Malcolm Needs

In the UK, the donors are tested with two anti-D reagents. One of these is called Totem (I can't remember who makes it, but will post tomorrow when I go back to work). This reagent not only detects partial DVI, but many, many other partial Ds (it is the best donor reagent anti-D I have ever used, but completely useless for patients). I'm not sure what other countries use. :):)

Suffice it to say that most politicians (of any party) are about as popular in the UK (and, I suspect in other countries) as bubonic plague (and about as useful). :D:D:D:D

In the UK, all the units of group O, D Negative emergency blood are also K Negative, for just such a situation. Incidentally, whilst I was working at Westminster Hospital (now closed) I had a sample in from a member of staff working at the Houses of Parliament (not an MP) and this had plasma that was a distinct shade of brown. I had never seen a sample like this before, so I called my Reader in Haematology (one down from the Professor) to have a look at it. He had never seen anything like it before either, but it turned out it was a symptom of Legionnaire's disease, and that is what this patient had. As a result, they closed most of Parliament and put in new plumbing and air conditioning. I always feel that I missed my chance in life to help my country by keeping quiet and letting the politicians get infected too!!!!!!!!!!!!!!!!!!!! :devilish::devilish:

For donors in the UK, we type each time they donate (unless the grouping reagent is incredibly rare), but where the donor has been genotyped, a confirmation a second time is sufficient for the rest of their "donation" lives (if you see what I mean). :)

Yep! They were the good ones. It was the ones that were stupid enough to actually go and try and get them about whom we were suspicious (nevertheless, as one of these [somehow] I've still got a job)!!!!!!! :D:D:D:D:D:D:D

Other occasions where you might see a haemolysed specimen is when the patient is undergoing a hyperhaemolysis crisis and, I understand, although I have never seen a case myself, March Haemoglobinuria. :):)

I think the reason they ask for irradiated blood on all the haematology/oncology patients is because many of them are either immunocompromised or on purine analogues, in case they get unirradiated blood by mistake, because these patients are more likely to get transfusion-associated graft versus host disease than others. :confused::confused:

It may just help (I don't know) if you get your patients genotyped for the FY genes too. IN that case you may well find that a awful lot of your phenotypically Fy(a-b-) sicklers are genotypically either FYB/FYB or FYB /FY, in which case they can safely be given Fy(a-b+) blood, rather than completely Duffy matched (because of the up-stream GATA-1 mutation), once they have made other antibodies than Rh and K. It may be easier to match (albeit, genotyping is not cheap). :confused::confused:

I think I'll ask for that to be put in our User Guide!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :cool::cool::cool::cool::cool:

How true this is I don't know, but I've heard it comes from a particular bit of nepotism that took place in the UK in 1887. The (then) very young Arthur Balfour was appointed to the important post of Secretary for Ireland by the (then) British Prime Minister, Lord Salisbury, who happened to be his uncle. Lord Salisbury's forename was Robert, and, of course, the diminutive of Robert is Bob. :D:D:D

We often see gross haemolysis in patients with a really rampant "cold-reacting" auto-antibody, and this is equally unavoidable. :)

Thank God! It's not just me then. I often find myself debating (out loud) what step to take next with a difficult case, and my colleagues think that I am mad. Mind you, there could well be other and additional reasons why they think I'm mad..............!!!!!!!!!!!!!! :imslow::imslow::imslow::imslow::imslow:

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.