Malcolm Needs

Boy, this is a difficult one! If the screen is positive the first time around as 1+, or maybe even 2+, but is negative again using the same cell at least twice more by the same technique, then I would be happy that the original findings was an error, but otherwise no. I certainly wouldn't be happy if the screen were positive, but two panels were negative, unless the positive screening cell was included. It may be that the screening cell is positive for an antigen not represented on any of the panel cells, and that the antibody is genuine. Do you perform your tube technique by pre-warming the reactants prior to mixing? If not, it could be worthwhile pre-warming one set and performing the same panels at room temperature (but, again, I would always include the positive screening cell). It could also be worthwhile trying a NISS tube technique, in parallel with the LISS tube technique, with, of course, an appropriately longer incubation time, just in case the antibody is "LISS only". These are only initial musings, whilst I'm waiting for my young son to get ready for bed. I'll think about it more tomorrow! :eek::eek:

There are such a huge number of ways of having a transfusion reaction, that I'm not sure that you could have a Transfusion Reaction Proficiency Test without a narrower title (see attachments). No, sorry, the file is 13.7MB in zipped form, and I can only attach a file 4.7MB large in zipped form. If you send me an email address to malcolm.needs@blueyonder.co.uk, I'll send it to you. :confused::confused:

I agree with you John, but in the UK it is the Law. This Law was passed with the thought (and now the realisation) that vCJD could be passed on by a blood transfusion. There is good reason why an individual who has themselves been transfused cannot be accepted as a blood donor (see slide 20 of the PowerPoint lecture "Donors and the Donation Process" in the References section). Sadly, this Law was passed by politicians who, although advised by the great and the good of Transfusion Microbiology, still made o right horlicks of the whole thing. So, under the Law in the UK, not only can we not use a person's blood for donation for other people if they themselves have been transfused, but, strictly speaking, without a medical deviation, we cannot use it for an autologous transfusion! Normally, of course, this would not matter, BUT this extends to ALL patients, and so, if we have a (non-existent) patient with, for example, an anti-k+Vel, requiring blood from another (non-existent) donor who is also k-, Vel-, they would not be able, under the Law as it stands, to give blood for an autologous transfusion! Clever eh???????!!!!!!!!!!!!!!!!!!!! We have to reject donors who have made an atypical alloantibody through stimulation by pregnancy, just in case they have had a transfusion without knowing it. Can you imagine the fuss if someone was to go down with vCJD having had blood from such a donor, even if there was no evidence that the transfusion caused the vCJD? So, basically, although I agree with you, we have no choice. :eek::eek:

Keisterkid I am really sorry; I have reread my post and it does indeed sound hostile, which was unintentional. What I meant was that I would not go to the expense of washing them in the first place (unless the antibody titre was really high, or the unit was destined for a recipient of small stature). You are absolutely correct in saying that the gift should not be wasted, but as far as I am aware, apart from when plasma-rich components have been given to recipients of small stature, there are no credible cases of such a component causing a clinically-significant transfusion reaction, save one case of an anti-K in a donor that reacted with another K+ transfused unit. Therefore, why go to the expense of washing the red cells when, as John says, there is so little chance nowadays, with the packing of red cells and the resuspension in something like SAG-M, of a reaction. As I said in an earlier post, I used to use these units myself, so I am not advocating throwing them away, but I am also not advocating washing them. Once again, sincere apologies for the unintended tone of my earlier post, which was, I admit on re-reading, well over the top. :redface::redface::redface::redface::redface:

I've checked with someone who has worked in our Testing Department for many years, and we do discard any unit found to have an atypical alloantibody, even if it is probable that the stimulation came about by pregnancy.

I'm sorry keisterkid, you may not pass on the cost, but there is a cost. There is the cost of the maintenance of the cell washer, there is the cost of the liquid consumables, such as the saline, there is the cost of the electricity to run the cell washer, there is the cost of the sterile bag into which the washed blood goes, there is the cost of the sterile docking tubing, there is the cost of the sterilising of all of these, there is the cost in terms of time of the person undertaking the washing, there is the cost of the labeling of the new bag, etc, etc. The fact that there is no difference in pricing is not down to the fact that there is no cost, but the fact that your clients do not complain is down to the fact that you do not pass on the cost; but ask your finance people if there is a cost. In no way am I saying that it is not a usable product (see my immediate previous post), but don't pretend that washing these units does not have a cost. :mad::mad::mad::mad::mad:

I agree entirely with everything you have posted Eoin, particularly about that fact that it is a very interesting case and well worth sharing. The one thing that I could possibly, not so much disagree with you, but just maybe remind you that many Laboratories do not have access to a monospecific anti-IgA reagent, either in a bottle, or in CAT, and I have my doubts as to whether skyanto would have such access (although, of course, I don't know for certain), which would probably mean that the coating is IgG, C3d or both (hence the anti-A eluted) - but I still agree with you about IgA-mediated AIHA, and about a positive DAT not always giving a significant AIHA. :):):)

Yes, actually, I'm looking at this with a UK-centric mind, and I do agree with both you and Ellen Zeigler, and, indeed, have used such units myself in the past. The problem in the UK is that anybody who has themselves been transfused is then banned from donating blood because of the risk from variant Creutzfeldt-Jacob disease, and, of course, any donor with an antibody (unless it is through pregnancy) will have been transfused. All units of blood in the UK are also leukodepleted and plasma reduced, but most are also tested for high-titre ABO antibodies, so, if it were not for the risk of vCJD, I'd probably be in totalfavour of using these units, but I still wouldn't go to the expense of washing them. :redface::redface:

I wouldn't want them, and I certainly wouldn't go to the expense of washing them.

Oh yes shily, you are right. It was just that skyanto wanted a method.

Far, far too late!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :rolleyes::rolleyes:

One way is to treat the plasma/serum/eluate with 0.01M dithiothreitol (DTT) at 37oC for about half-an-hour. This has the effect of disrupting the J-chain holding together the IgM molecule, by reducing some of the sulphydryl bonds. You then perform a titration, using the IAT at 37oC and a monospecific anti-IgG reagent. Don't forget to use something like an auto-anti-I (which is going to be IgM) as a control. Hope this helps. :):):)

Yes, we have them over here in the UK too. There are two types. The first is the Technical Advisory Group for Transfusion Science, run by the Hospital Chief Biomedical Scientists, but with input from the NHSBT (Hospital Liaison, a Consultant Pathologist to give clinical input and the Reference Service Manager). The second is a User Group, run by the NHSBT. These are some of the most useful meetings I attend. In addition, the various Regional Transfusion Committees run Education Days each year. This is all in addition to the vaarious education days run by the Special Interest Groups of the British Blood Transfusion Society, and various meetings held by the Institute of Biomedical Science, The Royal College of Pathologists and the Severe Hazards of Transfusion Scheme (SHOT), to name but a few. :D:D:D:D

I agree.

Only she knows!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I daren't ask!!!!!!!!!!! :eek::eek::redface::redface:

I also agree, but the lady about whom I wrote swears that she has had no opportunity to have had a miscarriage. Mind you, having said that, she works at the world famous Kew Botanical Gardens, and she thinks that she "caught" the anti-D from an exotic plant! You can make of that what you want! :confused::):confused:

I didn't feel insulted either; maybe I should have done!!!!!!!!!!! Having said that, if you had been for real Mabel, everyone's opinion is as valid as everyone else's, as far as I'm concerned, and I'm not easily insulted anyway. I have a "hide like a rhinosaurus" (and many say the looks)! :D:D:D:D:D

Hi Candace, Yes, anti-D can be detected for a quite remarkable length of time after the last apparent stimulation. Just to check my facts, I went back to Mollison's Blood Transfusion in Clinical Medicine, Ed Harvey G. Klein and David J Anstee, 11th edition, 2005, Blackwell Publishing. In Chapter 3 "Immunology or Red Cells", page 70, it is stated, "...Some IgG antibodies (e.g. anti-Rh D) decline far more slowly and may be readily detectable 30 years after the last stimulus." Whilst in Chapter 5 "The Rh Blood Group System (and LW)", page 191, it is stated, "Anti-D can sometimes bedetected in the serum a very long time after the last known stimulus; for example, it has been found in a woman 38 years after her last pregnancy." Whilst neither of these cases can compete with your 47 years, it seems likely that such an antibody (particularly if it were very strong when first stimulated) could be detectable for such a length of time. Incidentally, we have been following an anti-D in a lady in her mid-twenties for about 5 years now, with a quantitation level of 35IU/mL (we start worrying about anti-D causing HDNF with a level above 4IU/mL) and she states quite categorically that she has never had a transfusion and has never been pregnant. I suspect that this anti-D, whatever its cause, will be around for many years to come. :eek::eek:

Congratulations Lara! :D:D:D:D:D:D:D:D:D

Well, rather like a child with selective hearing, I think I must suffer with selective dyslexia!!!!!!!!!! :rolleyes::rolleyes:

Agreed. That was sort of what I was getting at in my earlier post. :redface:

I agree with this (although I must admit that I misread the middle consonant for vowel the first time I read it)! :D:D

Hmmm. Maybe she's after a job at my place then. She would fit in well with the rest of my staff, all of whom, from the most junior to the most senior, spend every spare moment taking the micky out of me; and they're a superb bunch - I wouldn't have it any other way! :D:D:D:D

I know from where you are coming heathervaught, but that statement is not absolutely true (or, at least, it is not true for the UK Guidelines). A patient is still eligible for an electronic issue of blood or an "immediate spin" cross-match if the antibody detected is NOT clinically significant. For example, if wide thermal amplitude "cold" auto-antibody is present or, come to that a warm auto-antibody is present, but extensive serological work shows that no clinically significant atypical alloantibodies are present (or as much as it is possible to say), then the patient would still be eligible for, at the very least, an IS cross-match, on the grounds that a serological AHG cross-match would almost certainly be incompatible anyway. I know I am being pedantic here, for which I apologise, but needs must (if you will forgive the (intended) pun! :redface::redface:

I was in "Word" at the time (which was why I had to do it as an attachment). When in "Word", if you go to "insert" on the tool bar, and look at the drop down menu, you will come to something labelled as "symbol...". If you press on that, you are given a whole load of different alphabets, symbols (such as smily faces, etc), and you just press on one of those and, "Bob's your uncle"! :):)