Malcolm Needs

ABSOLUTELY (but try telling that to Human Resources)! :eek:

We have something similar in the NHSBT in the UK. It is called Task Based Training. Here, the trainee signs to say that they have read the document, have understood it and are confident in carrying out the task, whereas the trainer signs it to say that the trainee is competent in the task. That having been said, the onus is still on the trainee to make the effort to read and understand the document, and if no such effort is made, we have the option of disciplinary action. It is one thing to make the effort, and yet still not understand it, or not be confident to perform the task; it is quite another not to make the effort in the first place. :(

That's one heck of a list! Once I get back to work properly (after the New Year) I may be able to help with some of the rare red cells (Lu(a+b-), Lu(a-b-) dominant type, which will also be (effectively) AnWj-, r'r', r"r", McC(a-), Lan-), but I can't promise. I depends what donors turn up. Have you tried becoming a member of SCARF (Serum, Cells and Rare Fluids)? If not, look them up on a search engine and see if you are eligible. Some of the rare antisera and, come to that, rare cells that you are looking for are so rare, I think that is the only way you are going to find them. That having been said, anti-Ce is as common as muck. Almost all so-called anti-C reagents (including monoclonal anti-C reagents) are, in reality, anti-Ce (just try them in parallel against any R1r and R1Rz cells). It is monospecific anti-C that is really rare. :eek::eek:

Yes I am, however, these days I'm more saggy than Sagittarian!!!!!!!!! I hope you have a really brilliant day Kate - come to that, I hope you have a really brilliant year! Enjoy the wine; I will be having just a small glass or ten tonight myself (purely for medicinal reasons, you understand). By the way, how many years of illegal drinking was there first!!!!!!!!!!!!!!!!!!!!!!???????????????????? (several in my case). :D:D:D:D

Hi Emily and welcome. You will learn an awful lot from this site (I think I can safely say that we all have). Never, never be afraid to be wrong, but always be petrified to not admit that there is something you do not know. Nobody, but nobody knows everything, but the fool always finds it difficult to admit this. If you have had the honour of being taught by jcdayaz, from what I have read of her posts, you have had an excellent start in your professional life. Post away, and have no worries about making a fool of yourself; I make a fool of my self on a regular basis!!!!!!!!!! :D:D:D:D:D

well???????????

I have the same problem with my salary. My outgoings always seem to expand sufficiently to make my income seem insufficient! I have a feeling that this is a universal problem!!!!!!!!!!!!!!!!!!!!!!!!! :D:D

Yes, I did see it thank you adiescast, but I thank you again. I did get some lovely gifts, including a couple of Bob Dylan CDs I wanted and dome very nice bottles of wine and port. I intend to get outside those over Christmas! I imagine, compared to my old gravel path of a voice, you have the voice of an angel! Thanks once again. Malcolm :D:D:D:D:D

Even then though, an IgM anti-D tends not to "fit" the D antigen as well as does an IgG anti-D (there is an anti-I-like element to the specificity), and is still detected optimally at 37oC, I would still be surprised if it could be detected by immediate spin technique (unless it is the anti-I-like element that is being detected).

Unless the patient is of particularly small stature, I wouldn't so much be surprised, as amazed that the titre reached 32, and, unless the Rhogam was given in very late September, and the tests performed in very early December, I still think that the anti-D is immune. If the lady had an immune anti-D in August/September, and Rhogam was given, then the titre could be higher than expected, as there would be a cumulative effect.

Ah, but age is relative. You are only as old as you feel yourself to be. Right this second, I'm well over 100!!!!!!!!!!! :D:D

Hmmmmm. Thank you, but watch your mail closely for the next couple of months. One or two of the packets could just be ticking!!!!!!! :cool::cool::cool::cool::cool:

love it!!!!!!! :d:d:d:d:d

Yes, sorry, I meant the method. :redface:

Yes, I think I am correct insaying you only use 1, 500IU (but I could well be wrong).

I am very sorry Jives, but I can't answer your question. Here in the UK, the NHSBT does not titre any plasma containing anti-D (or anti-c come to that). We quantitate it using International Units against a standard anti-D (see the lecture on HDN in References, Document Library, User Submitted, Educational). That having been said, we do titre all other antibody specificities and (usually) only get worried if the titre reaches 32. In so saying, I would be surprised if an antibody could reach a strength sufficient to give a titre of 32 unless it was immune. Could I ask a couple of questions? You say the titre was 32, 5 days after administration of Rhogam, but I would think from the fact that you also say that 5 months later the titre was barely 1. Am I correct in assuming the Rhogam was given close to, or after birth of a baby? Am I correct in assuming that the second sample was taken 5 months after the administration of the Rhogm? If my assumptions are correct, I would say that the anti-D was most certainly immune, rather than passive, as the half-life of an IgG immunoglobulin is, give or take, 21 days, and so unless the lady was given a bolus dose of anti-D imunoglobulin, there is virtually no chance that you would be able to detect this passive anti-D after 5 months. :confused::confused:

I would agree with that. I don't use an ECHO, but many of the hospitals that refer to us do, and we have seen a steep increase in such referrals since these machines have been introduced.

Don't know what you mean Mabel:sarcasm:!!!!!!!!!!!!!! I would go with testing the father against the mother's plasma/serum first. Even if the mother and father are ABO incompatible, you could always use blood group substance to take out the mother's ABO antibodies or, better still, as this may dilute out such a weak antibody, adsorb the mother's antibody onto the screening cell, and then elute it. This will leave the putative low-incidence antibody free of maternal ABO antibodies. If then the father's red cells react against the isolated antibody, then I would pull out all the plugs to identify the specificity. As you say, this antibody could have been formed in the previous pregnancy (or in this pregnancy) and could get stronger (and more clinically significant) during the pregnancy. Identification of any such antibody is a pain, but identification may help predict if it has the potential to cause haemolytic disease It could be one that is known to adsorb onto the apical surface of the placenta, such as an antibody in the Cromer Blood Group System, in which case there should be no more worries, but it could equally be one that has been known to cause problems in the past. If dad doesn't react with the isolated antibody, then, hey, life's a dream and I wouldn't take it any further. I'm always more worried about potential HDNF in these cases than transfusion. Hope this helps (even if I'm not pregnant myself)!!!!!!!!!!!!!!!!! :D:D:D:D

Someone probably does, but I'm blowed if I do!

I've been thinking about this, and I cannot see that even a de novo immune anti-D would show up in an immediate spin, let alone Rhogam. In almost all cases the immune anti-D will be IgG (you would be exceptionally lucky/unlucky to pick up an immune anti-D that is pure/almost pure IgM), and the Rhogam, by definition, would be IgG (early work on both sides of the Atlantic showed that the injection of IgM anti-D not only did not prevent immunization, but was actually like adding fuel to the fire), and so, unless I am missing something (like a potentiater), how would you detect either by immediate spin technique? Am I missing something obvious to everyone else???????? By the way, I agree with your post adiescast, although we do also like to know the dose of anti-D immunoglobulin given (there are several different doses used routinely in the UK, from 250IU through to 1, 500IU). :confused::confused::confused:

Happy Birthday from me too John. I thought you meant that you were born on Christmas Day. By the way, don't these youngsters (like Donna) just love insulting those of us who are challenged in years!!!!!!!???????? :D:D:D:D

When I first read this post, I must admit that I thought it was a bit harsh, but on reflection I think you are quite right. It is, after all, the duty of all employees to keep up to date with new documentation that is relevant to them, and if they don't, they are putting patients at risk. As a colleague of mine would say (and often does about my managerial prowess), "Harsh, but fair"! Mind you, even he (and Human Resources) bulked a bit when I suggested that the Laboratory should get an Iron Maiden. They all suggested that I perform the Change Control and the validation!!!! :eek:

I would have no problem calling this an auto-antibody. Not only do we call this an auto-antibody in my own Reference Laboratory, but this is also written into the National SOP used by the NHSBT in the UK. So far, we haven't killed any patients because of this!!!!!!! :)

It's just a term we use over here for a young man with acne (not very flattering I'm afraid).

Well, it's the evening of the 16th December (at least, it is in the UK) and so I think it is close enough now to wish everyone, of whatever faith or of no faith, a very Merry Christmas and a Happy and Prosperous New Year, and to thank you all for your wonderful posts that have both broadened and deepened my knowledge of all things to do with Blood Transfusion. Have a good one. :D:D:D:D