Malcolm Needs

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I'll do what I can. I've got a few (about ten or so) I've used in my own lectures that I'll pass on to you with pleasure. For ease, would you trust me with private messaging an email address I could use please? I'll keep it to myself, of course. Malcolm. P.S. It may have to be tomorrow now.

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Do you think somebody should tell them that ABO HDFN sometimes gives a Negative DAT result in the fist two or three days of life, and that they might actually be better off looking for clinical signs, rather than performing diagnoses on the result of pathology results???????

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I think that it depends upon the state of the baby. For example, if the mother is D Negative, and has been in receipt of anti-D immunoglobulin, and the baby has a positive DAT, but is showing no other signs of HDFN, then we wouldn't perform any further testing. If the baby has a lowish Hb, and the mother is group O and the baby group A or B, we may take a look at the mother's IgG ABO status, and then perform an eluate on the baby. Where we might really "go to town" is if the baby is showing overt signs of HDFN, we might well go the "whole hog" and perform an elution, just in case there is a maternal alloantibody directed against a low prevalence antigen also expressed on the red cells of the father. If this is suspected, it would be easy enough to adsorb out any IgG anti-A or anti-B on the baby's red cells, without adsorbing out the potential antigen against a paternal low prevalence antigen. The specificity of such an antibody would be interesting, but not necessarily vital, as, should the baby require a transfusion, suitable blood should be easy to obtain.

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Thanks Lorna. I'll have a look and see what I can provide but, as I see that you are working in the Isle of Man, may I suggest you get a copy of the BCSH Guideline "Pre-Transfusion Compatibility Procedures in Blood Transfusion Laboratories" from 2012 (which is available free on-line - just put in BCSH Guidelines), and these have a few at the end of the Guideline. In addition, have a look on this site under "Library" at the top of the page, where you might find more than one thing (probably under "Education", but not only there), that will be of use to you.

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I CANNOT tell from the information you have given (not least because the phenotype of the reverse typing cells and the panel cells are unknown to me). I would very strongly suggest that you send samples to a Red Cell Reference Laboratory to get this sorted out, BEFORE the patient needs a transfusion in an emergency. From what you do tell us, I think the antibody/antibodies are unlikely to be fatally clinically significant, but it depends on the true specificity/specificities and the underlying pathology.

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