Malcolm Needs

Study With Me : Introduction to Blood Transfusion 2
https://immunohematologymadeeasy.com/study-with-me-introduction-to-blood-transfusion-2/

Malcolm, you appear to have know all the greats.  I had the honor of meeting a few  of them over the years and it's sad to witness the passing of an era of such amazing discoveries.

I was introduced to Dr. Tippett at an AABB annual meeting. I was a newbie SBB and manager. I had recently sent her my first example of an Rh positive mother who had anti-D. Dr. Tippett was very lovely and a giant in our field. I was thrilled to meet her.

It is with immense regret that I have to say that I learned yesterday that Dr Patricia Tippett died at the age of 93 on 1st August 2023.

I first met Pat in the early 1970's, when I was a callow youth who had just left school and was working at the IBGRL when it was in Gatliff Road in London (when Dr Kenneth Goldsmith was the Director) and Pat was working in the opposite building in the MRC Blood Group Unit, then under Drs Rob Race and Ruth Sanger.

Pat is probably most famous for her work on the Rh Blood Group System, including categorising the then know Partial D types and for realising that the RH genes were twofold; namely RHD and RHCE.
She was. of course, one of the greats, but was as friendly to this callow youth as I started out in the profession, as she was to everyone who were already greats within the field.

May she rest in peace.

It is with immense regret that I have to say that I learned yesterday that Dr Patricia Tippett died at the age of 93 on 1st August 2023.

I first met Pat in the early 1970's, when I was a callow youth who had just left school and was working at the IBGRL when it was in Gatliff Road in London (when Dr Kenneth Goldsmith was the Director) and Pat was working in the opposite building in the MRC Blood Group Unit, then under Drs Rob Race and Ruth Sanger.

Pat is probably most famous for her work on the Rh Blood Group System, including categorising the then know Partial D types and for realising that the RH genes were twofold; namely RHD and RHCE.
She was. of course, one of the greats, but was as friendly to this callow youth as I started out in the profession, as she was to everyone who were already greats within the field.

May she rest in peace.

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Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

Yes, nationally in the UK, via BSH Guidelines.

Some references related to the Platelet Glycoprotein, GPIV
B. R. Curtis, J. G. McFarland. Human platelet antigens – 2013. Vox Sang 2013;106:93-102
Curtis BR, Ali S, Glazier AM, et al.: Isoimmunization against CD36 (glycoprotein IV): description of four cases of neonatal isoimmune thrombocytopenia and brief review of the literature. Transfusion 2002; 42: 1173–1179
Ikeda H, Mitani T, Ohnuma M, et al.: A new platelet-specific antigen, Naka, involved in the refractoriness of HLA-matched platelet transfusion. Vox Sang 1989; 57: 213–217
Curtis B, McFarland J: Detection and identification of platelet antibodies and antigens in the clinical laboratory. Immunohematol 2009; 25: 125–135

If you will be getting any of those units back then a FDA inspector may want to see their storage records.  Some will, some won't, depends on the inspector.  Better to be prepared for the one that wants to see them.  In this case a little paranoia may be a good thing.

I just answered this question.

My Score PASS  

I just answered this question.

My Score PASS  

I just answered this question.

My Score PASS  

I've had further thoughts upon this case (having told you not to worry about it - I live a sad life - NOT!).
It struck me that the patient has an Rh type of D+ C+ c+ E+ and e+, suggesting that the probability is that the patient has a genotype of DCe/DcE (R1R2), but this may not be the case.  She could have one of the rarer Rh genotypes, such as DCE/Dce (RzRo), DCE/dce (Rzr), Dce/dCE (Rory), etc, and this may be potentially important.
Some years ago, Joyce Poole explained to me that most grouping reagents labelled as anti-C are, in fact, a mixture of anti-c and anti-Ce, and this, she told me, included most monoclonal anti-C reagents (which surprised me, to be honest).  This is because the vast majority of the red cells transfused that stimulate an anti-C would have the haplotype of either DCe or dCe, or both, and will, therefore, also stimulate an anti-Ce.  As a result, these "hybrid" anti-C/anti-Ce reagents will react more strongly with red cells expressing the Ce compound Rh antigen (Rh7) and the C antigen (Rh2), than with red cells that only express the C (Rh2) antigen.
This would not, incidentally, explain the stronger than normal reaction with the e antigen.

However, if the patient does express one of the rarer Rh types mentioned above, say she is RzRo, she can actually produce an allo-anti-Ce, and most antibody panels only contain C+ red cells that are only Ce+ as well.  In other words, her antibody in the plasma MAY be identified as an anti-C, whereas it is actually a monospecific anti-Ce, which would neatly explain why she has an apparent anti-C.

Of course, she may also have an auto-anti-C, or a mimicking auto-anti-C (and, possibly, an allo-anti-Bg of some sort).  Sadly, for a nerd like me, I doubt if we will ever know!
I think it was John C Staley who once accused me of looking for zebras, when I hear horses hooves (I may be wrong, but I think it was John).  Anyway, this proves that he was absolutely correct about me!!!!!!!!!!!!!!!!!!!!!!!!

I'm all for the concept of quality and the strive to provide the safest blood products to patients, but I won't deny that sometimes many of our current practices in blood banking in terms of achieving that "quality" seems excessive, unnecessary, and sometimes it feels like a mere quality charade for inspectors and regulators. Considering the hight cost that blood banks have to incur to meet all quality regulations, it may be worth studying the financial impact of the many quality measures that regulate the practice of blood banking and to what extent these measures are actually contributing to achieving the quality needed to provide the best blood products to patients.

I'm afraid I still can't agree with this methodology, for a couple of reasons.
Firstly, antibody/antigen reactions are, largely, governed by the Law of Mass Action.  As a result, and given a steady state of conditions (e.g. temperature), however long the incubation time may be, once a state of equilibrium is reached, there will be no net gain of antibody coating antigens, however long the incubation time may be extended.
Certainly, LISS will increase the rate of association of antibody and antigen enormously, but this will apply equally to the auto-antibody as any allo-antibody that may be present, however, of course, some antibodies will only react visibly with red cells that have homozygous expression of a particular antigen, and, if such an antibody is present, it will be very difficult to detect in the presence of an auto-antibody, but can still cause a haemolytic transfusion reaction, albeit, usually a delayed reaction, but it can still cause damage to the renal system in particular.

For these reason, I would always perform an adsorption, to get rid of the auto-antibody, even if I had no intention of performing specificity tests on the auto-antibody (although, it goes without saying, I would go all out to try to ascertain the specificity of any allo-antibody detected).

I am trying to write a book at the moment, called "Human Red Cell Serology and Blood Groups for Beginners", and Chapter 2 deals with Serological Techniques.  I attach the draft copy, which also gives relevant references, the odd diagram and abbreviations I use throughout the various chapters.
Chapter 2 Serological Techniques in Routine Blood Transfusion and Red Cell Immunohaematology Laboratories.docx Chapter 2 Serological Techniques in Routine Blood Transfusion and Red Cell Immunohaematology Laboratories Figures.docx Abbreviations.docx

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Not in a blood collection center, so no policy.  But scientifically there is no rationale for donor deferment.  The vaccines are not live/attenuated but rather just protein with no potentially infectious material of concern to recipients.  The virus, in any case, should only infect respiratory mucosa and thus would represent minimal to no risk to recipients even if present in donor blood (similar to coronavirus and influenza).

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I would thoroughly recommend that you contact Rachel Moss Hibbttt at Imperial College Healthcare NHS Trust.

I would thoroughly recommend that you contact Rachel Moss Hibbttt at Imperial College Healthcare NHS Trust.