Malcolm Needs

I'm not sure, but I believe what is being discussed in this thread is a rise in temperature and other minor symptoms. I am worried, though, that there are some places where the report of a suspected transfusion reaction takes so long to get to the Blood Bank. In the case of a more acute transfusion reaction, the symptoms of a red cell antibody reaction can mimic the symptoms of the transfusion of a bacterially infected unit of blood or blood component. If the unit or the blood component is bacterially infected, your Blood Supplier needs to know as soon as possible, because other components made from the same unit may be out there at another hospital (or even in the same hospital) and these need to be quarantined with immediate effect. I'm not entirely sure how well the ward staff understand this, and the need for any suspected transfusion reaction to be reported to the Hospital Blood Bank, and then on to the Blood Supplier as a matter of urgency, and we need to get this information across in words of one syllable. :eek::eek:

I agree - rouleaux is not, after all, cause by a red cell antibody.

It's an absolute pleasure. I often think that we are guilty of not fully explaining things to the patients.

Good for you! That is a great attitude.

Yes and no! Certainly in the UK, any blood that is given to a newborn baby is group O (but it has been tested to make sure that the ABO isoantibodies are NOT strong) and this probably applies in the USA as well. The reason for this is that the blood is usually required fairly urgently after the birth, and so there is not much time to "organise" an ABO identical donor (we have to have some on the shelf ready to go at all times). Group O blood can be given to almost everybody in the world, apart from incredibly rare people who have the Oh type (and I do mean incredibly rare). The other thing is that, until the baby is born, we have little to no idea of the baby's ABO group, and under such circumstances, group O is the safest by far. Although there is no doubt that group B individuals are rarer than either group O or group A (but commoner than group AB) there are plenty of group B people in the population who are Cw-, Le(a-) and K-.

Washing a donor's red cells free of plasma (and, incidentally, most white cells and platelets) is not quite the same thing I'm afraid Esther. Most donor's plasma will not contain (what are termed) atypical antibodies (in this case, your anti-Cw, anti-Lea and anti-K), but will only contain ABO antibodies (typical isoantibodies). We can wash the red cells free of most of the plasma, but not all (which is why we give ABO identical blood in as many cases as possible). Your anti-K is probably high titre, if one of your earlier pregnancies resulted in a baby that had problems due to your antibodies. This means that if some of the plasma is left (even in a diluted form) it may still contain at least a residual amount of the antibody. Even this residual amount of antibody may (but not necessarily will) harm your baby. It is really not worth taking the risk. I'm sorry about the use of "technical jargon", but after a few years in the job, it becomes difficult to explain it in plain English! :)

Have read this right Eric? You would not test a patient who had made anti-E for the c antigen? What about the fact that R1r (give or take) are approximately 32% of the random European population (giving the Basque region of Spain a wide berth, where rr is about 25%), and who will never make anti-c, whilst R1R1 people make up (give or take) approximately 16% of the random population. Take my advice. Rh type your patients!!!!!!!!!!!!!!!!!! :eek::eek:

It depends what the rules say, but we would trust the results of another NHSBT Red Cell Immunohaematology Department (whether they would trust ours is, of course, another matter)!!!!!!!!!!!!!!!!!!!

Excellent thoughts.

Does this also mean that after we retire- there will be no one left to sort out serological problems or anamolous group results by tube techniques?Will labs will be run by folk who will depend solely on automation with no problem solving skills whatsoever??

The rules are quite complicated and differ from country to country. If you are living the USA, as I think, this is probably best answered by one of the members of BBT from the USA. If I answered, I would be using the UK rules, and they will not apply.

This is the address of the Contronics website. www.contronics.co.uk/ They are good, but I understand, a little pricy. I'm not sure about that, so I may be doing them a complete disservice.

If we move any equipment, even if it is within the Laboratory, Quality requires us to perform a full Change Control. We try not to move anything; ever!

