Malcolm Needs

Excellent idea.

I fully accept, John, that a card stating the patient has an antibody directed against a low frequency antigen is not terribly enlightening, but for reasons given by me in an earlier post in this thread, there are very good reasons why, often, nothing more specific can be written on such a card. That having been said, however, it would serve to alert a Blood Bank of the potential, albeit tiny, danger of issuing blood by electronic issue (EI). I fully accept that there must have been hundreds of patients with such antibodies who have already been safely and successfully transfused with EI blood, but, one day, it is going to happen that such a transfusion will result in a haemolytic transfusion reaction (possibly fatal, but more likely resulting in renal failure, but not a fatality), and if we know that a patient has such an antibody, a serolgical cross-match should be performed, so that this tiny gamble is not taken. It's the old thing, "If it were my mother....". :):)

Thanks! That's the one!!!!!!!!!

Somebody posted the Wise Ole Saying, "It's better for people to think you a fool, than to open your mouth and prove it" (although I can't find the post to quote it right now), but it looks like I've done it (AGAIN)!!!!!!! :eek::eek:

You are quite right. We normally do these tests at 20oC and/or 4oC, but the colleague put them in the wrong incubator (one used by another Department - but they worked, so hey)!!!!!!!!!!!!!!!!!!! :D:D:D:D

I have two alternative creative ideas. Either tell the nurses to get educated about how blood components need to be stored if they are to be effective, or (my favourite), shoot the nurses! :eek::eek:

I couldn't agree more. Tim's depth and breadth of knowledge is astoundingly - almost frightening! :):)

I should have added (one of the most important things - so, of course, I left it out!!!!!!!!!!!!!!:rolleyes:) that we have done a Risk Assessment on this.

I suspect that the rules and regulations in the USA will bevery different to those used in the UK, but we do this all the time, if the antigens are rare (or extremely common), and, as long as the antigen is stilld etectable at a reasonable strength (or, in the case of antigen negative cells, the antigens on a cell of equal age and condition is detectable), I see no reason why not. In some cases, it rather begs the question, how else are you going to do it? :confused:

Mind you, been there, done that, got the tee-shirt. I did work in a hospital environment for about 15 to 20 years (Westminster Medical School, Mayday University Hospital and Ealing District General Hospital), so I really do know what you mean. :redface::redface:

Oh, we get those too!!!!!!!!!!!!!!!! :eek::eek:

I know. I know. And you are right John. Sorry. (But it is good fun; the work-ups, not the gloating)!!!!!!!!!!!!!! :redface::redface::redface:

You are going to hate me jcdayaz!!!!!!!!!!!!!! Today, we had in a patient who was group A, with anti-Fya. The problem was that there was a desrepancy in the ABO group, in that the plasma reacted with the A1 cells. I asked my colleague to investigate this, in case it was an A2 with anti-A1, or an anti-M, etc. She tested the plasma with the panel by direct agglutination at 15oC, and lo and behold, it was the anti-Fya. We tested with Dithiothreitol, and the reaction disappeared, although it was still present in diluted untreated plasma. We tested the DDT-treated plasma by LISS tube IAT at 37oC, together with the dilution control, and the result was that there was a weak reaction, showing a small amount of IgG anti-Fya present, but the majority of the anti-Fya was IgM!!!!!!!! "Rare as hen's teeth" (the clean version of the Wise Ole Saying)!!!! :D:D:D:D

Far from it; you are absolutely correct in this statement. I wish they would; it would make life far simpler! :)

No, not at the moment. All of my staff seem to love the job too, and so staffing is very stable (even if the boss is mentally unstable!!!!!!!!!!!!!!!). :redface::redface:

This is what I keep telling my staff about the way to treat a Reference Service Manager, but they still insult me!!!!!!!!!!!!!!!!!!! :tongue::tongue::tongue::tongue::tongue:

Don't be too upset if that is NOT the answer; the theory is pretty left field, as I said. At least auto-anti-A1 is rare, but recorded; my theory is not!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

They could have done, but not me; I'm too bone idle!!!!!!!!!!!!!! :D:D:D:D

Just as a matter of interest, how did you A1 type the patient's red cells? Did you use Dolichos biflorus? The reason I ask is that this lectin also contains an "anti-Cad". I know that this is a bit "left field", but it could just possibly be that the patient's red cells are A2, with anti-A1, but are also strongly Sd(a+). There I go, looking for zebras again! On the other hand, auto-anti-A1 has only been reported very rarely. :confused::confused:

Hi Lisa, The most authoriative method of finding out is to contact the CPD Department of the IBMS directly. If you telephone 020 7713 0214, they should be able to tell you, or find out for you. :):)

It is true that anti-U is rare (usually -yesterday excepted!), but this being London, we have quite a high ethnic mix, including a high Black population, and we have some 50 odd hospitals on our books, and all anti-U's (and any other unusual antibodies) will come through the Reference Laboratory as a matter of course. We, therefore, see a fairly high number of antibody specificities that most people would only see once or twice in their lives (and which is why I just LOVE working here, even if that does make me sound a bit odd [or odder])! Pregnant lady, with anti-k today! :D:D:D:D

Well ,yes and no (a really helpful answer, I realise!). Because we have been screening for rare phenotypes for about 25 years here at Tooting, we have a number of "tame" U- donors upon whom we can call whe we need them, so that we have fresh "wet" units. The only problem is, sometimes these donors are bled for a specific patient, and it turns out that this patient does not require transfusion (blood was, however, required on stand-by). These units are then sent up to the National Frozen Blood Bank for cryopreservation, if they are less than 7 days old. However, because the donor has given blood, there is a "rest period" they must take before we can attack their veins again, so, if they are side-lined for this reason, then, yes, we do have to rely on frozen blood. The problem with that is that we have a considerable number of patients throughout the UK with anti-U, but only a finite number of active U- donors, and so the number of U- units frozen is never great, and they have to be "rationed out" by a Consultant. It's not easy! :):(:eek::(:)

Yep, and it is going to get better, as there is every chance that both will require transfusion, and they are at different hospitals, many miles from one another - so we can't even reserve the units for both - we have reserve units for each. Hey hoe! :(:(