Malcolm Needs

Right. Thanks.
There is NO WAY that I would rule out, in particular, a Kidd antibody with a single cell showing heterozygous expression. Either I would find more cells that are E-, Jk(a+b-), or I would cross-match E-, Jk(a-) blood.

Right. Thanks.
There is NO WAY that I would rule out, in particular, a Kidd antibody with a single cell showing heterozygous expression. Either I would find more cells that are E-, Jk(a+b-), or I would cross-match E-, Jk(a-) blood.

And, not to add confusion to the mix, if the antibody were just forming, subsequent testing with new samples could show stronger reactivity. There are so many variables involved, it is hard to generalize some of these things.

Thank you for your replies.
 
The titre is quite low and the method is gel.
 
Malcolm, if television dramas which depict some pretty morally debased individuals are a true reflection of our contemporary society, your third possibility may require some further investigation. However I'm going with the naturally occurring Anti-E instead of the unnaturally broken nose.
 
Thanks
 
Richard

Just got back to work after 20 days off.  Not sure why I came back but that's another story for another day.  To stay on topic.
 
Merry Christmas and Happy New Year to everyone.
   

In the UK, BCSH Guidelines state that an FMH is not required before 20 weeks gestation, as the standard does of anti-D immunoglobulin will cover the mother for entire volume of an entire foetal bleed.

Hi Richard,
There are three possibilities (from what you say).
The first is, of course, that the lady has, at some time in her life, received a transfusion from an E+ donor.
The second is, as you quite correctly say, a naturally occurring anti-E (a very common finding).
It could be that the lady is pregnant through another male and is too worried to admit this, but I have doubts about this, as it is highly unusual to detect an Rh antibody in a first pregnancy by a different male partner (and you would probably have your nose broken if you suggested this!!!!!!!!!!!!!!!!!!!).
I would suspect that the titre is quite low (am I correct?) in either case.
I have grave doubts about an E variant (although, of course, these do exist) as they are very, very rare.

Hi Richard,
There are three possibilities (from what you say).
The first is, of course, that the lady has, at some time in her life, received a transfusion from an E+ donor.
The second is, as you quite correctly say, a naturally occurring anti-E (a very common finding).
It could be that the lady is pregnant through another male and is too worried to admit this, but I have doubts about this, as it is highly unusual to detect an Rh antibody in a first pregnancy by a different male partner (and you would probably have your nose broken if you suggested this!!!!!!!!!!!!!!!!!!!).
I would suspect that the titre is quite low (am I correct?) in either case.
I have grave doubts about an E variant (although, of course, these do exist) as they are very, very rare.

MERRY CHRISTMAS EVERYONE AND HAVE A HAPPY AND PROSPEROUS NEW YEAR!

Hi kirkaw,
I do not know the "rules" that apply in your particular part of the world, but, certainly, in the UK we would give cross-match compatible blood in this situation, unless the anti-V is particularly strong.
Firstly, not all anti-V's reported are, actually, anti-V, as it has been found to be a very heterogeneous type of antibody when tested against various rare Rh phenotypes.
Secondly, Geoff Daniels reports in the 3rd Edition of his book "Human Blood Groups" (page 214) that "No clinically significant anti-VS or -V has been reported. Anti-VS and -V are usually reactive by an antiglobulin technique..."
Thirdly, Marion Reid, Christine Lomas-Francis and Martin Olsson report in the third edition of their book "The Blood Group Antigen FactsBook" that alloanti-V has only ever been implicated in mild, delayed haemolytic transfusion reactions (page 216).
Fourthly, given that anti-V was first described in 1955 and, although it is not a particularly common antibody, the V antigen is expressed on about 1% of the white donor population and about 30% of the Black donor population, one would have expected that several people with anti-V have been transfused with V+ blood over the years, but none have been reported to have caused a clinically significant haemolytic transfusion reaction (and, don't forget, anti-V is unlikely to be detected by normal antibody screening cells, and so it is likely that some individuals with anti-V have been transfused with V+ units issued by electronic issue, albeit that anti-V and anti-VS are usually found in mixtures of other specificities, rather than as single specificities).
I would, therefore, contend that blood found to be compatible by IAT cross-match would be quite safe to transfuse.

