Malcolm Needs

Surely, it depends upon the circumstances? Are you talking about an exchange transfusion at birth for HDN, or an exchange transfusion in a child or adult with, for example, sickle cell disease? :confused::confused:

Actually, you can use such blood for transfusion, but it is best if it is irradiated prior to use, just to be on the safe side. :):)

Hi sona, Do you mean 1%, or 1 g/dL? :confused::confused:

No, just been extremely busy for the last couple of days! :)

Hi rravkin, Jill Storry and Martin Olsson have comparatively recently published a fantastic review in Immunohematology. Storry JR, Olsson ML. The ABO blood group system revisited: a review and update. Immunohematology 2009; 25: 48-59. Some of this may go towards answering part of your questions, and I have taken the liberty of attaching most of the section from this review entitled, "Antibodies in the System". A further section, entitled, "Clinical Significance" goes on to discuss other aspects of ABO antibodies. The whole review really is worth a read. Best wishes, Malcolm :D:D:D:D:D Storry JR.doc

Did he have a positive DAT and auto draaa? If he had a life-threatening haemorrhage, you would have to give least incompatible. If not, you have time to investigate. Firstly, you could perform a titration, to see if he has what used to be called a high titre, low avidity (HTLA) antibody. If this is the case, you could then try and see if the antibody could be inhibited by ABO compatible plasma. If this is the case, then the antibody is almost certainly anti-Ch or anti-Rg. Neither of these specificities are clinically significant, and so, as long as there are no other underlying antibodies, incompatible, let alone least incompatible blood can be safely transfused. The other thing you could do is perform a full phenotype to see if he lacks a high frequency antigen, such as Lu(. To be honest, with these weak reactions, whatever the specificity, the chances are that this time the antibody will not be cliniczlly significant, and that least incompatible can be safely transfused, but not necessarily next time. :):)

You certainly can Ashref, HI! And welcome to BBT! :D:D:D:D

Welcome Deny. Yes, it is a great site, and I'm sure the members will help you if they possibly can. I know they have helped me a lot. :D:D:D:D

Much as it grieves me to say so, I agree with what you say Rashmi (well, not about the time to consider - I still think 8 months was pretty quick for you :rolleyes:). The way I see it, the further up the ladder you go, the more responsibility you take in the Laboratory, and this is reflected in your job description, but this job description does not in any way absolve you from doing the more "mundane" jobs within the Laboratory that were in your previous job description. If, for example, you are the lead in your Laboratory, and a freezer needs defrosting, if you are the only person who is free at the time, then you defrost the freezer; you don't wait until a more junior staff member is free. The same applies to general cleanliness and tidiness in the Laboratory. It is everyone's responsibility. :(:(

I have not heard this, but it would come as no surprise whatsoever. Whilst the UK definitely needed some Laws to stop prejudice of all kinds (it used to be rampant), it has now got to the stage where political correctness has not gone so much mad, as completely and utterly insane. It has got to the stage that conversations between friends have become quite stilted if there is a chance of being overheard, just in case an innocent remark can be regarded as racist, sexist, oldist (you name it, we've got an "ist" for it in our Laws now - except smokist - you are actively encouraged to insult smokers) and they are reported to the authorities. In the old days, however, and still this is true of most of our Laws, you are presumed innocent until proved guilty, but with some some of these "ist" Laws it is just the opposite - and trying to prove innocence is almost impossible. I've known completely innocent peoples' lives ruined by false accusations. It is like living inside George Orwell's book "1984" sometimes. The really daft thing about it is that the Government, of whatever political persuation, fail to see that interpreting the Laws in such a way (or allowing the Laws to be interpreted in such a way), plays straight into the hands of right wing extremist parties. Anyway, end of rant, (sorry about that) and, no, I haven't heard that it is going to be introduced into the Health Service (but watch this space, as they say). :mad::mad::mad::mad::mad:

No eric1980, that's quite a quick reaction for Rashmi!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

I'm sorry to be a pain and disagree (I really am) but it is only testing a symptom, and is not a diagnostic test. The diagnostic test is the result from Microbiology. I totally agree that Mycoplasma pneumonia can have this effect, but there are also other causes (but I do sympathise if the doctors insist - there is not much you can do, except suggest to them they read Petz and Garratty - and I can just see them doing that!!!!!!!!). Once again, apologies for being an old grouch! :o:o:o:o:o

If the DAT is positive, are you able to tell us the underlying pathology causing this (sorry, so many questions)? And his ethnicity? Yes, the reaction could be 3+, and can go up to 5+, but this would be very,very rare. Thanks for that information Antrita. :):)

But why are you doing the titration in the first place? What does it tel you (or the Clinician)? :confused::confused:

That wasn't quite what I meant. What I meant was, if there is any slack in the system, you can guarantee it will be filled by some new Quality requirement, or Health and Safety requirement, or similar, that has never been required before (like the pancake races or concker playing that has been banned in certain areas of the UK because of Health and Safety concerns, where there has never been an injury since time immemorial).

