Malcolm Needs

I know I shouldn't say this kwm5321 (not knowing the details) but I just wonder if the Reference Laboratory were having you on a bit of string, and trying it on; suggesting that you and your team wouldn't know that what they were saying was untrue. I've known of (stupid) Reference Laboratories do this in the past I'm ashamed to say.

Thanks Gina; that is a really useful post. If you are still working with George, please give him my very best wishes and wish him a Merry Christmas and a Happy New Year from me. :D:D:D:D:D

a) You do - but I don't care! I'm not sure, because this is handled by Doris Lam (my excellent deputy), but I do know they all get time. c) NO. I mean there were no atypical alloantibodies present (by a multitude of techniques, except super glue), and the money spent on us doing this is wasted!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

I think this is the practice of the huge majority of Blood Banks. As I said in an earlier post, I don't know of the clinical significance when the cord DAT also shows complement activity, but, certainly in the cases I've seen, there was no clinical haemolytic disease (but there is always a first time - it wasn't that long ago that Gerbich antibodies were thought to be clinically benign as far as HDN was concerned). :):)

NO! I'd be out of a job!!!!!!!!!!!!!!!!!!!!!!!!!!!! ....and then who would Rashmi (RR1) insult????????? :eek::eek::eek::eek::eek:

Touche! Mind you, I am deeply, deeply wounded! No, to read the SOPs (and other documents). I also try to give them protected time to read journals and papers for their CPD, but am less successful at that (the trouble is hospitals, such as ****** keep sending us samples with nothing in, but we still have to run them)!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :tongue::tongue::tongue::tongue::tongue:

We never filter patients' plasma, and I have never heard of this way of getting rid of auto-antibodies before. Would you mind expanding on this a little for an ignorant idiot????????? :confused::confused::confused:

Sorry if I have confused you a bit here, but Gm and Km have nothing to do with the Rh Blood Group System; indeed, they are not red cell antigens at all. Gm stands for gamma-marker and Km for kappa-marker. These are antibody idiotypes (antigens on the gamma and kappa parts of the antibody). Each individual makes antibodies of one type (although there may be more than one allelomorph per individual, e.g. an individual may be G1m1 and G1m2). All their antibodies, whatever the specificity, will have the same Gm type and Km type. This is why I say that, if the anti-D only shows one Gm and Km type, it is probably an immune anti-D, whereas, if there are multiple Gm and Km types, it is likely to be derived from anti-D immunoglobulin; but there could also have an underlying immune anti-D present. In other words, these idotypes can be used to rule in an immune anti-D, but not to rule out an immune anti-D. That having been said, if there are several idiotypes present, and the antibody is of low titre, it is a fair guess that it is from a dose of anti-D imunoglobulin. I hope this explanation helps! By the way, I'm not sure anyone does this on a regular basis any more. We used to do it when I was first working with Diana Brazier at the WHO Blood Group Reference Laboratory, but that was way back in the mid to late 1970s. No, I do sleep, eat, drink, etc, although my wife does moan at me from time-to-time about reading books too much, but it's a hobby and she is very understanding; I guess that's one of many reasons I love her and my 10-year-old son!!!!!! :D:D:D

We have not performed a study (indeed, I'm not certain how one could), but I doubt if it is maternal complement on the grounds that we would expect to see it much more frequently involved with any other maternal antibody that is capable of stimulating the complement cascade......but I don't know. :confused::confused:

I must admit, as a pure (well, maybe a little sullied) blood group serologist, I have little or no knowledge of this, but there is a chapter (chapter 15) in A Manual for Blood Conservation" edited by Dafydd Thomas, John Thompson and Biddy Ridler, tfm Publishing Limited, 1st edition, 2005 (ISBN 1 903378 24 9) that talks about this, if that is any help. :confused::confused:

That's why I'm more in favour of fair and proportional blame.