Hope these help.QC of 0.01M DTT.DOC0.01M DTT Instructions of use.DOC

Hi Richard,
There are three possibilities (from what you say).
The first is, of course, that the lady has, at some time in her life, received a transfusion from an E+ donor.
The second is, as you quite correctly say, a naturally occurring anti-E (a very common finding).
It could be that the lady is pregnant through another male and is too worried to admit this, but I have doubts about this, as it is highly unusual to detect an Rh antibody in a first pregnancy by a different male partner (and you would probably have your nose broken if you suggested this!!!!!!!!!!!!!!!!!!!).
I would suspect that the titre is quite low (am I correct?) in either case.
I have grave doubts about an E variant (although, of course, these do exist) as they are very, very rare.

Merry Christmas to everyone, from someone working this day!
 
Linda

OK, I spoke to Nay today and he said the following.
In many of the cases he has seen, the hyperactivated macrophages are not necessarily in the spleen. Indeed, in many sickle cases, there has been a splenectomy, either through surgical intervention or through auto-splenectomy (where the spleen necroses). He also said that the hyperactivated macrophages are often in the bone marrow, but he has seen them phagocytosing the red cells in the peripheral circulation.
He said that he had not seen anything in the literature about giving small aliquots of blood, rather than a full unit, but he said that, in certain circumstances, the haemolysis would take place over a few days, rather than as an acute thing, and in other cases, once the acute phase has happened, although transfusion should be avoided if possible, once the acute phase is over, the hyperhaemolytic syndrome settles down, and never occurs again. He wondered if this had happened in the case of your co-worker.
Hope that helps (and I hope I have written what he said accurately)!!!!!!!!!!!!!!
:fear::fear:

[ATTACH]447[/ATTACH][ATTACH[ATTACH]447
IF I have attached these files properly, then they may be of use.
The PowerPoint was written by Dr. Nay Win, my Consultant, who is an expert in the field of hyperhaemolysis, and originally suggested the theory of hyperactive macrophages, a theory that is rapidly gaining support throughout the world.
The particular slides that may be of interest are from 61 to about 85.
:fingerscr:fingerscr:fingerscr:fingerscr:fingerscr
Transfusion of Sickle and Thalassaemic Patients.zip
Transfusion of Sickle and Thalassaemic Patients.doc

Yes, there are Techs. like that everywhere (and it seems to be becoming even more difficult to find experienced, knowledgeable staff with a good work ethic).  So, what I resorted to years ago (and about 3 Hospitals ago) is a little thing called "accountability."  You don't do your job (or don't do it correctly), and you get written up.  You get written up enough....and there will be consequences (and though it is extra work on my part, I manage to find ways to track almost every/any aspect of a task that is supposed to be done).  Once staff know you can track things back to them; and once they know there are ramifications....sadly, for "some" people, that is the only thing that will get them to do their jobs correctly.  And I can tell you this in all honesty (not at all meant as a reflection on me)....but when I have started at a new place (in-charge) and seen all of the above....and "forced" improvement (sometimes with kicking and screaming from some staff); I can say with all honesty that in every place I have left, the staff honestly thanked me at the end for "raising their standards."  They may have fought me all the way....but they could see the difference in their work performance after time and were actually proud of themselves.  That makes it worth it!  
Another problem I have encountered is people who are just trained "how" to do something (or "what" to do); not the "why" or theory behind it.  I always teach by principles because my philosophy is that if someone understands why they do things the way they do, they are much less likely to forget steps; to recognize when something is not right; and to be able to trouble-shoot problems when they do encounter them.  People that are just taught "what" to do, are errors waiting to happen (and will not understand when you try to correct them, because they were never taught that way in the first place).  But again, there are 2 types of workers; those who may have been taught that way but have the motivation to want to understand what they are doing and to do a good job; and are willing to learn and understand what they were never taught; and those who just want a paycheck.
 
And unfortunately, they don't teach work ethic much anymore.....do they?  
 
Brenda Hutson, CLS(ASCP)SBB

Merry Christmas

Merry Christmas!
 
Donna

Merry Christmas everyone!!

Thanks for the snow, Cliff!  Merry Christmas to everyone!
 
Donna

After I brought up the idea of hyperhemolysis, our medical director got with the hem-onc doc and they decidedd that is what it has to be. He is being treated with plasma exchange and I don't know what else. I hope he doesn't have another sickle crisis anytime soon. Thanks for all your input. Merry Christmas everyone.

Cliff, you are a complete STAR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

UPDATE!!
I sent an email to and got a reply from Mark Yazer - the SCARF site is down for maintenance. Whew - I was afraid it had gone out of existance.

I spoke too soon.  I don't think I can find the smashing lights, but you now have snow!