Malcolm Needs

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I never did it like this. We always incubated at 37oC, and usually had the luxury of using a mega amount of plasma from an entire unit of blood from an immunised donor, rather than from a patient or an expiring grouping reagent. This also meant that we had the luxury of being able to chose a donor with a weak form of the antibody. That worked for us (including preparing samples for teaching and exams at college/university. Sadly, I retired in October 2016, so I am no longer in a position to even try the way your old supervisor did this. Thank you so much for your kind words. I am not at all sure that I deserve to be called "a whiz", but, being excessively vain, I'll take it!!!!!!!!!!

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We would indeed!!!!!!!!!!!!!!!!!!!!!!!!!!

This is almost certainly NOT the paper that you wanted referenced, but it may help in an emergency. Win N, Needs M, Thornton N, Webster R, Cheng C. Transfusion of least-incompatible blood with intravenous immunoglobulin plus steroids cover in two patients with rare antibody. Transfusion 2018; 58: 1626-1630. (DOI: 10.111/trf.4648).

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Yes, I didn't think it was directly pertinent to your case Mabel.

I don't think this is the reason in the case you describe, particularly in the case of the baby's D typing, but, just to remind people, a monoclonal anti-D taken straight from the fridge, and not allowed to come to room temperature before used for testing, can lead to false positive results. See Thorpe SJ, Boult CE, Stevenson FK, Scott ML, Sutherland J, Spellerberg MB, Natvig JB, Thompson KM. Cold agglutinin activity is common among human monoclonal IgM Rh system antibodies using the V4-34 heavy chain variable gene segment. Transfusion 1997; 37: 1111-1116. DOI: 10.1046/j.1537-2995.1997.37111298088038.x., and Thorpe SJ, Ball C, Fox B, Thompson KM, Thorpe R, Bristow A. Anti-D and anti-i activities are inseparable in V4-34-encoded monoclonal anti-D: the same framework 1 residues are required for both activities. Transfusion 2008; 48: 930-940. DOI: 10.1111/j.1537-2995.2007.01624.x.

"Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago. Thanks for your words of comfort." You are STILL not giving ANTI-D Kym; you are giving D Positive red cells. The other thing is that, within the White populations, but more so in the Asian populations, there is a very good chance that giving group O, rr blood will stimulate the production of an anti-c (IF any Rh antibody is stimulated), and that can be just as "dangerous".

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I remember the great George Garratty telling me once that measuring haptoglobins AFTER blood has been given is an absolute waste of time, money and reagents, UNLESS the pre-transfusion haptoglobin levels have been measured. I believed him!!!!!!!!!!!!!!!!!!!!

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No, you are giving group O, D Positive red cells to these patients; not anti-D. Of these patients, 15% of the White patients have the potential to then become immunised and may produce anti-D themselves, but better that than dying. However, not all such recipients will produce an anti-D, as it is well-known that when blood is given in a situation where the patient may be exsanguinating, the patient is less likely that normal to make such antibodies. Even if they do go on to make anti-D, as they are male, the chances of the anti-D affecting a future pregnancy are zero, whatever the WOKES may say these days. We have been doing this in the UK for at least a decade, and we have not experienced many problems with either male or female (over 50) patients.

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Certainly in the case of an anti-Vel, it can be vital to use serum, rather than plasma, as it can frequently only be detected by using an AHG that detects complement. I DO SO AGREE WITH YOUR FINAL SENTENCE.

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