Kate, do you, or anyone else for that matter, use Thrombelastograpgy (or something similar) in such cases? There is a theory that this gives are more immediate (and possibly more accurate) measurement of the patient's haemostatic state, on the grounds that the coagulation sample tested in the Laboratory only gives a snap shot of the patient's state when the sample was taken, and is only then as good as the sample taken in the first place? Having said that, I believe this is used more commonly in the Operating Theatre than in Accident and Emergency, and I also hear a rumour that it is not as good as was first thought (although this could be idle gossip). :confused::confused:

Kate, despite some of my cynical, grumpy old man comments in many of my posts (most of which are slightly tongue in cheek) I am convinced that this is the right way to go. The airline/aircraft business was, I think, the first (in the UK anyway) to take up a "no blame" system of reporting errors, and it has worked wonderfully in improving safety. We are supposed to be working towards this in the NHS as a whole (and the NHSBT in particular), but your telling word is "mostly". I'm yet to be totally convinced of "no blame", but I am totally convinced of "fair and proportional blame". :)

Very cynical, and ABSOLUTELY true to life!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D

I would be inclined to give Fiona Harper, the Quality Manager at NHSBT-Tooting Centre, a ring. She is absolutely excellent at this kind of thing. I'm not sure if it is open to staff outside the NHSBT (she would know), but they also do a course on how to use the documents and how to perform the assessments. It could be worthwhile asking (although you may have to go to Brentwood for this, as there is where the course is usually held, and that is a pain of a place to get to). :)

Hmmmmmmmm!

Pretty dangerous if the alloantibody happens to be an anti-Jka!!!!!!!!!!!!!! No, alloantibodies do NOT always have a higher titre than the auto-antibody. Many of our "regulars" with wAIHA have alloantibodies that are no longer detectable, but I certainly would give them nothing but antigen negative blood. :(

I would start from day 1. I know what the text books say about babies having a poor complement system, and that the DAT is always IgG only, but don't you believe it! I have seen cord bloods with a positive DAT by IgG and C3d. In each case, I may add, the maternal antibody was related to the Kidd Blood Group System (either anti-Jka or anti-Jkb), but if it can happen with these, then there is the possibility that it can happen with other specificities. What the clinical significance of this is, is another matter altogether................ :):)

I've just thought, the other thing you could try is to treat the "offending" screening cell with chloroquine diphosphate, just in case it has a strong Bg antigen and the mum has made HLA antibodies (quite possible in pregnancy).

ABSOLUTELY (but try telling that to Human Resources)! :eek:

We have something similar in the NHSBT in the UK. It is called Task Based Training. Here, the trainee signs to say that they have read the document, have understood it and are confident in carrying out the task, whereas the trainer signs it to say that the trainee is competent in the task. That having been said, the onus is still on the trainee to make the effort to read and understand the document, and if no such effort is made, we have the option of disciplinary action. It is one thing to make the effort, and yet still not understand it, or not be confident to perform the task; it is quite another not to make the effort in the first place. :(

That's one heck of a list! Once I get back to work properly (after the New Year) I may be able to help with some of the rare red cells (Lu(a+b-), Lu(a-b-) dominant type, which will also be (effectively) AnWj-, r'r', r"r", McC(a-), Lan-), but I can't promise. I depends what donors turn up. Have you tried becoming a member of SCARF (Serum, Cells and Rare Fluids)? If not, look them up on a search engine and see if you are eligible. Some of the rare antisera and, come to that, rare cells that you are looking for are so rare, I think that is the only way you are going to find them. That having been said, anti-Ce is as common as muck. Almost all so-called anti-C reagents (including monoclonal anti-C reagents) are, in reality, anti-Ce (just try them in parallel against any R1r and R1Rz cells). It is monospecific anti-C that is really rare. :eek::eek:

Yes I am, however, these days I'm more saggy than Sagittarian!!!!!!!!! I hope you have a really brilliant day Kate - come to that, I hope you have a really brilliant year! Enjoy the wine; I will be having just a small glass or ten tonight myself (purely for medicinal reasons, you understand). By the way, how many years of illegal drinking was there first!!!!!!!!!!!!!!!!!!!!!!???????????????????? (several in my case). :D:D:D:D

Hi Emily and welcome. You will learn an awful lot from this site (I think I can safely say that we all have). Never, never be afraid to be wrong, but always be petrified to not admit that there is something you do not know. Nobody, but nobody knows everything, but the fool always finds it difficult to admit this. If you have had the honour of being taught by jcdayaz, from what I have read of her posts, you have had an excellent start in your professional life. Post away, and have no worries about making a fool of yourself; I make a fool of my self on a regular basis!!!!!!!!!! :D:D:D:D:D