Malcolm Needs

Despite what I have said, I am also a huge supporter of electronic issue of blood, and, yes, I accept that, on rare occasions a patient with an atypical alloantibody directed against a low incidence antigen will be transfused with a unit of blood that is positive for the corresponding antjgen; and it may well cause an immediate, acute transfusion reaction. Such a situation though, would be disappearingly rare. If, however, we know that a patient has, or is suspected of having, an atypical alloantibody directed against a low incidence antigen, even if the actual specificity is unknown, then I would feel duty bound to carry out a serological cross-match. I also appreciate that my stance is in line with "what the eyes don't see, the mind doesn't miss"! :redface::redface::redface:

Yes, it does work like that Steve (usually)!!!!!! :D

Hi Trektech2, I'm extremely flattered by what you wrote, but there are many, many other posters on this site who know at least, if not more than me. A Wise Ole Saying, "Never mistake my verbosity (with the number of entries that I post on here) for expertise - the two are not the same." I think that the important word in the Technical Manual is "most". This is true, but there are plenty of atypical alloantibodies directed against low incidence antigens out there that are most certainly clinically significant. One only has to look in the literature to see that, for example, anti-Wra (of the Diego Blood Group System), is, in many cases clinically insignificant, but in other, rare cases it has caused a severe an immediate haemolytic transfusion reaction. Although not everyone would agree with me (including some of my own bosses), I think that if a person is either known, or suspected, of having an atypical alloantibody directed against a low incidence antigen in their system, they should not be a candidate for electronic issue, until it is proved that the antibody is benign (and that is very difficult without doing biological assays). I agree with you that this patient needs a card, albeit, you cannot put a specificity to the antibody. Actually, to a large extent, that doers not matter, because most individuals who produce such an antibody produce a "soup" of specificities against low incidence antigens. :):)

I know some that are well into their eighties who still have adolescent brains (and certainly one fifty-five-year old)!!!!!!!!! :rolleyes::rolleyes:

The SOPs of which I spoke are now available under References, User Submitted, SOPs, for those interested. :D

I don't think that your SOP is incorrect. How can auto-agglutination come about unless there is an auto-antibody present to cause the auto-agglutination? It would be a matter of semantics, but for the fact that they actually mean the same thing in the long run! Possibly a case of the new doctor wanting to make his or her mark, and choosing the wrong subject? Auto-agglutination is the demonstration of an auto-antibody, whether the DAT is positive or negative (and probably would be positive, if you were able to use monospecific anti-IgM, anti-IgA, etc. :(

I've never seen one like that, but a colleague of mine in Leeds, Yorkshire described a case with an FMH of 220mL, with the baby's birth Hb of 3.3g/dL. The baby, who was bleeding chronically throughout most of the pregnancy, survived and is now well. :):)

Ouch!!!!!!!!!!!!!!!! :(:(

I am just about to submit two SOPs to the References section of BBT on exactly this subject. The one is on how to make up the solutions required, and the other is on how to freeze and recover the cells. These will take a couple of days before they are accepted/rejected, and so, if you would like them quicker, please send me a personal message with an email address. :):)

Perhaps she thought she had to use different coloured crayons for drawing this specimen!!!!!!!!!!!!! Worrying isn't it? :bonk:

Some of you may have got a slight hint on this site that I am not a great fan of one of our accrediting agencies; namely the MHRA, however, this is exactly the kind of thing that they would come down on "like a ton of bricks" (i.e. nothing in the package insert); and quite right too. :)

It's not just me then. Politicians really are "thoroughly respected" throughout the world! :rolleyes::rolleyes:

Now, now! Your comment might well be quite true and just, but you didn't actually need to put it in print!!!!!!!!! :haha::hug::haha:

Yes, this is true about HTLA's. This is why I say that, following auto, or indeed alloadsorption, an auto-antibody will be adsorbed out, but will leave the underlying HTLA (which will, of course, be an alloantibody) in the plasma. Where can you read it - that is an extremely good question! Off the top of my head (and I am off work at the moment), I honestly cannot remember! I will get back to you, unless anyone else knows. :):)

Yes. In the UK, cards are issued to all patients who have clinically significant antibodies (and some to those who have clinically insignificant, but serologically "difficult" antibodies, such as anti-Ch), to pregnant women who are D Negative, to some transfusion-dependent patients with, for example, sickle cell disease, with their full blood type from ABO and Rh, through to Kidd, and to patients who are IgA deficient, and who have made anti-IgA. I think that is the lot (off the top of my head), but there may be others. They seem to work very well in some groups, but not so well in others. The antibody cards, for example, vary from those individuals who never carry them (or discard them), or, if they do carry them, never show them to anyone when they are admitted to hospital (really useful!), to those that have had them since the year dot (and carry around these moth-eaten, dog-eared old cards that, to be honest, are so difficult to read, they are almost useless. Overall, I am very much in favour. I know of one lady who carried around a card stating that she had anti-Coa, which had been given to her 10 years previously, and this helped us immensely (despite the fact that, by then, she had also produced an anti-Doa) {nice case, by the way]. :):)

Not necessarily! This would have been the mother's probable Rh type. In fact, she could have been CDe/Cde, and the baby Cde/cde. :)

Yes, I would imagine that HDN due to anti-c is much, much more common than HDN due to anti-D in your area of the world, if, as I suspect, you live in Far East Asia. :confused::confused:

Thank you for your kind words shily. Yes, indeed, your memory does not deceive you concerning infants up to four months, and there is some slight evidence that such infants' immune systems become tolerant to "foreign" antigens and may never produce antibodies against certain antigens. In fact, studies have shown that even approximately 15 to 20% of D- adults will never produce anti-D after several immunological challenges with D+ red cells. On the other hand, however, the same studies showed that an equal number of D- individuals have what can be loosely described as a "hyperactive" immune system, and will produce anti-D after a very small initial immunological challenge of D+ red cells (sort of "super producers" of anti-D). I think, therefore, that I would rather be "safe than sorry" in the case of paediactric male trauma patients, and give them D- red cells in an emergency, if they are available. :):)

Thanks Tim; I'm well on the mend now. Wel, I wasn't about to let him think that my two neurones were disconnected! :)

Goodness me! I seem to have started something here. :eek::eek:

I take that, very much, as a compliment. :):)

Nuffink to do wiv me Guv!!!!!!!!!!!! :haha::haha:

Yes, it's a bit like "pre-op", which covers all surgical procedures from an ingrowing toenail to a heart-lung transplant! :):)