Or, "Quality is a journey like a obstacle race without a destination." :(:(

Working in a Reference Laboratory in London, we see a few of these a year. How strongly did the patient's red cells react with your routine anti-D reagents? What is his ethnicity? Was his DAT positive or negative? If the reaction between your routine anti-D reagents was strong, and the patient has Black ethnicity, it could well be a Partial D III. If your routine anti-D reagents detect Partial D VI, it could be that. If the DAT was positive, it could be an auto-anti-D (or an auto-anti-LW mimicking an auto-anti-D). I would be really interested in what your Reference Laboratory report. Will you let us know when you get the report please? :confused::confused:

What do you think? What we did and what is left to do to sort it out. The initial results showed a group A individual with the forward group, and an AB individual with the reverse group by DiaMed gel column agglutination technology (CAT). Although this confirmed the findings of the referring Hospital Blood Transfusion Laboratory, we have no automation, and, as any manual technique has a higher chance of mistakes than automated techniques, simply because a human is involved, the first think we did was to repeat all tests from the index sample. The results were the same. The question at this stage was, what was the lady’s past history? She was a White European pregnant lady (early gestation of less than 28 weeks), had one miscarriage for unknown reasons, had no twin, was healthy, had not undergone a stem cell transplant. How were we going to “attack†the case? We re-typed the lady’s red cells with several different clones of anti-B, in case our routine blend of clones did not react with a certain group B epitope present on her red cells. These were all negative. We repeated the reverse group with a pool of group B red cells (a pool, in case, once again, her own anti-B was recognising an epitope not necessarily carried on the our routine group B reverse grouping red cells) at 4oC. These tests were also negative. We were not much farther forward at this stage! The likelihood was that there was a weak B antigen present. Such antigens are extremely rare in White Europeans. We used a monoclonal anti-B to try to adsorb anti-B onto the lady’s red cells, and then used the Lui technique to try to elute any anti-B off again. Crucially, because monoclonal anti-B can actually be anti-B(A), we used both group A and group O cells as the negative controls to test the eluate. The results showed the eluate to contain anti-B, reacting 4+ with the test group B red cells and 0 with both the group A and O red cells. The lady was, therefore, a group ABel. Unfortunately, no saliva was submitted, and so we could not (easily) look for A and/or B soluble substances. She could be a very weak acquired B, but the missing anti-B tends to rule this out (such individuals usually have an anti-B that reacts with normal group B individuals, but not with other individuals with acquired . We could rule out hypergammaglobulinemia and agammaglobulinemia, because the lady was healthy, and such individuals normally suffer from either low level, or high-level chronic infections. Pregnancy can reduce the levels of anti-A, anti-B and/or anti-A,B, but the key word here is “reduceâ€, rather than “ablateâ€. Pregnancy can also reduce the expression of the ABO antigens, but, once again, the key word is “reduceâ€, rather than “ablateâ€. In any case, the lady’s A antigen was as strong as would be expected. So, there remains the possibility of a micro-chimera or a genuine ABel phenotype. Although the lady has no twin, there remains the possibility that there was actually a twin in utero that was fully absorbed in utero, that there was a twin, resulting in circulatory anastomosis, but who was dead at birth (and the lady was never told about this), or that the lady is a dispermic chimera. We did not see any mixed-field reactions, but then we did not see any mixed-field reactions with the anti-B sera used. That notwithstanding, I am hoping to get another sample from the lady, so that this can be checked at a molecular level. There is the possibility that the lady is a Cis-AB, as such individuals usually have a weak B antigen, but they also tend to have weakly reacting anti-B, reacting against the epitope(s) of the normal B antigen that they lack. We did not detect any anti-B. Most likely is that the lady is a genuine ABel, but once again, this would have to be proven at a molecular level. So far as I know, there are only two molecular changes that have been reported that cause Bel. These are 641T>G, leading to a Met214Arg amino acid change in the 3-α-galactosyltransferase, or 669G>T, leading to a Glu223Asp amino acid change in the 3-α-galactosyltransferase. I warn readers though; I am no expert in this area of our work. Once again, I am hoping to get another sample from the lady, so that this can be checked at a molecular level. Once I have the molecular results (if I can get more samples; the lady is, apparently, normally a bit “twitchyâ€, and so may refuse) I will post these. Hope this helps! :D:D:D:D

Ha, Ha!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

This is very similar to what we do in the UK. :):)

In that case sona, I'm sorry, but I have no idea what would cause this.

We have the same on Pulse.

Welcome Palin. Yes, it is a wonderfully friendly, and well-informed website. I love it! :D:D:D:D

Thanks for your comments. As I say, according to the referring hospital, the lady is somewhat nervous by nature, and so, if we can prove the cause by other ways, we would rather not go down this road just yet, but if we have to do so eventually, I suppose we will. :):):)