Malcolm Needs

We use an enzyme panel automatically, together with an IAT panel. Does this mean that you do not necessarily do the same? :confused::confused:

Yes, in extremis I would agree with this.

Hi David, I'm not saying you are wrong about the women of child-bearing age (I wouldn't dare!), but in my attachment I do make an arguement as to why I think this should be done. IT DOES NOT MEAN THAT YOU HAVE TO ACCEPT MY ARGUEMENT, I HASTEN TO ADD!

I must say, except in the circumstances I alluded to in my earlier posts, it does sound somewhat over the top to me too!!!

The case being that the patient was male, I honestly do not know why the supervisor was so worried, unless the patient was, or was likely to become transfusion dependent (in which case, I would also be wary of them making an anti-c; they had already shown themselves to be a responder by making anti-E+K).

Do I take it that the patient was a female of child-bearing potential (hateful phrase)? If so, I can quite see your supervisor's concern. In terms of "common" antigens, the c antigen is the second most immunogenic, behind the D antigen. If a person who is c- is transfused with c+ blood, there is a very high likelihood that they will produce an anti-c. Anti-c is amongst the three most common causes of clinically significant haemolytic disease of the newborn/foetus. Therefore, if the patient is c-, you would not want them to be stimulated to produce anti-c, and you would give c- blood. This only pertains if, for example, the patient is an R1R1, rather than, say, an R1r, and is female. I attach an essay I did a few years ago concerning this and other occasions when you might give phenotyped blood. It may be of use, or it may not, but it is there if you want to read it. Phenotyped Red Cell Transfusions.doc References.doc

Thanks shily. A higher percentage than I thought, but I see that you are still not "swimming" in the stuff!

Congratulations!!!!!!!!!!!

Oh yes. I am not saying that this kind of emergency cannot happen. All I'm saying is that, these days, they should be exceptionally rare.

I must admit that I was/am curious to know why, in these days of vastly improved antenatal care, with MCA Doppler/ultrasound commonly available and planned delivery, any lady with an at risk pregnancy is not sent to a Specialist Fetal medicine Unit for pre-natal care and, if necessary, delivery; certainly in the USA? Except in cases of severe ABO HDN in the first pregnancy (very rare) or HDNF due to an antibody that was not detected during the pregnancy (either because it was directed against a low incidence antigen, or because the lady did not attend antenatal appointments), such emergencies in a "local" hospital (sorry for the derogatory term - I've been racking my brain for the correct term and have failed miserably) should be exceedingly rare, and it follows that the need for such emergency blood should be equally rare. As I say, I'm more curious than anything else. :confuse::confuse:

Hi Mabel, EDTA saline is sort of what it says on the label; it is saline that has EDTA added to it. This is used in the IS XM to suspend the red cells so that it inhibits complement in the serum to which they are added (it doesn't matter if you are using EDTA plasma), as C1 can cause steric hinderance of ABO antibody attachment, causing a prozone and, therefore, the danger of a false negative result. Thus, blood of the wrong ABO group could be transfused. I agree with you entirely that electronic issue is safer than a serological cross-match, because it does not involve human error, but, if the situation is so urgent that an IS XM is required, electronic issue would not be allowed in the UK, because we only allow it if a) the sample has been typed on automation and the results transmitted without human intervention, there are two types the same and c) there are no clinically significant atypical alloantibodies either in the present sample or in the patient's history (there are lots of other rules governing its use, but these are the main three in this instance). I would contest that, in such an emergency situation, none of these criteria could be met. Obviously, I am not sure of the rules governing electronic issue in other countries; being notoriously parochial!!!!!!!!!!!!! :)

Brilliant! Maybe she could have used the "clot" that sent it down in the first place! Love it Mabel.

Hi Cindy, I've only just read your post in full. I am only too pleased that some of my stuff was able to help you out, but that is what BBT is all about as far as I am concerned (that, and the odd laugh)! Malcolm

I think the key may be in the name of the thread! USA Armed Services Blood Program (and the O stands for Office). Glad to help you out Rashmi!!!!!!!!!!!!!!!!!!!!! :blowkiss::blowkiss:

I agree entirely with this Mabel. The danger from giving unnecessary anti-D immunoglobulin (even though it is a human blood derivative, and may contain a blood-borne transmissible virus) is minimal, compared with the known (and much more common) danger of haemolytic disease of the foetus/newborn.

Well, 1 in 650, 000 is what the Editorial says (and I had it front of me when I quoted it).

Heartiest congratulations.

I totally agree with you John. Nobody in my own Laboratory would dream of cross-matching units from segments other staff in my own Laboratory had snipped off from units, let alone segments snipped off from elsewhere. It is a recipe for a disaster!

Sorted! Hope it helps. The Continued Use of the Term.doc

In the UK, we are having reported increasing episodes of laser pointers being shone into the eyes of pilots landing and taking off from airports. This may have something to do with it????????????????

Yes I can, but it may be a rather long explanation for a post, so I will write a word document today (or, at least, I will if I get time, otherwise it may have to be Friday) and post it as an attachment. I hope this is okay.

Hi there Muhammad, The SOP I was talking about is the attachment in the post above yours. You can download it from there. Best wishes, Malcolm

I think this is because there is no mention throughout of the presence of an apparent anti-C. With very few exceptions, all C+ red cells are also G+, and, in fact most weak to moderate anti-Gs will tend to react more strongly with C+ red cells (such as R1R1 and r'r) than with D+ red cells (such as R2R2 and Ro); this, despite the fact that, of the common Rh types (excluding things like D-- and D..) R2R2 expresses the highest number of D antigen sites. When an anti-G is present on its own, reactions will always mimic an apparent anti-C+D. Of course, as the cell that often stimulates the production of the anti-G is an r'r, there is often a true anti-C (or anti-Ce) element to the antibody as well.