Malcolm Needs

Would you be able to disclose the underlying pathology of the patient please?

Welcome WVLAB. If you are anything like me, you will love this site, and soon get hooked!

Welcome shawnsimpson834.

Welcome asare offeh.

Welcome HeidiH.

Welcome BWL.

Welcome Cheyenne Ward.

It is usual for the C+, D- red cells (e.g. r'r) to react with an anti-G more strongly than a C-, D+ red cell (e.g. R2R2), BUT, this is by no means "diagnostic". As Jsbneg says above, it would be far safer to perform the proper tests, to ensure you have ascertained the correct specificity/specificities. The attached PowerPoint may or may not help (ignore if it is not helpful). The G Antigen and Anti G.pptx

The Donath-Landsteiner Test for the Donath-Landsteiner antibody (IgG auto-anti-P that binds complement) that causes PCH (see the PowerPoint I attached above).

Welcome mrosol.

I was joking about the specificity being between "anti-O" and "anti-Q", in that anti-P, the specificity almost always involved in a case of PCH is a "cold-reacting" IgG anti-P that "fixes" complement (and P is between "O" and "Q" in the Western alphabet). A pretty poor attempt at a joke, I fully admit! While I am not saying definitely that it is a case of PCH, the fact that the patient has a suspected AIHA, that the auto-antibody appears to be "cold-reacting", that it is IgG and that it also involves activated complement, strongly suggests that this may be the line to go down as an investigation. We didn't perform a DL test routinely by any manner of means (despite being a London based Red Cell Immunohaematology Laboratory). It was always discussed between our own Consultant (or, at night, weekends or Bank Holidays) by the on-call Consultant, but all of the staff knew how to perform the test, even if they were a lone worker. We always used to dread being asked to perform such a test as a lone worker, as it took so long to do!

I have an idea of what I think it might be, but I would hesitate to say without a bit more information concerning the condition and underlying pathology of the patient. How old is the patient? Have they recently had something like an atypical pneumonia? I think, without knowing the answer to the above questions, that the specificity of the antibody MAY be between "anti-O" and "anti-Q". I would suggest performing an indirect DL-test. I may well be wrong, OF COURSE, but the attached may help. Paroxysmal Cold Haemoglobinuria (PCH).pptx

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Welcome Erin Graves.

Welcome jsbneg. Are you? If so, you are very rare!

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Welcome Dbug26.

I am still a member of the aabb, the ISBT and the BBTS, and so receive all of their journals, AND also get the American Red Cross's Immunohematology journal. I LOVE reading through them. I also still lecture a bit and, of course, am on here. This all keeps me mentally stimulated.

We normally used a ratio of 1:1, unless the antibody was particularly weak, in which case we would, on occasions, go up to 4 of plasma/serum to 1 of red cells in NISS (BUT, make sure that such a ratio is written into your SOP).

Welcome Lorna Middleton.

Welcome Asif Dawar.

Welcome noora.

I cannot find the reference for which I was looking, and I wonder if (now I am in my dotage) I have mis-remembered and that it was one of a couple of papers stating that IgM ABO antibodies are easier to inhibit than are IgG ABO antibodies. The references for these are Witebsky E. Interrelationship between the Rh system and the ABO system. Blood 1948; 3: 66-79, and Kochwa S, Rosenfield RE, Tallal I, Wasserman LR. Isoagglutinins associated with erythroblastosis. J Clin Invest 1961; 40: 874-883. My apologies.

Welcome txlabtech.

How do you get hold of the extremely rare antibody specificities I mentioned (such as anti-Vel) to regroup units sent from, possibly, frozen blood banks, that they have typed as Vel Negative before the unit is sent out?