Malcolm Needs

Actually, auto-anti-D is more common than a lot of people think, and I would have no hesitation calling this one an auto-antibody. We see at least six or seven a year in our reference laboratory here at Tooing in the UK, and the International Blood Group Reference Laboratory gets rather upset with us when we miss one and send it down to them for investigation as an alloanti-D in a possible partial D patient.

Well, the answer is yes and no! Yes, we do the former (test at a dilution of 1/100 against both A and B red cells on an Olympus), but if there is a reaction we do not mark the units as high titre positive! Rather, we marked those that do NOT react as high titre negative (HT-). For a reason unbeknown to me (I think it has something to do with EU Regulations, but I'm not sure), and apart from ABO and the D, C, c, E and e antigens of the Rh Blood Group System, anything else for which we test is only printed onto the unit label if the test is negative. For example, if we test for HbS, and we find the donor to be HbS-, then HbS- is printed on the unit label, but if we find the donor to be HbS+, we do not print HbS+ on the label - the HbS status is just not shown. The same applies for blood groups. If we test with anti-K, and we find the donor to be K-, then K- is printed on the unit label, but if we find the donor to be K+, we do not print K+ on the label - the K status is just not shown. As I say, why I just do not know. :(

As a Reference Service Manager (and not yet totally driven insane; despite what Rashmi may say) I would thoroughly recommend not bothering to send in your samples from patients with antibodies directed against low-frequency antigens, and just give cross-match compatible blood! For one thing, identifying the specificity of such an antibody (if it's not something like an anti-Wra) is like looking for a needle in a haystack. For another, such a patient usually makes multiple specificities of antibodies directed against low-frequency antigens, and so a) we would probably never identify all those present, as we do not have access to red cells expressing every low-incidence antigen, and very often, a cell that has been identified as, for example, Li(a+) isn't, because it was identified with an anti-Lia that also had, for example, anti-Bxa in it, but we didn't know that. Lastly, for now (as my rant muscle is running on low) the chances of you cross-matching blood, and then giving a unit that is likely to cause a clinically significant haemolytic transfusion reaction are so low as to be all but zero (just think of the number of patients who have been given blood by electronic issue, some of whom must have antibodies directed against low-incidence antigens, and some of whom have probably been given blood positive for the corresponding low-incidence antigen, and you see what I mean). I shall now go and lie down in a darkened room!!!!!!!!!!!!! :crazy::crazy:

I thought it probably was, but it's worthwhile being on the safe side for the less experienced amongst us.

I am tempted to be facetious and say "What about anti-Leb!", but,actually, that is exactly how I feel about anti-Leb. Anti-Leb has, on very, very rare occasions, caused red cell destruction, but, like anti-Lea, the reaction is self-limiting, and , after initial destruction, most of the red cells transfused are still in circulation many hours after they are transfused (probably because the antigens themselves are soluble and "come off" the red cells pretty quickly, and then block the antibody in vivo). There has only ever been one report of anti-Leb causing HDN, and even then it was sub-clinical HDN (so the case was fairly dubious). I would quite happily ignore the antibody completely and given cross-match compatible blood. :)

Hi Andy. I know how you feel, but try to keep off the mead; it's quite a strong drink you know!!!!! :D:D:D:D

Hi Yanxia, Good question! Sorry, but the totally honest answer is, I don't know. It was a decision made several years ago by the Red Cell Immunohaematology Section of the NHSBT (before I joined) and is does not seem to be 100% logical. I will go back and ask at the next meeting of all the reference Managers (but that will not happen for some time). Perhaps the decision needs to be re-visited, but there may be a logical answer of which I am unaware.

We've had a sample in to test for Weak D. Nothing unusual in that, you may say. Except that the patient is 96-years-old! I mean, for goodness sake, does it blank, blank matter at that age?????????????? :cries::cries:

Yes. The other really useful one is "Pre-op". Does this mean treatment to an in-growing toenail, or does it mean a liver transplant? Very useful if you are using an MSBOS! :):)

Well, as I say, we couldn't prove anything, but...............

I would be quite comfortable giving blood that has been found to be compatible by LISS tube IAT, even if it were found to be incompatible by gel IAT, provided that the people performing the tests are well practiced in the technique (i.e. currently, as opposed to historically, competent in pewrforming the technique). Your Director should remember that, before the gel technique came about, almost all cross-matching was performed by the tube IAT (and earlier than that, we used saline, rather than LISS), and we did not kill every patient with an antibody!

You really shouldn't enourage him adiescast, he will soon become very very unbearable!!!!! I think Jo has definitely taken the prize for managing 3 manuals. I'll try not to mention the 'C' word for the next few weeks, but i'm sure Malcolm will try to remind us, so will need to come up with some suitable insults if I can.

I think that you are thinking along the right lines, but i think it is a combination of SHOT, SABRE (another haemovigilence scheme), CPA and MHRA (the last two being regulatory bodies), and throw in a bit of GMP (good manufacturing practice). I also think that you are thinking along the right lies in that this is the future for the USA. While most of it is welcome, in that it does improve the way we do things, a certain percentage of it is a pain in the ****, with little to show for improvement. :mad::mad::mad:

I would agree entirely with that, except in cases of a stem cell transplant, where it depends on the blood groups of the donor and the recipient, and the length of time after the transplant. You also have to be a bit careful with patients of small stature (particularly neonates).

Yes (in fact, it was more than one unit - it was a few years ago, so some of the details are a bit hazy, but it may have been as many as three). The patient was under general anaesthetic, and so, of course, only the overt symptoms were seen (generalised bleeding, temperature, etc) by which time it was too late. Of course, the patient could not tell them that he felt unwell. It was a laboratory error. We never did get to the bottom of what he either did or didn't do (which probably saved him from, not only being struck off [as he was], but a jail sentence, because we suspect he was as high as a kite on-call - but could prove nothing). :eek::eek:

jlemmons, you have my sincere sympathy. :comfort::comfort:

Cheek! I knew I shouldn't have agreed with you earlier in this thread!!!!!!!!!!!!!!!! :threaten::threaten:

Quite right too (not that my birthday is on the 23rd mark you, but it is before Christmas)!!!!!!!!!!!!!!!!!!!!!!!! :D:D

Forgot to ask yesterday. Mind like a sieve. No, I was wrong. Apparently, the case I was thinking of was apheresis platelets. :redface::redface:

No, sorry, that isn't what I meant. What I meant was that the group A blood that had been transfused to the unfortunate patient appeared to have been totally cleared from his circulation (as, indeed, had most of his own red cells, as innocent bystanders to the complement cascade), as we could not detect any group A cells in the post-mortem blood sample, but, although the DAT of the post-mortem blood sample was negative, we could still elute anti-A from the few red cells that were left. The original unit that was transfused in error was most certainly a group A, and reacted normally with anti-A. Sorry for any confusion. Having said that, Apae reacts a bit like the scary phenomenon that you describe (but is most unlkely to cause an acute transfusion reaction i a group O patient.

We have just received a sample from one of our hospitals on a pregnant woman. "Antibody detected by enzyme only. ?anti-N??" Even if I'm exsanguinating, please don't send me there!!!!!!!!!!!!!!!!!!!!!!!! It was anti-Le(a+ by the way. :eek::eek:

30 pages! Goodness me, we send ours away to be bound! Bah humbug, by the way. It's not even December yet. There is still a VERY important date to come before 25th December. :mad::mad::mad: