Malcolm Needs

These people live in another world I am sure!

Actually, come to think of it, if we have time, we wash the platelets too.

Medicines and Healthcare Products Regulatory Agency (that's the polite version anyway)! Thanks Mary. :):)

We are a blood supplier in the UK, although I do not work on the donor side of things (strictly patients, and strictly red cells), but I know that we would never condone giving platelets in ABO incompatible plasma, unless it was proved to be ABO antibody high titre negative, and only then in extremis (say the baby had neonatal alloimmune thrombocytopenia with an ongoing intracranial haemorrhage, and the platelet antibody causing it was directed against a very high frequency platelet antigen and no ABO plasma compatible platelets were available).

For those of you who have read my posts on this page, you will know that we were inspected by an MHRA Inspector from hell. I can now reveal that we have been inspected by the MHRA again last week. The inspector was extremely thorough and, of course, picked up the odd minor non-conformance, but he was pragmatic where necessary, he listened, he was pleasant, but firm and he had a sense of humour. This just goes to prove that a) not all inspectors are the same and that it is quite possible to be firm and thorough, without being arrogant and dogmatic. Why the first inspector thought this was necessary, or part of his job is way beyond me. :eek:

Hi irshadaad, If I understand your question correctly, you are asking if the blood from a donor who is G6PD deficient or who is HbS positive can be used to transfuse a patient who is anaemia? If I am correct, the answer depends upon why the patient is anaemic in the first place. In the UK, we will accept a donor who is, for example HbAS, but will not accept a donor who is HbSS, on the grounds that the latter will be medically unfit to be a donor. Having taken this donor's blood, we are quite happy to give this unit of blood to a patient who is, for example, anaemic because they have an anaemia due to a chronic bleed, but would not give it to a patient who is anaemic due to sickle cell crisis, or is a sickle cell patient who is being "topped up" prior to flying (where they will be exposed to an environment that may be lower in oxygen content than would be "normal"). We would also not give such blood to a paediatric or neonate patient because the oxygen carrying capacity of the donor red cells would be considerably less than that of a donor who is HbAA (it must be remembered that the neonatal patient's body, in particular, is used to being "supplied" with oxygen from red cells that are predominently HbFF). The HbAS donor's red cells would, physiologically speaking, regard the neonates circulation as an environment "starved" of oxygen, and would not, therefore, give up its oxygen easily to the tissues (which is what is, after ali, the raison d'etre for the existance of red cells. HbSS donors would be turned down on medical grounds, on the basis that they need their blood more than do other patients(if you see what I mean). To a certain extent, the same arguements apply to a donor who is G6PD deficient, except that the UK would almost certainly exclude such donors from giving blood in the first place on medical grounds. That ahving been said, unless the patient is exposed to, for example, fava beans post-transfusion, and unless the percentage of circulating G6PD blood is high after transfusion (as it probably would be in a neonate or paediatric patient) then it should be okay. I hope I have gone some way to answering your question, but I'm absolutely certain other people could answer your question better than have I; but it's a start!!!!!!!!!!!!!!!!!!! :redface:

This is, essentially, the same as the Guidelines in the UK.

Yes, absolutely right (although, any plasma containing, for example, anti-Kna, will have been "tested to death" for the presence of an underlying atypical alloantibodies directed against the major blood group antigens against a battery of Kn(a-) red cells, kept for reference work, so we are pretty sure that there will be no overt haemolytic transfusion reactions). Thanks for the offer, but, if you don't mind, and don't think me too cheeky, I'll swap the teo lattes for a glass of red wine!!!!!!!!!!!!!!!!!!!!! :D

Although it is now 7-years-old, and so some of the newer antibodies described are not quoted, you couldn't get a much better paper , in my opinion, than: Daniels G, Poole J, de Silva M, Callaghan S, Smith N. The clinical significance of blood group antibodies. Trans Med 2002; 12: 287-295.

The simple answer is "yes". You must treat these patients in exactly the same way that you would treat other patients, with the proviso that they are possibly more likely to make alloantibodies, as they have been exposed to many that are foreign (although, that having been said, I doubt if their immune system is up to much for the first couple of days).

Ah right. Now I understand where you are coming from. Sorry about the misunderstanding.

It's a pleasure.

I must agree with L106 that this system must "hold you to ransom" on occasions. It may be okay if you have a plasma containing one or two antibodies, but when you have an plasma containing three or four (or more) alloantibodies (even if they are of a "common" specificity), it must give you a headache as to how to find the necessary red cells. How do you cope with, for example, a sickle cell patient with an anti-U, an anti-Fy3 or an anti-Jsb? How would you find three examples of U-, K+k- or Fy:-3, K+k- cells, or, come to that three examples of Js(a+b-), Jk(a-b+) red cells (or would you alloadsorb in such circumstances)? :confused:

Yes, it can be a bit obscure. Basically, what it means is that, if we cross-match using the raw plasma and we detect no reactions, or we cross-match using auto-adsorbed plasma, and we detect no reactions, then the blood is issued as "compatible with". If we cross-match using the raw plasma, in which we have detected a clinically insignificant antibody, such as anti-Kna, we cannot provide Kn(a-) blood, as so we will cross-match and choose the least incompatible, and issue it as "suitable for". If we cross-match using inhibited plasma, as in the case of anti-Ch or anti-Rg, we will also issue as "suitable for". If we cross-match using alloadsorbed plasma, and we detect no reactions, we issue the blood as "suitable for". The difference between the autoadsorbed plasma and the alloadsorbed plasma is that autoadsorption will leave behind an alloantibody directed against a high frequency antigen (such as an anti-Vel) - hence the "compatible with", whilst the alloadsorption will almost certainly take out an antibody directed against a high frequency antigen (again, such as anti-Vel) - hence the "suitable for". To put it another way, if we issue blood as "compatible with", we are pretty sure that there will be no adverse reactions, whereas if we issue blood as "suitable for" we are hoping that there will be no adverse reactions (but it is still, to a certain extent, an in vivo cross-match). I hope that helps to explain the difference. If not, get back to me. :)

We had a lady in today with an anti-D level of 829 IU/mL. We assume this one to be immune, rather than prophylactic!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Tonight (its 21.30 over here) I found the article on the computer by going into: Google Put in "Transfusion AABB" Go to "Transfusion - Journal Information" Once in, over on the right hand side is a bit marked "view sample issue" Go to 2003 - Volume 43 and expand it. Go to Issue 11 (November 2003). Go to the editorial and you can download a PDF of the article. AND, I KNOW YOU WON'T BELIEVE THIS, BUT IT WAS FREE!!!!!!!!!!!! :D:D

Hi Brenda, If there is, then I'm afraid I don't know it. You could try going onto the Transfusion website, but I suspect you would have to pay for any downloads. Occasionally, very occasionally, you can Google and get a paper up. Sorry I can't be more help. The only other thing I can suggest is that you send me an email on malcolm.needs@nbs.nhs.uk with your work address, and then I can photocopy my copy and send it to you. Sorry, not a lot of help I know. :redface::redface: Good news! I've just Googles Transfusion AABB and managed to get the article up that way, so you can get via their site! :):):)

No problem (after all, he wrote it, not me)!!!!!!!!!!! :D

Brain power? Bang goes any chance that I could do it then!!!!!!!!!! :o:o

There ws an editorial, written by Lawrie Petz, a few years ago in Transfusion that may be of interest to people. It is: Petz LD. "Least incompatible" units for transfusion in autoimmune hemolytic anemia: should we eliminate this meaningless term? A commentary for clinicians and transfusion medicine professionals. Transfusion 2003; 43: 1503-1507. The final paragraph should be of particular interest. :)

Our National SOP actually states that we should cross-match with the raw plasma and the adsorbed plasma, if there is sufficient raw plasma available. On average, we deal with about 4 or 5 DAT positive samples a day, most with a panagglutinin giving a 4+ or 5+ reaction across the board. I've never quite seen the point of cross-matching against the raw plasma in such circumstances, knowing before I start that the units will be 4+ or 5+ incompatible. It's a waste of time (1+ or 2+ panagglutinins maybe, but not when they are that strong). You would be amazed just how many times I have insufficient raw plasma left to perform these useless cross-matches! The 50 odd hospitals that we deal with as their Reference Laboratory (from very large London Teaching Hospitals to small Private Hospitals) are a varying lot too. SOme are quite happy to perform an immediate spin cross-match if we detect no atypical alloantibodies following differential adsorption, some will do this if the auto-antibody is 1+ to 2+, but will want us to cross-match if the auto-antibody is strong, or if we identify atypical alloantibodies following differential alloadsorption, whilst others (some quite reasonably sized District General Hospitals) want us to cross-match for them even when the autoantibody results in 2 cells kissing each other in the IAT. This last cohort really annoy us! :mad::mad:

p.s Malcolm.... too much info!!!....my analysers have a strictly professional relationship with the LIMS.

Yes; firstly I would agree with you that, in this particular case, there is insufficient evidence (well, none actually) for the presence of an auto-antibody. Secondly, I agree with you about the antibody characteristics making a difference. Thirdly, I would agree with you that these discussions are wonderful, especially if one can keep a mind open to other people's opinions, which, it would seem, nearly every poster can do. P.S. Thanks for the comment.

Hi Trey, and welcome. If you are as lucky as I have been, you will learn enormously from this site (and in a very short period). There are some wonderfully knowledgable people who post, who are more than willing to share their knowledge. It is great.

In principle, I do agree with you Brenda, but when we detect an underlying atypical alloantibody post-adsorption (say an anti-Fyb for arguement's sake), we do like to cross-match, just to make sure that we are not giving Fy(b+) blood (albeit, the cross-match could easily miss an Fy(a+b+) unit if the anti-Fyb is very weak).