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Everything posted by Malcolm Needs
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This reply also applies to the excellent post above by Debbiel. Do these "experts" not understand, as do most, if not all people involved in blood group serology (and even blood transfusion) that it has been known for years and years that not every antibody reacts by all techniques, however experienced the person performing the test may be. I once had an anti-S that reacted by tube IAT, but refused to react by gel, even though I sent it out to a large number of hospitals who I knew used both techniques. I also think that all true experts have either read, or are aware of Leger RM, Garratty G. Weakening or loss of antibody reactivity after prewarm technique. Transfusion 2003; 43: 1611-1614. Sadly, it would appear that (SOME) of the Quality "Experts" are not as expert as they like to think.
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Dee, Harry and I (especially me) have cocked up in a major way this year and would like to apologise to as many people as possible who would normally expect to receive Christmas cards from us. I bought the cards, but then left it too late to write our and send any (particularly those of our friends in other countries) and, what with the postal strikes, it is now too late. That notwithstanding, we would like to apologise profusely for the/my error, and wish everyone involved a Very Merry Christmas and a Happy and Prosperous New Year. We would also like to thank those people who have been much more organised that us/me and have managed to get cards sent to us. We very much appreciate it.
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It would be highly unusual for hospitals in the UK to retest antigenicity (at least, those supplied by the NHSBT). Some years ago, one of the Consultant Doctors in the NHSBT (I forget who, to my shame) wrote an open letter to all the hospitals guaranteeing that any blood groups on the bags are correct. In every case, the bags/donors are typed for ABO, D, C, E, c, e and K at least twice, BUT, on top of that very few of the hospitals, unless they are large teaching hospitals, can afford to keep sufficient CE-marked grouping reagents for all of the common blood groups. They would certainly not carry antibodies against such antibodies as anti-Vel, anti-Lan, anti-Kpb, anti-Jsb, anti-Fy3, anti-Inb etc, or the genotyping for V-, VS-, etc, so it is a bit of a non-question in a way, because we have a huge admix of ethnicities in and around London, Manchester, Birmingham, etc meaning we see a fair smattering of antibodies against these specificities.
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We've all done it at some time - ESPECIALLY me!
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MTP cut-off policy, or Lethal Dose of Blood Products
Malcolm Needs replied to jshepherd's topic in Transfusion Services
I agree with Auntie-D. I issued well over 100 units to the police dog handler blown up in the "Harrod's Bomb", and he also survived. -
I have seen numerous cases of Oh, and they all had pretty strong reverse groups, rather than weak or negative reverse groups.
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I agree entirely with Neil Blumberg (although, of course, as a former Biomedical Scientist, I don't have his legal authority), but there are situations involving adults where the reverse group will not always match the forward group (for example, post certain bone marrow/stem cell transplantation procedures - see, for example, Needs ME, McCarthy DM, Barrett J. ABH and Lewis antigen and antibody expression after bone marrow transplantation. Acta Haematology 1987; 78: 13-16, DOI: 10.1159/0002205828, and Hult AK, Dykes JH, Storry JR, Olsson ML. A and B antigen levels acquired by group O donor-derived erythrocytes following ABO-non-identical transfusion or minor ABO-incompatible haematopoietic stem cell transplantation. Transfusion Medicine 2017; 27: 181-191. DOI: 10.1111/tme.12411.) for perfectly natural reasons, and in such cases, we also followed the forward group - at least, after the advent on ABO monoclonal antibodies.
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I am a little worried about this because, even if there are VERY low numbers of isoagglutinins, if there is a normal level of complement, it can still be extremely dangerous, as there is massive amplification within the complement system (see the excellent attached PowerPoint lecture, written for me by my friend Grant Webb). The Complement System.pptx
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If the problem is that the reverse group is too weak to allow for a safe IS cross-match, DO NOT ALLOW AN IS CROSS-MATCH. It is simple.
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Welcome PBM.
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QUITE!
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Emergency Neonatal Transfusion in Small Hospitals
Malcolm Needs replied to mollymotos's topic in Transfusion Services
The paedipacks supplied by NHSBT, or, rather, the donors are also tested for unusually high levels of potassium ions, as a result of findings a few years back where babies had been affected by fresh, rather than stored blood from such donors (natural hyperkalaemia). -
Welcome Andrea Pointer.
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Welcome waterbug.
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Welcome Fatimah Ramos.
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Welcome Hakea.
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Welcome Labgurl84.
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True, but who is going to perform tests, such as ADCC, that cost a certain amount of money, as well as time, when M Negative units are generally easily available?
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What a waste of expensive phenotyped blood.
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Welcome Courtney, and Happy Birthday for a couple of days back!
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In the UK this problem should not occur, as our BSH (BCSH) Guidelines mandate that our screening cells have homozygous expression of certain antigens, one of which is M.
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Best suggestion yet!!!!!!!!!!!!!!!!!!!!!!
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Welcome Poppys.
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That is true John, BUT it is STILL the complement (specifically the Membrane Attack Complex of C5b, activated C6, C7 and C8 molecules and about 6 activated C9 molecules) that causes the haemolysis, which is why autologous red cells are also destroyed.
