Malcolm Needs

Welcome to this wonderful site REN_NH.  Enjoy.

I agree entirely, EXCEPT, we should think of females of child bearing POTENTIAL, rather than child bearing AGE.  Think, for a moment, of a female who is group A, D Negative, who is, for example, 11 years old.  Sorry to be picky, but, so often, these female children do not get the anti-D immunoglobulin they should be given.

I agree entirely, EXCEPT, we should think of females of child bearing POTENTIAL, rather than child bearing AGE.  Think, for a moment, of a female who is group A, D Negative, who is, for example, 11 years old.  Sorry to be picky, but, so often, these female children do not get the anti-D immunoglobulin they should be given.

I agree entirely, EXCEPT, we should think of females of child bearing POTENTIAL, rather than child bearing AGE.  Think, for a moment, of a female who is group A, D Negative, who is, for example, 11 years old.  Sorry to be picky, but, so often, these female children do not get the anti-D immunoglobulin they should be given.

RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first.
Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. 
Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow. 

Sounds to me like you should only be concerned with the fact that you might be needing 2 exchange transfusions and a bleeding mom to occur at the same time. Busy, but not unmanageable. Maybe make sure you have blood and plasma per your SOP for the exchange in house, and plenty of A pos for mom. Good luck! 

I would most strongly advise you to send a sample, possibly even multiple samples throughout the pregnancy, to a Reference Laboratory.

As the patient is pregnant, there is the possibility that the Jk(a) antigen you are detecting is actually being expressed on the red cells of the foetus, and you are detecting it as a result of a foeto-maternal haemorrhage.  However, the Jk(a) antigen is not necessarily straight forward, as there are weakened forms of the antigen (and the Jk(b) antigen come to that) where there are amino acid substitutions remote from the site usually associated with the Jk(a) and Jk(b) antigens (280 of the mature protein).
In addition though, you have, obviously, to consider the health of the unborn baby who, even if the antibody does turn out to be a maternal auto-anti-Jka, may cause haemolytic disease of the foetus and newborn, albeit this will usually be be very mild.
I attach a PowerPoint which may, or may not help you in your decision to send a sample to your local Reference Laboratory (also tell them the ethnicity of the patient).
 
Interesting case - please keep us informed.
In Depth Lecture on The Kidd Blood Group System.pptx

In emergencies, we always accept verbal orders for transfusion.  These should be followed up by a request documented in our electronic medical record, but that's after the fact.  If you have a paper system, then the followup order is documented that way.  There is a regulatory/accreditation requirement, which I consider bureaucratic, obstructive and useless,  that these emergency requests require a signed release from the ordering practitioner, if the transfusion is not fully tested for the recipient.  

We did pretty well yesterday, with 28 total posts.   

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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.
 

Great forum where sharing experiences is very useful, usually not found in publications. keep Going and Happy New Year!

I heard a lecture a while back, and I can’t find my notes, but I believe this could be the Er 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.

Another try… Jr(a) 

Let's start 2024 with a fun challenge!
We will send an email to all members today letting them know.
Let's see if we can get 100 posts in one day in January.
We'll start with next Thursday, January 4, 2024.
We'd have over eight thousand posts if every active member made just one post!
Don't save up; please post between now and next Thursday. 
Need some ideas?
Reply to something in the unanswered topics list. If it's your first post, make an introduction. Start a new topic with something you've been curious about.

To all those members around the world you celebrate it, Merry Christmas.

To those who do not, have a wonderful day too.

And hopefully, a slow day in the blood bank if you are working!

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.

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.

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 couldn't agree more with you YorkshireExile.  At a stretch, and I mean, at a stretch, it MAY be relevant to such tests as quantification and titrations, where you are giving a result involving a measured number, ascertained with red cells that may express different numbers of antigens, which may themselves involve protein or carbohydrate substitutions, but that is all.
How on Earth your inspector thought that this was remotely relevant to blood grouping, with all the positive and negative controls used to ensure the antisera are working properly, and the temperature mapping of everything these days, like you, I cannot see the point.  Either he or she was trying to justify their position as an inspector, and/or was going well over the top.
I would be amongst the first to say, very loudly, that Quality in the world of Blood Transfusion was pretty low at one point, but now, there are times when Quality issues actually interfere with the laboratory doing its job, for no good reason, and this seems to me to be one.
END OF RANT.

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