Honestly, I do agree with both of you (as I said, there is a patient on the end of the order), and putting it on the computer as a special need is what we do too. It's just that I see no reason why others should just be allowed abdicate their responsibilities. :(

I completely agree with what you are proposing, but on the other hand, you are then taking on a lot of responsibility, and who will get it in the neck (and quite possibly sued) if someone in the Blood Bank forgets. The point is, it should be the responsibility of the ordering physician, and then they get it in the neck (and quite possibly sued) if they forget. They get paid for taking this responsibility; but, of course, there is a patient on the end. :cool::cool::cool:

From the number of studies performed before routine antenatal anti-D immunoglobulin prophylaxis was introduced in the UK Donna, I would be absolutely amazed if it was the Rhogam had caused the rise in the baby's bilirubin. :eek:

Many of the NHSBT Centres use Contronics. Unfortunately, I am now at home, but will find out more and contact again tomorrow. :)

My pleasure. The risk of bacterial contamination is, I must admit, extremely low, but it is, nevertheless a risk, and one that can be illiminated by using donor blood.

My pleasure.

Hi Andy, Yes, that is what I meant in my post. By the way, welcome to the site; you will be a great asset. :D:D:D:D

This is all to do with the relative rarity of group O D Negative blood (roughly about 7.2% of the White population, and rarer in other populations). The D antigen is the most immunogenic of all the red cell antigens (apart from ABO), which means that a person who is D Negative is highly likely to produce an anti-D if transfused with D+ blood. Anti-D, in itself, is not dangerous, just because it is in the circulation. However, the antibody will cross the placenta and with destroy foetal red cells if they express the D antigen. Therefore, we try to avoid giving D+ blood to any female of "child-beariong potential" (horrible phrase), just in case they are D Negative. Actually, in the UK, we would not consider giving group O D+ blood to a female in an emergency who is less than 60-years-old (and the same applies to K+), unless there was no other choice (i.e. the hospital had run out of group O D- blood, the lady was in danger of exsanguination, and no group O D- blood could be transported to the hospital in time to save her). I hope this is of help. :)

Hi Esther, My own thoughts are that one would only use maternal blood for transfusion of a baby in extremis, when no other suitable blood is available. The danger of GvHD is a very real and present danger that can only be mitigated by irradiation of that blood. If your antibodies are anti-Cw, anti-K and anti-Lea, the chances are that the problem antibody of the three is the anti-K, but Cw-, K-, Le(a-) blood from unrelated donors would be readily available, and I would choose this blood ahead of maternal blood every time. Whilst your own red cells would be compatible (assuming that you are the same, or have a compatible ABO blood group as your baby, which is not necessarily the case) your blood would also have to be washed free of the "offending" antibodies in the plasma, prior to irradiation, and the more manipulation of the unit, however careful one can be, the more chance that there is of bacterial contamination. The answers to your two questions, in my opinion are, therefore: 1. It is important to avoid giving your baby maternal blood, unless there is no alternative, and 2. I think that you would be wise to accept the advice of the Blood Bank that is not interested.

My ER person that didn't know their own Blood Bank could cross-match blood. jasonviau's ER person that didn't know that O Neg was not 0 Neg. Who do they let into ER these days???????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! HELP!!!!!!!!!!!!!!!!!!!!!!!!!! :eek::eek::eek::eek::eek:

Yes Linda, I see where you are coming from, but a colleague of mine has just had a horrible case where a D- lady with bleeding varicies made anti-D. She had an anti-D, but they did not do her other Rh antigens. She then went on to make an anti-c because she turned out to be an r'r', so it may also be worthwhile doing the other antigens in the case of someone who has made anti-D! In the case of a 70-year-old male undergoing a one-off surgical procedure, such as a THR with an anti-E, who was R1R1, I wouldn't worry if he made an anti-c too! :eek:

I am from the UK, and so do not know the rules and regulations of which you speak, but at least some of the problem lies with your parent company for you not being able to access their computer (especially in this day and age). :eek: