Malcolm Needs

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! :):)

When I worked in the hospital environment, the KB was also performed in the Blood Transfusion Laboratory. This was some years ago, but I always wondered about this. The reason being that, it was quite rare to see a positive KB that required a count for quantity (as opposed to the positive control). This meant that, when a count was required, the Biomedical Scientist/Technician (who only worked in BT, and not routinely in Haem) was not well-practiced in accurately counting a very minor cell population (this was in the days before flow cytometry for FMH estimation). However, those in the Haematology Department were well-practiced in doing so, as they regularly performed reticulocyte counts manually. I would have thought, in those days anyway, it would have been better for the KB to have been performed in the Haematology Department. I'm sure things have changed now. :confused::confused:

Thanks for that and, yes, I am feeling much better now. I think you are correct in your assumption concerning coming last in the physician's "Favourite Patient of the Day" competition. He rather looked like a dog that had swallowed a wasp!!!!!!!! :D:D

I must say, I found it immensely difficult to resist making a comment about lunch/breakfast myself!!!!!!! Normally, of course, I can't resist such temptations, and get myself into deep trouble. :D:D:D:D:D

We would quite often telephone the submitting physician and tell them that we cannot undertake forensic work, and ask them if they would like us to forward the specimen to Scotland Yard's Laboratory. :(

On most computer systems used by Blood Transfusion Departments in the UK (if not all), it is possible to put any special requirements (e.g. irradiation, CMV-, HbS-, etc) on to the system in such a way that any blood that does not meet these requirements cannot be issued, rather in the same way that ABO incompatible blood, or blood that has not been tested for a particular antigen, in the case of a patient with a clinically significant atypical alloantibody, cannot be issued. Once on there, it takes a very high level of security to remove this requirement (although, of course, there has to be the ability for its removal from time to time, such as in the case of stem cell transplants, when the ABO group may change). HOWEVER, Guidelines make it quite clear that the onus to request any special requirements is on the requesting physician, and if these requirements are not made clear on the request form, particularly on the initial request form, and blood not meeting these requirements is issued and transfused, the buck stops (as it should) with the requesting physician. There is also an onus on the requesting physician to tell the Laboratory, in writing, should anything change (such as further requirements, or the fact that there is no longer a need for irradiated components). :)

Thanks very much indeed Steve. I am well on the way to getting back to full fitness. I did not realise just how painful diverticulitis could be. I was bouncing off the bed whenever they were proding and poking! "Tummy ache"? Indeed, they way they treat you as if you are a complete idiot, I think that is what they would want us to call it!!!!!!!!!!!!!!!!!!!!!!!!! :D:D:D:D

I think that one of the reasons is that D- individuals are far more common in the West, than they are in China (indeed, in the Far East as a whole). Depending where you are, as the figures vary quite a lot (about 15% in the UK, approximately 25% in the Basque Region of Spain), D- blood is much more available than it is in China. The D antigen is probably the most immunogenic antigen (after the A, B and H antigens) in human blood, probably because it is a fair size polypeptide of some 416 amino acid residues, which is completely "missing" in D- individual. Therefore, there is a very high chance that an immunological challenge with D+ red cells in the circulation of a D- individual will result in the production of anti-D. Obviously, a young male has the rest of his life to live, with a chance that, at some time during his life, he may require further transfusions, and with a slimmer chance that he may require emergency blood at some point, in which case he may then be given D+ blood. If he has made an anti-D early in his life, this, obviously, may result in a diasterous transfusion reaction. In the case of trauma (which is really what this thread is driving at, I think) there is a higher risk of the boy needing further transfusions during his life as a result of the initial injuries (e.g. reconstructive surgery, plastic surgery, joint replacement, etc), and so it is a reasonable idea to try to avoid him making an anti-D early in life, if he happens to be one of the 15% of the population that are capable of so doing. These are my thoughts, but others may disagree, or cite other reasons that are better than mine. (By the way, I haven't forgotten that I have to look out those papers on ABO for you. I am off sick at the moment - again!) :):)

True, but the fact that they are NOT voting suggests that they are not looking on this site (or, at least, that they cannot be bothered to become members), which suggests regression, rather than progress. The term "Honorary Transfusionists" worries me. Either you are a transfusionist (and know your stuff) or you are not a transfusionist. "Honorary Transfusionist" is like saying that someone is "a little bit pregnant"!!!!!!!! :confused::confused:

I would like to add one of my own. "Never, ever, patronise". I have just spent a few days in hospital with acute abdominal pain. Whilst in there, some pompous senior doctor came up to me and said, "You have what we call diverticulitis". I asked him who "we" were, and what us lay people should call what I had? He was quiet for a moment, and then replied, "Oh, I mean it is what doctors call the condition." So I asked him again, "What should I, as a member of the public call it then?" At last, he replied that I should call it diverticulitis as well. I thanked him, and suggested, very politely, that, perhaps, in future, he should say, "You have a condition called diverticulitis (substitute any other condition)", rather than assume complete ignorance on the part of the patient. I don't think that I was very popular with him (did I care?!!!!!!). :mad::mad::mad::mad::mad:

It could also be that, some of the Haematology Biomedical Scientists that are also in charge of Blood Transfusion are egocentric enough to consider themselves well-versed in Blood Transfusion?????? :mad::mad::mad:

At least in Europe (I don't know if it is available in other parts of the world), DiaMed produce something called ID-CellStab, which is a red cell preservative. This is designed, as far as I know, to preserve the red cells from the point-of-view of antigenicity, rather than oxygen carrying capacity. It is wonderful stuff! We keep our "wet cells" for several weeks in this. If you can get hold of some (or something similar - I don't know if other companies make it), you may be able to keep your rare cells just that little bit longer before they fall apart!? :confused::confused:

At my age, that is not "fairly recent"; it mens that it has only just happened!!!!!!!!!!!!!!!!!!!!!!!!!! :eek::redface::eek:

I couldn't agree more John. Even if the patient has made "new" red cell antibodies during his/her stay, this will not alter the group, nor the efficacy of any plasma or platelet components given. The only thing that might change is if the patient has produced, for example, an anti-IgA, requiring IgA deficient plasma products, but you are not going to pick that up with a type and screen, just as the result of reaction with the next lot of plasma-based components.

As a self-confessed fan of giving group O, D positive to older male patients, I also agree with these sentiments about young males group O, D negative blood.

These are pretty difficult questions (well, actually, the questions are easy - it's the answers that are difficult)! In answer to your first question, it is very rare indeed that a warm auto, that reacts by IAT and by enzyme technique, will not be adsorbed out by auto-adsorption (if that is possible), and then you can usually show that the auto-antibody has been adsorbed out by reacting the adsorbed plasma against chloroquine-treated autologous red cells. If these then give negative results, but random red cells still give positive results, then there is a fair chance that you have an underlying HTLA antibody, the specificity of which, if you have the available red cells, you can then identify. In answer to your second question, it very much depends if you have performed the patient's phenotype before the transfusion, otherwise you are, to a large extent, guessing what phenotyped cells to use (unless you are lucky enough to be able to use PCR to genotype your patient. Given that you may know your patient's type, and particularly if you suspect an underlying antibody directed against a high-incidence (or reasonably high-incidence) antigen, or if we are thinking in terms of multiple antibodies directed against "common" antigens, then we would often use this kind of adsorption, rather than the traditional differential adsorption with the three cells (BUT, be aware that finding the correct cells can sometimes take an enormous amount of time, and might involve adsorption and elution techniques). :):)