Malcolm Needs

Welcome Joan P.

Welcome Amy Brown.

Welcome David Zemke.

Yes John, With higher dose anti-D immunoglobulin, the DAT of a D Positive baby is quite often positive. In the UK it is now quite common to give a dose of 1, 500 IU of anti-D immunoglobulin at 28 weeks of gestation and, as a result, many babies have a positive DAT, but I have never heard of clinically significant HDFN as a result, Physiological jaundice is also quite common in newborns, whether the mother was given anti-D immunoglobulin or not, and whether the baby is D Positive or D Negative.

Welcome Mermaid27.

Thanks for that. I was actually aware of this paper (I have know one of the authors, Heidi Doughty for many years - and she has my greatest respect), but you will also note that the title rather makes my point.

I am uncomfortable with the use of the term "child-bearing age" because, if the bit in the brackets isn't properly interpreted, a four-year-old D Negative female (for example) might be given D Positive blood because she is NOT of child-bearing age, but is, of course, of child-bearing potential.

No, we didn't publish as, although the case was new to me, Joyce Poole had seen this kind of thing a few times.

Well, the simple answer is "YES", but whether you believe me or not is up to you. When I was the Reference Service Manager of the Red Cell Immunohaematology (RCI) Laboratory at the Tooting Centre of the National Health Service Blood and Transplant (NHSBT), we had a patient's sample referred to us from one of our samples from the East Coast of England (I have to be careful not to identify either the patient or the hospital) who had an anti-K, having never been transfused with K+ blood. However, this patient consistently had a positive anti-K in their plasma, and also, believe it or not, could have anti-K eluted from their erythrocytes, Knowing the situation (i.e. we had not supplied K Positive blood to the hospital for this patient for many years, AND knowing that they knew what they were doing - they would NOT have given K Positive blood), I was wondering if either I, and/or my staff (in their case, almost impossible, even if I was fallible) and so we sent the sample to the International Blood Group Reference Laboratory (IBGRL) for confirmation. The report we got back (from Joyce Poole) was that they also detected an anti-K, from an apparently K Negative patient with a positive DAT, but the eluate was (again, apparently) anti-K! Unfortunately, we lost track of this patient, BUT, if Joyce was a bit foxed by this case, I feel TOTALLY free to be foxed as well! Her theory was that this was a case of a "mimic-anti-K", rather in the same way of almost all WAIHA specificities being a mimicking "specific Rh antibody". Since then, of course, it has been shown that low prevalence antigens within the Kell Blood Group System can lead to "strange" antibody specificities within the Kell Blood Group System, together with weakly expressed antigens within the Kell Blood Group System. I am NOT saying this is a total answer to your query (but it is the best I CAN DO!).

Most certainly it can. There have been published papers on newborn babies being typed as D Negative, and K Negative, not because they have received an IUT, but because their mother's antibody has such a high titre that they sensitise virtually every antigen site on the cord red cells, thus causing a sort of prozone effect. The same can happen with a "blocking antibody" and AHG. It is also not uncommon for newborn babies with ABO HDFN to have a negative DAT, and be released from hospital, only to be brought in again when they become "floppy", and for the DAT to then be positive.

Welcome MCHJulie.

As have I, but I STILL don't understand the need to try and determine the specificity of an antibody causing a WAIHA, when almost all of them, if not actually all of them, are only mimicking specificities only, and so, to give truly compatible blood would mean giving something like Rhnull units, or En(a-) units - and why would anyone waste such precious units on such a case? Indeed, as so many were proved to be anti-Rh17 or anti-Rh18, or, indeed, anti-Wrb, why even wasted such rare red cells proving that the wheel has already been invented? Sorry, but I just don't understand this obsession.

Welcome MMendoza.

Welcome Bet'naSBB.

Welcome AChavis.

Welcome mollymotos.

Welcome Jina.

Welcome RFord.

Welcome Roman.

Welcome RedWoodLabRat.

In the UK, unless a piece of work (such as running positive and negative controls) is signed and dated by the person carrying out the work, it is regarded as not having been done in the first place. While I am not, by a long way, in favour of everything suggested by either "Internal Quality", or "External Inspectors", in this I stand four square with them. On the other hand, when they prescribe what colour ink we should use, they can go take a running jump, as far as I am concerned.

It is with huge regret that I have to report the fact that I have heard that Dr Larry Petz died on 2nd June following a short illness. One of the all time greats of the world of blood transfusion. May he rest in peace and I send my condolences to his family, friends and colleagues.

Welcome BBsue.

Welcome Sharon Kimble.