Malcolm Needs

Hi Fluffy agglutinates, The result with the anti-H is the really puzzling one for me. Yes, the ethnicity "fits" for a sub-group of B, but even with a group A1 or a group A1B you would expect some sort of weak reaction with anti-H. Could you tell me at what temperature the patient's red cells were incubated with the anti-B and anti-A,B, whether the anti-A,B was a genuine anti-A,B, or was it a mixture of monoclonal anti-A and monoclonal anti-B, were the patient's red cells enzyme-treated and the tests repeated and what method was used for the elution (heat, acid, alkaline, Lui)? Lots of questions I know, but the answers will all give clues. ...but I am puzzled by the reaction with the anti-H. Could be your suspicion of a Bmh is correct! HIGHLY unusual! By the way, do you know the answer, and has the sample been sent to Joyce? :confused::confused:

What worries me a little about your proposal (although I can quite see from where you are coming dcharland) is that, very often the units transfused to neonates have their haematocrits artificially increased by disposing of the some of the plasma. Will not the adult units have a "normal" haematocrit and, therefore, the neonates could be in danger of ending up with a form of iatrogenic anaemia or worse, if the anaesthetists adjust the haematocrit in an uncontrolled way, circulatory overload? I don't know, I am only asking. :confused::confused::confused:

Amen to that. :)

No, no, they should be allowed to go on holiday, and, of course, some of the money we pay towards the reagents must pay towards these holidays (reasonble profits). There is a difference between them selling excellent reagents and reagents that are just a mixture of others, on the mis-guided premise that we actually need them. The difference between a 5 star hotel and a 4 star hotel!!!!!!!!!!!

Now that idea I could live with!

Thanks for that confirmation. Yes, he would have done because, apart from the fact that he was originally using an out-dated grouping reagent (from what I understand) he was also using a reagent that contained a small amount of anti-C and a large amount of anti-Ce. Of course, only the small amount of anti-C would react with an R2Rz red cell sample; the large amount of anti-Ce would not, and therefore the reaction would be weak. I am not a vindictive person, but I still think that you should report this chap to his manager, as what he is doing is downright dangerous. If he were to use this out-dated grouping reagent to type units, he could end up giving C+ blood to a patient with anti-C. Goodness only knows what would happen if he were to use an out-dated anti-JKa. It frightens the life out of me. :eek::eek:

Hi, It is spoken about in Geoff Daniels' book, Human Blood Groups, 2nd edition, Blackwell Science, 2002, Chapter 2, Section 2.11 Overlapping specificities of A- and B-transferases: B(A) and A( phenotypes, pages 41-42. In relation to the A-transferase bringing about group B red cells, the two references he cites are; Navaratnam N, Findlay JBC, Keen JN, Watkins WM. Purification, properties and partial amino acid sequence of the blood-group-A-gene-associated alpha-3-N-acetylgalactosaminyltransferase from human gut mucosal tissue. Biochem J 1990; 271: 93-98. and Yates AD, Watkins WM. The biosynthesis of blood group B determinants by the blood group A gene-specified alpha-3-N-acetyl-D-galactosaminyltransferase. Biochem Biophys Res Commun 1982; 109: 958-965. I should say that, although I have read Geoff's book (indeed, I reviewed it for the BBTS) I have read neither of these cited papers. :)

Thanks, but no! I just enjoy my work. Don't feel intimidated; I am one of the very lucky, very few for whom it's more of a hobby than work. :D:D

Well, fortunately most of them are directed against low-incidence antigens, though not all by any means, but the patient is still a right pain for whom to find potentially compatible blood. There is some good news though; the patient is not in my patch of hospitals!!!!!!!!!!!!!!!!!!!! Strangely enough though, the patient we had the biggest problems finding blood for just recently only had 2 antibodies; an anti-Fy3+Jka. We had no Fy(a-b-), Jk(a-b+) donors on the books in the UK!

What that makes you bmsjbatt is the salt of the Earth. The key to this thought is the phrase after the word "but", because, unlike me, at least you (and Rashmi) try! :redface::redface:

I certainly will try shily/Yanxia, but I am actually off work until next week, and so it may take a few days.

