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Malcolm Needs

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  1. Like
    Malcolm Needs got a reaction from John C. Staley in O Positive transfusion to unknowns in Massive   
    I am sorry, but this part of your post is simply untrue.
    I have checked in my copy of Mollison PL.  Blood Transfusion in Clinical Medicine.  6th Edition, 1979.  Blackwell Scientific Publications.  In this is an entire Section in Chapter 8 devoted to "Rh Immunization by Transfusion", where he describes a large amount of experimentation, both involving deliberate injection of D Positive red cells into D Negative individuals, and also of D Positive units being transfused into D Negative individuals, bot accidentally and deliberately in the case of bleeding patients, including cases where only one unit was transfused.
     
    Without looking through all of the editions that I own, I am almost certain that this work was quoted in the later editions, including the 12th edition written by Harvey Klein and the late, great Dave Anstee.
  2. Like
    Malcolm Needs reacted to Neil Blumberg in O Positive transfusion to unknowns in Massive   
    Transfusion has much more serious adverse effects than making an anti-D.  Increases in infection, sepsis, thrombosis, inflammation and mortality for example. 
    There are no data to my knowledge of long term effects of anti-D formation in patients not having future pregnancies.  Most such patients come to the attention of the transfusion service because they have anti-D or simply because they are Rh (D) negative. They are then transfused with D negative blood if need be, in something like 99.99% of cases.  The rare patient who gets Rh positive blood (trauma patients) do sometimes have increases in bilirubin, LDH, etc. and delayed or rarely acute transfusion reactions. These are bad for patients, so you are right, for these rare patients, the outcomes can be dire.  But there few alternatives to transfusing Rh (D) positive blood to most patients in emergencies.  And very few will have future transfusion reactions.
  3. Like
    Malcolm Needs reacted to donellda in BloodBankTalk: Dombrock Blood Group System   
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    Malcolm Needs reacted to Kim D in BloodBankTalk: Dombrock Blood Group System   
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    Malcolm Needs reacted to Jbowker in BloodBankTalk: Dombrock Blood Group System   
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    Malcolm Needs reacted to exlimey in Elutions   
    First step is to determine what are you trying to prove. Do you want staff to merely have a productive/reactive eluate, or do you need them to identify the specificity, too?
    As Malcolm says, if you're in a blood center/centre, with access to whole units of plasma containing IgG antibodies of various specificities, it can be relatively easy to sensitize red cells with the appropriate phenotype (from your RBC inventory). Using D+ cells with anti-D is the simplest approach (or use Check Cells). This would certainly satisfy the mandate for a productive/reactive results. But, if you want the added challenge of antibody ID, using the same cocktail of reactants each time will lessen said challenge (as Cliff commented).
    But, back to basics.....make sure you have a specificity which is IgG in nature, reactive only by IAT. It should be relative strong WITHOUT LISS or PEG enhancement - use the standard/original saline-IAT to chose your antibody source. Always incubate your sensitization phase at 37C. You may need to vary the ratios of packed cells to serum to get optimal results (typically at least 2 volumes of antibody to one volume of packed cells). The shelf life of the sensitized cells may be increased by suspension in a red cell storage solution/preservative.
  7. Like
    Malcolm Needs reacted to exlimey in BloodBankTalk: Dombrock Blood Group System   
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    Malcolm Needs reacted to Arno in BloodBankTalk: Dombrock Blood Group System   
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    Malcolm Needs reacted to alt5575 in BloodBankTalk: Dombrock Blood Group System   
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  10. Like
    Malcolm Needs got a reaction from John C. Staley in Incompatible transfusions in the presence of antibodies to high incidence antigens   
    This is almost certainly NOT the paper that you wanted referenced, but it may help in an emergency.

    Win N, Needs M, Thornton N, Webster R, Cheng C.  Transfusion of least-incompatible blood with intravenous immunoglobulin plus steroids cover in two patients with rare antibody.  Transfusion 2018; 58: 1626-1630.  (DOI: 10.111/trf.4648).
  11. Like
    Malcolm Needs got a reaction from John C. Staley in O Positive transfusion to unknowns in Massive   
    We would indeed!!!!!!!!!!!!!!!!!!!!!!!!!!
  12. Like
    Malcolm Needs got a reaction from jshepherd in O Positive transfusion to unknowns in Massive   
    "Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago.  Thanks for your words of comfort."

    You are STILL not giving ANTI-D Kym; you are giving D Positive red cells.
    The other thing is that, within the White populations, but more so in the Asian populations, there is a very good chance that giving group O, rr blood will stimulate the production of an anti-c (IF any Rh antibody is stimulated), and that can be just as "dangerous".
  13. Like
    Malcolm Needs reacted to Mabel Adams in Incompatible transfusions in the presence of antibodies to high incidence antigens   
    Yes, that is valuable for the treatment advice.  For the transfusion decisions, my plan is to say, "don't unless necessary", then, if there are enough compatible units and Ab titer is very high, start with a couple of compatible units. Once antibody has been bled out, then use random units and, if you can guess when the last few units will be given, make them the more compatible ones to reduce the RBC destruction in the coming days.  If titer is lower or there are few to no compatible units, start with random units and try to fill the patient up with the (more?) compatible units at the end.  Maybe with sufficient immune suppression as your article suggests, we wouldn't have to try to guess when the last few units will be transfused.  We could keep the compatible ones for single unit transfusions over the ensuing days.
  14. Like
    Malcolm Needs got a reaction from Mabel Adams in Incompatible transfusions in the presence of antibodies to high incidence antigens   
    This is almost certainly NOT the paper that you wanted referenced, but it may help in an emergency.

