Malcolm Needs

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! :):)

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). :)