I couldn't agree more (and this comes from someone who is totally IT illiterate). :)

Assuming that the patient is of Black ethnic origin, and that her D antigen reacts normally with all examples of anti-D, I would strongly suggest that she is partial D III. Are my assumptions correct? If not, I'll have to re-think. :confused::confused:

No. I fully accept that a good Quality System is vital, and a poor Quality System can be worse than having no Quality System at all. That notwithstanding, "Quality" and "Fun" are the definition of antonyms and "Quality" and "Utter Boredom" are synonyms in my dictionary!!!!!!!!!!!!!!!!!!!!!!! :redface::redface:

Ah, maybe so, but that doesn't make your definition wrong (or mine come to that); just different. I just wondered if you could/would give me a little sprinkling of examples, so I know where you are coming from?

Just as a matter of interest, what is your definition of rare in such cases? Working in a Reference Laboratory, I suspect my definition may be quite different to yours. :confused:

I know what you mean. I think I am correct in saying that we have a thalassaemic patient somehwere in the UK who has 24 identified atypical alloantibodies (so far).

No, we do exactly the same when we are trying to identify the specificity of an antibody, but the way I read it (and I am happy to be corrected if I've got it wrong) they were using out-dated grouping reagents to type an antigen (and a pretty common grouping reagent in anti-C at that). This is something that we would NEVER do, except in exceptional cases where the grouping reagent is fantastically rare (say an anti-Era). :(:(

"in-dated"!!!!!!!!!!! That is disgusting. For a start off there is no way that they should be using an out-dated reagent. Secondly, most anti-C reagents (anti-Rh2) are, in fact, anti-Ce (anti-Rh7), and that includes monoclonal "anti-C" reagents (I've been caught out myself with this one) and that is why, if there is any chance whatsoever that the Rz haplotype may be involved, YOU LOOK EVEN MORE CLOSELY. Indeed, I would go as far as to say that any decent reference laboratory should use an R2Rz as a positive control for their anti-C reagents (I know this is impossible for Hospital Blood Banks, but that is why samples are sent to Reference Laboratories - they have more access to rare reagents, if not, so it would seem, to more conscientious Technicians/Biomedical Scientists!!!!!!!!!! My own staff (and some of them are members of this site) had better not make a similar error! Sorry, that sounds like a threat. It's not meant to sound like a threat. It's meant to sound like a PROMISE. :angered::angered:

Please believe me when I say I do know what you mean, and think it's a great thing, BUT, with my record on the spelling front, if I see one of my staff reading an SOP I've written, and they DON'T point out a spelling error, I take it as a moment of triumph!!!!!!!!!!!!!! :D:D:D

Sorry KKidd, I only know of the BSCH Guidelines, and like I said, I'm not sure that anyone outside the UK would take any notice of them (some in the UK don't either - but that's another story)! :redface::redface:

Well Mabel, I had the great honour of hearing Martin Olsson give a lecture at the Royal College of Pathologists at Doug Voak's retirement do a few years ago. It was absolutely fascinating. He was saying that, even then, there were over 80 different kinds of genetic backgrounds to the A transferase, but that, even then it wasn't that simple! For example, the transferase resulting in an Ax in Finland (say) is quite different to the transferase resulting in an Ax in Japan (say), but that all those in Finland (or, at least, around one area of Finland) were genetically identical, and the same goes for the (area) of Japan. So the genotype may differ, but the phenotype is similar. Personally, I wish they'ed never started doing this kind of thing. Makes us serologists feel redundant! PaulSunV, more power to your elbow! Get rid of the anti-A,B. It pays for suppliers holidays. :)

As the manager of a Reference Laboratory, I agree with you ENTIRELY. The only thing I would say is that we always make sure tht the hospital receiving a telephoned report KNOW from the word go that such a report is an interim report and that the final report may differ from the telephoned report, on the grounds that not all the tests will have been finished. In such a situation, we always err on the side of safety (e.g. give X negative blood, assume the patient is X negative, assume the antibody to be allo, rather than auto, until proved otherwise, etc).

Blow me Kate. If you're beginning to fell like a dinosaur, spare a thought for us blue/green algae!!!!!!!!!!!

Absolutely.