Malcolm Needs

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Who is this lady, and why did she win fame with regard to the genetics of the Rh Blood Group System?

Absolutely spot on. Well done! See Karamatic Crew V, Tilley LA, Satchwell TJ, Al Subhi SA, Jones B, Spring FA, Walser PJ, Martins Freire C, Murciano N, Giustina Rotordam M, Woestmann SJ, Hamed M, Alradwan R, Al Khrousey M, Skidmore I, Lewis S, Hussain S, Jackson J, Latham T, Kilby MD, Lester W, Becker N, Rapedius M, Toye AT, Thornton NM. Missense mutations in PIEZO1, encoding the Piezo 1 mechanosensory protein, define the Er red blood cell antigens. Downloaded from http://ashpublications.org/blood/article-pdf/doi/10.1182/blood.2022016504/1922096/blood.2022016504.pdf on 30th September 2022.

I'm afraid not. Many of the Blood Group Systems are multi-pass proteins.

Okay then, here is another one. A schematic of the showing the extracellular domain of the Piezo1 protein between amino acid residues 2198 and 2431. WHat is the Blood Group System?

Yep! See Reid ME, Lomas-Francis C, Olsson ML. The Blood Group Antigen FactsBook. 3rd edn, 2012, Academic Press. ISBN: 978-0-12-415849-8.

No, I'm afraid not.

No, I am afraid not.

No, I'm afraid not.

Here's one to start. This is a schematic of a molecule carrying a particular blood group antigen. The antigen is expressed on fewer Japanese individuals than most (but not all) ethnicities. What is the antigen?

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To a VERY large extent I agree with you, if for no other reason than, it is NOT for laboratory workers to decide on the way a patient is treated (including monitoring during pregnancy). That having been said, no medical director can be expected to be an expert in ALL aspects of medicine, including pregnancy and foetal medicine, and so a good medical director should be prepared to take advice from world famous scientists, such as the late Prof Dave Anstee, and the very much alive Dr Geoff Daniels.

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I just answered this question. My Score PASS  

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No Mabel. As always, Geoff is ABSOLUTELY right (and I would NEVER, in any case, go against one of the world's GREATEST in terms of Blood Group Serology). Thank you also for your kind words, and I totally agree with your conclusion.

I wouldn't bother, to be honest. Apart from the fact that the Lutheran antigens vary in strength of expression, making it difficult to ensure that the recorded titres would "match up" one to another, but the expression of the Lutheran antigens on foetal and cord erythrocytes is known to be weak. On top of that, of course, there is the problem of finding a regular source of adult erythrocytes with heterozygous expression. In addition, anti-Lua and anti-Lub can be either IgG or IgM but are more commonly IgM. It might be worth your while treating the maternal plasma/serum with a reducing agent such as 0.01M dithiothreitol, 2-mercaptoethanol or ZZAP to see how much, if any, IgG is present. Even if the antibodies are IgG, they are thought to be adsorbed on to foetal Lutheran glycoprotein on the placental tissue. Lastly, as you so rightly say, clinically significant HDFN caused by anti-Lub is incredibly rare, and so, all in all, you could be giving yourself an awful lot of work for very little return. If you do decide to test the maternal plasma/serum with reducing agent, and you find that there is an element of IgG present, it might be worthwhile just performing a titre once, in order to see that you have not got one of these incredibly rare examples that might cause clinically significant HDFN, and, as lone as the titre isn't massive. I would rest easy. If you want, I can cite references to back up what I have written above, but I haven't done so straightaway, as actually finding some of these papers to read is equally hard work!!!!!!!!!! I hope that helps.