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Malcolm Needs

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Everything posted by Malcolm Needs

  1. True, but both the original question, and the question that resurrected this post were referring to antibody/antigen reactions. I don't think anyone would be made enough not to use a microscope to make that kind of estimate, unless you are using a fluorescence-activated cell sorter (FACS) with Fluorescein (FITC)-labelled anti-D, which is (just a bit) more accurate than is the human using a microscope! Flow Cytometry.pptx
  2. Ah, there I totally agree (except for antibodies related to antigens within the Kell Blood Group System - again, see the Guidelines).
  3. Most certainly a big rise is a worry, but a titre that remains at 32 is also a worry (see the Guidelines I cited above). If you don't believe them, try the Royal College of Obstetricians and Gynaecologists (RCOG). The management of women with red cell antibodies during pregnancy. Green-top Guidelines No.65; May 2014. https://www.rcog.org.uk/globalassets/documents/guidelines/rbc_gtg65.pdf. Essentially, they say the same thing. I am, I must admit, somewhat surprised, given your own professional history, and the fact that you work in the Isle of Man, which is covered by both sets of Guidelines, that you think that way.
  4. Yes, we always did. It made no difference to the antigens expressed on the red cells, or to the antibodies in the plasma (as long, of course, that there was sufficient sample to test in the first place).
  5. See my comment of September 16th 2012, and the comments of Peter Issett I quoted.
  6. True, but if you read page 660 of Issitt PD, Anstee DJ. Applied Blood Group Serology. 4th edition, 1998, Montgomery Scientific Publications, you will see that the percentage of Jk(a-b-) individuals was very much over-estimated in the original paper.
  7. Yes, this was more or less along the lines of the UK Guidelines on the subject (see British Committee for Standards in Haematology (BCSH): White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, Allard S. Guidelines for blood grouping and red cell antibody testing in pregnancy. Transfusion Medicine 2016; 26: 246-263 [doi: 10:1111/tme.12299]).
  8. Oh, silly me. I was too stupid to notice that. Thank you for putting me back on the straight and narrow.
  9. That is true, but then they need to follow the pregnancy by other means, such as ultrasound and/or mid-cerebral artery Doppler measurements are performed to ensure the health, or otherwise of the foetus is followed.
  10. Malcolm Needs


  11. I couldn't agree more. That's why I mentioned so many caveats.
  12. exlimey, I would most certainly agree with your first comment. In the VERY old days, when I was merely middle aged, and we only had access to tube tests and reagents, including AHG, and techniques (such as tile techniques), we didn't kill patients by the thousand, so techniques that are a little less sensitive than are available these days, will not necessarily condemn the patient to a certain and painful death, despite the deafening shouts of those who are gainfully (and, in many cases, VERY gainfully) employed within the neo-science of quality for quality's sake (we needed to pull up our socks in terms of quality, but it has got out of hand). On the other hand, having seen a fair smattering of Jk(a-b-) patients with anti-Jk3, I am unaware of "sticky" Jk(a-b-) red cells, even when they have been cryopreserved and reconstituted. I am willing to, and will freely admit to being wrong, if I am proved so.
  13. This is an almost impossible question to answer, as it is ALWAYS the responsibility of the physician looking after the patient to perform a risk assessment as to which he or she thinks is the higher risk - viz is it a higher risk to go ahead with the transfusion, or is it a higher risk to leave the patient without a transfusion? He or she will take advice from such professionals as the Pathologist, but, in the end, only they can take the decision. That having been said, it also depends whether any or all of those antibodies listed are detectable in the present sample, or whether some are historic, and, therefore, if some of these can be "ignored" from the point-of-view of transfusion, such as the anti-N. In extremis, the clinical significance of the antibodies can be assessed by use of bioassays, such as MMA, ADCC and CLT, and even looking at the IgG subtypes of the antibodies. If it is decided that it is safer to go ahead with the transfusion, than to withhold the transfusion, it could be made safer by the use of IVIgG (see, for example, Win N, Needs M, Thornton N, Webster R, Chang C. Transfusion of least-incompatible blood with intravenous immunoglobulin plus steroids cover in two patients with rare antibody. Transfusion 2018; 58: 1626-1630 [doi: 10.1111/trf.14648], and Win N, Almusawy M, Fitzgerald L, Hannah G, Bullock T. Prevention of hemolytic transfusion reactions with intravenous immunoglobulin prophylaxis in U- patients with anti-U. Transfusion 2019; 59: 1916-1920 [doi:10.1111/trf.15230]). Finally, I MUST remind readers that I am a (retired) Biomedical Scientist, and NOT a clinician.
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