    Win N, Needs M, Thornton N, Webster R, Cheng C.  Transfusion of least-incompatible blood with intravenous immunoglobulin plus steroids cover in two patients with rare antibody.  Transfusion 2018; 58: 1626-1630.  (DOI: 10.111/trf.4648).
  15. Like
    Malcolm Needs reacted to John C. Staley in O Positive transfusion to unknowns in Massive   
    There is going along to go along and then there is accepting ample amounts of data from extremely reliable sources.  It's not about "sales" it's about trying to serve the population in general, based on the best knowledge we have currently and being willing to accept that.  If what you are doing works for you in your little corner of the world, that's great but making light of advancements because it doesn't fit your paradigm and accusing some of the best professionals out there of being uncaring is..........
    I'll stop now.  I've been in this group for more years than I care to count and don't want Cliff to ban me. 
  16. Like
    Malcolm Needs reacted to John C. Staley in O Positive transfusion to unknowns in Massive   
    I've said it before, inertia is the strongest force in the universe.  From my 35+ years as a blood banker and supervisor of both donor services and transfusion services, I have come to the conclusion that, as a general rule, blood bankers are extremely slow to change when not resisting it completely.  This appears to be especially true if they are not actively involved in the change or keeping up on the literature.  I saw a great may changes during my tenure and not all of them were comfortable at first.  Giving O Pos blood to massive bleeds was just one of them.  The data supports it, no matter what our long held concerns and fears try to tell us.  Many of those long held fears and concerns were primarily theoretical, especially in how prevalent and disastrous the outcomes would be.  I have a number of stories to prove my point but I think I'll stop now and step off my soapbox.

  17. Like
    Malcolm Needs got a reaction from John C. Staley in O Positive transfusion to unknowns in Massive   
    "Though giving even one anti D when you didn’t need to seems like harm to patient. Would have been thought that ways years ago.  Thanks for your words of comfort."

    You are STILL not giving ANTI-D Kym; you are giving D Positive red cells.
    The other thing is that, within the White populations, but more so in the Asian populations, there is a very good chance that giving group O, rr blood will stimulate the production of an anti-c (IF any Rh antibody is stimulated), and that can be just as "dangerous".
  18. Like
    Malcolm Needs reacted to Marilyn Plett in O Positive transfusion to unknowns in Massive   
    O negs are still used in excess of their numbers in the general population. I've worked on both the donor side and the transfusion side. The pressure on O neg donors is huge. They are asked to donate as often as possible. We owe it to these donors to be good stewards of their donation.
  19. Like
    Malcolm Needs reacted to Razberry in BloodBankTalk: Diego Blood Group System   
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  20. Like
    Malcolm Needs reacted to Mabel Adams in Rh D type changing strength over time in same patient   
    I am aware of this for the Alba anti-D but never had the reference, so thanks for that.  That reagent, with its potentiators, definitely will pick up i on cord cells and, we suspect, the occasional i adult.  It is worse if it is cold. It disappears at 37C so is pretty obviously not D.  We use it because it has a similar sensitivity for weak D to Ortho gel (usually!!!).
  21. Like
    Malcolm Needs reacted to Mabel Adams in O Positive transfusion to unknowns in Massive   
    We give O pos for all uncrossmatched blood orders for males and females over 50.  We've done it for a couple of decades.  We avoid it if the recipient is known to have anti-D already.  We have seen very few make anti-D.
  22. Like
    Malcolm Needs reacted to donellda in BloodBankTalk: Monospecific antibody   
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  23. Like
    Malcolm Needs got a reaction from John C. Staley in Haptoglobin part of transfusion reaction?   
    I remember the great George Garratty telling me once that measuring haptoglobins AFTER blood has been given is an absolute waste of time, money and reagents, UNLESS the pre-transfusion haptoglobin levels have been measured.

    I believed him!!!!!!!!!!!!!!!!!!!!
  24. Like
    Malcolm Needs got a reaction from Yanxia in Haptoglobin part of transfusion reaction?   
    I remember the great George Garratty telling me once that measuring haptoglobins AFTER blood has been given is an absolute waste of time, money and reagents, UNLESS the pre-transfusion haptoglobin levels have been measured.

    I believed him!!!!!!!!!!!!!!!!!!!!
  25. Like
    Malcolm Needs got a reaction from Mabel Adams in Haptoglobin part of transfusion reaction?   
    I remember the great George Garratty telling me once that measuring haptoglobins AFTER blood has been given is an absolute waste of time, money and reagents, UNLESS the pre-transfusion haptoglobin levels have been measured.

    I believed him!!!!!!!!!!!!!!!!!!!!
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