Malcolm Needs

Believe me Marilyn, this situation has not changed one iota! :eek::eek:

I agree entirely. Good communication is everything in almost all situations. :):)

Hurrumph! Not in my lab I don't Andy! Nice to see you posting again. :D:D:D:D:D

I can see your problem. In the UK we automatically do a screen on all groups sent to us, because it's paid for by National Insurance. I cannot understand, however why, if your ER doctors are working with a pregnant lady, they would not order, not only a screen, but given that many of these ladies would either be suffering some kind of trauma, or a PV bleed, a KB. Seems daft to me. Surely they are opening themselves up to litigation if the foetus is affected by a maternal antibody, or they order too little anti-D immunoglobulin? :confused::confused::confused::confused:

LOVE IT! That has brightened my day. :D:D:D:D

Yes, I must admit that I did think of that after I had posted. You would have to ensure that the patients being compared are in the same "category", and even then, that their clinical condition at the time of transfusion (i.e. how "ill" they are) is also comparable; NOT AN EASY TASK BY ANY MEANS, I KNOW. :redface::redface:

True!

One way would be to do a look-back and see if those who were given "compatible" units required fewer transfusions than those that were given !incompatible/suitable" units.

Agreed.

I'm not sure what the hospitals in the UK do nowadays, but we have noticed that lady's and their babies are being sent home so quickly that ABO HDN is sometimes not immediately noticed because the bilirubin has not risen to any huge extent prior to discharge. As a result, more severe cases of ABO HDN are becoming more common, because the mum's themselves are, of course, not trained to notice, or react to, early development of jaundice.

Yes, I know from where you are coming, but supposing the lady has come from another country? We quite often get pregnant ladies who have arrived from other parts of the world (Africa, Asia, different parts of Europe, particularly eastern Europe), many of whom have poor English, and then it is not so easy. :confused:

Of course, the other problem for everyone is when a lady has received RhIG at another venue, prior to coming to your own hospital. What do you do then, especially if she knows that she was given an injection, but does not know what it was? :confused::confused::confused:

When I was working in the hospital environment, we required a type per admission.

I think that your suggestion that the patient has antibodies against an antibiotic/perservative in which the cells are suspended is probably the correct one. Many of our hospitals use screening and panel cells that are suspended in DiaMed ID-CellStab, whereas we use them suspended in DiaMed ID-Diluent 2. Every now and again, we get a sample in from a Hospital that has found an antibody reacting with all cells tested. When we test it, we get completely negative results, unless we use cells suspended in DiaMed ID-CellStab. I have contact Imelda Bromilow of DiaMed in Switzerland about this, and she was also aware of such cases, and it is thought that it has something to do with an antibody the patient has made against an antibiotic in the liquid in which the red cells are suspended, but, as yet, she was not certain which one it was, or whether there are multiple specificities in different patients' plasma. :)

Hi Antrita, The answer is "yes", but they are few and far between. Mostly, this is because the specificity of the antibody is rare, or that the extreme potency is rare. In the old days, we used to use the total haemolysis of the test cells as a guide to the probable specificity, which was usually anti-H in an Oh patient, anti-Vel in a Vel- patient, anti-I in a ii adult patient or anti-P+Pk+P1 (anti-Tja) in a pp patient. Just occasionally, we would also see this in a patient who had an extremely potent IgG anti-Lea, reacting strictly at 37oC. Now, of course, everyone uses EDTA samples and, of course, the EDTA chelates Ca++, Mg++ and Mn++, all of which are required as co-factors in the classical complement pathway, and so I have not seen such an antibody now for many years (although we have seen the odd anti-Vel, anti-H and anti-I - they only caused agglutination because they came from EDTA samples). Actually, the use of EDTA is a disadvantage to Reference Laboratories in such cases, as we no longer have the guide of haemolysis. C'est la vie! :):)

Thanks. That's the one! :D:D:D:D

At the grave risk of sounding big-headed, you could try going into References at the top of the page, then go to Document Library on the drop down list and then go to Educational Materials, where I have put a number of PowerPoint lectures, together with explanatory Word Documents. They may, or may not be of any help, but they might be worth a quick look (if only to ensure that you want something else). Be warned, some of them are quite "UK-centric" and a few need updating.

Good luck Lisa. Nice to have you on board. Just looking through some of the esxcellent posts given by people on this site will help (it has me), but I'm sure other people will have better suggestions. :D:D:D

I think it's French for "thanks"!!!!!!!!!!!!!!!!!! :redface::redface: (Sorry; that's awful)!

Welcome Heather. Even as an experience Blood Banker (for "experienced", read "old"), I find this site exceptionally useful for learning new things. :D:D:D:D

Yes, I'm habitually guilty of this one!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :eek:

In my opinion (and I know I am very opinionated), this is where the phrase used by the NHSBT in the UK, "suitable for", comes in so handy, because it makes no definitive statement about compatibility after either auto- or (more importantly) alloadsorption. :)

You are far from dense! It is the fault of UK terminology! It stands for Cold Autoimmune Haemolytic Anaemia, and so, therefore, it would be far more logical for it to have the acronym CAHA, but CHAD is what it is!!!!!!!!!!!!! :)

This is certainly not done routinely in the UK, although it may be done if there is something like a known abdominal trauma (say a car smash or an assault, or something like that).

Sorry, I also meant to say that, no, the foetus can have enough blood volume to sensitize the mother much earlier than 28 weeks gestation. Indeed, if there is a sensitizing event after 12 weeks gestation in a D Negative pregnant lady in the UK, anti-D immunoglobulin prophylaxis is given (but only half of the normal dose - 250IU, rather than 500IU). :redface::redface: