Malcolm Needs

There is absolutely no reason to give group O red cells to a recipient who is A3.  Even if the patient does develop an anti-A1, unless that antibody is reactive at strictly 37oC, they can still receive A1 red cells, but, if the anti-A1 does react at 37oC, there is no reason not to transfuse with A2 red cells that are IAT compatible.
Personally, I have never seen loss of A or B antigens through ALL, but I have with AML.  In fact, in one case, we were able to follow whether the patient was in remission or relapse by the strength of the reaction of the A antigen with various anti-A reagents, but this was many years ago, and I honestly can't remember whether these were human-derived polyclonal reagents or early monoclonal reagents.

Hello everyone, 
Here is a new 100% educational opportunity (with PACE credits) for those who are interested in FNAIT. Here is the link to register Webinar | Bio-Rad
 

Agree entirely Ensis01, BUT, even then there can be a considerable variation in antigen expression, and so I still maintain that the previous sample should always be run in parallel.

Years ago we had a transplant team come from a larger hospital to harvest from a brain dead donor.  We were 4 hours away from them and 3 hours away from ARC.  As the sole overnight Lab worker in a rural hospital, I had to give many units to keep his organs alive, which included STAT taxi's, etc.  The transplant team said to me "tell the Lab they are doing great".  I said "consider it done, I am the only one here".  It was the worst night shift, Blood Bank-wise I have ever had in my 32 years due to it being all on paper then.  I would expect that the Transplant procurement team could bring their own box of blood along with their ECHMO -like device nowadays.  Isn't the "patient" now in their hands once considered a donor?  This should be reviewed by some committee along with AABB, etc.,  and regulations made to absolve the hospitals of any liability.

Agree entirely Ensis01, BUT, even then there can be a considerable variation in antigen expression, and so I still maintain that the previous sample should always be run in parallel.

For consistency you should probably have guidelines about the cells you select; i.e. stipulate for anti-D titers use R1R1 cells (or R2R2 or...), and for other antibodies stipulate the use of either heterozygous or homozygous expression of the antigen. 

If the titre is on a new patient, we (UK) would a NIBSC (National Institute for Biological Standards and Control) anti-D.
If it is a second or subsequent sample, we would titrate the stored (and frozen) previous sample, in parallel with the new sample.  If there was found to be a difference in titre, we would again use a NIBSC anti-D in parallel.

I thought for the first time I would share one of the educational webinars we have been producing with the ISBT because it is a fascinating topic addressed by a great lecturer (Sue Johnson).
So do miss out on the opportunity to watch the recording of this ISBT educational webinar Could it be drugs? How to differentiate AIHA from DIIHA Start zoom webinar | The International Society of Blood Transfusion (ISBT)
 

Discarding your tips is also the AABB standard practice:

A research team led by NHS Blood and Transplant scientists based in Bristol, at NHSBT’s International Blood Group Reference Laboratory (IBGRL), and supported by colleagues at the University of Bristol, has discovered a new blood group, MAL. 🙌 🩸

They identified the genetic background of the previously known but mysterious AnWj blood group antigen, thus allowing identification and treatment of rare patients lacking this blood group.

Louise Tilley, Senior Research Scientist, IBGRL Red Cell Reference at NHS Blood and Transplant, said: “The genetic background of AnWj has been a mystery for more than 50 years, and one which I personally have been trying to resolve for almost 20 years of my career. It represents a huge achievement, and the culmination of a long team effort, to finally establish this new blood group system and be able to offer the best care to rare, but important, patients."

hashtag#NHSBT hashtag#GiveBlood hashtag#SaveLive hashtag#NHSCareers Activate to view larger image,

I thought this would fit quite well with this discussion on new blood group system/antigen discovery
Advancement of new molecular tools for discovery of blood groups - Transfusion Today - October 2024 

Hats off to Nicole and the whole IBGRL team  

A research team led by NHS Blood and Transplant scientists based in Bristol, at NHSBT’s International Blood Group Reference Laboratory (IBGRL), and supported by colleagues at the University of Bristol, has discovered a new blood group, MAL. 🙌 🩸

They identified the genetic background of the previously known but mysterious AnWj blood group antigen, thus allowing identification and treatment of rare patients lacking this blood group.

