Malcolm Needs

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And there in lies the danger. Well said John. AS an ex-Reference Laboratory Manager, I think that ALL results should be confirmed, ABO or otherwise.

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In the UK, we recommend performing a crossmatch if an atypical alloantibody has ever been detected in a patient's plasma (or, in the case of something like anti-Vel - serum), knowing full well that, on occasions, we will not detect "incompatibility", as, of course, we do not know the "zygotic expression" of most antigens on the red cells of the donor blood, unless we have selected the units specifically. That having been said, the "rules" in the USA are often very different to the "rules" in the UK!

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No problem Mabel, BUT, what I don't understand is why your Pathologist didn't tell the OB doctors "to get knotted" when they asked for the antibody to be titrated. As far as I am aware, there has only ever been one peer-reviewed paper suggesting that a maternal anti-Le(a) has caused "clinically significant" HDFN (Carreras Vescio LA, Torres OW, Virgilio OS, Pizzolato M. Mild hemolytic disease of the newborn due to anti-Lewisa. Vox Sang 1993; 64: 194-195. DOI: 10.1111/j.1423-0410.1993.tb05387.x.) and, from memory, I believe that this was not, how should I put it, universally accepted! More to the point though, given that there a[[ears to be no detectable anti-Le(a) in the plasma at the moment, have you checked the lady's present Lewis phenotype? It could be that she is now Le(a+b-), or even Le(a-b+). Excuse me asking, as I am sure you probably know this, but there may be others reading this who do not, it has been known for many years that pregnant women may become transiently Le(a-b-) and may even produce Lewis antibodies. It was originally thought that pregnant women produced less Lewis glycolipid, but it is now thought that this is not so. It has been theorised that the increased incidence of the Le(a-b-) phenotype during pregnancy may be a result of increased concentration of plasma lipoproteins during pregnancy (Hammar L, Mansson S, Rohr T, Chester MA, Ginsburg V, Lundblad A, Zopf D. Lewis phenotype of erythrocytes and Leb-active glycolipid in serum of pregnant women. Vox Sang 1981; 40: 27-33. DOI: 10.1111/j.1423-0410.1981.tb00665.x.). In pregnant women, the ratio of lipoprotein to red blood cell mass increases more than fourfold, so that much more Lewis glycolipid is attached to plasma lipoprotein than is available for the red blood cell surface. I shall now shut up and let others comment!!!!!!!!!!!!!!!!!!!!!!

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I think it very much depends upon one's definition of the wording used as to what causes a problem. It could be clinical or serological or both.

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Auto-anti-M is VERY rare, but is negative with papain/ficin treated red cells.

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