Posts posted by John Eggington
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I'd do an auto against ficin treated patients cells. A positive results could be due due auto-anti-D but I think it would more likely represent an 'enzyme auto', as there's a reasonable chance the anti-D is 'allo'. Either interpretation would be 'OK' as both mean 'select' D- blood for xmatch, which is probably what you'd do anyway. A negative result would put you back in the 'what is it?' situation.
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My thoughts are; if the unts given 4 weeks ago were 'random' Rh phenotypes, then all will (almost certainly) have been e positive (and have a good chance of being f positive, and slightly less so of being C positive). The circulating residue would give phenotyping results that are difficult to interpret, promote an (allo) immune response, and give ambiguous auto/DAT results (patricularly if the technique of auto and DAT vary a little). So I'm till clutching at straws for my 'boring' answer!
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How about something more boring;
1) Rh/JK typing results not valid because of recent transfusion
2) Patient is R2R2, not R1R2
3) Antibodies detecetd (anti-f +/- anti-e +/- anti-C) are weak alloantibodies
4) Auto/DAT results are 'inconclusive' because only the residual cells fron 4 weeks ago have antibody coating them
5) Delayed-type 'transfusion reaction' is occuring (but not clinically significant)
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I was just making a general point, that this particular example highlighted - that there are other things to think about. I know some antibodies, that you'd expect to be detected by 'enzymes' (the cited anti-E, for example), may not react as you'd like, but they're not common enough to make us doubt our 'enzyme' panels, I hope (which is why they get published, I guess - who wants to read about ant-E that was detected by 'enzymes'!). Hooves and zebras, as is oft quoted here...
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Try this link, as a start (clogs are named);
http://www.labmanager.com/?articles.view/articleNo/1133/article/Appropriate-Footwear-in-the-Lab
It looks like a Canadian site, but might be a useful starting point (if only to show the regulation is a Canadian one)
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Take a look at this, too;
http://www.bbts.org.uk/PDFs/events/D%20Bruce%20Antenatal%20monitoring%20of%20anti-D%20and%20c.pdf
Also, I'm sure the AABB technical manual does give information on 'titre scores' (I don't have a copy to hand, so can't be more specific), maybe you could try another look?
Saline incubation...why is this SOP still allowed?
in Transfusion Services
Time out
Labgirl, are you referring to a 37C tube IAT, with red cells suspended in saline, with a 30 minute incubation, that gives a 'negative' result?