Malcolm Needs

Couldn't agree more Deny. One only has to look at the "ideal" haemoglobin level for surgical patients pre and post procedure, and how this has changed over the years to see how true are your words of wisdom. :D:D:D:D

That is true, and seems a worthwhile way of doing it, but one must also remember that the donors will have a normal range of haematocrits, which will also complicate matters. :redface:

Very true, very true. I remember that, in days bygone, however, the doctor would make a tentative diagnosis and then order pathology and other tests to prove or disprove their diagnosis. Now, they seem to be so frightened of litigation (and who can blame them in these litigious times) that they order blanket tests and make the diagnosis from the results. I wonder which is best from the point of view of the patient and from the cost/benefit perspective? :confused::confused:

Sorry, but it is mentioned that the patient is a male, so I doubt if pregnancy comes into it!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

I totally agree.

I will quote from page 14 of Klein HG and Anstee DJ. Mollison's Blood Transfusion in Clinical Medicine. 11th edition, Blackwell Publishing, 2005. "Phlebotomy remains the overwhelming choice for the initial therapy of polycythaemia vera. Although red cells from such patients survive normally, polycythaemia vera is a clonal, progressive, myeloproliferative disorder and patients are at increased risk for developing leukaemia. As a rule, this blood is not used for transfusion, although the risk of acquiring a graft of malignant cells from the donor seems to be neg;igible, even in recipients whose immune mechanisms are supressed by disease or drugs." It is for the reasons of this low risk, and bearing in mind that, one day, I may require a transfusion from such a donor, that I suggest irradiation. :):)

Yes, I was just being devilish!!!!!!! :):)

Ideally, blood of the same ABO group, or Oh, but these are very,very rare. In this case, as there is no anti-H, I would want group O that is negative for high titre ABO antibodies. I say this, knowing that such blood may stimulate an anti-H. This would, of course, cause problems if maternal transfusion is required later in life, but would not cause a big problem with another pregnncy. :)

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." :(:(