Malcolm Needs

As the titration result was the same upon repeat, it may not have been due to antigen site number, but it still may have been. The reason I suggested anti-G (or anti-G+C) rather than anti-C+D is that, in most cases involving anti-G (or anti-G+C) reactions with R1R1 and r'r red cells are usually stronger than with Ro or R2R2 red cells (and it must be remembered that R2R2 red cells, on average, tend to have the highest number of D antigen sites amongst the "normal" D+ Rh types). In this case the anti-C titre was consistently higher than the anti-D titre, strongly suggesting an anti-G (or anti-G+C), rather than an anti-C+D. None of this is, of course, conclusive until proven (as is the presence of anti-C+D), but it is highly suggestive. Anti-G does occasionally cause clinically significant haemolytic disease of the newborn, but it is rare. Clinically significant haemolytic disease of the newborn caused by anti-C, especially at this titre, is exceedingly rare. I would be interested, not only in the clinical condition of the baby at birth, but also if the baby was r'r, rather than D+? I note that the "baby" would now be 4! :confused::confused::confused:

I would agree with you about the higher percentage Lara.

In such a situation, we would tell our Consultant Haematologist as a matter of urgency. He/she should have the power to make the physician see sense.

AT the top of this site, you will find "References", go into Document Library, User Submitted, Educational Material and you will find a lecture written by my Consultant exactly on this subject.

Gerbich antibodies can be odd things at the best of times ( we had an anti-Ge3 that was papain-sensitive, confirmed by the International Blood Group Reference Laboratory). It would be nice to know what kind of Ge negative was the patient? Were they ever tested by a Reference Laboratory (or are you from a Reference Laboratory?

Yes, and it is usually to do with the number of antigen sites on the red cells, rather than an antibody difference. That having been said, the antibody titre could well have not changed at all, but it may also be a factor of titration not being that sensitive (a difference of 1 tube is often seen between workers or between two individuals performing the titration on two different occasions). The fact that the anti-C was stronger than the anti-D makes me wonder if the antibody was actually anti-G? I would imagine that the baby was clinically unaffected? :confused::confused:

As I understand it from the literature, it is between 1 and 2% of the population. Like you, I think that if the patient is bleeding enough for uncross-matched blood to be given, any reaction will take place on the floor!

I would have no problems with this, but am very busy this weekend (on-call tonight [Thursday], annual leave tomorrow {but going to the Natural History Museum with my wife and son], lecturing at a one day congress at the University of Westminster on Saturday and on-call again on Sunday), so it will hve to be some time next week. :D:D:D:D

With the move towards lower haemoglobin levels before transfusion (except in the case of cardiac patients), I doubt if the amount taken for testing would really harm the patient.

Could not agree more.

Gosh, I remember those! Awful things!

Hi ANgela and welcome.

Loads, and I could only get to page 3. The site wouldn't let me go any further.

This is another poll in which 16 people voted, but nobody replied. I don't think there were any comments to make.

I don't think this one required any replies Cliff. It was just that I wanted somewhere to hang the algorrithm, and I had forgotten on to which thread it should go!

29 people voted on this one Cliff, it's just that none of us made any comments. As my good friend Rashmi started this thread, I am quite happy to make some comments, but they may not get through the firewall!

Hi Anna, Thanks for that. Now, I know you're not going to believe this, but I actually understood your explanation! Wonders will never cease! :excited::eyepoppin:excited:

It could well be that the adhesive on the back of the labels has not been proven to be safe. By this, I mean that some adhesives have been shown to migrate through the plastic of the bag and leech into the blood. We had this problem in the UK. We had to get labels with an adhesive that was proven not to go through the plastic, or did not affect the blood if it did (I think the former).

Oh yes Rashmi. I agree that writing the Technical Agreement is easy enough. Getting them to take any notice whatsoever is another thing entirely. As you know, we have Service Level Agreements with all of our hospitals, and this covers the hospitals responsibilities to us, as well as ours to them. One bit of this involves providing samples that are fit for purpose (fully labelleed, adequate in volume, etc), and yet we have to reject a goodly proportion of samples sent to us because they are either poorly labelled or are just plain inadequate in volume (and this is after me regularly having a rant at TAG meetings).

Yes, I thought that availability could be a problem.

, but then a procedure stating transfusion staff involvement might just be easier to do?

Have you tried getting supplies from the Bio Products Laboratory in the UK. I believe I am correct in saying that they have been awarded an FDA licence. That having been said, I do not know about availability or price, but if you are short it could be worth a try.

Yes, I meant anti-C3c in my earlier post; not anti-C3b. 54 and I still don't know what I'm talking about!!!!!!!!!!!!!!!!!!!!!!!!!!

Hmmm, I have my doubts.

Well, we are the blood supplier, but yes, we do test most (if not all) units for high titre ABO antibodies and put the information on the blood bag labels.