Malcolm Needs

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There is absolutely no reason to give group O red cells to a recipient who is A3. Even if the patient does develop an anti-A1, unless that antibody is reactive at strictly 37oC, they can still receive A1 red cells, but, if the anti-A1 does react at 37oC, there is no reason not to transfuse with A2 red cells that are IAT compatible. Personally, I have never seen loss of A or B antigens through ALL, but I have with AML. In fact, in one case, we were able to follow whether the patient was in remission or relapse by the strength of the reaction of the A antigen with various anti-A reagents, but this was many years ago, and I honestly can't remember whether these were human-derived polyclonal reagents or early monoclonal reagents.

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If the test is showing no immediate rouleaux or agglutination due to a "cold reacting" antibody, I'm afraid that I am at a loss to see why anyone would leave the tests to see whether one or the other develops. Rouleaux is clinically insignificant in terms of blood transfusion, and ditto "cold reacting" antibodies, unless they are of wide thermal amplitude (in which case, there would almost certainly be agglutination visible straight away. Why waste reagents and expensive technician's time investigating a clinically insignificant phenomenon?

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Could NOT agree more Neil.

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Thanks Arno; that was really helpful. Yes, very well indeed thanks!

Is it just me that has missed it???????? I visited the ISBT site yesterday, and noticed that the Cost Blood Group Collection of Cs(a) and Cs(b) is no longer a Collection, but that the two antigens have been "promoted" to the CTL2 Blood Group System. I THINK that this is a recent happening. Can any member put forward a reference concerning this, as I have been unable to track anything down on Google (mind you, I hold both hands up to me being monumentally useless at driving a computer!!!!)??? Thanks in advance.

I was involved in one very unusual case (Win N, Needs M, Rahman S, Gold P, Ward S. An unusual case of an acute haemolytic transfusion reaction caused by auto-anti-I. Immunohematology 2011; 27 (3): 101-103. DOI: 10.21307/immunohematology-2019-182. This was caused by the unit being removed from the storage fridge and immediately transfused. If I remember correctly, however, because of the reaction, blood was put through a blood warmer on the ward as a precaution after this. I doubt very much though that it would be something that would be done on a regular basis.

In that case, I think that you would have been justified to have given "straightforward" D Positive blood in terms of a transfusion. This is based on two papers from experts on the subject. Sandler SG, Flegel WA, Westhoff CA, Denomme GA, Delany M, Keller MA, Johnson ST, Katz L, Queenan JT, Vassallo RR, Simon CD. It's time to phase in RHD genotyping for patients with a serologic weak D phenotype. Transfusion 2015; 55: 680-689. DOI: 10.1111/trf.12941. Sandler SG, Chen LN, Flegel WA. Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype. British Journal of Haematology 2017; 179: 10-19. DOI: 10.1111/bjh.14757. My own mentor, Joyce Poole told me that Weak D Type 1 individuals rarely produce an anti-D after transfusion with D Positive blood - although she had come across about three or four cases WORLDWIDE!!!!!!

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I just answered this question. My Score FAIL  

Thanks Mabel. Quite right too. Huge respect for Ed Snyder. Met him when he was given an award by the BBTS, and also when we both lectured in Rhode Island.

One of my own favourites is from Dr Brian McClelland MB ChB ND Linden FRCP(E) FRCPath, Consultant Haematologist, Scottish National Blood Transfusion Service, Edinburgh, UK, who said, "Transfusion has risks, but bleeding to death is fatal." I believe it was also him (although I could be wrong here) who said something along the lines of, "Giving perfectly compatible blood to a corpse is not a medical triumph!".

I am sorry, but this part of your post is simply untrue. I have checked in my copy of Mollison PL. Blood Transfusion in Clinical Medicine. 6th Edition, 1979. Blackwell Scientific Publications. In this is an entire Section in Chapter 8 devoted to "Rh Immunization by Transfusion", where he describes a large amount of experimentation, both involving deliberate injection of D Positive red cells into D Negative individuals, and also of D Positive units being transfused into D Negative individuals, bot accidentally and deliberately in the case of bleeding patients, including cases where only one unit was transfused. Without looking through all of the editions that I own, I am almost certain that this work was quoted in the later editions, including the 12th edition written by Harvey Klein and the late, great Dave Anstee.

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