbirgler.

OMG!!!!!!!!!!!!

Believe me when I say that you are lucky!

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.

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.

Welcome Becky.

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).

Welcome Tessa.

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).

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?

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.

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.

Welcome jack323.

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".

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.

Welcome MS2005.

Welcome MelanieQ.

Welcome JT Super.

Welcome MELANIE E. G..

Welcome Cautious Carol.

Welcome K Kindy.

Have you thought of thumb screws????????!!!!!!!!!!!!!!!!!!!!

Agreed. The ONLY time we might perform anything like a post-partum screen is if the baby's DAT is positive, and the baby has clinical signs of HDFN, but the mother has not been shown to have an alloantibody in her circulation during the pregnancy. In such a case, we may well test the maternal plasma (or an ABO adsorbed and eluted sample of the plasma) against the paternal red cells (if available) to see if the antibody is directed against a low prevalence antigen expressed on the paternal red cells. Having said that, however, this would only be useful in a further pregnancy with the same male, as providing the present baby with a unit for top-up or exchange would be easy if the antibody is directed against a low prevalence antigen

Absolutely correct Marilyn. In those days (1963, I was in infant/junior school and 1967, I had JUST started secondary school) I THINK we were only using whole blood for red cell transfusions, but I wouldn't know for certain.