Louise Tilley, Senior Research Scientist, IBGRL Red Cell Reference at NHS Blood and Transplant, said: “The genetic background of AnWj has been a mystery for more than 50 years, and one which I personally have been trying to resolve for almost 20 years of my career. It represents a huge achievement, and the culmination of a long team effort, to finally establish this new blood group system and be able to offer the best care to rare, but important, patients."

hashtag#NHSBT hashtag#GiveBlood hashtag#SaveLive hashtag#NHSCareers Activate to view larger image,

Switch back to the patient's own ABO type as soon as possible is my advice.  For everything.  RBC, platelets, cryo, plasma.  Worrying about the anti-A and anti-B in low titer whole blood is relevant, but so is the smaller amount of incompatible plasma in group O red cells, which are not low titer. There are rare reports of severe hemolytic reactions to group O red cells in non-O patients. Furthermore, the patient is continually making their own group A, B or AB red cells, so hesitancy about transfusing their own ABO type is not helping things get better.  By giving additional group O products we are making the problem worse, not adding safety in any way.
Furthermore, the non-O patient's endothelial cells, platelets, von Willebrand factor, hepatocytes, etc. are all incompatible with the transfused group O plasma, and their function is impaired when modeled in vitro, and leads to increased bleeding. 
Thus there is no benefit whatever in giving group O red cells (or whole blood for that matter) to non-O patients once the hemorrhagic problem is largely under control. And there is likely added risk.   It is only adding harm and reducing the inventory of group O blood for group O recipients.  A total mistake of the last few decades in my opinion. Giving group O plasma containing products to non-Os is only reasonable when you don't know the patient's blood group, or don't have their blood group in stock, or it's an emergency with no time for giving type specific.
No one ever went broke overestimating the importance of the ABO blood group in transfusion.  See attached for the literature references.
ABO trauma commentary Frontiers bioengineering.pdf Reconsider ABO compatible:universal donor.pdf ABO ARC MAC copy.ppt

So we ended up sending it out to ARC. 
 
Patient is subgroup A2 and Anti-M identified.

I just answered this question.
 
My Score PASS YEE- HAH!!!!!!!  I got one right!

Do you think somebody should tell them that ABO HDFN sometimes gives a Negative DAT result in the fist two or three days of life, and that they might actually be better off looking for clinical signs, rather than performing diagnoses on the result of pathology results???????

Oh it is!!!!!!!!!!!!!!!!!

I just answered this question.

My Score FAIL  

Oh it is!!!!!!!!!!!!!!!!!

Do you think somebody should tell them that ABO HDFN sometimes gives a Negative DAT result in the fist two or three days of life, and that they might actually be better off looking for clinical signs, rather than performing diagnoses on the result of pathology results???????

I think that it depends upon the state of the baby.  For example, if the mother is D Negative, and has been in receipt of anti-D immunoglobulin, and the baby has a positive DAT, but is showing no other signs of HDFN, then we wouldn't perform any further testing.

If the baby has a lowish Hb, and the mother is group O and the baby group A or B, we may take a look at the mother's IgG ABO status, and then perform an eluate on the baby.

Where we might really "go to town" is if the baby is showing overt signs of HDFN, we might well go the "whole hog" and perform an elution, just in case there is a maternal alloantibody directed against a low prevalence antigen also expressed on the red cells of the father.  If this is suspected, it would be easy enough to adsorb out any IgG anti-A or anti-B on the baby's red cells, without adsorbing out the potential antigen against a paternal low prevalence antigen.  The specificity of such an antibody would be interesting, but not necessarily vital, as, should the baby require a transfusion, suitable blood should be easy to obtain.

I think that it depends upon the state of the baby.  For example, if the mother is D Negative, and has been in receipt of anti-D immunoglobulin, and the baby has a positive DAT, but is showing no other signs of HDFN, then we wouldn't perform any further testing.

If the baby has a lowish Hb, and the mother is group O and the baby group A or B, we may take a look at the mother's IgG ABO status, and then perform an eluate on the baby.

Where we might really "go to town" is if the baby is showing overt signs of HDFN, we might well go the "whole hog" and perform an elution, just in case there is a maternal alloantibody directed against a low prevalence antigen also expressed on the red cells of the father.  If this is suspected, it would be easy enough to adsorb out any IgG anti-A or anti-B on the baby's red cells, without adsorbing out the potential antigen against a paternal low prevalence antigen.  The specificity of such an antibody would be interesting, but not necessarily vital, as, should the baby require a transfusion, suitable blood should be easy to obtain.

I tend to think that there are a number of factors affecting the reaction, such as changes to the pH, rather than just dilution, that would change the equilibrium constant within the Law of Mass Action that governs antibody/antigen reactions, but pH is only one of them.

Thanks Lorna.  I'll have a look and see what I can provide but, as I see that you are working in the Isle of Man, may I suggest you get a copy of the BCSH Guideline "Pre-Transfusion Compatibility Procedures in Blood Transfusion Laboratories" from 2012 (which is available free on-line - just put in BCSH Guidelines), and these have a few at the end of the Guideline.

In addition, have a look on this site under "Library" at the top of the page, where you might find more than one thing (probably under "Education", but not only there), that will be of use to you.