Malcolm Needs

We do all sorts of tests on samples to identify the specificity of the antibody(ies) with no reference to a Consultant. This includes instigating such things as a DL test or tests for mixed cold and warm AIHA. However, if our findings suggest an unusual combination of antibodies, a combination that would give us problems supplying blood (say an anti-U+Jka), an antibody against a high incidence antigen, we would take our results to the Consultant for him or her to report to the hospital. The same applies if we find a DL positive or a mixed cold and warm AIHA, as these require medical input for correct treatment. We would also consult with a Consultant if we think that other tests, performed by other Departments, such as HLA or platelet antibodies in the case of multiple stillbirths, could be the answer, but again, the need medical input. In this way, we are very lucky, because we are "given our head", but have excellent Consultants to back us up (and to suggest other tests that we may have overlooked). :):)

My goodness Yanxia, I certainly wouldn't worry about your English! I should be ashamed of the fact that I can speak no other language than English (and often people tell me that I am not much good at speaking that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!). :D

As a Reference Laboratory, we have access to plentiful supplies of R1Rz, and so would always rule out/in an anti-E accompanying an anti-c, but in 99.99% of cases (or more), clinically, it makes absoultely no difference whatsoever! If you are going to transfuse a patient who has anti-c, you would normally go for R1R1 anyway (I am accepting the fact that I am ignoring rare Rh patient types for now) and, in the case of a pregnant lady, the level of anti-c is usually far more important than the level of anti-E (and, if the level of anti-E is that high, and considered more important than the level of anti-c, the reactions will be noticably stronger with c+E+ red cells than with c+E- red cells). I do, therefore, see where you are coming from and agree. :)

Well, it is true that I am from a Reference Laboratory, but that having been said, the BCSH Guidelines in the UK strongly advise that an enzyme panel is run as well as an IAT panel, and so most Hospital Blood Banks will also run an enzyme panel. I do agree with you that, in the case of a warm auto (and many times in the case of a "cold" auto) the enzyme panel adds nothing. Yes, we run our enzyme panel in gels, but, unless there is an auto present, this panel is often extremely useful. :)

It is the word "punative" that worries me. This is exactly what these inspections should NOT be, but they seem to be like this on a regular basis in the UK too. Then, instead of you learning and improving the service as soon as possible, you spend a whole lot of time explaining things to your own Quality Department. :rage::rage:

I honestly can't remember if I've put this attachment on before. If I have, I apologise. If I haven't, it may, or may not, be of interest. You judge! :) Review of the current progress in developing universal red cell products and their potential to.doc

A very great pleasure.

What was her antibody(ies)? I know that we are not supposed to make moral judgments, but it seems to me that, if she had already lost 9 babies, anyet still had such disregard for the child she was carrying in her 11th pregnancy, the FDA should have looked at her and taken away her license!!!!!!!!!!!! :eek::eek:

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).